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Henderson Brothers, Inc.
in PA

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MN Legislative Commission on Pensions and Retirement
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Wellness Program Challenges and Opportunities for 2019
October 25, 2018 WEBCAST
Burnham

Employer-Only Forum on Wellness, Wellbeing & Engagement
January 23, 2019 in IL
Midwest Business Group on Health

Healthy Aging: Employer Strategies that Support the Older Workforce & Covered Retirees
February 20, 2019 in IL
Midwest Business Group on Health

Creating Multi-Generational Benefits for All Employees
April 18, 2019 in WI
The Alliance

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CMS Announces 2019 Medicare Parts A & B Premiums and Deductibles

"The standard monthly premium for Medicare Part B enrollees will be $135.50 for 2019, an increase of $1.50 from $134 in 2018. An estimated 2 million Medicare beneficiaries (about 3.5%) will pay less than the full Part B standard monthly premium amount in 2019 due to the statutory hold harmless provision, which limits certain beneficiaries' increase in their Part B premium to be no greater than the increase in their Social Security benefits. The annual deductible for all Medicare Part B beneficiaries is $185 in 2019, an increase of $2 from the annual deductible $183 in 2018." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Health Savings Accounts (HSAs): Compliance Obligations Under the Internal Revenue Code and ERISA

Nov. 28 webinar. Although HSAs have numerous tax advantages, it is easy to inadvertently fail to satisfy the requirements. This webinar will help health plan administrators navigate this sometimes treacherous terrain. BenefitsLink discount .

District Court: Health Plan Could Not Use Its Interpretation of 'Reasonable and Customary' Because It Did Not Disclose Methodology

"The court first determined that when a claimant specifically challenges the calculation of the 'reasonable and customary' amount for reimbursement purposes, ERISA's requirement that claimants be afforded a full and fair review necessitates disclosure of the plan's pricing methodology -- including any fee schedule used.... The court explained that the pricing method ... is not, on its face, arbitrary and capricious, but it is arbitrary to interpret a term in a way that contradicts the term's plain reading without explaining that interpretation." [ Zack v. McLaren Health Advantage, Inc. , No. 17-11253 (E.D. Mich. Sept. 20, 2018)]
Thomson Reuters / EBIA

DOJ Approves CVS/Aetna Merger, Contingent on Sale of Aetna's Medicare Part D Business

"The United States Department of Justice Antitrust Division announced on October 10, 2018, that it was conditionally approving the CVS/Aetna merger, a $69 billion transaction that combines the nation's largest retail pharmacy chain and the nation's third largest health insurer.... The approval is contingent upon the sale of Aetna's Medicare Part D Individual Prescription Drug business to WellCare, which Aetna recently announced it was prepared to do to gain regulatory approval.... [W]hile some additional state approvals are still required, the deal now appears poised to close before the end of the year." Akerman

How Will Combinations of Insurers and PBMs Affect Health Costs?

"According to the company, 82% of Americans live within 10 miles of a CVS retail location. So, a big payday could come from the combined company creating health-care clinics at retail locations offering a wide range of services. To make it work, there would have to be incentives -- in cost, quality, convenience, or some combination -- for people to use the clinics instead of emergency rooms and other traditional medical providers. With respect to employer-sponsored health plans, plan sponsors could install disincentives for not using such retail facilities." CFO

Who's Right on Protections for Preexisting Conditions? It's Complicated

"Medicare ... and Medicaid ... do not discriminate in either coverage or price on the basis of preexisting conditions. The two programs together cover roughly 130 million Americans -- nearly a third of the population. The majority of Americans get their coverage through work. In 1996, Congress protected people with preexisting conditions in employer-based coverage with the passage [HIPAA] ... The [ACA] ... built on those 1996 protections, and specifically sought to help people buying their own coverage." Kaiser Health News

Administration's Policies are Helping to Achieve Greater Choice and Lower Health Insurance Premiums

"[CMS] announced that the average premium for Obamacare plans on the Federal exchange will drop by 1.5 percent in 2019. This marks the only average premium decline since Obamacare took effect in 2014. Many States will see rates drop more substantially, including a 26 percent drop in Tennessee and 16 percent drop in Pennsylvania. The change in rates in most States represents a dramatic departure from the double-digit premium increases Americans experienced in recent years." The White House

On Drug Prices, Pharmacy Benefit Managers Are Not The Problem

"[D]rug prices continue to rise because competition is limited, and there often are no alternatives to the life-saving medications patients need. A recent investigation by the Associated Press found that in the first seven months of 2018, there were 96 drug price hikes for every drug price cut.... The real issue is the lack of competition in the prescription drug market--where drug makers protect their monopolies through a deliberate strategy to create patent fortresses. Drug makers accumulate redundant patents specifically to block any generic alternatives." Health Affairs

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Worksite Medical Clinics: 2018 Survey Results (PDF) Mercer

When Can an Employer Reimburse Individual Health Insurance Premiums? (PDF) OneDigital Health and Benefits

Form 5500s and the Proposal to Publicly Disclose Operational Noncompliance Winston & Strawn LLP