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November 20, 2020 logo logo
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[Guidance Overview]

Will New Health Care Transparency Requirements Lower Cost and Improve Quality?

"[C]onsumers looking to compare hospital prices will have both the hospital and plan data to look to, beginning in 2023. However, there are several key differences between the new price transparency rule for plans and issuers and the price transparency rule for hospitals, as outlined in [a chart.]" Icon to read more

Epstein Becker Green

[Guidance Overview]

Benefits Under Massachusetts Paid Family and Medical Leave Are Available January 1: What Employers Need to Know

"[B]eginning January 1, 2021, Massachusetts employees and some self-employed individuals will be eligible to take up to 26 weeks of paid, job-protected leave for family or medical reasons through the Commonwealth's Paid Family and Medical Leave program (PFML).... While the Department issued revised PFML regulations in July 2020, clarifying points of confusion and providing additional details, aspects of PFML's benefits program remain vague, including the employer's role in the application process and coordination of employer-provided benefits." Icon to read more

Davis, Malm & D'Agostine P.C.

[Guidance Overview]

All New York Employers Must Provide Sick Leave to Their Employees

"On September 30, 2020, all private sector employees in New York began to accrue sick leave under the state's new sick and safe leave law. The law covers all employees regardless of industry, occupation, part-time status, overtime exempt status, and seasonal status. An employer may satisfy the law if it has a collective bargaining agreement or an existing leave policy (sick leave or other time off) that meets or exceeds the accrual, carryover, and use requirements provided in the law." Icon to read more


[Guidance Overview]

Guidance Issued on New York Paid Sick Leave Requirements

"New York State and New York City have recently issued guidance and documentation on the New York State Paid Sick Leave Law (the State Sick Leave Law) and amended New York City Earned Safe and Sick Time Act (the NYC Sick Leave Law), respectively. Both the State Sick Leave Law and City Sick Leave Law took effect September 30, 2020, with key provisions, including the ability to use increased leave amounts, beginning January 1, 2021." Icon to read more

Morgan Lewis

Managing Use of Health Care Services After People Satisfy Their Deductible: What Do Copayments and Coinsurance Do?

"Coinsurance reduces use of inpatient care and specialist physician office visits more than copayments do. However, while most employers already use coinsurance for inpatient care, only 44 percent use coinsurance for office visits.... [E]mployers seeking to manage use of health care services and spending -- especially among high users of health care services -- may look to moving from copayments to coinsurance for office visits as a way to do so." Icon to read more

Employee Benefit Research Institute [EBRI]

Better Prediction of Rising Health Spending to Improve Cost Containment

"Spending patterns over two years were best described by classifying patients into five groups: minimal users comprised 11 percent of the population; low-, moderate- and high-cost patients accounted for 15, 25, and 41 percent, respectively; and patients with rising costs were 8 percent of the population.... Across patients with similar baseline spending, the odds of subsequently incurring rising spending were higher for patients using fewer medications, having fewer office visits, seeing a larger number of different physicians and using tobacco. These factors suggest patients to target for intervention." Icon to read more

National Institute for Health Care Management [NIHCM]

What Are We Trying to Prevent Anyway? The Evolution of Preventive Services

"Preventive services are a key component of many health insurance plans. The introduction of the [ACA] brought about many legislative changes intended to improve the health of people in the United States. One such change was the introduction of mandatory coverage with no cost sharing for services determined to be preventive. Historically, preventive service status has been determined based on clinical evidence. This paper examines the evolution and future of preventive services." Icon to read more


Loss of Jobs with Health Coverage During the Pandemic Reveals Significant Industry Differences (PDF)

"Manufacturing workers were most affected by loss of jobs with employer health insurance because manufacturing has one of the highest rates of ESI coverage (66 percent). ... [B]ecause only 40 percent of workers in retail had ESI prepandemic, these workers accounted for 12 percent of lost jobs with ESI." Icon to read more

Employee Benefit Research Institute [EBRI]

Mental Health and Substance Use State Fact Sheets

"The state-level facts sheets explore the prevalence of mental illness and substance use and related deaths, and access, affordability, and costs of care. Key findings include: ... [1] Average biweekly data for October 2020 found that 37.7% of adults in the U.S. reported symptoms of anxiety and/or depressive disorder, up from 11.0% in 2019. [2] The states with the highest percentage of adults reporting symptoms of anxiety and/or depressive disorder in October 2020 were New Mexico (43.7%), Nevada (42.6%), Kentucky (42.4%), Louisiana (41.4%), and California (41.2%)." Icon to read more

Henry J. Kaiser Family Foundation

Benefits in General

Fall 2020 Employee Benefits Briefing

Audio recording. "[1] Fiduciaries should generally only consider pecuniary factors when choosing investments for plans that are subject to ERISA. [2] Plan sponsors should review their missing participant procedures in light of recent IRS guidance on tax reporting and withholding for accounts remitted to state unclaimed property funds. [3] Plan sponsors should review their health and welfare plan documents and consider whether any provisions can be added to mitigate against litigation risk and unnecessary expenditures.... [4] Fiduciaries should remain diligent in monitoring their plan's investment fund lineup, reviewing recordkeeping fees, and documenting their processes when making decisions involving the plan.... [5] Plan sponsors should review and update their COBRA documentation to make sure there are no deficiencies, and consider auditing their health plan's compliance with the mental health parity requirements." Icon to read more

Nixon Peabody LLP

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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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