Healia Health’s Post

For the past two legislative sessions, CBIA and a coalition of nonprofits and trade groups have pushed for a bipartisan, transformational bill giving small business employees access to quality, affordable healthcare, just as public sector workers, union members, and large company workers enjoy today. Legislators must address this growing disparity before it's too late—small businesses employ 95% of Connecticut's workforce and this is one of the key factors driving our high cost of living. #connecticut #affordability #healthcare #smallbusiness #transformCT

This is another in a series of good posts from law firms explaining the importance of CAA to employers with health plans and some specifics around the exercise of fiduciary duty. It also gets into some of the most recent ligtigation and gives a good check list for employer fiduciaries who are wondering where to start. There’s some particularly useful information here around assuring the documentation of broker/consultant total compensation and the importance of assessing the reasonableness of that compensation. This has been a difficult task for many employer fiduciaries who are receiving resistance from brokers/consultants as the fiduciary attempts to secure this documentation in writing. Quoting from this piece: “Under ERISA Section 408(b)(2), any contract related to a group health plan is not reasonable (meaning it’s a prohibited transaction) unless the direct and/or indirect compensation received by a health plan service provider (which equals $1,000 or more) is disclosed in writing to the plan fiduciary ahead of entering into the contract or extending the contract. For this purpose, covered “service providers” are brokers and consultants. These required disclosures are designed to provide group health plan fiduciaries with sufficient information to help determine whether the fees are reasonable, as required by ERISA’s fiduciary rules. Additionally, this law has enhanced cost awareness among health plan participants. You should note that plaintiffs’ attorneys are likely seeking information in these disclosures — or claiming these disclosures were not provided or received – to support participant claims against ERISA health plan fiduciaries and their service providers.” If your existing broker/consultant is reticent to furnish you with this information in writing, it should serve as a good indication that you have a problem and that the relationship and its terms warrant careful examination. #employer #employeebenefits #healthplans #compliance #fiduciary #disclosures #ERISA Christine Arnold Steve Schutzer, MD John Rodis, MD Lisa Trumble Chris Deacon Patrick Long Peter Hayes Dave Chase, Health Rosetta-discovering archaeologist Brian Klepper Scott Haas Ann M. Richardson, MBA Christopher Gormley Darren Fogarty Al Lewis 🇺🇦 🎙Spencer Smith, CSFS® Raju Kattumenu Wyatt Bosworth Stuart Sutley Dean Jargo Jamie Greenleaf AIF, CBFA, C(k)P Julie Selesnick Patrick Moore Tim Denman Mike Baldzicki Patrick Williams, AIF ® Les Wilkinson John Bass Doug Aldeen Derek Moore

This is a great article by Chris Deacon, pointing out the rising attention being paid to the fiduciary responsibilities of both plan sponsors and their administrators. The Federal government is starting to pay attention to health plans they way did with 401(k) plans several years ago. They're are defending the best interests of plan members and going after deceptive practices and pricing arrangements, and employers who are not paying attention to the contract arrangements they agree to that allow administrators, insurance carriers, and providers to take advantage of plan members, or who are "not spending employee contributed funds with proper discretion." Note*: Most Big Insurance carriers who are willing to attest to complying with the "No Gag Clause" Attestation, if you read their wording closely, are only attesting that their agreements with their interested parties contain no gag clauses. They do not attest that the plan sponsors plan agreements have no gag clauses.

Allow access to Healthcare through Associations, allow Short Term Medical Plans for those going through transitional periods, and ease some of the regulation on are 3 quick ways to start fixing Healthcare in CT.

I’m particularly fond of the embedded article that talks about heightened fiduciary health plan standards under CAA and how many of them compare to those required with 401(k). Also, how employers can think about their new fiduciary standards and required behavior changes in the context of how they manage their 401(k) duties. Many employers simply don’t know where to begin. Certainly, demanding plan data and analytics is a great start, but even a better start is securing disclosure on parties who service the plan. This is an enlightening and often shocking exercise for most that inspires specific actions. Great quote from the piece: “In addition to the ERISA 408(b)(2) fee disclosure requirement, group health plan fiduciaries now have a better line of sight into the structure and economics of their group health plans than ever before. This insight comes in the form of a series of new disclosure requirements that require plans to obtain and publish network and out of network payment rates, and to report plan drug and service cost information to HHS. Further, the CAA now requires employers to prepare periodic reports demonstrating compliance with the Mental Health Parity rules. These new rules give employers and plan fiduciaries unprecedented leverage with their service providers through increased transparency and improved awareness of the structure and economics of their group health plans. With this greater knowledge and understanding comes more risk of criticism that an employer or plan fiduciary could have looked closer—and should have looked closer—at fees and plan design in carrying out their fiduciary responsibilities. We think these new group health plan transparency and disclosure rules will drive new litigation against group health plan fiduciaries similar to what occurred in the retirement plan industry after ERISA 408(b)(2) became effective for 401(k) plans.” So, in summary, we’re now seeing high profile breach of fiduciary duty lawsuits much like we have for the last 20 years with retirement plans. We’re also seeing disclosures shining the light of day on previously unaccountable plan contracts. In short, employers need to start acting differently lest they become the target of lawsuits and lest they lose employees to other employers who are recapturing capital expenditures from their health plans previously conveyed to third parties furnishing no value. A new day. #employeebenefits #employers #healthcare #compliance #fiduciaryduty #valuebasedcare Christine Arnold Dean Jargo Brian Klepper Chris Deacon Patrick Long Stacey Richter Stuart Sutley Christopher Gormley Steve Schutzer, MD John Rodis, MD Lisa Trumble Scott Haas Doug Aldeen Dave Chase, Health Rosetta-discovering archaeologist Al Lewis 🇺🇦 Les Wilkinson Darren Fogarty Patrick Moore Josh Spivak Justin Leader Julie Selesnick Jamie Greenleaf AIF, CBFA, C(k)P John Bass Peter Hayes Ann M. Richardson, MBA Tim Denman Ryan Parker

Employers... take note! The DOL is actively applying a fiduciary standard to health benefit plans. It's time to roll up your sleeves and dig into your your benefits plan. Ignoring the issue puts you at risk for DOL enforcement action, and class action lawsuits! Don't be the low hanging fruit. Ask me about Fiduciary In A Box.

The only issue I would take with Wendell's assessment of our health system is the characterization that it is the worst of the richest nations. I don't believe the quality of care is bad, it's just that we do such a poor job of distributing care fairly. As we know, this is partly because the cost of care discourages Americans from accessing the system. And when they do, they wind up incurring debt that they can't repay. We know how to fix this! Nothing new is required and it's easier than you think. https://lnkd.in/gM9MjG_A is a great place to start if you are an employer needing a guide.

Top of UK businesses' wishlist for the new Labour government? Not tax breaks, or easing regulation, but fixing the NHS to help people get back to work. Underscores concern over sickness absence, which is running at record levels. In response, companies are turning to private health insurance + services, with demand at an all-time high. Important theme in this one by Michael O'Dwyer and me

My job is to help CFO's and HR people look like heroes. Because fiduciary duty applies to ERISA health and Welfare plans. A couple hot button items regarding the recent CAA lawsuit against Johnson & Johnson (https://lnkd.in/g6DNHbz2) - The lawsuit names the EVP, CHRO, VP of HR and specific individuals with benefit program oversight PERSONALLY in ADDITION to the organization. - This particular suit alleges that defendant breached their fiduciary duties and mismanaged the plan's pharmacy plan, which cost the plan, and in turn, the employees, millions of dollars. - The guts of the lawsuit allege that defendants should have done a better job of evaluating, selecting, and monitoring PBMs, and related contracts. - Plan fiduciaries are required to understand all direct AND indirect compensation received, AND where conflicts of interest may exist. There's more, much more. And don't expect this to be the last lawsuit of it's kind. It's amazing how much financial savings a pharmacy contract review or even a stop-loss contract review can provide. I just found over $650K in a review of a 250 person group and we kept the benefits and network THE SAME. PBM was killing them and feeding the broker with multiple hidden revenue streams! The employees will never know that anything was changed! HR Staff got all the credit, USI earned another long-term client. Everybody wins. Fiduciary duty is real. Do your job! #usioneadvantage #selffunding #pbm #employeebenefits #erisa #fiduciaryduty #beauthentic