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February 27, 2020 in AL
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Health Reimbursement Arrangement Plans Update
April 2, 2020 WEBCAST
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June 25, 2020 in IL
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[Official Guidance]

Text of Agency ACA Implementation FAQs, Part 41: Summary of Benefits and Coverage (PDF)

"The release modifies the SBC Template and Instructions as authorized for use on and after April 1, 2017 to update the statement after the Minimum Essential Coverage disclosure ... [and] to include an additional option for issuers completing the Minimum Value disclosure on the SBC.... The release also updates the versions of the Calculator, Guides, and Narratives that were authorized for use on and after April 1, 2017 in a number of ways.... Group health plans and health insurance issuers of individual and group market coverage will be required to use the 2021 SBC, 2021 Instructions, 2021 Guide and Narratives, and, should they choose to use the Calculator, the 2021 Calculator, beginning on the first day of the first open enrollment period for any plan years ... that begin on or after January 1, 2021, with respect to coverage for plan or policy years beginning on or after that date.... Use of the Calculator is not required."

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

[Guidance Overview]

ACA Affordability Safe Harbors: A Primer

"[T]he W-2 safe harbor is based on earnings for the current year rather than the past year. Therefore, the W-2 safe harbor might make more sense for a workforce where there are no pre-tax elections for things like 401(k) plans or HSAs. The rate-of-pay safe harbor could be well-suited for a population with a large number of hourly employees since it assumes a rate of 130 hours per calendar month no matter how many hours an employee actually works. An employer with lots of low-wage earners might want to use the FPL safe harbor to avoid having a high number of individuals for whom a contribution is unaffordable under another safe harbor."


[Guidance Overview]

HHS Releases Proposed Benefit and Payment Parameters for 2021

"The proposed regulations would require excepted benefit health reimbursement arrangements (excepted benefit HRAs) sponsored by non-federal governmental plan entities to provide participants a notice containing specified information about the benefits available under the excepted benefit HRA ... HHS's proposals would increase the maximum annual cost-sharing limit for 2021 ... The proposals would change how drug manufacturer coupons accrue towards the ACA's annual cost-sharing limit ... The proposals also include a rule to promote the accuracy of medical loss ratio (MLR) reporting and rebate calculations[.]"

Thomson Reuters Practical Law

Employees Want 'Health on Demand' Digital Solutions from their Employers

"[N]early half of US workers (49%) said they are excited by the prospect of a digital transformation of healthcare. Importantly, 48% said they would have more confidence in a digital health solution if it were offered by their employer, and 26% even say they would be more likely to stay with an employer that offered digital health solutions, such as an app to locate providers or access to virtual healthcare."


U.S. Sees Sharp Drop in Visit to Primary Care Providers, as Costs Rise

"Using data from an insurer that provides health coverage to about 20 million people per year across the United States, [a recent study] found that visits to primary care providers made by adults under the age of 65 had dropped by nearly 25% from 2008 to 2016. What's more, adults who went at least a year without a single visit to a primary care provider increased from about 38% to 46% in that period."

National Public Radio [NPR]

Primary Care Visit Decline in the United States, 2008-2016

"Commercially insured adults have been visiting [primary care physicians (PCPs)] less often, and nearly one half had no PCP visits in a given year by 2016.... [T]his decline may be explained by decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care."

Annals of Internal Medicine

Commuter Benefits Legislation Keeps Rolling

"Eight local and state jurisdictions currently require employers to offer commuter benefit programs, and the trend is expected to grow.... Employers may want to consider voluntarily offering such programs to employees nationwide in advance of any municipal or state requirements that may apply in the future."


Latest Cigna Case Illustrates Changing Landscape of ERISA Litigation

"[Plaintiffs allege] that Cigna set up a complex web of processes and procedures which has resulted in providers to be reimbursed for only a fraction of their incurred charges, rather than the amount they should be reimbursed under the plans administered by Cigna. The providers allege that these violations are compounded, because Cigna withdraws the entire dollar amount of the healthcare provider's claim from the trust funds of self-funded plans, but only pays a small portion of those funds to the provider and pockets the rest." [Advanced Gynecology and Laparoscopy of North Jersey. v. Cigna Health and Life Ins., No. 19-22234, (D.N.J. complaint filed Dec. 31, 2019]

Cohen Milstein

More Employers Embracing Caregiver Leave, Exploring Other Types of Leave

"30% of employers added new leave programs in 2019.... 24% are planning to add programs this year (with 18% considering new programs in 2021-2022). 24% of employers increased the duration of leave available last year.... 23% plan to increase the duration of leave this year (with 23% considering doing so in 2021-2022). 12% of employers expanded eligibility for leave benefits last year.... 8% plan to expand eligibility this year (with 15% considering doing so in 2021-2022)."

Business Group on Health

Press Releases

OneDigital Acquires Resources Investment Advisors
OneDigital Health and Benefits

Most Popular Items in the Previous Issue, Inc.
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David Rhett Baker, J.D., Editor and Publisher
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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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