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Mergers and Acquisitions: The Top Five Issues for Health and Welfare Employee Benefits Plans
June 28, 2018 WEBCAST
ABD Insurance & Financial Services

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DOL Provides Insight on 'Applied Behavior Analysis' Coverage

"The [proposed] FAQ creates a hypothetical plan that excludes experimental treatment ... Under the plan's definition, ABA therapy is not experimental, but the plan denied all claims for ABA therapy to treat children with ASD under the rationale that the treatment is experimental. In the same year, the plan approved treatment for medical/surgical conditions when the treatment was not defined as experimental. The FAQ holds that this hypothetical action by the plan is not permissible."
Graydon

Now is a great time to join Worldwide Employee Benefits Network (WEB)

Worldwide Employee Benefits Network helps me connect with thought leaders in the Benefits Industry. Join WEB today at www.webnetwork.org .

A Hospital ER Charges an 'After-Hours' Fee. Who Has to Pay It?

"Just because your health plan is balking now at paying the surcharge, that may not be the final word. Hospitals and insurers frequently sort out these surcharges between themselves, without holding patients responsible ... If it's an in-network provider, an insurer is generally responsible for addressing the billing of that code under its negotiated contract with the providers ... Medicare beneficiaries are not responsible for paying the surcharge." Kaiser Health News

No Magic Pill to Cure Specialty Drug Costs, But Here Are Some Preventive Measures

"Change where specialty drugs are administered ... Review your PBM contract.... Refer participants to patient and copayment assistance programs to receive financial help.... Establish a prior authorization program ... Encourage the use of lower cost alternatives.... Implement a care management program through which a care manager will work with participants taking specialty medications." International Foundation of Employee Benefit Plans [IFEBP]

State Policies to Address Prescription Drug Prices

"[S]everal states have taken steps to address prescription drug prices ... [in] three major categories: improving price transparency; increasing state negotiating power; and cracking down on price gouging. The experiences of these states demonstrate potential promising paths forward for other states[.]" Center for American Progress

Level Funding Opens the Door to Cost-Saving Health Claims Information

"Employers using a level-funded plan get access to detailed claims reporting, which highlights where employees are both overspending and underspending on their health insurance. With this information, employers can customize their health plan to better serve participant needs.... Employers have access to claims data and can see trends in their employees' healthcare that could be driving up costs.... employers may need to take a bigger role in educating employees about prescription drug plans--from helping them understand a formulary, to discussing mail-in pharmacy plans and generic versus brand name medications." Corporate Synergies

New Resource! How the New Tax Law Impacts Employee Benefits

Law, Explanation and Analysis of the Tax Cuts and Jobs Act of 2017 - expert guidance for benefits professionals that highlights the immediate impact of key changes and delivers practical guidance to help you navigate the most pressing issues. Learn More!

Declines in Hospital-Acquired Conditions Save 8,000 Lives and $2.9 Billion in Costs

"National efforts to reduce hospital-acquired conditions, such as adverse drug events and injuries from falls helped prevent an estimated 8,000 deaths and save $2.9 billion between 2014 and 2016 ... Examples of hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central-line associated bloodstream infections, pressure injuries, and surgical site infections, among others." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

The Impact of Length of Time Enrolled in a Health Plan on Consumer Engagement and Health Plan Satisfaction

"Overall satisfaction does not increase when participants are in health plans for long periods of time (e.g., 10+ years), regardless of whether the plan is a traditional health plan, consumer-driven health plan (CDHP), or high deductible health plan (HDHP). Likewise, consumer engagement does not increase with time enrolled in a health plan. However, there is some evidence that health savings account (HSA)-eligible health plan enrollees are more engaged in some aspects of their HSA the longer they have been enrolled in their HSA-eligible health plan." Employee Benefit Research Institute [EBRI]

Nevada Supreme Court Determines Definition of Health Insurance for Nevada's Minimum Wage Laws

"[T]he court was asked to clarify what constitutes 'health benefits' for purposes of paying Nevada's lower-tier minimum wage. The court answered that question by determining, based on 'common sense,' that 'the MWA requires an employer who pays one dollar per hour less in wages to provide a benefit in the form of health insurance at least equivalent to the one dollar per hour in wages that the employee would otherwise receive.' ... The MWA establishes a two-tier minimum wage in Nevada. The lower tier is equal to the applicable federal minimum wage rate (currently $7.25 per hour) and applies if qualifying health benefits are offered. The higher tier is a dollar more per hour (i.e., $8.25) and applies if such benefits are not offered." [ MDC Restaurants, LLC v. The Eighth Judicial Dist. Court , No. 71289 (Nev. May 31, 2018)]
Littler

Is Wining and Dining Still Worth It? A Look at Meals and Entertainment Deduction Today

"In the pre-TCJA law, meals provided by an employer at an on premise eating facility were exempt from former Code Sec. 274(n)(1) ... if they were excludable from the employee's income as a de minimis fringe benefit under Code Sec. 132(e)(2).... As a result of the TCJA ... [1] For amounts paid between December 31, 2017 and December 31, 2025, these meals are now subject to the 50% disallowance under Code Sec. 274(n)(1). [2] From January 1, 2026 on, no amount paid for employee meals, whether provided either for the convenience of the employer or at an employer-operated eating facility, will be deductible."
WithumSmith+Brown, PC

ACA Litigation Round-Up: The Individual Mandate and Cost-Sharing Reductions

"On May 21, 2018, two companies ... filed a new complaint and a motion to intervene as plaintiffs [in the individual mandate challenge]. If their motion is granted, these companies would join the 20 Republican state attorneys general and two individual plaintiffs against the Trump administration and 17 Democratic state attorneys general.... The employers ... argue that they should be allowed to intervene because they have suffered 'unique and substantial injuries' ... In particular, they object to having to comply with the ACA's employer mandate. Each has been assessed a penalty of about $3.8 million and $1.1 million for failure to comply with the employer mandate." Health Affairs

The CREATES Act: Stepping Closer to Drug Pricing Justice?

"The Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act, a bipartisan bill currently in the Senate, attempts to address one of the most prevalent tactics being used today; the brand name drug manufacturer refuses to sell their drug to the competitor (which needs the drug to conduct bioequivalence testing, so it can safely replicate it for generic use) by twisting FDA safety requirements.... The CREATES Act would allow the generic drug manufacturer to sue the brand manufacturer, compelling it into providing samples of the drug." Frenkel Benefits

The Value of Health Insurance Brokers

"The value of a broker appears to be in helping companies reduce plan enrollments, 'right-sizing' contributions, and in getting some of the wellness penalties and rewards right. Of course, this will vary since not all brokers are equal. Companies need to demand data." American Journal of Managed Care

Premature Denial of Long-Term Disability Benefit Claim Mitigates Claimant's Failure to Exhaust Administrative Remedies

"The Ninth Circuit ... held that genuine issues of fact remain regarding whether Liberty properly handled and denied Plaintiff's LTD claim before the full amount of time authorized under the Policy to submit materials had expired. Even though Plaintiff did not complete his claim submission until nearly a year after the policy deadline, the court apparently found that of no moment." [ Cuaresma v. Farmers Group Disability Income Plan , No. 16-16946 (9th Cir. May 31, 2018)]
Kantor & Kantor

White House Nominates Senate Aide as SEC Commissioner

"Elad Roisman, chief counsel to the Senate Banking Committee, has been nominated to the [SEC]. Mr. Roisman is the Republican nominee to the five-member commission to replace Michael S. Piwowar, whose term is set to end in June." Pensions & Investments

SEC Provides Updated Guidance on Proxy Disclosures for Compensation Plan Proposals

"Twelve of the CDIs relate to Item 10 of Schedule 14A, which sets forth the disclosure rules when a compensation plan is submitted to shareholders for approval, but only [one] interpretation, CDI 161.03, is identified as a substantive change:... [T]he new CDI confirms that it's acceptable to provide information on individuals or groups who did not receive contingent grants or will not otherwise receive determinable awards in a narrative along with the table, rather than in the table itself." Baker McKenzie

Taxes, Culture, and Big Investors: Effects on Executive Comp

"Institutional investors seem to be influencing pay programs. How are they tipping the scales? ... How should incentive design shift during times of disruption? After all, the bull market won't last forever.... How are compensation plans shaping culture -- or is it the other way around? ... [Is] there much ado about nothing when it comes to pay ratio reporting?" Meridian Compensation Partners, LLC

Preventive Care for Executive Compensation Programs

"The compensation committee should consider conducting a review of market data on program design. Doing so would inform committee members about competitive practices and how the design of the current incentive compensation programs compares to others in the market. Where variances exist between the company's approach and majority market practice, the committee should be comfortable with discussing the reasons for such variances." Meridian Compensation Partners, LLC

Press Releases

EPIC Holdings, Inc. Adds Janine Walter, SPHR, SHRM-SCP as Chief Talent Officer EPIC

Alliance Benefit Group Growing Again - This Time in the Chesapeake Region Alliance Benefit Group

Teladoc Acquires Global Virtual Care Provider, Advance Medical Teladoc

Charles Schwab Ranked Highest by 401(k) Participants in J.D. Power Group Retirement Satisfaction Study Charles Schwab Corporation

The Retirement Advantage Announces Jeffrey Schreiber as New Director of Sales The Retirement Advantage [TRA]

Sun Life Financial Acquires Maxwell Health Sun Life Financial

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