Health & Welfare Plans Newsletter

July 28, 2020

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View COVID-19 News and Resources

[Guidance Overview]

New Proposed Rule Simplifies Grandfathered Health Plans

"This proposed rule defines two new modifications regarding the cost-sharing limitations that create the desired compliance and flexibility.... Increases in cost-sharing measurement change will include either the current medical inflation or the premium adjustment percentage minus one, expressed as a percentage, plus 15 percentage points. The greater of these would cause a loss of grandfathered status."

OneDigital Health and Benefits

[Guidance Overview]

ACA Affordability Percentage Goes Up for 2021

"The increase in the affordability percentage will mean that employers will be able to increase what employees pay for employee only coverage, and still be affordable in 2021.... Employers with non-calendar year plans will be able to use the affordability percentage for 2020 until the start of their 2021 plan year. Alternatively, they may adjust employee contributions effective January 1, 2021 using the updated affordability percentage."

HUB International

[Guidance Overview]

Editor's PickPresident Trump Signs Drug Pricing Executive Orders Reinforcing the Administration's Priorities

"Although the drug pricing executive orders are unlikely to be implemented before the 2020 election, they reinforce the administration's priorities on drug pricing. As stakeholders plan for the years ahead, they should be mindful of their potential impact on their operations. This [article] provides an overview of the President's drug pricing executive orders and describes their scope and potential impact."

K&L Gates

[Guidance Overview]

DOL Issues New Guidance on COVID-19, the FFCRA, and the FMLA

"The DOL noted that neither the FMLA nor any other law it is responsible for enforcing prohibits an employer from making these changes to its paid leave policies ... [E]mployers should remember that state laws, e.g., California's, may impact their ability to change paid leave policies.... DOL noted that employers have some flexibility in returning an employee to work who has been self-quarantined under FFCRA if they have concerns over the spread of COVID-19; notwithstanding the obligation to return the employee to the same or equivalent position with the same or equivalent pay and benefits."

Foley & Lardner LLP

[Guidance Overview]

Roundup of Selected State Health Developments, Second-Quarter 2020 (PDF)

12 pages. "Lawmakers in three states -- Idaho, Indiana and Virginia -- passed laws imposing pharmacy benefit manager (PBM) oversight. Despite the pandemic, Massachusetts, New Jersey, and Washington, DC required employers and health insurers covering residents to file state reports for 2019 coverage. Insurance laws tackled during the quarter include benefit mandates, insulin cost sharing and gender nondiscrimination. Other health-plan-related issues involve coordination of benefits with auto insurance in Michigan, as well as facilitating telepsychology and cross-border mental health treatment in a growing number of states."

Mercer

Third Circuit: Out-of-Network Health Care Provider's Breach of Contract and Promissory Estoppel Claims Not Preempted by ERISA

"This issue comes up more frequently now with managed care organizations creating networks of doctors or preferred providers, and the issue that arises is: at what rate should the insurer pay for services provided by out-of-network health care providers. And what happens when the insurer expressly agrees to pay the out-of-network provider, before services are rendered?" [The Plastic Surgery Center, P.A. v. Aetna Life Ins. Co., No. 18-3381 (3d Cir. Jul. 17, 2020)]

Lane Powell PC

D.C. Circuit Upholds Short Term Plans as Alternative to ACA Plans

"The district court granted summary judgment in favor of the Departments, holding that [1] the 2018 STLDI Rule was a reasonable interpretation of HIPAA and the ACA and [2] the change from the 2016 Rule to the 2018 STLDI Rule was not arbitrary and capricious. Specifically, Judge Leon noted that, 'the ACA's various reforms are interdependent and were designed to work together as features of the individual Exchange markets.... However, Congress clearly did not intend for the law to apply to all species of individual health insurance.' " [Association for Community Affiliated Plans v. U.S. Dept. of the Treasury, No. 19-5212 (D.C. Cir. Jul. 17, 2020)]

Troutman Sanders

Benefits in General

Different Perspectives on Phased Retirement, Retirement Ages and Working in Retirement (PDF)

13 pages. "With an increase in longevity and years in retirement, many people need or want to work longer or work as part of their retirement.... Organizations should undertake a deep and rigorous study of their demographics, business needs, talent needs and benefit plans. This will better position them to create policies that allow them to capitalize on the knowledge, expertise and human capital of their entire workforce, including older workers."

Benefits Quarterly, published by the International Society of Certified Employee Benefit Specialists [ISCEBS]

Benefit Plans in M&A Deals: Avoiding That Call After the Deal Has Closed

"Most employee benefits issues have quantifiable exposure that can be factored into the deal terms if issues are timely identified. The scope of due diligence in this area is also easily budgeted and quantified -- if you know what you are doing. Getting good results for buyers and sellers requires more than just a robust set of reps and warranties."

Employee Benefits Law Group

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020 BenefitsLink.com, 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 BenefitsLink.com, 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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