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Health & Welfare Plans Newsletter
November 22, 2021
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8 New Job Opportunities
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[Guidance Overview]
HIPAA Penalties Increase Again
"The penalty amounts are adjusted annually for changes in the cost of living. These updated amounts for 2021 apply for penalties assessed on or after November 15, 2021 for violations that occurred on or after November 2, 2015.... [T]he penalty amounts vary based on the
penalized entity's level of care." MORE >>
HUB International
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[Guidance Overview]
HHS Regs Include Expansive New Prescription Drug and Health Care Reporting Requirements for Employer Plans
"The extra requirements in [the Interim Final Rule] that are not in the statute include reporting the following by each state in
which an employer plan has participants: [1] Detailed prescription drug data and health care service cost data; [2] The number of plan participants with a paid prescription drug claim; [3] The total dosage units of prescription drugs dispensed and number of paid drug claims; [4] Plan premium amounts; [5] Prescription drug rebates, fees, and other remuneration broken down by the amounts received by the plan and the
amounts passed through to participants for each therapeutic class of drugs; and [6] The impact of prescription drug rebates, fees, and other remuneration on premiums and out-of-pocket costs." MORE >>
HR Policy Association
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[Guidance Overview]
Administration Announces Steps to Protect Consumers and Improve Ground Ambulance Billing Practices
"[HHS] unveiled details about the establishment of ... the Ground Ambulance and Patient Billing (GAPB) Advisory
Committee ... [which] will be charged with providing recommendations to the Secretaries of [HHS], Labor, and Treasury on ways to protect consumers from exorbitant charges and balance billing when using ground ambulance services.... Individuals interested in serving on the GAPB Advisory Committee may either self-nominate or be nominated by an organization. Applications must be submitted within 20 days of the publication date of the
Federal Register notice [scheduled for Nov. 23, 2021]." MORE >>
U.S. Department of Health and Human Services [HHS]
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[Guidance Overview]
Do FMLA Leave Requests Scare You?
"Most HR professionals, regardless of whether they're solo practitioners, consider the Family and Medical Leave Act (FMLA) one of the toughest workplace laws to administer. But it's not an insurmountable task if you pay attention to detail and
documentation." MORE >>
Society for Human Resource Management [SHRM]; membership may be required to view article
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House Passes Build Back Better Act with Paid-Leave and ACA 'Firewall' Provisions
"[The Build Back Better Act (HR 5376)] proposal would apply to all employers regardless of size and
require employers to provide leave to all workers regardless of length of service, job type or worker classification.... [T]here are significant differences [from the FMLA] in employee notice requirements and the definition of who qualifies as a family member." MORE >>
Society for Human Resource Management [SHRM]; membership may be required to view article
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Congressional Doctors Lead Bipartisan Revolt Over Policy on Surprise Medical Bills
"Congress passed the No Surprises Act last December ... after long, hard-fought negotiations with providers and insurers finally yielded an agreement that lawmakers from both parties thought was fair ... But now many doctors, their medical associations and members of
Congress are crying foul, arguing the [independent dispute resolution (IDR) rule] released by the Biden administration ... favors insurers and doesn't follow the spirit of the legislation." MORE >>
Kaiser Health News
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The Insurance Warrior Takes on a $61 Billion Company
Podcast, with transcript. "Although the surgery was his only option, his insurance denied the claim. That's when his wife ... contacted Laurie Todd, who calls herself the 'Insurance Warrior.' ... Fourteen years later, the speeches they gave in a conference
room full of executives are a master class in winning insurance appeals ... [T]aking on your health insurance provider often means going up against your employer. That's because most large companies 'self-insure.' And in this case, that employer was one of the biggest businesses in the world." MORE >>
Kaiser Health News
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Unvaccinated Workers Pay More for Health Insurance at Some Companies
"[As] COVID cases climb once again, more companies are putting aside carrots and turning to sticks in an effort to protect their workers. From Utah grocery chain Harmons to Wall Street banking giant JPMorgan Chase, companies are telling their unvaccinated workers to get the shots
or pay more for health insurance." MORE >>
National Public Radio [NPR]
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An Analysis of the HHS-Operated Risk Adjustment Technical Paper on Possible Model Changes (PDF)
"At the national level, ... receivers are likely to receive less risk transfers while payers are likely to pay less risk transfers.... Results were different in the individual market compared to small group market.... [R]isk score components for medical condition categories
(HCC), prescription drug condition categories (RXC), and enrollment duration factors (EDF) decreased." [See also HHS-Operated Risk Adjustment Technical Paper on Possible Model Changes, Oct. 26, 2021] MORE >>
Wakely Consulting Group
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Employee Benefits Jobs |
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Webcasts and Conferences (Health & Welfare Plans) |
Finding the Benefit Sweet Spot
November 23, 2021 WEBCAST
ArmadaCare
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Last Issue's Most Popular Items |
Employer-Provided COVID-19 Testing: An Employee Benefits Q&A
Ogletree Deakins
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HHS Announces Adjustments to Civil Monetary Penalties for HIPAA, MSP, and SBC Violations, Effective November 15, 2021
Thomson Reuters / EBIA
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Court Dismisses Former Employee's COBRA Claims Against TPA
Thomson Reuters / EBIA
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BenefitsLink Retirement Plans Newsletter, ISSN no. 1536-9587.
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