Health & Welfare Plans Newsletter

January 27, 2021

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[Guidance Overview]

Exceptional Usefulness and Quality and Usefulness iconEmployer Reporting for State Individual Mandates (and Other Deadlines)

"[S]ome states have adopted so-called individual mandates requiring individuals to purchase health insurance or pay a penalty. To support these mandates, states are requiring employers and/or carriers to provide reporting of the health coverage they have offered. [This article provides] a summary of some of these requirements." Icon to read more

HUB International

[Guidance Overview]

New York State Provides Supplemental Guidance for Its Paid Quarantine Leave

"Since the Leave was enacted, a frequent question from employers has been whether employees are entitled to use the Leave multiple times -- e.g., if they are subject to mandatory quarantine or isolation on more than one occasion. The guidance ... [confirms] that an employee shall not qualify for more than three quarantine/isolation orders ... [and thus] will only be eligible to use the Leave three times. The guidance, however, does not specify whether this limitation applies on an annual basis." Icon to read more

Reed Smith

[Guidance Overview]

New Fee Disclosure Requirements for Health Plan Brokers and Consultants

"The Consolidated Appropriations Act, 2021 ... imposes new compensation disclosure requirements upon brokers and consultants to group health plans covered by [ERISA]. Additionally, new disclosures in the individual market related to compensation were added to the Public Health Service Act. This alert summarizes these new disclosures and highlights important considerations for both plans and service providers." Icon to read more

Groom Law Group

Virtual Open Enrollment Post-Evaluation: What to Know for Next Time

"Prepare ahead of time as much as possible ... Provide for all types of learning and communication ... Track and measure ... Go to the source." Icon to read more

Connect Your Care

Health Insurance Antitrust Exemption Eliminated

"CHIRA is not likely to bring significant changes to the operations of health insurers because [1] it leaves the exemption in place for certain critical activities; [2] other federal antitrust exemptions may nonetheless apply; and [3] health insurers' procompetitive activities should be found lawful under the federal antitrust laws.... Health insurers should expect increased antitrust litigation, and possibly government investigations[.]" Icon to read more

Jones Day

Exceptional Usefulness and Quality iconHow Employers Are Combating Escalating Health Care Costs in 2021

"[1] Administration/data analysis initiatives ... [2] Cost-sharing initiatives ... [3] Plan design/program initiatives ... [4] Purchasing/provider initiatives ... [5] Utilization control initiatives." Icon to read more

International Foundation of Employee Benefit Plans [IFEBP]

Has Widespread Work-From-Home Undone Years of Health Plan Cost-Containment Gains?

"[T]he explosion of remote working, which is now here to stay, has undercut the efficacy of cost-containment investments such as on-site clinics, on-site wellness programs, local provider networks, and other investments requiring high utilization in order to pay off. When and if those investments will realize their anticipated ROI is now questionable." Icon to read more

BenefitsPro; free registration required

Growing Number of Employers Acting as Catalysts for Change to Shift Health Benefits Market and Drive Innovation

"Employer top health benefit priorities for 2021 include ensuring members are engaged in the programs offered and using benefits, along with COVID-19 related initiatives and chronic condition management. Top payment reform strategies being used now or planned in 2021 consist of specialty drug management (89%), centers of excellence/episodes of care (75%) and steerage within networks (69%). Top threats to the affordability of employer-sponsored health coverage consists of specialty drug costs (72%), high-cost claims (64%) and specific diseases and conditions (46%); about 15% of respondents don't see industry consolidation or intermediary conflicts of interest as a threat." Icon to read more

Midwest Business Group on Health

What Is a Sedentary Occupation, Anyway? How a Job Analysis Can Win Disability Claim Denials

"[W]hat if there is evidence in the record (like a job analysis) that the claimant's job 'could be performed by alternating sitting and standing'? This evidence may be sufficient for the court to sustain a conclusion that the job was not sedentary. And if the job is not sedentary, then -- the claimant could perform her job even though she could not sit for more than four hours in an eight hour workday." Icon to read more

Lane Powell PC

Two Proposals to Strengthen Paid Leave Programs

"[This brief discusses] the evidence base for expanding investment in return-to-work services for at-risk workers and testing a temporary disability benefit. [The authors] propose providing grants to states to test and expand promising models for return-to-work services in conjunction with paid family and medical leave programs. [They] also propose testing a new temporary disability insurance benefit outside the context of the Social Security Disability Insurance program." Icon to read more

Urban Institute

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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 2021 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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