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Healthcare Association of New York State
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Benefit Services Group
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SetAway, LLC
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Prescription Drug Costs: Can Increased Competition Restrain Prices?
June 14, 2018 WEBCAST
Alliance for Health Policy

Health & Welfare Benefit Plans 2018 National Institute
October 29, 2018 in DC
American Bar Association Joint Committee on Employee Benefits [JCEB]

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IRS Clarifies 'Letter 227' and Releases Sample Letters

"Letter 227 acknowledges the ALE's response to Letter 226J and explains the outcome of the IRS's review and the next steps to fully resolve the penalty assessment. There are five different versions of the letter ... With the 2015 penalty assessments underway, it is important for ALEs and their advisors to be on close lookout for all correspondence from the IRS relating to employer shared responsibility.... [It] is advisable to confirm that copies of previously filed Forms 1094-C and 1095-C are readily available to expedite a response to the IRS." Thomson Reuters / EBIA

Simple Cafeteria Plan Provides Alternative to Nondiscrimination Testing

"[A] simple cafeteria plan is treated by the [IRS] as meeting the applicable nondiscrimination rules associated with cafeteria plans ... Code section 125(j) ... establishes [1] which employers can sponsor a simple cafeteria plan; [2] which employees must be eligible under a simple cafeteria plan; and [3] what contributions must be provided under a simple cafeteria plan[.]"
Fraser Trebilcock

Duluth, Minnesota Enacts Paid Sick Leave Law

"The Ordinance will apply to employers with five or more employees nationwide. Covered workers in the city of Duluth will be entitled to accrue one hour of paid sick leave for every 50 hours worked, up to a total of 64 hours per year, though use of sick leave may be capped at 40 hours per year. Where such an accrual method is used, employees must be permitted to carry over up to 40 hours of unused sick leave for immediate use in the following year." Proskauer

PCORI Fee Payment Due July 31 (PDF)

"Health insurers and self-insured plan sponsors are required to report and pay [Patient-Centered Outcomes Research Institute (PCORI)] fees annually ... The report and fees are due on July 31 with respect to the plan year that ended during the preceding calendar year.... [F]or calendar year plans, the fee that is due July 31, 201 8 applies to the plan year that ended December 31, 2017." EPIC

Voluntarily Sharing Family's Cancer History Bars GINA Claims, Court Holds

"In dismissing the GINA claim, the court held that because Williams voluntarily informed his supervisor (and two other people) that cancer ran in his family, his GINA claim failed. Furthermore, the court noted that Graphic Packaging never required him or any of his family members to submit to a genetic test. Williams has since appealed the dismissal of his case to the Sixth Circuit Court of Appeals." [ Williams v. Graphic Packaging Int'l, Inc. , No. 16-102 (M.D. Tenn. May 8, 2018)]
Bradley

ERISA Plan's Anti-Assignment Provision Bars Healthcare Provider's Benefit Claim

"[T]he Ninth Circuit noted that reasonable reliance on a material representation is one of the requirements necessary to establish an equitable estoppel claim. In the instant case, the court observed that the plaintiff did not attempt to obtain the plan documents until after it had already filed the lawsuit. Therefore, the court concluded that any reliance the plaintiff placed on the insurer's misrepresentation concerning the existence of an anti-assignment provision was 'unreasonable.' " [ Eden Surgical Center v. Cognizant Technology Solutions Corp. , No. 16-56422 (9th Cir. Apr. 26, 2018; unpub.)]
The Wagner Law Group

'Right to Try' Legislation Enacted; No Impact on Benefit Plans Expected

"The legislation does not mandate employer-sponsored plan coverage of drugs the FDA characterizes as investigational or experimental drugs. Indeed, most employer plans explicitly exclude those drugs from coverage.... [E]ven if a plan sponsor wanted to offer this type of coverage, doing so would pose administrative challenges. Prescription drugs must have FDA approval in order to have a national drug code (NDC), which is necessary for a pharmacy benefit manager or a pharmacy to process a claim." Conduent

Get Ready for the Digital Future of Total Rewards

"AI systems ... will be able to: [1] Match an employee's family status, age, career stage, life preferences and aspirations with the organization's total rewards opportunities, to help employers refine their rewards offerings. [2] Consider a worker's age, education, career stage, job, skills, work unit and location to customize rewards communications for content, style, language and delivery medium (text, e-mail, phone, chatbot, mail, handout, brochure or pictures)." Society for Human Resource Management [SHRM]

The Reshaping of the ACA (PDF)

"The Tax Cuts and Jobs Act of 2017 zeroed out the ACA's individual mandate penalties.... [T]he 2020 rules for determining EHB benchmark plans ... [will be] more flexible.... More latitude on EHB benchmarks may make plans less restrictive and help control health plan costs." Marsh & McLennan Agency LLC

Press Releases

Provident Trust Group Listed as Wealth Advisor 2018 Best IRA Custodian Ascensus

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