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[Guidance Overview]

Text of HHS Proposed Key Dates for Calendar Year 2021: Qualified Health Plan Data Submission and Certification; Rate Review; and Risk Adjustment (PDF)

"This [3-page chart] summarizes key dates for calendar year 2021 regarding some activities and policies that are outlined in other documents." Icon to read more

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Reminder: New SBC Templates and Glossary Required for Plan Years After December 31, 2020

"In 2019 [CMS] revised the Summary of Benefits and Coverage (SBC) materials and supporting documents for use for plan and policy years that begin on or after January 1, 2021. The revisions to the forms and templates reflect the elimination of the individual mandate requirement, which became effective for the 2019 plan year.... All SBC materials for plan and policy years beginning on and after January 1, 2021 must comply with the new requirements." [Editor's note: Links to CMS materials and supporting documents are available here.] Icon
to read more


Ninth Circuit Rejects Dialysis Provider's Challenge to Plan's Reimbursement Provisions Under Medicare Secondary Payer Rules and ERISA

"The Ninth Circuit dismissed the provider's claims, concluding that: [1] The provider's claim for benefits, which it brought as the beneficiary's assignee, was based on the alleged MSP violation. [2] The provider could not bring a claim for equitable relief under ERISA because the assignment form did not include an assignment of equitable claims." [DaVita Inc. v. Amy's Kitchen, Inc., No. 19-15963 (9th Cir. Nov. 24, 2020)] Icon to read more

Thomson Reuters Practical Law

Pandemic Lowers Employer Health Care Costs for First Time in Decades

"2020 medical claims are projected to decrease at a rate that is on average 5 percentage points lower than initially projected. The COVID-19 impacts for 2020 dental and vision benefit claims will also decrease budgeted costs further. Insurance carriers expect average downward cost impacts of 15% for dental benefits and 8% for vision benefits. One factor in lower health care cost trends is the deferral of non-essential care by Americans during the pandemic." Icon to read more

PLANSPONSOR; free registration may be required

SAG-AFTRA Health Plan Facing Class Action Over Cuts to Coverage

"The SAG-AFTRA health plan is at the center of a putative class action brought by a group of actors who say premiums have skyrocketed and medical coverage is being stripped from elderly guild members under the guise of a COVID-19-related restructuring ... The actors -- led by the iconic Ed Asner -- are suing the SAG-AFTRA Health Fund and its board of trustees for allegedly breaching their fiduciary duties." [Asner v. The SAG-AFTRA Health Fund, No. 20-10914 (C.D. Cal. complaint filed Dec. 1, 2020)] Icon to read more

The Hollywood Reporter

Cancer Survivorship: Challenges and Opportunities for Employers (PDF)

48 pages. "[A] cancer diagnosis and treatment together comprise just one part of the patient journey. What happens when people move beyond active treatment to survivorship? ... [This guide] is designed to provide you with information on the challenges and opportunities associated with cancer survivorship and practical guidance on creating a workplace that supports people living with cancer and is productive for all." Icon to read more

Northeast Business Group on Health

Improving Payment Accuracy in Health Insurance Marketplaces

"Despite real differences in how the three study countries administer risk adjustments, ... even the sophisticated risk adjustment methods they currently use fail to accurately compensate health plans for the risks represented by specific enrollees.... This study demonstrated the important payment improvements that can be achieved across the board by reinsuring against losses for the small portion of enrollees whose care is grossly undercompensated and suggests this reinsurance will not weaken plan incentives to effectively manage care for these very high cost patients." Icon to read more

National Institute for Health Care Management [NIHCM]


To Reform Health Insurance, Let Employees Be in Charge

"A recent survey ... found that about one in six (15 percent) employers are planning to offer or considering the HRA option, with larger employers expressing an even stronger interest. It makes every sense that they should do so, given the widespread benefits: employers gain predictability in health-care costs, while workers gain a bigger choice of plans and coverage they can take with them from job to job.... The HRA regime seems far preferable to the well-intentioned, albeit bureaucratic and clunky, regime outlined in the AEI paper." Icon to read

The Federalist

Benefits in General

Vary Your Tools for Communicating About Employee Benefits

"Perception of company benefits has a direct impact on employee satisfaction, productivity, retention, and recruitment.... Current trends are showing that each of the four or five generations which may be represented in your organization have different concerns." Icon to read more

Inside Business

Sixth Circuit Opinion Outlines Ways to Defend Disgorgement and Breach of Fiduciary Duty Claims Under Section 1132(a)(3)

"[T]ypically claimants seeking ERISA-governed benefits make claims for recovery under Section 1132(a)(1)(B). Now you are likely seeing more simultaneous assertions of equitable claims for breach of fiduciary duty and disgorgement under Section 1132(a)(3). A successful claimant asserting this theory may recover additional forms of monetary relief, and may get broader discovery. But the availability of relief under Section 1132(a)(3) claims is narrow ... So, how do you defend Section 1132 (a)(3) equitable claims?" [Davis v. Hartford Life & Accident Ins. Co., No. 19-6091 (6th Cir. Nov. 19, 2020)] Icon to read more

Lane Powell PC

Press Releases

Most Popular Items in the Previous Issue

HHS Issues Final Rule on Drug Company Rebates
Society for Human Resource Management [SHRM]; membership may be required to view article

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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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