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Northeast Professional Planning Group
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Benefits and Breakfast: Minimizing the Risk of Plan Litigation
July 17, 2018 in IL
Drinker Biddle & Reath LLP

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Telehealth Reimbursement May Be Coming to Medicare: CMS Proposes Medicare Payment for Virtual Visits and Review of Pre-Recorded Images

"[CMS], for the first time, has proposed payment for virtual visits to established patients regardless of such patients' location, effective January 1, 2019.... CMS is seeking comment on the types of communication technology that may be used in furnishing the virtual services, including whether audio-only telephone interactions are sufficient compared to interactions that are enhanced with video or other kinds of data transmission." Drinker Biddle

Upcoming July 31 Deadline for PCORI Fee Payment

"The 2017 PCORI fee for calendar year plans is equal to the average number of lives covered under the plan for 2017 multiplied by $2.39. This is a slight increase from last year. Self-insured plan sponsors should use IRS Form 720 (Quarterly Federal Excise Tax Return) to report and pay the fee. Insurers are responsible for paying the PCORI fee for insured plans." Winston & Strawn LLP

No Funding for DOL Association Health Plan Rule in Budget Bills

"The House and Senate appropriations bills didn't address a request from the White House in its February budget proposal to increase funding for [EBSA] 'to develop policy and enforcement capacity to expand access to AHPs.' Both bills would cut funding to the Labor Department overall." Bloomberg BNA

Employers, Health Plans Should Prepare to Respond to Last-Minute Health Plan Legislation This Fall

"The legislation passed by the Ways & Means Committee ... includes bills that would: [1] Provide relief for employers relief from the Obamacare's employer mandate and delay for an additional year the effective date of the widely disliked 'Cadillac Tax;' [2] Overrule the 'Use it Or Lose It' requirement ... for healthcare flexible spending arrangement plans (HFSAs) ... [3] Expand expand the availability and usability of HSAs in a multitude of ways.... [A] review of the Committee's schedule makes clear that it isn't finished with health care reform." Solutions Law Press

Delaware, Virginia Enact Paid Family Leave for State Workers

"Beginning April 1, 2019, full-time state workers in Delaware ... will be eligible for 12 weeks of paid maternity or paternity leave after the birth or adoption of a child six or younger. Workers are eligible for the benefit after one year of employment.... In Virginia, Gov. Northam signed an executive order June 26 that authorizes paid parental leave for employees of executive branch state agencies. Eligible workers will be able to take up to eight weeks of paid parental leave to bond with a newborn, or to care for a child under the age of 18 newly placed for adoption, foster care, or custodial care." Bloomberg BNA

In Beneficiary Dispute, Supplemental Life Insurance Policy Was Subject to ERISA

"The Seventh Circuit concluded that the policy failed the safe harbor ... because the employer had performed all administrative functions associated with maintenance of the policy.... In particular, the SPD indicated that: [1] The employer was the policyholder for all components of its plan, of which the supplemental life insurance policy was one listed item of several components. [2] The supplemental policy would remain part of the employer's group insurance policy, though it could be converted to an individual life insurance policy in certain situations." [ Cehovic-Dixneuf v. Wong , No. 17-1532 (7th Cir. July 11, 2018)]
Thomson Reuters Practical Law

Managing and Monitoring High Cost Claimants Is Top Benefits Strategy for Employers

" '[M]anaging and monitoring high cost claimants' is the top health benefits strategy that US employers will be focusing on for the next five years. More than three quarters (77%) of US employers with 500 or more employees said this strategy was 'very important' or 'important' ... The rapid rise in high cost claims is most likely a key driving force behind this strategic prioritization by employers." Mercer

Insurers Offer Tools to Dig Into Health Costs

"Three of Michigan's largest health insurers developed various software and support tools that provide employers with detailed reports on how their workforces spend health care dollars and where they access care.... 97 percent of human resource practitioners believe they need better tools to evaluate health care cost and use data to make better decisions on benefit plans." Crain's Detroit Business

The High Cost of Healthcare: Patients See Greater Cost-Shifting and Reduced Coverage in Exchange Markets 2014-2018 (PDF)

28 pages. "[1] Health plan networks have grown increasingly narrow ... [2] Non-subsidized exchange marketplace premiums have increased faster relative to other markets, such as employer-sponsored insurance and Medicare Advantage, since 2014; [3] Deductibles and maximum out-of-pocket limits (MOOPs) have grown across all payers ... [4] [C]ost-sharing for services after the deductible has remained relatively constant ... [5] Federal and state rules around network adequacy have not kept pace with the growing patient burden." Avalere, for Physicians for Fair Coverage [PFC]

CMS Halts ACA Risk Adjustment Transfers

"CMS' decision presents two sets of issues for payers. One is an immediate question of cash flow for payers that were expecting to receive, in some cases, millions of dollars in payments ... for example, one Florida insurer was set to receive $666 million ... Longer term, for payers, the decision creates a large amount of uncertainty about the viability of remaining in the ACA markets." PwC

ERISA Advisory Council to Meet August 14-16

"[T]he 192nd meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on August 14-16, 2018.... The purpose of the open meeting is for Advisory Council members to hear testimony from invited witnesses and to receive an update from [EBSA]. The EBSA update is scheduled for the morning of August 16, subject to change." Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Press Releases

OneDigital Health and Benefits Acquires Beneflex Insurance Services OneDigital Health and Benefits

Capital Advisors Family Office S.A. is the First Latin American Investment Advisor Certified for Investment Advisor Fiduciary Excellence Centre for Fiduciary Excellence [CEFEX]

AHIP Adds Four Health Insurance Providers to Its Membership America's Health Insurance Plans [AHIP]

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