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Executive Benefits Webinar: Eliminating the Retirement Gap
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Gallagher

Tightening-up Executive Compensation: Five Steps for Defusing Litigation Risks and Better Enforcing Restrictive Covenants
August 28, 2018 WEBCAST
Wagner Law Group P.C.

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Text of Agency Final Regs: Short-Term, Limited-Duration Insurance

121 pages. "This final rule amends the definition of short-term, limited-duration insurance for purposes of its exclusion from the definition of individual health insurance coverage. This action is being taken to lengthen the maximum duration of short-term, limited-duration insurance, which will provide more affordable consumer choices for health coverage." Internal Revenue Service [IRS]; Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; U.S. Department of Health and Human Services [HHS]

31st ECFC Annual Symposium

The 31st Annual ECFC Symposium combines networking and professional development to provide those involved in healthcare consumerism with practical advice, education and updates on the regulatory front.

HHS: Administration Delivers on Promise of More Affordable Health Insurance Options by Liberalizing Short-Term, Limited-Duration Insurance

"The rule allows for the sale and renewal of short-term, limited-duration plans that cover longer periods than the previous maximum period of less than three months. Such coverage can now cover an initial period of less than 12 months, and, taking into account any extensions, a maximum duration of no longer than 36 months in total. This action will help increase choices for Americans faced with escalating premiums and dwindling options in the individual insurance market.... The average monthly premium for an individual in the fourth quarter of 2016 for a short-term, limited-duration policy was approximately $124, compared with $393 for an unsubsidized individual market plan." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Association Health Plan Regs Face Challenges (PDF)

"The DOL acknowledged that AHPs will be MEWAs and that states will retain their existing authority related to MEWA regulation and enforcement.... Since many states, including California, have substantially limited the establishment of MEWAs -- particularly self-insured MEWAs -- in order to avoid abuse, it is unclear whether the expanded availability on AHPs under the new regulations will even be feasible in some states.... Another hurdle for AHPs will be state mandates and definitions for small and large group insurance ... The regulations also result in differing treatment of AHPs under various federal laws." Boutwell Fay LLP

Administration Loosens Restrictions on Short-Term Health Plans

"Insurers will again be able to sell short-term health insurance good for up to 12 months under final rules released Wednesday by the Trump administration. This action overturns an Obama administration directive that limited such plans to 90 days. It also adds a new twist: If they wish, insurers can make the short-term plans renewable for up to three years." Kaiser Health News

ERISA Preempts State Regulation of PBM-Pharmacy Pricing Agreements

"[S]everal states have enacted legislation designed to regulate the prices that pharmacy benefit managers, as third-party administrators for ERISA-governed plans, agree to reimburse pharmacies for dispensing prescription drugs to ERISA plan members. These regulations run afoul of ERISA, as the US Court of Appeals for the Eighth Circuit has twice held." McDermott Will & Emery

New ERISA Regulations for Disability Claims and Appeals

August 13 webinar will explain what new practices to follow, how to change past practices to become compliant with the new regulations, and the risks of non-compliance. Discount for BenefitsLink readers .

Will Insurance Companies Be Able to 'Steer' Patients to and from Providers?

"The Supreme Court's opinion in ... raises alarm bells in a multitude of 'platform' industries, where a single intermediary negotiates with both sides of a so-called 'two-sided' transaction.... In the health care context, insurers (as intermediaries) negotiate with employers on behalf of employee patients and with provider networks.... In the health care context, the American Medical Association (AMA) is concerned that this change in antitrust analysis could pave the way for denial of insurance referrals, which would be evaluated pursuant to substantially weakened antitrust principles." [ Ohio v. American Express Co. , No. 16-1454 (U.S. June 25, 2018)]
Marcia Boumil and Gregory D. Curfman, in Health Affairs

Local Development of a Culture of Health: Learning from Sentinel Communities

"The Culture of Health is focused on establishing health as a priority and affecting change in four Action Areas: making health a shared value; fostering cross-sector collaboration to promote health and well-being; building healthier and more equitable communities; and strengthening health services and systems.... But how do communities move toward prioritizing health, and how does social change happen across diverse American communities?" Health Affairs

An Assessment of the New York Health Act: A Single-Payer Option for New York State

"The [New York Health Act (NYHA)] would create a state-sponsored single-payer health program called New York Health that would provide coverage to all residents of New York State.... [T]he authors estimate that the NYHA could expand coverage without substantial increases in overall health care spending: in the short term, health care spending would be relatively similar if administrative costs are reduced and would grow more slowly over the longer term than under the status quo if provider payment rates are restrained. However, the NYHA would require new taxes and shift financing among households and businesses." RAND Corporation

2018 Summary of Individual Market Enrollment and ACA Subsidies

"The profile summarizes insurer financials, marketplace enrollment, and federal assistance provided to households purchasing insurance coverage through the insurance marketplaces, incorporating recently released data from the 2018 open enrollment period and early 2018 effectuated enrollment snapshot. [A table summarizes the] estimates of effectuated marketplace enrollment and associated federal financial assistance for the CY 2016 through CY 2018 time period." Milliman

Only PBMs Benefit from Rebate-driven System

"[R]ebates are not only driving higher list prices -- they are driving higher net prices and overall drug benefit costs.... We need to adopt a system that is focused on getting the right patient, the right drug, in the right dose and amount, at the right time, in the right location, and at the best price (considering what it truly costs to do everything else). This is a system that is driven by the value to the patient and not to the PBM." Chelko Center for Benefits Management

With Federal Rules Weakened, States Should Act to Protect Against Short-Term Health Plans

"Before the recent flurry of activity, three states -- Massachusetts, New Jersey, and New York -- already effectively prohibited short-term plans, and Oregon limits short-term plans to three months or less and restricts renewals. Several other states have protections in place that may at least mitigate the effects of the rule changes.... Yet most lack sufficient protections against adverse selection that could result from the federal rule changes for short-term plans (and also for Association Health Plans, or AHPs[.])" Center on Budget and Policy Priorities

Text of EBSA Request for Nominations to the 2019 ERISA Advisory Council

"The terms of five members of the [Advisory Council on Employee Welfare and Pension Benefit Plans (the ERISA Advisory Council)] expire at the end of this year. The groups or fields they represent are as follows: [1] employee organizations; [2] employers; [3] actuarial counseling; [4] investment counseling; and [5] the general public.... Nominations must be received on or before [the date that is 45 days after publication in the Federal Register, which is currently scheduled for August 2, 2018]." Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Form 5500 Schedule H and Financials for WRAP Plan: Show Only VEBA-Funded Benefits?

Large plan (10,000 participants). WRAP document covers three group health plans, a group dental plan, a group life plan, and others. Only the health plans are funded through a VEBA trust. Plan must file Schedule H and have an IQPA audit. For more than 10 years, the Form 5500 Schedule H and the auditor's financial statements have reported only assets and activity of the VEBA. The plan has been audited as a whole but the financials cover only the Trust. Is that the correct way? Should the other plans be included? I don't believe it would affect the balance sheet portion of the Schedule H because the fully-insured benefits would have a net-zero affect, but it would potentially affect the income statement. BenefitsLink Message Boards

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