National Kidney Month

By: Rebecca Modene PhD, RN – Manager of Clinical Underwriting March is National Kidney Month and March 12th is World Kidney day. Astoundingly 10% of the world’s population is affected by chronic kidney disease (Kidney.org, 2019). In the United States, an estimated 37 million American adults have chronic kidney disease (Kidney.org, 2019). According to the […]

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Be Proactive Not Reactive to Cancer Risks

By:  Rebecca c. Modene Phd, RN – Manager of Clinical Underwriting February is National Cancer Prevention Month, which coincides with World Cancer Day on February 4th. World Cancer Day started on Feb 4, 2000 by the Union for International Cancer control and its intent is to bring awareness to cancer from prevention to treatment worldwide […]

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Fourth Circuit Fiduciary Duty Decision

Fourth Circuit affirms Plan Administrator’s Status as ERISA Fiduciary in Life Insurance Case  In a recent appeal, Dawson-Murdock v. National Counseling Group, Inc., the Fourth Circuit Court of Appeals vacated a lower court’s dismissal of a claim by a deceased employee’s spouse against an employer for breach of fiduciary duty under ERISA in administering a […]
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ICHRAs and ACA Affordability Rules

Effective January 1, 2020, many employers will have the option of offering individual coverage HRAs (“ICHRAs”) to reimburse employees for individual health insurance coverage.  ICHRAs allow employers to satisfy the Affordable Care Act (“ACA”) mandate to offer health insurance to full-time employees in a manner distinct from sponsoring traditional insured or self-funded group health coverage.  […]
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Surprise Medical Billing – Federal Law Developments

Employers and employees alike experience the headache and often significant financial burden surprise medical bills (balance billing from an in-network facility where the patient unknowingly receives care from out-of-network providers) present.  While some states ban the practice, employers who sponsor or participate in self-funded medical coverage are generally not covered by these laws.   Surprise […]
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Association Health Plan Developments

A recent court decision calls into question the Department of Labor’s 2018 final rule on association health plans (“AHPs”).  On March 28, 2019, the United States District Court for the District of Columbia found that the rule’s interpretation of the term “employer” unreasonable and invalidated several components of the previously issued rule, a rule which […]
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DOL Proposed Changes to FMLA Forms

On August 5, 2019, the United States Department of Labor (“DOL”) published a notice seeking public comment on proposed revisions to several model FMLA forms. While use of the DOL forms in FMLA administration is optional for employers, employers who have previously relied on the forms published by the DOL should review the new proposed […]

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Updated HHS Civil Monetary Penalties

Department of Health and Human Services Issues Updated Civil Monetary Penalties for 2018 On October 11, 2018, the Department of Health and Human Services (“HHS”) issued a final rule updating its regulations to reflect required inflation-adjusted civil monetary penalty amounts.  While this update did not create new penalties, it does increase penalty amounts for penalties […]
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Proposed Regulations for HRAs

On October 23, 2018, the Departments of Treasury, Labor, and Health and Human Services released proposed regulations that would authorize employer-sponsored Health Reimbursement Accounts (“HRAs”) to reimburse employee premiums for individual health insurance.  This is a 180-degree change from the current rule prohibiting reimbursement for individual health insurance premiums, and the proposed regulations, when and […]

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How Does Level Funding Compare with Fixed Funded Products?

The large insurance companies including Blue plans (generally referred to as BUCA’s) are offering a version of self-funding we characterize as ”Fixed Funded”. We call them ”Fixed” since there is no options for the self-funded employer to modify the financing arrangement.  In real self-funding, the decision to ”Level Fund” is a choice made by employers […]

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