Today's News from BenefitsLink

66 pages. "[T]he Health Insurance Oversight System (HIOS) allows the government to collect data from individual and small group market Issuers. The collected data is aggregated with other data sources and made public on a consumer-facing website. The Rate and Benefits Information System (RBIS) web site gathers detailed plan benefit and eligibility data. This user manual explains the features and other aspects related to the use of the RBIS web site." [Version 05.00.00, Aug. 2018] Center for Consumer Information and Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Official Guidance]

Text of CMS Quick Reference Guide: Manage Data Changes for the Health Insurance Oversight System (PDF)

"This guide provides instructions for administrators to create and submit data change requests in HIOS.... Once users have the Company, Issuer, or Organization Administrator role, follow the steps [outlined] to access the Data Change Request function." [Version 03.00.00, Aug. 2018] Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

10th Circuit Decision Is Another Lesson on Bullet Proofing Your Claims Process

"The ERISA claim and appeal procedures need to be followed carefully and claim and appeal denials need to be carefully drafted, considering and discussing in the claim and appeal denial letters all of the evidence submitted, including addressing any weaknesses or omissions in the information submitted.... Review the expert consults in the file to see what they reviewed and if they reviewed all information in the file, if they analyze all of the arguments raised by the participant, and if the analysis considers the plan's requirements." Winstead PC

Five States Win $839 Million Obamacare Lawsuit

"Texas Attorney General Ken Paxton is leading a five-state coalition that ... won an $839 million judgment against the federal government ... [The ACA] requires medical providers to pay a Health Insurance Provider Fee (HIPF). Even though the ACA exempts states from paying that fee when providing health care, ... [HHS] created a regulation requiring states to pay the fee anyway, a fee that is styled as a tax on the states.... [Judge Reed O'Connor struck down the] HHS rule because it violates the plain language of the ACA law. O'Connor ordered the federal government to pay Texas the $305 million that the Lone Star State had paid in HIPF fees, as well as the fees of the other states, for a total of $839 million." [ Texas v. U.S. , No. 15-151 (N.D. Tex. Aug. 21, 2018)]
Breitbart

How to Tame Health Care Spending? Here's a One-Percent Solution

"[W]hat if the most workable answer isn't something big, but hosts of small tweaks? ... [R]esearchers [recently] concluded that the health care system could probably save a lot of money -- around $5 billion a year -- by paying the long-term care hospitals the same prices that are paid to skilled nursing facilities, the places that most long-term patients end up in when there is no long-term care hospital nearby. If they're right, the savings would probably be in the 1 percent range." The New York Times; subscription may be required

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Group Life Insurance a Desirable Voluntary Employee Benefit

"Although just over a quarter of employed Americans (27%) have voluntary group life insurance, 68 percent of workers who say they don't because their employer doesn't offer it would be somewhat or very likely to purchase it if offered at their company.... 60 percent of employees who have it say it's to protect family/loved ones from future financial hardship; ... 27 percent to replace a spouse/partner's income in the event of their passing; and 26 percent to leave an inheritance for children or grandchildren." OneAmerica

Austin Court of Appeals Stays Effective Date for City's Paid Sick Leave Ordinance

"The ordinance was set to take effect on October 1, 2018.... On August 17, 2018, the Austin Court of Appeals entered an order staying the effective date of the ordinance during the pendency of the appeal. The next round of briefing is due on September 6, 2018." [ Texas Assoc. of Business et al. v. City of Austin , No. 03-18-00445 (Tex. 3d App. Aug. 17, 2018)]
Haynes and Boone, LLP

Multiple Paid Leave and Flexible Work Bills Introduced in Congress

"Several Members of Congress have introduced competing bills related to paid leave and flexible work schedules.... It is unclear whether any of these measures will be considered or even become law, but the number of federal bills and their bipartisan origin indicates that there is a chance of changes in these areas." Gray Plant Mooty

[Opinion]

Association Health Plans: Benefit of the Future or Blast from the Past?

"[T]he final regulations contain two provisions with the potential to significantly limit the usefulness of association health plans: [1] Nondiscrimination standards.... [2] No MEWA exemption." Future Enterprise

Benefits in General

[Guidance Overview]

Michigan Law Requires More Disclosure from Local Governments

"Some of the disclosure information will be available from various financial and actuarial reports that are already prepared each year for the units, some information is new with this law and will require the units to have additional work done by service providers ... For both retirement health systems and pension systems, if a unit is determined to have a system that is underfunded, it will be required to establish a corrective action plan. For fiscal years ending before December 31, 2017, the first reporting of funded status to the Treasury is due by six months after the end of the fiscal year, but no sooner than January 31, 2018." Watkins Ross

Most Popular Items in the Previous Issue

Interaction of COBRA and Medicare: Just How Do Those Rules Work Again? Lockton

Lifestyle Spending Accounts Add an Option to the Benefits Mix Society for Human Resource Management [SHRM]

New Tax Credit for Paid Leave: What Benefits Professionals Should Know Verrill Dana LLP

Press Releases

EACH Enterprise and Chatham Partners Announce Joint Initiative EACH Enterprise

Transamerica Entities to Pay $97 Million to Investors Relating to Errors in Quantitative Investment Models U.S. Securities and Exchange Commission [SEC]

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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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