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Health & Welfare Plans Newsletter November 13, 2020 |
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Newly Posted Election 2020 – What to Expect for Health Care Reform
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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[Guidance Overview]
"The Final Rule imposes two requirements on Payors relating to drug pricing. First, Payors must make certain drug pricing information publicly available through machine-readable files. Second, upon the request of a participant, a Payor must make available certain pricing disclosures to the individual participant at the participant's request." Ropes & Gray LLP |
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[Guidance Overview]
"This information includes seven content elements for disclosure: [1] Estimated cost-sharing liability ... [2] Accumulated accounts ... [3] In-network rates ... [4] Out-of-network allowed amounts ... [5] Items and services content list ... [6] Notice of prerequisites to coverage ... [7] Disclosure notice." Sheppard Mullin |
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[Guidance Overview]
"This new law, which becomes effective January 1, 2021, makes several significant changes to ... the California Family Rights Act (CFRA).... [1] CFRA leave now covers all private sector employers with five or more employees ... [2] CFRA leave expands the types of leaves available ... [3] CFRA leave eliminates prior restrictions ... [4] Small employer family leave mediation program." Goldberg Segalla |
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[Guidance Overview]
"Proposition 118 provides for 12 weeks of paid family and medical leave funded through a payroll tax paid 50/50 by employers and employees. An additional four weeks of paid leave are available for pregnancy or childbirth complications, bringing the maximum potential amount of paid leave to 16 weeks. Having passed as a ballot initiative, Proposition 118 will now become law.... [B]enefits under the program do not begin until 2024." Littler |
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[Guidance Overview]
"New York City recently amended its own Paid Safe and Sick Leave Law (NYC PSSL) to be more consistent with the accrual and usage requirements imposed by the newly-implemented New York State Paid Sick Leave Law (NYS PSL). This memorandum details the pertinent changes to NYC PSSL, which took effect on September 30, 2020." Clifton Budd & DeMaria, LLP |
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"A slight change to California Labor Code Section 233 grants employees the sole discretion to designate the type of sick leave they are taking. This aims to prevent an employer's intentional or erroneous designation of an employee's usage of sick days as 'kin care'. Any employee aggrieved by a violation of this labor code remains entitled reinstatement and actual damages or one day's pay and to appropriate equitable relief." Goldberg Segalla |
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"If you are a municipal employer in New York State struggling to find the answer to that question, you are not alone. In the absence of express language in your collective bargaining agreement, a definitive response is elusive. So elusive that the Second Circuit Court of Appeals has reached out to New York's Court of Appeals for guidance. Whatever answer the Court of Appeals returns, if any, the value of a carefully negotiated and precisely drafted collective bargaining agreement cannot be overstated." [Donohue v. Cuomo, No. 18-3193 (2d Cir. Nov. 6, 2020)] Bond, Schoeneck & King |
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"The percentage of workers reporting that they were extremely or very satisfied with health benefits increased from 49 percent in 2018 to 55 percent in 2020 ... Those extremely satisfied with the cost of health insurance increased from 9 percent in 2018 to 16 percent in 2020; those very satisfied jumped from 13 percent to 24 percent in 2020. Workers reporting that they were extremely satisfied with the costs of health care services not covered by insurance doubled from 7 percent to 14 percent between 2018 and 2020; the percentage reporting that they were very satisfied increased from 14 percent to 24 percent over that same time period. " Employee Benefit Research Institute [EBRI] |
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"Between 2011 and 2019, end-of-year account balances increased but remained low -- going from $1,990 in 2011 to $3,221 in 2019.... Average total contributions -- combined individual and employer contributions -- increased from $2,348 to $2,959 between 2011 and 2019.... Overall, 60 percent of accountholders withdrew funds. The average annual amount distributed was $1,897 in 2019, implying an average rollover of $1,062." Employee Benefit Research Institute [EBRI] |
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"ACA implementation was associated with 2 million fewer US adults with catastrophic expenditures each year.... However, improvements were not observed in higher income quartiles or among the privately insured, who represent an increasing share of those experiencing catastrophic expenditures.... Despite large coverage gains, 11 million US adults, including 6 million with private insurance, continue to experience catastrophic health expenditures annually." JAMA Network |
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"Enrollment in private health insurance plans in the individual, small group, and large group markets has historically been highly concentrated among a small number of issuers. GAO found that this pattern continued in 2017 and 2018.... Overall individual and small group markets have become more concentrated in recent years. The national median market share of the top three issuers increased by approximately 8 and 5 percentage points, respectively, from 2015 through 2018. With these increases, the median concentration was at least 94 percent in both markets in 2018." [GAO-21-34, Nov. 13, 2020] U.S. Government Accountability Office [GAO] |
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[Opinion]
"[T]he 2021 AV Calculator did not maintain the same relationships among metal levels that existed in prior years.... It is important that a single standard population be used for all metal levels ... in particular to ensure morbidity differences are not reflected across the metal levels' AVs. It appears that CMS is reflecting morbidity differences in the continuance tables, or otherwise using inconsistent populations for the determination of actuarial values across different metal tiers." American Academy of Actuaries |
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Benefits in General |
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"PEPs ... Lifetime income demonstrations ... Expanded access to 401(k) plans for part-time workers ... Optional distributions for qualified birth or adoption expenses ... Determination letters and opinion letter 'cycles'... Fiduciary duties of retirement plan investments ... COBRA penalties." Holland & Hart LLP, via Tax Executive |
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"[T]he court noted that the plan set forth a procedure for delegating discretionary authority, and provided that when the plan and SPD conflict, the plan controls. Because the committee was 'bound to follow the plan's procedures,' and failed to do so, the court concluded there was no effective delegation of authority. Therefore, the court held that the adverse benefit determination was subject to the nondeferential (de novo) standard of review." [Hampton v. Nat’l Union Fire Ins. Co., No. 18-6725 (N.D. Ill. Oct. 7, 2020)] Thomson Reuters / EBIA |
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"Here are five key changes: [1] A new name and new type of audit opinion! ... [2] Maintaining a current plan instrument.... [3] Properly administering the Plan and verifying that the ERISA financial statements are in accordance with the Plan's provisions, including maintaining sufficient participant records.... [4] The plan sponsor is required to determine whether an ERISA Section 103(a)(3)(c) audit is permissible, if the certification is appropriate, and if the certified information is correctly measured, presented, and disclosed in accordance with the applicable financial reporting framework.... [5] Providing the auditor with a substantially complete draft of the Form 5500 prior to the date of the auditor's report." Bradley J. Bartells, CPA, via LinkedIn |
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Press Releases |
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Most Popular Items in the Previous Issue |
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