Health & Welfare Plans Newsletter

December 16, 2020

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[Guidance Overview]

Proposed Changes to HIPAA Privacy Rule Would Promote Value-Based Health Care

"HHS would expand the right to inspect to add a new right for individuals to take notes, videos, and photographs of PHI -- and to use other personal resources to view and capture PHI -- in a designated record set (at a mutually convenient time and place). CEs could not impose fees relating to this new inspection right." Icon to read more

Thomson Reuters Practical Law

[Sponsored]

‘Tis the Season to Save on Employee Benefits E-Learning Courses

Make your education and professional development a priority in the new year. Whether you’re working remotely or back in the office, e-learning courses are the online training solution that fit into your busy schedule. Learn more

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]


Plans Must Cover Coronavirus Vaccine Without Cost Sharing

"All group health plans that are non-grandfathered under the [ACA] must cover the vaccine without cost sharing. The federal agencies have not yet stated when the '15 business day' time period for coverage must begin. We're using January 1, 2021, as that is 15 business days after the vaccine was authorized, but the date could be changed in the future." Icon to read more

Segal

Ninth Circuit Reverses Dismissal of HIV/AIDS Prescription Drug Claim Under ACA Disability Discrimination Rule

"The US Court of Appeals for the Ninth Circuit has held that plan participants requiring specialty medications for treatment of HIV/AIDS stated a claim for disability discrimination under Section 1557 of the [ACA]. The participants alleged that a pharmacy benefit manager's (PBM's) policy required them to obtain specialty medications through its designated specialty pharmacy for those medications to be considered in-network benefits available at a lower price." [Doe v. CVS Pharmacy, Inc., No. 19-15074 (9th Cir. Dec. 9, 2020)] Icon to read more

Thomson Reuters Practical Law

DOJ to Require Harvard Pilgrim to Divest Health Plan for Merger

"The Department of Justice is seeking to block Harvard Pilgrim Health Care's proposed merger with Health Plan Holdings unless it divests the Tufts Health Freedom plan, officials said Tuesday.... The department proposed a settlement at the same time, approving UnitedHealth Group or an alternative approved buyer of Tufts Freedom, part of Health Plan Holdings' commercial health insurance business in New Hampshire." Icon to read more

FierceHealthcare

Avoiding Costly ACA Reporting Errors

"Even with the repeal of the individual mandate, 1095-B reporting is still required. The IRS uses this information to enforce the employer mandate. It is also used when determining premium subsidy eligibility in the ACA marketplace." Icon to read more

Hall Benefits Law

Exceptional Usefulness and Quality iconFindings on the State of the PBM Industry: 2020 Report

28 pages. "This 2020 Report includes a cross-section of PBMs, with large and small, 'carve-out' and 'carve-in' organizations ... [The] report publicly identifies the Participating PBMs' comparisons in graph form for each section [and includes] educational articles ... ranging from Opioid treatment to maximizing PBM Audits, and understanding CoPay Assistance programs.... [By] sharing their policies, programs, and results, [the] participating PBMs are already demonstrating a degree of transparency[.]" Icon to read more

National Alliance of Healthcare Purchaser Coalitions

[Opinion]

Removing Firewall Employer Insurance and ACA Marketplaces: Who Could Benefit?

"Between 6 percent and 13 percent of people in nonelderly households covered by employer insurance could pay lower premiums through a marketplace plan if the firewall were lifted. The vast majority of those benefitting would be low- or middle-income families. Residents of southern states would particularly benefit, since their employee plan premiums often take up a larger percentage of household income than the national average." Icon to read more

The Commonwealth Fund

Benefits in General

[Guidance Overview]

DOL Issues Final Regs on Voting of Proxies on Securities Held in Employee Benefit Plan Investment Portfolios

"The final regulation applies to ERISA-covered retirement and health and welfare plans that hold shares of corporate stock, whether directly or through ERISA-covered intermediaries like common trusts, master trusts, pooled separate accounts, and 103-12 investment entities. The final rule does not affect employee benefit plans with respect to stock held through registered investment companies. The final regulation provides that the fiduciary duty to manage plan assets consisting of shares of stock includes managing the related shareholder rights." Icon to read more

Thomson Reuters Practical Law

Press Releases

Most Popular Items in the Previous Issue

Transparency in Healthcare Coverage: Understanding the Final Rule
Groom Law Group, via American Benefits Council

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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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