Health & Welfare Plans Newsletter

August 20, 2020

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[Guidance Overview]

Exceptional Usefulness and Quality and Usefulness iconAn Employer's Back-to-School Guide to Your FFCRA Child Care Leave Questions

"With some version of school starting up in a neighborhood near you, employers will face challenges as potentially significant numbers of employees will be called away from work to attend to parental duties, since many of their children are being forced into more remote learning this fall due to the COVID-19 pandemic.... 'Closed' school ... Use of intermittent leave and scheduling arrangements ... Documentation ... State and local laws ... Creative solutions."

FMLA Insights

[Guidance Overview]

Colorado Enacts Paid Sick Leave Law, Emergency Leave Requirements

"Through 2020, the Healthy Families and Workplaces Act (HFWA) requires all employers in the state, regardless of size, to provide emergency paid sick leave meeting the [FFCRA] provision to each employee not covered by the federal law. Beginning in 2021, employers -- including Colorado public employers -- will have to provide one hour of paid sick leave for every 30 hours worked and additional leave for future public health emergencies. Colorado joins 14 other states and Washington, DC, in enacting an accrued paid leave mandate for employers."

Mercer

[Guidance Overview]

CMS Finalizes Basic Health Plan Methodology for 2021

"Because the only two states that have adopted the [basic health plan (BHP)] have also expanded their Medicaid program, CMS proposes to incorporate an income reconciliation factor that solely reflects states that expanded their Medicaid program. For 2021, this factor is 99.23 percent. CMS will calculate the value of the income reconciliation factor based on the latest available year of marketplace data."

Katie Keith, in Health Affairs Blog

Eighth Circuit: North Dakota's PBM Law Is Preempted by ERISA, Therefore Unenforceable

"The Eighth Circuit's reversal of the trial court's position is in line with other cases that support ERISA preemption of various laws regulating PBMs. But further delineation seems likely, as the Supreme Court will address this issue next term when it reviews one of the precedential Eighth Circuit cases relied on here." [Pharmaceutical Care Mgt. Assoc. v. Tufte, No. 18-2926 (8th Cir. Aug. 7, 2020)]

Thomson Reuters / EBIA

2020 Benchmarking Survey of Health Savings Accounts (PDF)

48 pages. "The average participant contribution in 2019 was $2,595, the same as in 2018. The average account balance at the end of 2019 was $5,627, a slight increase from an average of $5,239 in 2018. The vast majority of responding organizations (83.8 percent) offer investment options for HSA contributions, though more than 80 percent require a minimum balance of at least $1,000 to inv est assets. While mutual funds dominate the types of investments offered, nearly a fourth of respondents also offer self-directed brokerage accounts -- including nearly half of smaller employers."

Plan Sponsor Council of America [PSCA]

Varying Employee Health Contributions by Income: Beware of Downsides

"To satisfy the [ACA's] employer mandate, [employers] have to offer affordable coverage, but affordable for a lower paid worker can mean a heavy subsidy for a higher paid worker. To address this, some employers look at tiering health plan contributions by income.... While an employer may save money with this strategy, it's important to consider the potential downsides of this approach."

HUB International

Conducting a Successful Benefits Enrollment for Employees Working Remotely

"[W]ith the pandemic continuing to force social distancing, employers won't be scheduling in-person enrollment meetings or health fairs. This year's enrollment calls for a new approach to reaching a remote workforce.... Video conferencing and webinars allow employers to present updates for the 2021 benefits package and also respond immediately to questions from employees."

Findley

Exceptional Usefulness and Quality iconObjective Versus Subjective Evidence in the ERISA Claims-Handling Process (PDF)

"Disability claimants regularly take the position that certain difficult-to-diagnose conditions ... cannot be proven through objective medical evidence. As such, they argue that it is unreasonable or arbitrary for an administrator of a disability plan governed by ERISA to require objective evidence of these disabling conditions. The notion that subjective symptoms must be given at least some level of consideration has gained traction in the federal courts over the last several years."

Greensfelder, via For the Defense

Overcoming Barriers That Might Be Limiting Your Employee Assistance Program

"It's up to the employer (or in cases of a stand-alone EAP, the vendor) to make sure and offer a reason for employees to engage.... Regularly update employees on the specifics of the benefit: How many counseling sessions are provided, what work-life resources are available, or whether legal/financial services are included, etc. By normalizing EAP usage, you can help employees overcome their own psychological barriers. "

Grooms Benefit Solutions

SCOTUS Schedules ACA Oral Arguments for November 10

"The consolidated [cases] will be heard one week after the presidential election, but a ruling is not expected until June.... The plaintiffs in both cases are asking the justices to rule on the constitutionality of the individual mandate without a tax mandate, and whether the mandate is severable from the rest of the law." [California v. Texas, No. 19-840; Texas v. California, No. 19-1019 (cert. pet. granted Mar. 2, 2020)]

HealthLeaders Media

Cleveland Clinic Teams Up with Aetna to Launch Insurance Plan

"The Cleveland Clinic struck a partnership with CVS Health subsidiary Aetna to form a new accountable care organization (ACO). The two companies plan to launch a co-branded insurance plan this fall."

MedCity News

Press Releases

Segal's Howard Fluhr Named EBRI Lillywhite Award Recipient
EBRI [Employee Benefit Research Institute]

Most Popular Items in the Previous Issue

Text of CMS Summary Report of 2018 Benefit Year Risk Adjustment Data Validation Adjustments to Risk Adjustment Transfers (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

View COVID-19 News and Resources

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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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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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