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Year End Legislative and Regulatory Benefits Update
December 6, 2018 in IL
Worldwide Employee Benefits Network [WEB] - Chicagoland Chapter

Pros & Cons of Copay Accumulator Adjuster Programs & Drug Copay Cards: Impacts on People in HDHPs
December 11, 2018 WEBCAST
Midwest Business Group on Health

Plan Sponsor Roundtable - What Keeps You Up at Night?
December 13, 2018 in OH
Worldwide Employee Benefits Network [WEB] - Northeast Ohio Chapter

Affordable Care Act Employer Reporting for 2018 Still Required: Update on Forms and Changes
January 10, 2019 WEBCAST
HRWebAdvisor

HRAs, HSAs, and Health FSAs: The Rules, the Changes, and Administrative Challenges
January 24, 2019 WEBCAST
HRWebAdvisor

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New Topics on the BenefitsLink Message Boards

New Comments and Topics

All Topics , Grouped by Forum

Proposed Regs Would Permit Employers to Reimburse Employee Premiums for Health Insurance Purchased in the Individual Market

"If these regulations ... are finalized in their current form, employers may choose to eliminate their group health plan coverage and establish an HRA that reimburses the cost of individual health coverage purchased by employees, if certain conditions are met. The proposed regulations even suggest that the regulators may create special rules that would treat an employer sponsoring one of these HRAs as fully satisfying the [ACA's] employer mandate ... This could potentially lead to a shift from traditional group health plans to a 401(k)-like defined contribution approach towards employer-provided health coverage, likely to be most popular with smaller employers." Foley & Lardner LLP

Now is a great time to join Worldwide Employee Benefits Network (WEB)

Worldwide Employee Benefits Network represents more than 30 areas of expertise within the Benefits Industry. Join today .

Employers Face Increased Litigation Over Plan Coverage of Residential Treatment and Wilderness Therapy

"With the uptick in litigation involving 'wilderness therapy,' along with the DOL, IRS, and HHS's guidance highlighting the priority of MHPAEA enforcement, it is of the utmost importance that employers, especially those with self-insured plans, review their plans to determine MHPAEA compliance. The self-compliance tool provided by the DOL is the perfect place to start since it includes the same audit checklist used by the agency in its enforcement actions." Frost Brown Todd LLC

Don't Forget to Set Your HRA COBRA Premiums!

"[U]sing a look back to the previous 12-month plan year period and calculating a cost per participant to determine the actual cost is the most common method ... Be prepared to then determine single versus family COBRA HRA rates and how to properly apply those to qualified beneficiaries." Frenkel Benefits

Beyond Words: Engaging Consumers in Changing Health Behaviors (PDF)

10 pages. "This article summarizes relevant concepts and findings from the fields of psychology, decision research, and social marketing and identifies best practices in developing consumer engagement. Employers can utilize this information when creating health care programs and tools to control costs and improve workforce health and productivity.... These programs must move beyond communication, beyond education, and beyond empowerment, to a state of effective engagement." Buck

Federal Mental Health Parity After 10 Years: Toward a Data-Driven Approach to Compliance

"In dozens of peer-reviewed articles, researchers have examined the impact of (and compliance with) the MHPAEA and other parity laws via a number of metrics, including dollar spent, overall use, out-of-network use, reimbursement rates, and imposition of prior authorization requirements and penalties. This type of data analysis, which has been advanced by health insurers, could become the standard for testing the design and implementation of [nonquantitative treatment limitations (NQTLs)]." Health Affairs

Now is the time to become a member of ECFC

ECFC is dedicated to maintaining and expanding employee benefit programs on a tax-advantaged basis. Members include employers, TPAs, health plan providers, brokers, payers, providers, payment networks, processors, and financial institutions.

2018 Benefits Strategy & Benchmarking Survey (PDF)

Infographic. "Finding the right benefits balance is a matter of steady improvement, not instant perfection. But getting there, and staying there, requires strategic investments in your people's total wellbeing, including their health, financial security and career growth -- at the right cost structure." Gallagher

The Commonality Challenge: Recent Rulings Show Path to Class Certification in ERISA Cases

"As recent decisions from federal courts in New Jersey and California illustrate, where plaintiff classes seek to challenge decisions by ERISA healthcare plan administrators, commonality is best achieved when the same benefit plan provision is at issue, as well as the same reason for denial of claims. Each of the cases discussed below involved a putative class pursuing claims against health plans based on denials and alleged underpayments for out-of-network services, and the classes in both cases failed to achieve certification." Arent Fox, via Lexology; free registration required

Walmart, Home Depot Adopt Health Insurer Tactic in Drug Copay Battle

"Walmart and Home Depot ... have embraced a health insurance strategy that punishes drugmakers for using discount cards to keep patients from switching or stopping their medications.... The programs, known as copay 'accumulators' and copay 'maximizers,' are expected to expand in the next two years, from about 25 percent of U.S. employers to as much as 50 percent ... Drugmakers are worried about the hit to profits if many more employers sign on. They are also concerned because they cannot easily track when the programs are being used." Reuters

District Court: California's Ban on Discretionary Language Does Not Apply to Health Insurance

"Many states have banned discretionary clauses in life and disability policies. But remember to look closely at the language... to see if the ban actually applies to the policy at issue." [ Brian H and Alex H v. Blue Shield of California , No. 17-3095 (N.D. Cal. Nov. 1, 2018)]
Lane Powell PC

Bye Bye Cadillac Tax, Hello Congressional Health Care Gridlock

"[S]ome or all of the following [may] be approved by the House now that the Democrats have control: [1] Expansion of the PPACA Improvements to the public exchanges; [2] Further Medicaid expansion; [3] Possible Medicare expansion; [4] Measures designed to block efforts to weaken the public exchanges; [5] Further controls on prescription drug prices; [6] Paid employee leave legislation." BenefitsPro

2019: The Year Health Insurance Prices Go Down

"There is no clear answer as to why fewer people are shopping ... The number [of] people who got an email saying, 'your plan was cancelled,' is down 98% from 2017.... The number of people who got an email saying, 'your insurance company is leaving the area,' is down 100% (it actually went to zero) compared to 2017.... The number of people who got an email saying, 'your prices went up 10% or more,' is down 59% percent compared to 2017." eHealth

Covered California Pops and Locks Into Enrollment Season

"[On] a stage designed to look like a hospital waiting room, seven dancers portraying ill and injured patients used body pops, flares and fancy footwork to show that 'life can change in an instant' -- the slogan for this year's Covered California marketing campaign.... By the end of this week, the bus will have made 23 stops in 16 cities ... Covered California wouldn't say how much it is spending on the bus tour and the dancers ... The agency is funded by fees, equal to 3.75 percent of premiums, that it levies on its health plans." California Healthline

With Hospitalization Losing Favor, Judges Order Outpatient Mental Health Treatment

"Since its inception, the court-ordered intervention has generated controversy. Proponents say it secures the comprehensive care that people with severe mental illnesses might not recognize they need. Yet other health experts question the effectiveness of the intervention and suggest it represents a quick fix in a mental health system that is not adequately serving patients.... A key advantage to assisted outpatient treatment, supporters say, is that it provides care for people who might not recognize the severity of their illness." Kaiser Health News

The Negative Impact of Workplace Health Promotion Programs Emphasizing Individual Responsibility on Weight Stigma and Discrimination

"Over time, there has been a steady increase of workplace health promotion programs that aim to promote employees' health and fitness. Previous research has focused on such program's effectiveness, cost-savings, and barriers to engaging in workplace health promotion. The present research focuses on a downside of workplace health promotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one's health, inadvertently facilitate stigmatization and discrimination of people with overweight in the workplace." Frontiers in Psychology

Reminders of What's New for Plan Sponsors in 2019

" All plans : New claims procedures regulations for disability benefits claims, after multiple delays, have finally been set.... Retirement Plans : Plan participants no longer need to take the maximum available loan under the plan before requesting a hardship withdrawal for plan years beginning in 2018 ... BBA changes to hardship withdrawals are likely to require a plan amendment to be adopted on or before the end of the 2019 plan year, and a summary of material modifications to be issued soon thereafter.... Health Plans : The IRS ... [set] the 2019 affordability threshold for the ACA employer mandate at 9.86 percent."
Findley

Press Releases

401(k) Prosperity is Certified for Fiduciary Excellence Centre for Fiduciary Excellence [CEFEX]

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Most Popular Items in the Previous Issue

Top 10 HSA Providers: Morningstar 2018 Assessment Morningstar

COBRA Notice Penalties Awarded in FMLA/Leave of Absence Litigation Thomson Reuters Practical Law

Final Regs Clarify Religious and Moral Exemptions from Contraceptive Coverage Mandates Katie Keith, in Health Affairs