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Health & Welfare Plans Newsletter December 10, 2020 |
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Newly Posted New York Paid Sick Leave Law: What Employers Need to Know
Ethical Considerations for Employee Benefits Lawyers: Pandemic Edition
Employee Assistance Plans - Helping Your Employees Navigate Through Uncertain Times
Understanding Connecticut Paid Family & Medical Leave
New Price Transparency Rules for Health Plans: Key Issues for Plan Sponsors, Service Providers, and Insurers
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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[Official Guidance]
70 pages. "This document contains final regulations to ... address the elimination of the deduction under section 274 for expenses related to certain transportation and commuting benefits provided by employers to their employees. The final regulations provide guidance to determine the amount of such expenses that is nondeductible and apply certain exceptions under section 274(e) that may allow such expenses to be deductible." Internal Revenue Service [IRS] |
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[Guidance Overview]
"The notice includes important proposed rules and parameters for the operation of the individual and small group health insurance markets in 2022 and beyond.... [1] Direct-enrollment flexibilities ... [2] Risk adjustment ... [3] User fees ... [4] PBM reporting ... [5] MLR changes ... [6] 1332 waiver regulation ... [7] Actuarial Value Calculator." Wakely Consulting Group |
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[Guidance Overview]
"The law applies to employees who are [1] working for that employer within Pittsburgh after the effective date of this ordinance, [2] normally work for that employer within the City of Pittsburgh but are currently teleworking from any other location as a result of COVID-19, or [3] work for that employer from multiple locations or from mobile locations, provided that 51% or more of such employee's time is spent within the City of Pittsburgh. An employee may take up to 80 hours of leave, and this time is in addition to time under the PSDA." Jackson Lewis P.C. |
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[Guidance Overview]
"The new FAQ posted on the IRS website announces that, for 2020, the 80/50 rule will be considered satisfied for a vehicle if, at the beginning of the 2020 calendar year, the employer reasonably expected the vehicle's use would satisfy the 80/50 rule but the rule was not actually satisfied 'due to the COVID-19 emergency.' For this purpose, the emergency is deemed to have begun on the date of the President's emergency declaration, which was March 13, 2020." Thomson Reuters / EBIA |
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19 pages. "Arkansas' Act 900 regulates the price at which pharmacy benefit managers reimburse pharmacies for the cost of drugs covered by prescription-drug plans.... The Court holds that the Act has neither an impermissible connection with nor reference to ERISA and is therefore not pre-empted.... [N]ot every state law that affects an ERISA plan or causes some disuniformity in plan administration has an impermissible connection with an ERISA plan. That is especially so if a law merely affects costs.... ERISA does not pre-empt state rate regulations that merely increase costs or alter incentives for ERISA plans without forcing plans to adopt any particular scheme of substantive coverage.... Like the New York surcharge law in Travelers, Act 900 is merely a form of cost regulation.... Indeed, Act 900 is less intrusive than the law at issue in Travelers, which created a
compelling incentive for plans to buy insurance from the Blues instead of other insurers. Act 900, by contrast, applies equally to all PBMs and pharmacies in Arkansas. As a result, Act 900 does not have an impermissible connection with an ERISA plan." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., Nos. 17-1609 and 17-1629 (8th Cir. Jun. 8, 2018; S. Ct. No. 18-540, oral arg. Oct. 6, 2020)] Supreme Court of the United States |
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"Employers should consider end-of-the-year plan amendments to document mid-year changes resulting from the pandemic and related government action. Employers should evaluate whether they have appropriately notified employees of changes in benefits, particularly those that have resulted in changes to any Summary of Benefits and Coverage. Employers should evaluate plan administration in the face of extended plan deadlines." Ballard Spahr LLP |
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"HHS has released proposed regulations with the 2022 benefit and payment parameters and insurance market and Exchange-related proposed rules. Although largely aimed at insurers and Exchange regulators, some provisions may be of interest to employers and their advisors.... [1] Annual cost-sharing limits.... [2] COBRA and exchange special enrollment.... [3] MLR reporting and rebates ... [including] Prescription drug concessions.... [and] Rebate prepayment." Thomson Reuters / EBIA |
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"Plan members use coupons to cover their copays and out-of-pocket costs. The savings may be a huge relief, but members haven't always realized that because their health plan or its PBM was using an accumulator, the value of the coupon not counting toward the deductible. The shock comes when the value of the coupon runs out.... [T]he new transparency rules for health plans issued by CMS in October include a provision that, effectively, requires health plans and PBMs to disclose to their beneficiaries that they are using accumulators or maximizers." Managed Healthcare |
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"The recent wins make it harder for states to rein in prescription drug costs and bring more transparency to the price-setting process. They've also weakened the protections ERISA put in place to prevent beneficiaries from having to pay inflated drug prices." Bloomberg Law |
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"The new program, along with other efforts related to the state health plan, is proposed to save $185 million through FY21, according to the article. Some state governments, like Connecticut, have high enough volumes that COVID-19 may accelerate their adoption of value-based payment models, according to Chad Mulvany." Healthcare Financial Management Association [HFMA] |
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[Opinion]
"Certain health plan practices threaten patient access to care and drive excessive administrative costs and burden in the health care system. While these concerns pre-date COVID-19, the current public health emergency both highlights and demands immediate action to protect patients and providers. Regulators should increase their oversight of health plans and implement a comprehensive simplification agenda, beginning with streamlining prior authorization requirements and processes, as well as monitoring for abusive payment delays and denials. These efforts will go a long way to addressing unnecessary costs in the system and allow for a more rational, navigable health system for patients." Physicians for a National Health Program [PNHP] |
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Benefits in General |
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"When an employee dies -- regardless of the cause -- employers often want to immediately help the employee's family financially in their time of grief, but a number of administrative, legal, and tax-related issues must be considered before an employer pays final compensation and benefits to the beneficiaries or estate of the deceased employee." Pillsbury Winthrop Shaw Pittman LLP |
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Press Releases |
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Medcom Benefit Solutions Appoints Tony Trombetta to Lead National Sales Expansion
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AWS Announces Amazon HealthLake
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McGinnis Lochridge Welcomes Traci M. Clements in Dallas
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Most Popular Items in the Previous Issue |
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