Health & Welfare Plans Newsletter

April 25, 2018

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Senior Pension Administrator
Primark Benefits
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Blue Ridge ESOP Associates
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County of Sonoma Human Resources Department
in CA

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Survey Is in for 2018 - Are Your Strategies Keeping Up?
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Best Practices in Employee Benefits Communication
May 3, 2018 in MD
Worldwide Employee Benefits Network [WEB] - Baltimore Chapter

ERISA Litigation Update: New Trends and Significant Changes
May 31, 2018 WEBCAST
Lorman Education Services

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[Guidance Overview]

Departments Issue Robust Mental Health Parity Implementation Guidance

"The newly released regulatory package reflects the departments' focus on compliance assistance in proposing specific examples of mental health parity violations along with a revised draft disclosure template. It also pushes for civil monetary penalties in connection with parity violations as a way to foster more effective MHPAEA enforcement." Conduent

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Claims Over Cost-Sharing Reductions Can Proceed as a Class Action

"[T]he CSR class includes any insurer that offered a qualified health plan in the 2017 or 2018 plan year who did not receive a CSR payment from the government to account for the amount it paid out in CSRs to enrollees. The government has to provide a list of potential class members by May 18, 2018." [ Common Ground Healthcare Cooperative v. U.S. , No. 17-877C (Cl. Ct. Apr. 17, 2018)]
Katie Keith, in Health Affairs

Blue Cross Takes Rare Loss on Monopoly Claim with Trial Pending

"Blue Cross Blue Shield of Rhode Island is facing a jury trial on claims it shut a hospital out of its network and quit reimbursing for care there to thwart a competing insurer that was slated to buy the hospital.... Blue Cross threatened Steward's entry into the Rhode Island market by embarking on a series of anticompetitive actions, the complaint said." [ Steward Health Care System v. Blue Cross & Blue Shield of Rhode Island , No. 13-405 (D.R.I. Apr. 23, 2018)]
Bloomberg BNA

What's Driving Health Insurance Costs in Utah? (PDF)

32 pages. "61% of Utahns purchase health insurance through employers. This is the highest in the nation and significantly higher than the U.S. average of 49%.... The average total premium for an employer-sponsored individual plan in Utah increased by an inflation-adjusted 34% from 2006 to 2016, and 30% for a family plan.... [These] increases are modest compared to the increases in the late 1990s and early 2000s." Utah Foundation

Peak Health Plan Premiums Give Rise to Activism in Charlottesville, Virginia

"Charlottesville now claims the dubious distinction of having the highest individual-market health insurance costs in the country ... [M]any residents found their only choice came with a 300 percent boost in premium costs.... [SB 672] redefined what a 'small employer' is so that self-employed people can buy insurance in the small-group market.... [M]any people ... found that the cost of adding an employee to a company of one allowed them to save money by obtaining insurance as a small group, though it still added significant overhead costs to these businesses." Kaiser Health News

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Factors to Consider About Reference-Based Pricing

"Assuming the employer provides clear information on how reference-based pricing will affect plan participants, this approach also supports insurance consumerism. Employees who understand the amounts that a plan will pay, and then seek out providers that will provide the right level of care at or around that cost, can potentially achieve lower out of pocket healthcare spend towards their deductible and out of pockets maximums.... To function properly, this approach requires a substantial amount of ongoing employee education & communications and personal support." Corporate Synergies

Benefits in General

Common Cyber-Risks Facing Your Benefit Plans

"Spear phishing involves a specific target in mind -- one ... that could be an employee of a health and welfare or pension fund.... Ransomware involves a malicious link or attachment within a phishing e-mail.... Business e-mail compromise (BEC) targets specific businesses or individuals who wire money.... Cybersecurity is no longer a matter just for the information technology (IT) department.... A separate but linked strategy for cyberfraud (the social engineering component) and cybersecurity (the IT infrastructure component) should be centrally managed with defined objectives and overarching principles." International Foundation of Employee Benefit Plans [IFEBP]

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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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