Category Archives: Uncategorized

Lower-cost, lower coverage plans coming?

In an article on Fox News (click here for the full article), the Trump administration proposed allowing insurers to sell 12-month long “short term medical plans.”  These used to be available, at a much lower pricing point, but the Obama Administration eliminated them for the most past.

Considering the increasing numbers of clients I speak to who are dropping coverage, or going without, because of the high premiums, this may be a very popular option.

“We need to be opening up more affordable alternatives,” Health and Human Services Secretary Alex Azar told reporters. “It’s one step in the direction of providing Americans with alternatives that are both more affordable and more suited to individual and family circumstances.”


DOL Reaches Settlement on 401k plans

From Plan Sponsor:


The U.S. Department of Labor (DOL) has entered into a settlement agreement with U.S. Fiduciary Services and three of its subsidiaries that provides for payment of more than $7 million to 42 retirement plans that suffered losses as a result of investments in fictitious loans made by Florida-based First Farmers Financial LLC (FFF).

The agreement and anticipated future payments from a pending receivership estate case involving FFF are expected to compensate the retirement plans fully for approximately $16 million in losses.

FFF created the fictitious loans and forged documents stating that the loans were guaranteed by the U.S. Department of Agriculture. Forty-two retirement plans invested in a fund exposed to the fraudulent FFF loans through subsidiaries of U.S. Fiduciary Services.

The DOL’s Employee Benefits Security Administration (EBSA) conducted investigations of the subsidiaries—Salem Trust Company, Pennant Management Inc., and GreatBanc Trust Company—for potential violations of the Employee Retirement Income Security Act (ERISA) in connection with the plans’ investments in a fund exposed to the fictitious FFF loans.

After its investigations, the DOL entered into the settlement agreement with U.S. Fiduciary Services and the three subsidiaries, resolving its claims of ERISA violations. Representatives of the ERISA-covered retirement plans that are due to receive settlement proceeds were also parties to the settlement agreement.

“Fiduciaries must work solely in the interest of participants and beneficiaries,” says Jeffrey A. Monhart, EBSA Regional Director in Chicago. “The Department of Labor conducts investigations and undertakes enforcement actions to protect Americans’ hard-earned benefits. This settlement restores vital benefits that rightfully belong to employees.”

Northwell Health working with Western Connecticut Health Network

Northwell Health and Western Connecticut Health Network have signed an agreement to jointly explore developing new clinical programs and services as well as sharing analytics.

As part of the deal, Northwell Health will provide the Danbury, Connecticut-based health care system with workforce development opportunities via its corporate university.

“This enables us to expand our footprint into western Connecticut and see where there might be areas where we can collaborate on clinical and non-clinical initiatives,” said Northwell spokesman Terry Lynam. “This helps us develop relationships with physicians in that region.”

Northwell has a small presence in Connecticut through Westchester Health Associates, a network of physicians and specialty practices it took over early last year. Westchester Health has more than 100 providers in 39 locations throughout Westchester and Putnam counties in New York and in Stamford, Connecticut.

Another 401k suit

NAPA is reporting another fee-based lawsuit against a Plan Sponsor:

“Yet another 401(k) provider and investment manager has been sued by one of its own participants for breaching its fiduciary duties to the plan – and while the claims are familiar, the venue is different.

This time the target is Mutual of Omaha in a suit filed last week in the U.S. District Court for the District of Nebraska by Berger & Montague and Schneider Wallace Cottrell Konecky Wotkyns LLP on behalf of Tamera S. Lechner, a participant in the plan, which had approximately 6,000 participants and some $500 million in assets.

Lechner alleged that the plan’s fiduciaries selected United of Omaha-branded investment funds “when each of these Omaha-branded funds invested all of its assets in another publicly available investment fund managed by an unrelated third party – causing the Plan to pay a fee to United of Omaha in addition to the fee charged by the underlying fund’s manager when the Plan could simply have offered the underlying fund and avoided paying any additional fee to United of Omaha.”


For the full article click here

Blue Cross Blue Shield SC addresses Opioid Epidemic

From Blue Cross on February 1:

As our state and nation mobilize to address the opioid abuse epidemic, BlueCross BlueShield of South Carolina is committed to doing its part. Starting April 1, 2018, new limits on opioid prescriptions will take effect for all employer groups with BlueCross pharmacy benefits.

We work with an independent panel of BlueCross network physicians and pharmacists, the Pharmacy and Therapeutics Committee, to develop and maintain our drug lists and policies. Clinical decisions are based on drugs’ efficacy, safety and value, with the goal of providing the greatest clinical effectiveness for the lowest cost.

Addressing opioid prescriptions specifically, the committee has focused on daily quantity limits and added requirements for prior authorization in some prescribing situations, basing its decisions on guidance from the federal Centers for Disease Control and Prevention.

According to the CDC, there were a record 33,000 U.S. deaths from opioid overdoses in 2015 — nearly half of them involving prescription medications. In 2016, nearly 5 million opioid prescriptions were filled in South Carolina, according to the S.C. Department of Health and Environmental Control.

“There is evidence that the more opioids are prescribed in a given region, the more likely it is that there will be a related increase in addiction and in overdose deaths,” said Dr. Matthew Bartels, BlueCross vice president and chief medical officer. “As this epidemic is addressed at the federal, state and local levels, we are hopeful that our new Opioid Management program will be part of the solution in South Carolina.”

Employers will not be able to opt out of the program. However, patients who have sickle cell disease, are undergoing cancer treatment, or are receiving palliative care or end-of-life care, will be exempt from the program requirements.

For details, please see this Update Bulletin on opioids from our Pharmacy Management department.

Attached to the policy bulletin about opioids is the regular Pharmacy Management Update Bulletin outlining some other drug list revisions. In particular, please note the coverage update affecting medications used to treat hepatitis C.

March 2018
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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck