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Health & Welfare Plans Newsletter

January 13, 2023

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[Guidance Overview]

New Air Ambulance Services Data Reporting Requirement

"[W]hile employers generally hold joint liability to ensure this reporting is completed, practically speaking, these reporting requirements are likely to fall on issuers and third-party administrators (TPAs) due to the fact employers are not likely to have access to the necessary data. Additional guidance on the submission process should be forthcoming."  MORE >>

Sequoia

[Guidance Overview]

Paid Leave for Any Reason Coming to Illinois

"On January 10, 2023, the Illinois legislature passed the Paid Leave for All Workers (PLFAW) Act, making Illinois just the third state in the country (after Maine and Nevada) to require private employers to provide earned paid leave to employees to be used for any reason.... The PLFAW Act will take effect on January 1, 2024, and ... will provide nearly all Illinois workers with a minimum of 40 hours of paid leave, or a pro rata number of hours, during a designated twelve-month period."  MORE >>

Ogletree Deakins

District Court Upholds Trial Lawyer's Long COVID Disability Claim

"The court's finding ... benefits long COVID sufferers who work in other cognitively demanding occupations. The ruling also established that a specific diagnosis is not essential.... Since there are no specific laboratory tests available to diagnose long COVID ... the absence of concurrence among Abrams's physicians as to his diagnosis was not surprising ... What obviously led to the favorable outcome here, though, was the consistency of the evidence favoring Abrams."[Abrams v. Unum Life Insurance Company of America, No. 21-0980 (W.D. Wash. Dec. 27, 2022)]  MORE >>

DeBofsky Law

California Lawsuit Accuses Drugmakers of Insulin Overcharging

"California is suing the United States' leading insulin makers and pharmacy benefit managers, accusing them of using their market power to overcharge patients for the life-saving drug ... The lawsuit, filed in California Superior Court in Los Angeles, targets Eli Lilly and Co, Novo Nordisk A/S and Sanofi SA, which together make more than 90% of the insulin drugs sold globally." [California v. Eli Lilly and Company (Sup. Ct. Calif. Los Angeles, complaint filed Jan. 12, 2023)]  MORE >>

Reuters; free registration may be required

A New Era in Healthcare Cost Regulation in California

"A newly created agency will begin collecting healthcare cost data to set statewide growth targets for healthcare costs by 2025. Healthcare transactions will be subject to new regulatory scrutiny for their impacts on cost and effect on healthcare market competition, starting in January 2024. Standards will be developed to promote alternative payment models by the end of 2024. Enforceable cost targets for payers and providers will be established by 2028."  MORE >>

Husch Blackwell

State Strategies for Controlling Health Costs: Implementation Guides

"Each guide lays out key design decisions that policymakers will need to make, as well as the strategic and operational considerations for success.... [1] Limiting the rate of growth in provider prices.... [2] Capping high provider prices.... [3] Adopting multipayer value-based payment models.... [4] Adopting multipayer hospital global budgets.... [5] Using rate review to make health insurance more affordable."  MORE >>

The Commonwealth Fund

Worker Satisfaction with Health Benefits Is Lower; Mental Health Is More Important (PDF)

"The percentage of workers reporting that they were extremely or very satisfied with health benefits fell from 60 percent to 55 percent between 2021 and 2022, returning to its 2020 level. Satisfaction shifted to somewhat satisfied. These changes occurred after a period in which the proportion of those extremely or very satisfied was essentially flat between 2013 and 2018."  MORE >>

Employee Benefit Research Institute [EBRI]

Workplace Supplemental Health Products and Disability Insurance Sales Increase in Third Quarter 2022

"Supplemental health insurance premium is up 11% year over year.  Disability insurance premium was up slightly -- driven by long-term disability sales.  U.S. workplace life insurance new premium was down 1% from the same period in 2021."  MORE >>

LIMRA

[Opinion]

American Academy of Actuaries Comment Letter to CMS: Draft 2024 Actuarial Value Calculator Methodology (PDF)

"Because the metal levels are meant to indicate the relative richness of the cost-sharing designs to help consumers make their plan choice, the committee suggests that the AVs be standardized to be measured on the same standard population where only benefit richness is being measured, and not morbidity differences.... The committee asks CMS to share their analysis using EDGE data with stakeholders. The committee ... believes that guardrails or a multi-year plan could be put in place for a smooth transition to EDGE data."  MORE >>

Individual and Small Group Markets Committee, American Academy of Actuaries

Employee Benefits Jobs

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Remote

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Webcasts and Conferences
(Health & Welfare Plans)

Important Questions Employers Should Ask Before Implementing PFML

February 23, 2023 WEBINAR

Disability Management Employer Coalition [DMEC]

An Updated Look at State PFML

March 15, 2023 WEBINAR

Disability Management Employer Coalition [DMEC]

Last Issue's Most Popular Items

HHS Considers Updating the List of Essential Health Benefits

The Commonwealth Fund

Can an ERISA Plan Limit the Time a Claimant Has to File a Lawsuit for Plan Benefits?

Thomson Reuters / EBIA

Prescription Drug Cost-Containment Strategies

International Foundation of Employee Benefit Plans [IFEBP]

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

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