Health & Welfare Plans Newsletter

March 19, 2018

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ESOP Administrator
Blue Ridge ESOP Associates
in VA, Telecommute

Sales Consultant for plan administration software
Ftwilliam.com - Wolters Kluwer Legal & Regulatory
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Director, Pension Action Center
University of Massachusetts Boston
in MA

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RTD Financial Advisors, Inc.
in NJ

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[Guidance Overview]

Maryland Provides New Information on Healthy Working Families Act
"The new guidance takes the form of sample policies and updated or new responses to the previously posted frequently asked questions .... [The] sample policies provide a useful framework ... although the policies will need customization ... For example, all the sample policies assume that an employer does not have another form of paid leave, which may comply with the Act, already in place."
Miles & Stockbridge

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A Uniform Standard of Review in ERISA Benefit Denial Cases: The Fifth Circuit Overrules Itself to Fall in Line with Other Courts
"In its decision, the Fifth Circuit ... noted that Firestone could be read to articulate a general standard of review, regardless of whether the denial was based in facts or in an interpretation of the plan language. It also determined that Pierre's reliance on an apparent distinction between the standard of review of a trustee's legal versus factual decisions could not withstand scrutiny." [ Ariana M. v. Humana Health Plan of Texas, Inc. , No. 16-20174 (5th Cir. Mar. 1, 2018)]
Littler

Sample Subrogation and Reimbursement Clauses for Summary Plan Descriptions
"[This article] provides sample subrogation and reimbursement clauses to be used in a summary plan description. Such clauses are typically used in an instance in which an employer's health or disability plan wants to avoid a situation in which a participant gets a double recovery for the same illness or injury."
Venable LLP

Arkansas House and Senate Approve Regulation of PBMs
"The bill would allow state regulators to supervise PBMs' networks to ensure that they provide convenient patient access to pharmacies and a fair and sustainable reimbursement rate for pharmacist services."
AISHealth

Insurers Remaining in ACA Markets Prepare for Continued Uncertainty in 2018, 2019
10 pages. "The anticipated rollback of the ACA's individual mandate led insurers to implement higher premiums in 2018 and will likely drive premiums even higher in 2019. However, insurers' views differed on the impact of repealing the individual mandate ... The midyear loss of the ACA's cost-sharing reduction (CSR) plan reimbursements drove 2018 premium increases ranging from 10 percent to 20 percent.... All insurers had concerns regarding an expansion of short- term and association health plans ... Although the current administration has offered insurers greater flexibility in benefit design, few insurers reported taking advantage of it for 2018.... In areas where insurers had effective monopolies, premiums have generally been very high."
Robert Wood Johnson Foundation

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[Opinion]

ECFC Letter to IRS Requesting Guidance for Application of Revised HSA Contribution Limits (PDF)
"Application of the current rules regarding excess contributions is administratively complex.... In the current situation where individuals made contributions based on guidance issued by the IRS that was revoked when new tax legislation was enacted, there seems to be no reason to impose the detailed excess contribution regime on individuals and those who administer HSA trusts and custodial accounts."
Employers Council on Flexible Compensation [ECFC]

[Opinion]

ERIC Asks For Pay Parity Change in Connecticut Telehealth Legislation (PDF)
"[L]egislation that mandates that reimbursement for telemedicine be the same rate as that of in-person services is simply illogical and unnecessary.... [R]eimbursement rates should be negotiated between providers and insurers, not mandated by government."
The ERISA Industry Committee [ERIC]

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David Rhett Baker, J.D., Editor and Publisher
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2018 BenefitsLink.com, 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 BenefitsLink.com, 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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