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Should Old Acquaintance Be Forgot? Our Retrospective on 2018 Benefits Issues
November 2, 2018 WEBCAST
McDermott Will & Emery LLP

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New Day for HRAs: The Ins and Outs of the New Proposed Regulation (PDF)

13 pages, Nov. 1, 2018. "This proposed regulation, which will be effective for plan years beginning on or after January 1, 2020 (and cannot be relied on before the effective date), makes drastic changes to the rules currently applicable to HRAs offered to active employees." Alston & Bird

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Proposed Rules Would Permit HRAs to Be Integrated with Individual Health Insurance Coverage

"The proposed regulations would permit HRAs to be integrated with individual health insurance coverage if the following six conditions are met. [1] All individuals covered by an HRA must be enrolled in individual coverage... [2] Restriction involving the same class of employees... [3] Same-terms requirement... [4] Opt-out provision... [5] Substantiating individual health insurance coverage... [6] Notice requirement." Thomson Reuters Practical Law

Change the Trajectory of Your Group Health Plan's Cost and Quality Outcomes

"[T]here is incredible value in the data held by the health plans, and it is through analysis of that data that sponsors can achieve transparency, strengthen their position as payers, and gain greater certainty as to quality and cost outcomes." BakerHostetler

Seattle Startup Raises $50 Million for AI Virtual Doctor Visits

"In New York, Boston, Seattle, Houston, San Diego, and 10 other major cities across the U.S., the average wait time to see a cardiologist for a non-emergency issue is six days or longer, while an orthopedic surgeon can take up to 18 days.... Seattle startup 98point6 ... aims to fill the coverage gap with digital clinics -- with the help of artificial intelligence (AI)."
VentureBeat

Changes Ahead for HIPAA?

"HHS plans to issue a request for information on a proposal to share a percentage of money paid by health care organizations through civil monetary penalties or monetary settlements resulting from data breaches with the affected individuals.... HHS's list also includes a request for information on whether HIPAA regulations are stalling progress toward increased care coordination and value-based payment systems, both of which require sharing of patient information." Mintz

CMS Market Saturation and Utilization Data Tool

"[CMS] has developed a Market Saturation and Utilization Data Tool that includes interactive maps and a dataset that shows national-, state-, and county-level provider services and utilization data for selected health service areas.... The data can also be used to reveal the degree to which use of a service is related to the number of providers servicing a geographic region." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

2017 Health Insurance Enrollment: Little Net Change, But Large Drop in Non-Group Coverage

"On net, 191,000 more people had coverage as enrollment in private insurance increased by 546,000, while public coverage decreased by 345,000. The individual health insurance market lost nearly 1.8 million enrollees in 2017, with customers who do not receive Obamacare subsidies accounting for 93 percent of that decrease. About 2.3 million more people gained employment-based coverage via self-insured plans." The Heritage Foundation

90% of Health Plans Think the Use of Alternative Payment Models Will Increase

"APMs increase reimbursement for high quality care and also for providers that save money for the system. The problem with APMs are: [1] quality is difficult to measure and providers may shift effort from unmeasured to measured dimensions of quality, and [2] providers may start to under-provide care to patients who need it." Healthcare Economist

Evaluating Stop Loss Coverage: Questions Self-Funded Health Plans Must Ask

"It is easy to think you can just shop this coverage each year for the lowest cost and move on, but before you consider that as a solution, consider these important provisions to evaluate: [1] Are the contract provisions the same? ... [2] Contingent or firm offer? ... [3] Does the contract provide immediate cash flow protection? ... [4] Are there 'run in limits?' ... [5] Does the stop loss contract match the Summary Plan Description?" Findley

Benefits Administrators: Time to Provide End-of-Year Notices

"With open enrollment approaching for many employers, ... [this article provides] a list of the various notices and disclosures generally required to be provided to participants around this time of year." [Covers notices and disclosures for both retirement plans and health & welfare plans.] Vorys

Press Releases

Ascensus Continues to Build Upon Qualified Retirement Plan Consulting and Administration Expertise with Agreement to Acquire Pension Works Ascensus

River and Mercantile Solutions Director Named President-Elect of the Conference of Consulting Actuaries River and Mercantile Group [RMG]

Employee Benefits Expert Advises Lockton Clients in Northern California Lockton

Health Affairs Council On Health Care Spending And Value Announces Membership Health Affairs

Employer Reduced Opioid Use 23% with Hinge Health's Evidence-Based Digital Back and Knee Care Programs Hinge Health

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Most Popular Items in the Previous Issue

Text of IRS Publication 5258: ACA Information Returns (AIR) Submission Composition and Reference Guide (PDF) Internal Revenue Service [IRS]

Proposed Rules Allow the Use of HRAs to Pay For Individual Market Coverage Groom Law Group

States Enter Association Health Plan Fray HUB International