Health & Welfare Plans Newsletter
February 6, 2020
Centers for Medicare & Medicaid Services [CMS] Woodlawn MD / New York NY / Bethesda MD / Telecommute
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[Guidance Overview]
The 2021 Proposed Payment Notice: Risk Adjustment
"The proposed risk adjustment user fee for 2021 is $2.28 per billable member per year, or $0.19 per member per month. CMS proposes to use the same methodology as 2020 to estimate administrative expenses to operate the program. As such, the proposed user fee for 2021 is very close to the $2.16 per billable member per year fee for 2020. CMS estimates that it will cost about $50 million in benefit year 2021 to operate the risk adjustment program."
Katie Keith, in Health Affairs
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Engaging and Monitoring Health Plan TPAs: Understanding Your Fiduciary Obligations (PDF)
"The [DOL] has recently shown a heightened interest in investigating health plans governed by [ERISA] for compliance. ERISA fee litigation is also shifting into the health plan arena, and the investigation of self-funded health benefit plans and the fees charged by the TPAs servicing them is one of the focus areas. Plan fiduciaries have a duty to understand and monitor the fees collected by TPAs. TPAs that assume fiduciary functions through administrative services agreements (ASAs) with self-funded health plans have an obligation to be transparent about the fees they collect from the plan."
International Foundation of Employee Benefit Plans [IFEBP]
Most Employees Willing to Give Employer-Provided Digital Health Tools a Chance
"Nearly half of U.S. workers say they would have greater confidence in a new digital health solution if it was provided by their employer, and more than a quarter said that the provision of digital health tools would have a positive impact on their decision to stay with their employer ... Four in 10 polled U.S. employers said they believed that digital health offerings would help their company retain its staff, with 68% saying they plan to increase investment into digital health products over the next five years."
MobiHealthNews
House Votes to End Controversial USPS Payments for Future Retirees' Health Care
"The House on Wednesday voted to end the U.S. Postal Service's mandatory payments toward the health benefits for future retirees, advancing a measure that would eliminate a controversial requirement the cash-strapped mailing agency has defaulted on for years.... The Postal Service has lost money for 13 consecutive years and a majority of those losses stemmed from the prefunding requirement.... [Critics] have estimated the law requires USPS to fund the benefits for retirees up to 75 years in the future, an obligation virtually no other government entities face."
Government Executive
Profitability in the Health Care Market Has Never Been Better
"Continued consolidation by health insurers and hospitals systems combined with coverage expansion has improved profits for both. Profits for Florida HMOs increased by 12% in 2018, and South Florida hospitals reported average profit margins of 8%, their highest in recent years.... The health insurance market has grown significantly more concentrated in the last three years as companies like Anthem and Blue Cross Blue Shield have acquired a number of HMOs. In 2018, the four largest HMO companies -- the five Blue Cross Blue Shield HMOs, Humana, UnitedHealthcare's HMOs and WellCare -- had 64.2% of the market, compared to 51.5% two years earlier."
Bob Laszewski's Health Care Policy and Marketplace Review
"While FMLA regulations state that 'the flu' ordinarily does not meet the Act's definition of a 'serious health condition,' the flu can still qualify as a serious health condition under the FMLA if it meets that definition, such as inpatient care or continuing treatment by a health care provider.... [E]ligible employees might be entitled to FMLA leave when taking time off for examinations to determine if a serious health condition exists[.]"
Jackson Lewis P.C.
Benefits in General
Artificial Intelligence in Employee Benefits (PDF)
"AI can highlight benefits areas that may interest particular groups of employees, such as paid time off (PTO) or retirement options for older employees and medical or disability benefits for employees with families. AI also assists employees with making informed and logical decisions.... Although AI can be an asset for helping employees make complicated benefits decisions, employers should be aware of some of the limitations and other considerations, including data privacy."
International Foundation of Employee Benefit Plans [IFEBP]
[Opinion]
Financial Wellness: The New Must-Have Employee Benefit
"The transformative nature of employee financial wellness is still not widely appreciated in corporate America.... The aha moment has yet to happen regarding the potential of financial wellness to redefine the contract between employer and employee for the greater good. As a result, comprehensive financial wellness is often viewed as a nice-to-have benefit, not a must-have.... For employees, though, financial wellness is a must-have."
Marthin De Beer, in Forbes
Selected Discussionson the BenefitsLink Message Boards
Travel Allowance in Lieu of Mileage Reimbursement
"My employer would like to give an employee a travel allowance in lieu of them needing to submit mileage reimbursement forms monthly. I know this is taxable, but would it be considered supplemental wages? If so, it will be separated from their normal wages, so would this be best to do at the Supplemental rate? Would this need to be coded for the W-2's?"
BenefitsLink Message Boards
Press Releases
The Retirement Advantage, Inc. Hires Trey Galuppi as Multiple Employer Plan (MEP) Specialist The Retirement Advantage [TRA]
Most Popular Items in the Previous Issue
Text of Agency ACA Implementation FAQs, Part 41: Summary of Benefits and Coverage (PDF) U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
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