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January 18, 2021 logo logo
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[Official Guidance]

Updated Summary Report of 2017 Benefit Year Risk Adjustment Data Validation Adjustments to Risk Adjustment Transfers (PDF)

89 pages; Jan. 15, 2021. "The purpose of releasing this updated report is to correct for a minor misassignment of hierarchy condition categories (HCCs) that occurred to certain issuers' 2017 benefit year HHS-RADV results which affected all 2017 benefit year HHS-RADV error rates used in the calculation of risk adjustment transfer adjustments.... While this issue did not change the risk pools impacted or the identification of outliers, it did cause small changes in the dollar amounts of the 2017 benefit year HHS-RADV adjustments to risk adjustment transfers for all issuers with transfer adjustments." Icon to read more

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

[Guidance Overview]

EEOC Proposed Wellness Regulation Restricts Incentives for Voluntary Programs But Offers Path for Programs That Satisfy ACA Standard

"The proposed regulations address the court's concern with the 2016 regulations by specifying that any incentive that is more than de minimis would render a program involuntary. But the proposed ADA regulation offers a new 'safe harbor' that would allow health plans to offer bigger incentives to participate in certain health-contingent wellness programs -- but not to provide family medical history or other genetic information -- if the requirements under the HIPAA regulations are satisfied." Icon to read more


[Guidance Overview]

Exceptional Usefulness and Quality iconTimeline and Application of New Surprise Billing and Transparency Laws and Rules (PDF)

This 4-page chart compiles all recent laws and rules concerning healthcare price transparency, as of December 30, 2020. Icon to read more


[Guidance Overview]

Under the HEROES Act, Employers Can Help Pay Your Student Loans

"The HEROES Act extends student loan assistance under IRC Section 127 for five years.... [E]mployers may now pay employees up to $5,250 per year towards qualified educational expenses, student loan repayments (both principal and interest), or a combination of both -- tax free -- until December 31, 2025." Icon to read more

Epstein Becker Green

Health Insurer Pays $5.1 Million to Settle Data Breach Affecting Over 9.3 Million People

"Excellus Health Plan reported that the breach began on or before December 23, 2013, and ended on May 11, 2015. The hackers installed malware and conducted reconnaissance activities that ultimately resulted in the impermissible disclosure of the protected health information of more than 9.3 million individuals, including their names, addresses, dates of birth, email addresses, Social Security numbers, bank account information, health plan claims, and clinical treatment information." Icon to read more

U.S. Department of Health and Human Services [HHS]

HHS Sued Over Georgia Plans to Push Health Consumers to Agents

"Georgia's plan to overhaul how state residents buy health insurance under the [ACA] would 'tear a hole' in the ACA, 'eviscerating' its achievements, a federal lawsuit says.... Georgia Gov. Brian Kemp's administration has said private websites will provide better service and offer more options that will boost insurance coverage in the state. Critics worry the move will make it harder to shop for insurance and drive healthy people to cheaper plans that provide limited coverage, increasing insurance premiums for older and sicker people who need the comprehensive benefits required by the ACA." [Planned Parenthood Southeast, Inc. v. Azar, No. 21-117 (D.D.C. complaint filed Jan. 14, 2021)] Icon to read more


Trade-Offs in Public Health Insurance Design

"Although the advantages of moving to such a single-payer plan might be appealing, there are large hidden costs that must be considered." Icon to read more

JAMA Network

Benefits in General

Considerations for Recognizing and Addressing Participants with Diminished Capacity (PDF)

42 pages. "[T]he Council recommends that the [DOL] highlight the issue of the risks to individuals resulting from diminished mental capacity, including potential financial exploitation, including: [1] As part of the Department's outreach and education programs, provide general public education ... [2] Publish information ... on the topic, with a focus on ... best practices recommended by the financial services industry ... [3] Issue guidance that recognizes that fiduciaries may voluntarily adopt policies or procedures that: (a) impose reasonable temporary restrictions on participant plan actions ... when participants exhibit signs of diminished capacity or financial exploitation, and/or (b) encourage actions by participants such as the identification of a 'trusted contact,' require confirmation of a Power of Attorney authorization's continuing effectiveness, or take other reasonable steps ... to protect participants from potential fraud and financial abuse." Icon to read more

Advisory Council on Employee Welfare and Pension Benefit Plans, Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Press Releases

NCEO Captive Insurance Program Will Launch This Summer
National Center for Employee Ownership [NCEO]

Most Popular Items in the Previous Issue

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Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2021, 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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