Defined Contribution Plan Administrator
MGA Consultants, Inc.
in MD

Pension Plan Administrator
Growing Retirement Plan Administration Firm
in NY

Outside Sales Representative
Advanced Plan Designs, LLC
in MO

RPS Client Services Manager
Heartland Financial USA, Inc.
in IA

Senior Retirement Benefits Specialist
Cummins
in TN

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Small Tweaks, Big Impact: The Power of Behavioral Decision-Making for the Plan Sponsor
April 2, 2018 WEBCAST
International Foundation of Employee Benefit Plans [IFEBP]

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Supreme Court Again Rejects Sixth Circuit Finding of Lifetime Retiree Medical Benefits
"The Supreme Court granted certiorari and reversed the Sixth Circuit in a single order and unanimous per curiam opinion, without the normal requirement of briefs by the parties on the question presented. In doing so, the Supreme Court sent a clear message that the Sixth Circuit's interpretation of Tackett was wrong, and that Judge Sutton's dissent correctly states the law." [ CNH Industrial N.V. v. Reese , No. 17-515 (U.S. Feb. 20, 2018, per curiam)]
McGuireWoods

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FMLA Claim Advances Because of Insufficient Documentation
"The court noted that to prevail on an FMLA interference claim, the employee merely needs to show that he or she was entitled to benefits under the FMLA and that he or she was denied them.... [The employer] attempted to support its position by pointing to documentary evidence, but the district court assessed this evidence as 'insufficient.' The court noted that one handwritten note appeared to be written on a notepad, with no letterhead or any insignia that would identify the origin." [ Baske v. Public Service Electric & Gas , No. 16-105 (D.N.J. Feb. 14, 2018)]
Society for Human Resource Management [SHRM]

Drug Pricing Lawsuit Proceeds Against Cigna as Lawmaker Calls for a Closer Look at Express Scripts Deal
"[A] federal judge in Connecticut ruled that the bulk of the claims against Cigna could proceed. A complaint filed by several members in October 2016 accused the insurer of violating [ERISA] ... by charging members more than 10 times the amount the insurer paid the pharmacy for certain drugs. The plaintiffs allege Cigna did this by requiring pharmacies to collect a higher copay from patients and then 'clawed back' the difference between the contracted fee and the copay." [ Negron v. Cigna and OptumRx , No. 16-1702 (D. Conn. Mar. 12, 2018)]
FierceHealthcare

Improving the Affordability of Specialty Drugs by Addressing Patients' Out-of-Pocket Spending
"[The authors] document how some of the cost-sharing provisions in commercial insurance and Medicare Part D plans have led to higher out-of-pocket spending and unprecedented levels of financial toxicity for patients needing specialty medications.... [They] provide several policy solutions to improve the affordability of specialty drugs by targeting patients' out-of-pocket spending [and] suggest methods that payers may consider to align the generosity of coverage with a drug's value in terms of both clinical benefit and cost."
Health Affairs

Promoting Competition to Address Pharmaceutical Prices
"This brief surveys the two principal types of pharmaceutical competition -- inter-brand and brand/generic -- and examines the reasons they may fail to produce lower prices for patients ... The brief then reviews the policy interventions that could help address these shortcomings. Such proposals include increasing the efficiency of generic drug approval, allowing temporary importation of drugs during domestic shortages or price fluctuations, and discouraging the improper use of patent exclusivities."
Health Affairs

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Policy Strategies for Aligning Price and Value for Brand-Name Pharmaceuticals
"To achieve the difficult balance between necessary incentives for innovation and affordability, many economists favor 'value-based' pricing, in which the price for a new drug reflects an assessment of the comparative effectiveness of the drug compared to other available treatments. [This brief explores] the different varieties of value-based pricing, and [outlines] several measures through which drug competition may be increased, supported by regulatory steps and payment mechanisms to bring drug prices into greater alignment with their underlying clinical value."
Health Affairs

Obamacare Stability Plan Calls for $30 Billion Reinsurance Fund
"The proposal, sponsored by Sens. Lamar Alexander (R-Tenn.) and Susan Collins (R-Maine), would reduce insurance premiums by an average of 10 percent in 2019 and by 40 percent over three years, according to the outline. Alexander expects these promises of lower rates and a more stable insurance market to persuade fellow lawmakers to include his proposal in the upcoming omnibus spending bill."
Bloomberg BNA

Congressional Letter to CMS Requesting Changes to 2019 Advanced Notice and Call Letter (PDF)
"For CY 2019, CMS is proposing to fully phase-in a new payment methodology ... [which] is not set based on actual bids submitted by the Employer Group Waiver Plans (EGWPs), but is instead based off bids submitted by non-EGWP plans. This new payment methodology may reduce employers' ability to provide retiree benefits through a consolidated health plan encompassing both Medicare benefits and supplemental retiree offerings, thus reducing beneficiary choice.... [We] request that CMS reconsider the changes finalized by the previous Administration as part of the CY 2017 Final Notice and instead find a payment methodology that will best account for the difference in the proportion of beneficiaries who are enrolled in a Health Maintenance Organization (HMO) versus a Preferred Provider Organization (PPO)."
Energy and Commerce Committee, U.S. House of Representatives

New Disability Claims Procedures Take Effect April 2, 2018
"Plan sponsors should start by identifying which of their ERISA plans allow for an exercise of discretion by a claims administrator in determining the disability status of a participant.... [It] is this exercise of discretion -- rather than the application of an impartial, objective standard -- that implicates the Final Rule. Accordingly, claims under a health plan, a long- or short-term disability plan, or even a retirement plan could be affected."
Verrill Dana LLP

Are Your Qualified and Nonqualified Employee Benefit Plans in Compliance with the New ERISA Disability Claims Regs?
"[W]here a plan does not provide for its own fiduciaries to make a determination of disability -- but instead defers to the determination made by the administrator of another plan (like the employer's long-term disability plan) -- then only the terms of the other plan need to be amended. Examples include health plans that extend eligibility, or deferred compensation plans that provide accelerated vesting, to claimants who are receiving benefits under the employer's long-term disability plan or Social Security Disability Insurance (SSDI)."
Katten Muchin Rosenman LLP

Work Habits of the New Millennium
"Currently only 2.6% of US employees consider their home as their primary place of work, but of Gen-Y workers, 3 out of 5 expect to work remotely.... 89% of smartphone owners use them while at work.... 24% of employees use a smartphone or tablet as their primary work-related device.... 35% of employed Millennials have started their own business on the side to supplement their income. 46% of Millennials want to start their own business within the next 5 years.... 38% of Millennials who are currently working said they were actively looking for a different job."
Grooms Benefit Solutions

What You Should Know About Your Plan's ERISA Fidelity Bond Coverage
"Plans should have ERISA fidelity bond coverage from an approved provider as of the beginning of the plan reporting period with a coverage amount in accordance with the regulations.... Who needs to be covered? ... What type of coverage do I need? ... Which coverage is required to be disclosed on the Plan's annual Form 5500? ... How much coverage do I need? ... Is my provider an approved provider?"
WithumSmith+Brown, PC