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Health & Welfare Plans Newsletter

May 31, 2022

3 New Job Opportunities 3 New Job Opportunities


No Surprise: 'Pure' Reference-Based Pricing Is Always Superior

"The most effective way to address the NSA legislation, particularly elements of the IDR process, is to adopt a 'pure' RBP plan. This structure doesn't depend on a network's ability to negotiate a price for a specific provider in a specific location for specific services. There are no in- or out-of-network claims, nor is there any determination of a median in-network rate. Based on the guidance received to date, pure RBP appears to avoid the NSA IDR process -- because there are no contracted rates."  MORE >>


Early Impacts of the No Surprises Act on Patient Billing

"The regulations estimated that 17,000 claims per year would be subject to the arbitration process established by the law to settle disputes over out-of-network payments from insurers to providers. But ... that number would be exceeded by a wide margin if even a tiny fraction of the projected 12 million claims ends up in the process formally known as independent dispute resolution (IDR)."  MORE >>

Healthcare Financial Management Association [HFMA]; free registration required

Her First Colonoscopy Cost Her $0; Her Second Cost $2,185. Why?

"The [ACA] made preventive health care such as mammograms and colonoscopies free of charge to patients without cost sharing. But there is wiggle room about when a procedure was done for screening purposes, versus for a diagnosis. And often the doctors and hospitals are the ones who decide when those categories shift and a patient can be charged -- but those decisions often are debatable."  MORE >>

Kaiser Health News

FDA Allows Pharmacists and Wholesalers to Import Drugs from Canada

"Pharmacists and drug wholesalers can import prescription medicines from Canada for up to two years as part of state programs aimed at bringing down drug costs ... The guidance lays out requirements for importing drugs from wholesalers licensed by Canadian regulators and for testing and labeling the drugs. It excludes some controlled substances, biological products and infused drugs."  MORE >>



Taxpayers Paid Twice for Healthcare During COVID-19 Pandemic

"It's obvious why public health spending would surge during a pandemic. But what could justify the nearly $65 billion increase in private insurers' overhead? And how is it that two thirds of that increase came from private insurers' subcontracts with Medicare and Medicaid?"  MORE >>

MedPage Today

Benefits in General

Arbitration of ERISA Claims: Where Are the Courts and Congress Headed?

"Due to lack of Supreme Court guidance on these issues, it is still not clear the extent to which particular arbitration provisions may apply to ERISA fiduciary breach claims. However, several Circuit Courts of Appeal have now weighed in and a bill called the Employee and Retiree Access to Justice Act has been introduced in the House and Senate (HR 7740 and S 4219) with the express purpose of making predispute and nonconsensual post-dispute arbitration clauses unenforceable. What is a plan sponsor favoring arbitration to do?"  MORE >>

Cohen & Buckmann, P.C.

Employee Benefits Jobs

View job as Retirement Plan Analyst - Defined Contribution
          for Compensation Strategies Group, Ltd Retirement Plan Analyst - Defined Contribution

Compensation Strategies Group, Ltd

Remote / Beaumont TX

View job as Retirement Plan Analyst - Defined Contribution
          for Compensation Strategies Group, Ltd

View job as Sr Advisor New Business - Insurance & Financial Services
          for National Rural Electric Cooperative Association (NRECA) Sr Advisor New Business - Insurance & Financial Services

National Rural Electric Cooperative Association (NRECA)

Arlington VA / Lincoln NE

View job as Sr Advisor New Business - Insurance & Financial Services
          for National Rural Electric Cooperative Association (NRECA)

View job as Relationship Manager
          for HORAN Relationship Manager


Cincinnati OH

View job as Relationship Manager
          for HORAN

Press Releases

Pension Rights Center’s Founder Karen Ferguson Receives Posthumous Award Recognizing Her Importance to Employee Benefits Field

Pension Rights Center

Ameritas Announces Newly Elected Officers


Webcasts and Conferences
(Health & Welfare Plans)

No Surprises Act Strategies Compliance

June 7, 2022 WEBCAST

Foley & Lardner LLP

Last Issue's Most Popular Items

Proposed Revisions to the HIPAA Privacy Rule: What Group Health Plan Sponsors Need to Know

Trucker Huss

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PCORI Filings and Fees (2022 Edition)

Kushner & Company

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BenefitsLink Retirement Plans Newsletter, ISSN no. 1536-9587.

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