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[Guidance Overview]

Texas Surprise Billing Legislation and Rules Went Into Effect on January 1

"[P]ayors are mandated to make payment to out-of-network providers for emergency care, or where care is provided by out-of-network providers who are based in a facility (and thus have little choice or discretion regarding which patients to accept).... [O]ut-of-network providers are prohibited from billing patients for any amounts in excess of the patient's applicable out-of-network copayment, coinsurance and deductible, regardless of whether the payment received from a third-party payor covers all of the provider's billed charges."

Seyfarth Shaw, via Lexology; free registration required

'Transparency in Coverage' Rule: Potential Requirements for Employers

"The goal of the rule is to create greater transparency in the health care industry by requiring group health plans and health insurers to provide consumers with access to information similar to what is included in an explanation of benefits (EOB) form. Consumers could get the information before obtaining treatment rather than after, allowing them to more easily comparison shop for health care services and prescription drugs."

International Foundation of Employee Benefit Plans [IFEBP]

Don't Get Bitten by Your COBRA Notices

"[A] recent wave of class action lawsuits challenges whether employers' COBRA notices were sufficient.... [P]laintiffs generally allege that the notice they received did not include all the information set forth in the regulations or in the DOL's model notice, and that the average plan participant could not understand the notice.... Thus far, employers have been unsuccessful in defeating these COBRA notice lawsuits at the pleading stage.... There are steps employers can take now to minimize the risk of being swept into this COBRA notice litigation."


Telemedicine and the Challenge of Patient Compensation Funds

"A major challenge for all telemedicine providers operating with a national footprint are with [patient compensation funds (PCFs)] and the various requirements that individual states will dictate.... Participation in a PCF requires individual limits for each provider, which adds more cost and complexity to the overall insurance program for the telemedicine company."


Health Policy Predictions for 2020

"States will take the lead ... Surprise billing, price transparency and prescription drug cost control will remain hot issues   ... Privacy and data security will be front and center ... The most significant federal activity will come from the executive and judicial branches, not Congress ... Don't count the private market out!"

MZQ Consulting, LLC

The Way Your Company Can Offer Health Insurance Is Changing in a Fundamental Way -- and No One Knows About It

"What do you need to know if your employer notifies you that this new option, known as an individual coverage health reimbursement arrangement, or ICHRA, is going into effect? [1] You'll receive funds to contribute toward your health insurance costs.... [2] You'll hold the reins on your health insurance options.... [3] The health plan is yours to take with you. But the HRA is specific to your job.... [4] You may need to pay out of pocket for a portion of your plan.... [5] Why wasn't this an option before, and am I likely to be the only one using it?"



Congress Could Improve the Tax Code and Health Coverage by Redesigning the Tax Subsidy for Employer Insurance

"When Congress voted in December to repeal the [ACA's] 'Cadillac tax' on high-cost employer-sponsored health insurance plans (ESI), it took health policy in exactly the wrong direction. Rather than fully preserving the exclusion from taxable income of these insurance benefits, Congress should have further scaled it back, or even repealed it. That step could have helped slow the growth in health care costs and generated new revenue that could have been used, in part, to expand access to health coverage for low- and moderate-income people."

Howard Gleckman, in Forbes


House Health Leaders Call on HHS and DOL to Reduce Confusion and Financial Risks for Medicare-Eligible COBRA Beneficiaries

"[T]he Chairmen and Ranking Members of the House committees with jurisdiction over health care sent a letter to [HHS] Secretary Alex Azar and [DOL] Secretary Eugene Scalia  ... [which] called on the agencies to address the confusion and financial risks that often confront Americans who are Medicare-eligible and receive coverage under a group health plan subject to [COBRA]."

Committee on Ways and Means, U.S. House of Representatives


Sacrificing Public and Private Health Insurance for 'Medicare for All'

"Some House Democrats are co-sponsoring legislation to outlaw virtually all Americans' public and private health insurance and replace it with a new government plan. Americans must fully grasp the necessary trade-offs -- the sacrifices -- they would have to make if Congress were to create and run such a massive program. Congress can -- and should -- take a different approach."

The Heritage Foundation


ERIC Takes Seattle Back to Court Over New Employer Health Care Mandate

"ERIC believes the new law is preempted by ERISA, because its requirement that hotel employers make direct payments to employees or provide coverage under their group health plans has an impermissible reference to and connection with an ERISA plan."

The ERISA Industry Committee [ERIC]

Benefits in General

Call for Entries: Employee Benefits Law Simplification Award

"The American College of Employee Benefits Counsel hereby invites academics, practitioners, and any other individuals interested in the employee benefits system to submit proposals to simplify employee benefits law. A $10,000 prize for the winning submission will be awarded ... [E]ach proposal should include [a detailed analysis] that: [1] Thoroughly details the simplification that will result from the proposal and the benefits of that simplification.... [2] Explains how the proposal either enhances or, at the least, has no material adverse impact on employee/participant rights; and [3] Identifies and analyzes other ancillary advantages or benefits and any policy tradeoffs.... The Simplification Award Template ... provides comprehensive guidance on the format of a submission.... Submissions for the Third Annual ACEBC Simplification Award must be received no later than Midnight, Eastern Time on May 1, 2020."

American College of Employee Benefits Counsel

Editor's Pick Common Law Marriage and Employee Benefits

"Given the challenges associated with common law marriage, here are some best practices for employers to consider: [1] Determine if you have employees in states that allow common law marriage.... [2] Consider whether qualifying events that result in a person adding or dropping a spouse should require evidence (and what evidence is required). [3] Include the evidence requirement in the applicable plan language.... [4] Apply the evidence requirement consistently with all impacted employees."

HUB International

Selected Discussions
on the BenefitsLink Message Boards

HIPAA Requirements for Actively at Work Treatment

"Medical plan requires that a participant be 'actively at work' to be eligible. The definition of 'actively at work' includes the following: 'As required by HIPAA, absence from work due to any health factor (such as being absent from work on sick leave) is treated, for purposes of the Plan or coverage under the Plan, as being actively at work.' I have not ever heard of such a requirement under HIPAA. What provision(s) of HIPAA or the regs address(es) this?"

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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