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[Guidance Overview]

Competitive Health Insurance Reform Act Signed Into Law, Repeals Antitrust Exemption for U.S. Health Insurers

"The Competitive Health Insurance Reform Act has amended the McCarran-Ferguson Act such that health insurers will now be subject to the same federal antitrust laws as other industries; other insurers, however, will continue to have federal antitrust immunity. Repeal of the antitrust exemption subjects health insurers to increased scrutiny by federal antitrust authorities ... as well as private parties seeking to bring federal antitrust claims, which may counsel for a re-examination of antitrust compliance policies." Icon to read more

Akin Gump

[Guidance Overview]

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

"This document summarizes key dates for calendar year 2021 regarding some activities and policies that are outlined in other documents. CMS is not soliciting additional comments on the substance of the underlying policies or key dates through release of this document." Icon to read more

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

[Guidance Overview]

Exceptional Usefulness and Quality iconComplying with the Consolidated Appropriations Act: Actions for Group Health Plan Sponsors and Plan Administrators

"Upon request, group health plans will need to have and readily produce comparative analyses showing that the plans comply with the parity requirements, as well as other requested information. The Departments will publish reports of their investigations, identifying those plans out of compliance with the parity requirements. Sponsors and plan administrators of group health plans need to take immediate action to prepare for the Departments' inquiries. They may also need to make changes to their plan design and agreements with their plan vendors." Icon to read more

Nixon Peabody LLP

[Guidance Overview]

EEOC Proposes New Rules on Permissible Incentives for Employer-Sponsored Wellness Programs

"Since [2017], employers have lacked guidance on how to structure wellness programs without violating the requirements of both the ADA and GINA that individuals' disclosures of health information be voluntary. The EEOC's new rules seek to balance the competing interests. However, given the Biden Administration's recently issued freeze on proposed rules that have not yet been enacted, employers should not act on the EEOC's proposed rules yet." Icon to read more

Reed Smith

[Guidance Overview]

Exceptional Usefulness and Quality iconStates, Cities Tackle COVID-19 Paid Leave

"This GRIST provides brief summaries of the new state and local paid leave benefits, as well as guidance addressing how current paid leave benefits apply during the COVID-19 pandemic." Icon to read more


Disclosures to Welfare Plan Participants: A Fiduciary Duty (PDF)

"The existing fiduciary principles are not by their terms restricted to employee pension benefit plans, but can equally well -- and should -- be applied in the welfare plan context. This article will explore one such area -- the need to provide information to participants in group health plans that will provide them with the opportunity to identify the choices that are in their own best interests, and [enable them] to make informed, cost-conscious decisions." Icon to read more

The Wagner Law Group

Selecting the Right Benefits Administration Provider

"[M]ake a comprehensive list of your 'must-haves' and 'nice-to-haves'.... [I]dentify your current pain points, and then document what your ideal experience would be like.... [R]emember to consider any expensive, time-consuming, or risky operating processes that can be automated.... [G]ive yourself plenty of time so you do not end up with a rushed implementation.... As you narrow down providers, confirm that they can meet your timeline for the launch of your new solution." Icon to read more


Opt-Out Arrangements for Group Health Plans: Employer Compliance Considerations (PDF)

"[1] If an opt-out is offered in combination with a fully insured plan, check with the carrier to confirm that the opt-out payment does not violate any contractual agreement with the carrier; [2] If an opt-out arrangement is offered in combination with a self-insured plan, be aware of potential 105(h) nondiscrimination issues ... [3] Make sure that offering an opt-out does not ... lead to lower plan participation overall if that is not your intended outcome; [4] Ensure that the opt-out payment is offered under a Section 125 plan and amend the written Section 125 plan accordingly." Icon to read more

Cowden Associates, Inc.

Opportunities for Purchasers and Physicians to Accelerate Care Delivery, Innovation and Value

15 pages. "Recommendations for employers [include]: [1] Explore integrated behavioral health models that have a single access point for mental health services, consolidating diverse services to holistically treat patients. [2] Ease delivery of care by working directly with provider groups to eliminate the need for several vendors. [3] Review current networks to ensure that high-quality physicians are promoted and behavioral health is integrated. [4] Address waste, fraud and abuse by requiring carriers to provide an action plan to ensure accountability.[5] Request effective metrics that evaluate provider performance." Icon to read more

National Alliance of Healthcare Purchaser Coalitions

Empowering Employees to Take Control of Expensive Chronic Medical Conditions

"90% of the nation's healthcare spending -- $3.8 trillion dollars -- is due to chronic health conditions. While it's up to the individual to have the desire to engage with their employer's chronic condition management programs, it's also on HR to provide clear guidance and easy access to available resources.... But how do you inspire individuals to engage without being overbearing or seen as self-serving?" Icon to read more

Tango Health

How Do You Make Health Care More Patient-Centered?

"All forms of communication should be easily accessible and in language that is clear and easy to understand.... Research study and clinical trial designs must include patient engagement to ensure resulting evidence reflects patient needs and expectations ... Patients should be informed, in language they understand, about their coverage ... Value-based care and payment models should include patient-centered quality and outcome measures." Icon to read more

Healthcare Economist


Is the Traditional Health Plan Network About to Go the Way of the Dinosaurs?

"There is a need for safe and relatively painless solutions within the group health insurance market, particularly for smaller companies and those that don't have the time, resources, inclination, and vision to innovate when it comes to health insurance. A fully-insured PPO plan, usually offered by a BUCAH, has been filling that niche for decades.... [By] 2023, all of that negotiated price data will have entered the marketplace. When everyone knows how much a provider really will accept for services rendered from all kinds of payers, what will happen to group plans structured around contracted rates that may or may not be a good deal?" Icon to read more

MZQ Consulting, LLC


Rationalizing a Medicare Buy-In Policy for Adults Ages 50 to 64 That Builds on the ACA

"[O]lder adults are at substantial risk of high health care spending, making health insurance coverage critical to their financial security.... [U]ninsurance rates have varied with age before and after ACA implementation. [The authors] highlight some main findings from a recent report that estimated the health insurance coverage and spending effects of Medicare buy-in policies and discuss what buy-in policies could achieve if they were implemented alongside the ACA." Icon to read more

Urban Institute


Expanded Coverage for COVID-19 Testing Must Include Limits on Costs for Participants

"The most efficient and equitable way to conduct testing on a mass scale is through a federally-funded public effort that tests everyone, regardless of insurance status, but until Congress enacts such a program, mandating insurance coverage is an important lever to improve access to testing.... Mandating that insurers cover and waive cost-sharing for more COVID-19 tests is a welcome policy change, but a few gaps remain that likely require Congressional legislation to address." Icon to read more

The Brookings Institution

Benefits in General

[Guidance Overview]

Tracking Federal COVID-19 Laws Affecting Employee Benefits, Jobs (PDF)

20 pages. Summary of significant employment-related provisions in COVID-19 relief legislation, including measures affecting: [1] Retirement plans; [2] Health benefits; [3] Paid leave benefits; [4] Other health, welfare and retirement benefit requirements; [5] Other tax credits, deductions and financial aid for employers and individuals. Icon to read more


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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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