Issue 63

Brightline (pediatric mental health)'s transformation, and what employers need to know

Brightline is a health company in the pediatric mental health space and has great results with patients. Unfortunately, like so many other companies, they've struggled to scale through employers and health plans. The CEO, Naomi Allen, wrote a really honest piece on Medium about their issues and what transformations they're making.

Pediatric mental health is a really important issue to employees but this shift reflects the issues we see in distribution information to members through employer health plans.

They're doubling down on what they do really well, which means supporting families but reconsidering their distribution model. I do wonder, if you've used Brightline, how you found it? While we love hearing about different health solutions in the market, we face a ton of obstacles to getting the relevant services in front of the employees who could benefit most at employers.

Looking for an alternative to Founder Mode? Consider... Bureaucrat Mode

lol

Wondering what to do with your medical renewal increase?

Many of my clients came to me as new benefits managers who were looking to understand and then enhance the benefits they inherited. We've formalized this process into what we call the Health Plan Scorecard.

This is a 100 point scorecard that helps benefits managers determine what they're doing really well, and what they can do to enhance their program. In the spirit of this newsletter, our goal is to help new benefits managers make their plans a competitive advantage. Let me know if you've been looking for a way to perform due diligence on your new benefits.

Newsome signs expanded infertility coverage in CA

Gov. Newsome signed SB 729 which will require CA health insurance plans to cover infertility services starting next year. This is huge news as about 3% of CA births every year (~11,000) are the result of IVF and that rate is increasing.

While the benefit design is not yet released (expect that by EOY or early 2025), we do know that it is expanding the eligible population to include LGBTQ people. Expect it to feature step treatments so you likely won't be able to get IVF day one.

Infertility insurance supplements have been available in CA but they've generally sucked - my opinion - and most groups didn't offer them. Instead, employers looked to vendors to handle this area of care and spend by contracting with companies like Carrot, Progyny, Maven, and ARC Fertility.

In our experience, we like any program that relies on utilization pricing to drive transparency, as opposed to PEPM costs which are harder to unpack for employers.

Note that this requirement applies to Fully Insured Health Insurance offered out of CA, not self-funded health plans. This is the state insurance law vs ERISA distinction that is one component of the decision to offer a fully insured health plan or self fund it.

??Labor & Employment Updates

Election Season: Key Reminders for Employers

With the 2024 election in full swing in the U.S., employers should anticipate political discussions and activity in the workplace. From employees taking time off from work to vote to expressing their political opinions during work, employers should remember a few key points related to their employees’ rights to eliminate potential issues in the workplace. Full Article

Fifth Circuit Affirms DOL's Authority to Set Salary Thresholds For FLSA Exemptions

On September 11, 2024, in Mayfield v. Department of Labor, the U.S. Court of Appeals for the Fifth Circuit upheld the Department of Labor’s (DOL) authority to set minimum salary thresholds for overtime exemptions under the Fair Labor Standards Act (FLSA). This decision reinforces the DOL’s ability to require a minimum salary for executive, administrative, and professional (EAP) exemptions, known as “white-collar” exemptions. Read more

AI and HR: Navigating Legal Challenges in Recruiting and Hiring

Hiring executives are asking if the compliance costs and discrimination risks outweigh the anticipated benefits of using artificial intelligence (AI) tools for hiring and employment-related activities. Read more

SCOTUS to Clarify Employers’ Burden of Proof for FLSA Exemptions

Employers may get a clear answer on the evidence needed for Fair Labor Standards Act exemptions when the U.S. Supreme Court starts its term in October. The Supreme Court will take up E.M.D. Sales, Inc. v. Carrera, a case that asks the court to determine which evidentiary standard employers must meet to show that an employee is exempt from the FLSA. Read more

OSHA’s Walkaround Rule Showdown in Court: Will the Agency Be Allowed to Tread on Employers’ Rights?

The Occupational Safety and Health Administration’s (OSHA’s) Walkaround Rule has sparked a legal showdown between business associations and OSHA in a U.S. District Court in Texas. The agency’s rulemaking powers and businesses’ civil liberties are at stake. Read more

Sixth Circuit Affirms NLRB’s Expansive Interpretation of Protected Concerted Activity (US)

We first reported in February 2023 on a surprising and alarming decision by the U.S. National Labor Relations Board (NLRB or “the Board”)—In re McLaren Macomb—which concluded that the mere proffer of a severance agreement with broad confidentiality and/or non-disparagement provisions could violate Section 7 of the National Labor Relations Act (NLRA), which protects the right of employees to engage in concerted activity for their mutual aid and protection. Read more

Illinois: Employer Zero-Tolerance Marijuana Policy Justified Termination, Federal District Court Agrees

A recent federal court decision agreed an Illinois employer had the right to enforce a zero-tolerance policy on marijuana use. Off-the-job marijuana use can trigger employee discipline so long as it is not unreasonable or discriminatory. Read more