Aon Hewitt Legislative Reporting

Risk. Reinsurance. Human Resources.

Global Health Update This bimonthly Update summarizes recent legislative developments and trends related to health care and highlights recently passed and pending legislation that may require employers to take action to comply with new rules or review existing plans.

Recent Developments Africa and the Middle East

Egypt

Cabinet backs national health insurance bill.

The Cabinet has now approved the Health Ministry's draft national health insurance bill. Among the highlights:

Details of financing will follow an actuarial study due in the coming weeks. The government expects to subsidize care for 30-40% of the population.

The system would be governed by three administrative bodies; a financing entity, a health services body, and an office for accreditation and maintaining quality of care.

The private health care sector will be subject to the standards set by these bodies.

Primary care units would serve as gatekeepers to the rest of the system.

The bill will go to the National Council for legal review before it is referred to Parliament. If passed, it is expected to take 12-13 years to roll out.

Gabon

Health scheme contribution rises.

A decree that went into effect on January 1, 2017 doubled the private-sector employee contribution for sickness and maternity coverage under the compulsory Health Insurance Scheme to 2%. The employer contribution is still 4.1% and the maximum salary subject to the levy remains XAF 2.5M per month.

April-May 2017

Global Health Update | Aon | April-May 2017 2

Israel

Disability benefit reforms expected.

A panel appointed by the Finance Ministry to investigate disability benefits has delivered its preliminary recommendations to the relevant ministries. The monthly disability pension, now NIS 2,342 (US $640), is due for an over 50% rise to NIS 3,800 under the new budget, but it would still lag far behind the minimum wage of NIS 5,000. The panel will propose another substantial increase, but has not yet committed to an annual trigger such as a minimum wage peg. The group also aims to end disincentives for gradually returning to the workforce so the formula for reducing benefits for disabled persons with employment income is up for review.

Kuwait

Panel proposes mandatory health insurance for foreign visitors.

The Parliamentary Health Affairs Committee has approved a proposal to make the purchase of local health insurance a prerequisite for any foreigner visiting Kuwait. The insurance would limit them to coverage at the expatriate-only hospitals and clinics now in preparation, so the plan could not take effect until this network is operational. The Interior Ministry would flesh out the plan, including any possible exemptions.

Global Health Update | Aon | April-May 2017 3

Americas

Bahamas

National Health Insurance—Phase II

Phase II, the enrollment stage of the National Health Insurance (NHI) system, launched on April 24. All Bahamian citizens and legal residents are invited to enroll and select their primary care physicians at this point. A package of health coverage, initially just primary care services from May 2017 and expanding to full coverage in 2020, will be fully financed by the government, but there may be a dedicated levy once the system is fully established. While there is no copayment and no lifetime limit, there will be limited budgeting for treating an array of the more costly procedures, categorized as "catastrophic care." People with private health insurance must provide documentation of coverage when they register. They are still entitled to NHI membership and many are expected to prefer its free coverage, but they are encouraged to have a supplemental private health insurance policy.

Bermuda

Financial services tax on insurance premiums

The Financial Services Tax Act 2017 introduced a 2.5% tax on the gross premiums of domestic insurers. There is an exemption for those premiums attributed to only health insurance coverage. It applies to tax periods for quarters starting on or after April 1, 2017.

Brazil

Ruling on constitutional right to health care is overdue.

Brazil's constitution states that health care is " right of all persons" but the public health system, SUS, has a limited formulary of approved treatments and medication, so there has been a spate of court rulings in recent years successfully challenging SUS's coverage restrictions. Known as "judicialization of health care," this approach to combating SUS limitations was slated for a definitive ruling in the Federal Supreme Court last September, but has encountered some delays. A deceased justice's replacement was approved by the Senate in late February and the case is back on the Court's agenda. There should be a ruling later this year

Canada

2017 Ontario Budget

Aon Canada has produced a bulletin on the 2017 Ontario Budget.

Courtesy of Aon Canada

Quebec bill would limit pre-existing condition factor.

On April 4, 2017, Bill 794, An Act to regulate using health as a risk determination factor in insurance contracts, received first reading.

This bill purports to introduce a prohibition against considering the fact that a person has had a “disease” (a cancer pathology and any chronic pathology whose effects can, as attested by therapeutic advances and scientific data, be significantly and

Global Health Update | Aon | April-May 2017 4

sustainably contained by treatments) as a risk determination factor in an insurance contract once a certain period of time has elapsed since the end of the treatment protocol.

The bill introduces, for persons who have had a “disease,” a “right to be forgotten” once a certain period of time has elapsed since the end of the treatment protocol. In such cases, the bill provides that using health as a risk determination factor constitutes discrimination. Furthermore, the policyholder and the insured are exempted from their precontractual representation obligation under Article 2408 of the Civil Code of Québec. The bill also grants insurance applicants the right to be informed of this prohibition.

Please note that this is a private member’s bill and it may not have the support required to become law.

Source: Bill 794, An Act to regulate using health as a risk determination factor in insurance contracts.

Courtesy of Aon Canada

Federal Budget 2017

On March 22, 2017, the Canadian government tabled Budget 2017: Building a Strong Middle Class. Among other matters, Budget 2017 proposes changes to employment insurance, family leave, and flexible work arrangements under the Canada Labour Code, Medical Expense Tax Credits, and the Canada Savings Bonds Program.

Budget 2017 proposes the expansion of Employment Insurance (EI) benefits by:

Providing for a new EI caregiving benefit of up to 15 weeks (new benefit will cover a broader range of situations where individuals are providing care to an adult family member who requires significant support in order to recover from a critical illness or injury);

Making EI parental benefits more flexible (proposed changes will allow parents to choose to receive EI parental benefits over an extended period of up to 18 months at a lower benefit rate of 33% of average weekly earnings); and

Allowing women to claim EI maternity benefits up to 12 weeks before their due date (expanded from the current standard of eight weeks).

It also proposes amendments to the Canada Labour Code to:

Ensure that workers in federally regulated sectors have the job protection they need while they are receiving caregiving, parental, or maternity benefits (consistent with proposed changes to EI benefits);

Provide workers with the right to request more flexible work arrangements (such as flexible start and finish times and the ability to work from home, new unpaid leaves for family responsibilities, to participate in traditional Indigenous practices, and to seek care if they are victims of family violence, and more flexible bereavement leave);

Limit unpaid internships; and

Strengthen and modernize compliance and enforcement provisions.

Please see Aon Hewitt’s Information Bulletin for further details.

Courtesy of Aon Canada

Consultation on draft OHS modernization regulations

On March 18, 2017, proposed Regulations Amending the Canada Occupational Health and Safety Regulations were published for comment in the Canada Gazette.

Global Health Update | Aon | April-May 2017 5

The proposed amendments to Part XII of the Canada Occupational Health and Safety Regulations (COHSR) would apply to all federally regulated employers and employees in federally regulated industries, except onboard employees on ships, aircraft, or trains and employees in the oil and gas sector under federal jurisdiction, and would:

Update the references for all standards that are incorporated by reference;

Modernize the section on fall-protection systems in order to properly reflect industry standards and practices and to reference newly developed standards;

Revise the requirements for the selection, fit, care of, use, and maintenance of respiratory protection equipment;

Revise the section on Protection Against Moving Vehicles to better protect the employees; and

Align federal requirements under Part XII with those under other parts of the COHSR, the Code, and provincial laws, and clarify the regulatory text.

Comments can be submitted until April 17, 2017.

Source: Regulations Amending the Canada Occupational Health and Safety Regulations

Courtesy of Aon Canada

Chile

Highlights of legislative agenda

There are some notable measures on the horizon for the second quarter of 2017:

The Labor Ministry has delivered a bill to the Senate that would require all private-sector establishments with at least 200 employees to set a 1% quota for disabled workers or people on disability pensions. Those with at least 100 workers would be urged, but not obliged, to maintain that quota.

People on temporary contracts who have worked at least 15 days would be entitled to severance pay at a rate of 2.5x daily salary per month worked.

A severance payment would be introduced for workers who die while in service.

Colombia

SG-SST compliance review

The Labor Ministry recently extended the deadline for implementation of the System of Management of Health and Safety at Work (SG-SST) from January 31, 2017 to June 1, 2017. The responsibility to assess dangers, develop an improvement plan, carry it out then monitor the outcome applies for all public- and private-sector companies, with no minimum size. This is to be carried out by employers with the participation of their workforce and with Labor Risk Administrators (ARL) offering advice and training.

Guyana VAT exemption for medical services

The Guyana Revenue Authority has issued a press release clarifying the new value-added tax (VAT) exemption for medical services, “… Exempted are a supply of medical, dental, hospital, optical, or paramedical services, other than veterinary services…” as well as a range of medical supplies and prescription drugs.

Global Health Update | Aon | April-May 2017 6

Jamaica GCT planned for health insurance premiums.

The Finance Ministry's paper Revenue Measures for Financial Year 2017/2018 includes a proposal to apply a 16.5% General Consumption Tax (GCT) in respect to health insurance premiums from April 3, 2017. In addition, income received by nonresidents from Jamaican residents as General Insurance Premiums would be subject to a 15% withholding tax from year of assessment ending December 2017.

United States

HHS Finalizes Rules to Stabilize Individual Insurance Market.

This is an expansion on an earlier synopsis:

On April 13, 2017, the Centers for Medicare and Medicaid Services of the Department of Health and Human Services (HHS) released final regulations aimed at stabilizing the individual and small group health insurance markets. The final regulations amend standards relating to special enrollment periods, guaranteed availability, and the timing of the annual open enrollment period in the individual market for the 2018 plan year; standards related to network adequacy and essential community providers for qualified health plans; and the rules around actuarial value requirements. The regulations become effective June 19, 2017.

The Aon Hewitt bulletin, which details the changes, is available here.

Courtesy of Aon U.S.

President Trump Signs H.J. Res. 37 Into Law; Nullifies Former “Blacklisting” Executive Order.

On March 27, 2017, President Trump signed H.J. Res. 37 into law. The legislation invalidates Executive Order 13673—Fair Pay & Safe Workplaces. Signed by President Obama in July 2014, Executive Order 13673 required prospective federal contractors to disclose labor law violations and provided agencies guidance on how to consider labor violations when awarding federal contracts. It also directed the Department of Labor (DOL) and Federal Acquisition Regulatory Council to issue regulations and guidance to implement the requirements.

Additionally, President Trump on the same day issued an Executive Order (Presidential Executive Order on the Revocation of Federal Contracting Executive Orders) officially revoking the initial authorizing Executive Order signed by President Obama. President Trump’s Order directs the DOL and other executive agencies to “…consider promptly rescinding any orders, rules, regulations, guidance, guidelines, or policies implementing or enforcing the revoked Executive Orders…”

H.J. Res. 37 is available here.

The Presidential Executive Order on the Revocation of Federal Contracting Executive Orders is available here.

Courtesy of Aon U.S.

House Passes Small Business Health Fairness Act.

On March 22, 2017, the U.S. House of Representatives passed with a 236–175 vote the Small Business Health Fairness Act of 2017 (H.R. 1101). The bill would “improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees.” As part of the provisions, the proposed legislation would expand the ability of small employer groups and individuals to join together to obtain health insurance through an unregulated association health plan.

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H.R. 1101 progresses to the Senate for consideration. In a Statement of Administration Policy, the White House indicated its support of the measure.

The full text of H.R. 1101 is available here.

A fact sheet on H.R. 1101 is available here.

Global Health Update | Aon | April-May 2017 8

Asia

China

Pilot projects for health network variations

The National Health and Family Planning Commission press release outlined a State Council agreement to stage a nationwide array of "medical partnership" pilot projects in 2017. This will help determine the most efficient models for coordinating the superior health care services concentrated in large urban centers with the far less robust rural health facilities. Within government guidelines setting out the administrative, financial, and staffing aspects, all major public hospitals are expected to develop their own partnerships, using telemedicine and other online resources to raise the quality of their rural counterparts.

Tax break on health insurance premiums

Following a successful pilot project launched last year, the State Council has approved a nationwide tax deduction on commercial health insurance premiums included in the Premier's new economic stimulus package. The modest annual deduction of CNY 2,400 (US $348.50) per person is set to launch on July 1, 2017.

Individual health insurance purchase with balance of mandatory medical insurance account balance

The bellwether Shanghai Municipal Government has announced that, since January 1, 2017, citizens can purchase individual commercial health insurance with their balance in the mandatory medical insurance account.

Courtesy of Aon China

Obligatory LTC insurance mulled.

The former Vice Minister for Human Resources and Social Security, now serving on the National Committee of the Chinese People's Political Consultative Conference, has proposed that the government add long-term care insurance to its roster of social insurance programs. He recommended a pilot program starting with disabled seniors. The government has not made that commitment, but it has included some long-term care initiatives in its five-year plan on elderly care. There will be more state investment in nursing homes and rehabilitation services for the elderly and the private sector will be invited to have a role in the elder care market.

India

Stronger broker regulations proposed.

The Insurance Regulatory and Development Authority (IRDA) has proposed tighter regulations for insurance brokers. Under the draft rules:

The minimum capital requirement would double to INR 10M (US $155,300) for direct brokers, INR 40M for reinsurance brokers, and INR 50M for composite brokers.

Brokers would be permitted to offer risk management services.

Policies would be set for comparison and distribution of insurance products.

The CEOs and CFOs of insurers and insurance brokers would be required to submit an annual certificate if their total remuneration exceeded stipulated limits.

A brief public consultation on the draft closed on April 15.

Global Health Update | Aon | April-May 2017 9

EPFO pensioners to receive ESIC coverage.

The Labor Minister noted during parliamentary debate that the nearly six million pensioners now covered by the Employees Provident Fund (EPF) should soon become eligible for medical benefits under the Employees State Insurance Corporation (ESIC). The minister said that this initiative targets low-income pensioners who may have trouble affording health insurance, implying that voluntary EPF members and those subject to the prospective sharp rise in the threshold for mandatory participation (elsewhere in this issue) may not benefit from this initiative. The proposal will be addressed in the next meeting of the EPFO central board of trustees.

Cabinet endorses National Health Policy 2017.

The Cabinet has approved National Health Policy 2017, which aims to deliver universal health care that is both affordable and high quality. There is strong emphasis on preventive care and health promotion with free drugs, diagnostic and emergency care available in all public hospitals. A larger government role in health care will entail gradually more than doubling health care's portion of the GDP to 2.5%. The plan would not introduce a health levy.

Kazakhstan

Adjustments to health contribution phase in

Further amendments to the government's health reform legislation include an additional step for the employer contribution timetable. Revised figures are:

1% from July 1, 2017.

1.5% from January 1, 2018.

2% from January 1, 2020.

3% from January 1, 2022.

Revised figures for the government's contribution reach 3.75% in January 2018 and climb to 5% in January 2022. The employee contribution is still 1% from 2019 and 2% from 2020, but the range of disadvantaged people exempt from this contribution would expand.

Mongolia

Health contributions to rise.

Parliament has approved measures raising both employer and employee social health insurance (SHI) contributions. Effective January 1, 2018, the employee rate, 10% of salary-related income capped at MNT 240,000 per month, will rise to 12.5%. The uncapped employer contribution, which varies by sector and now ranges from 11-13%, will increase to a range of 13.5-15.5%.

Myanmar

Occupational safety bill

The Labor Ministry's draft Occupational Safety and Health Act was recently circulated for public consultation. In the works since 2012, it would modernize and consolidate workplace safety measures that have seen little change since 1951. Among the changes at this stage:

Employer and employee workplace safety obligations would be set out.

Global Health Update | Aon | April-May 2017 10

The roles and powers of workplace inspection officers would be established.

New safety training/disaster preparedness and protective equipment requirements would be introduced for a number of sectors.

In addition, certain long-standing inequities will be addressed. Workers compensation would not be financed exclusively by workers, they would not be expected to purchase their own safety equipment, and limits on compensation for workplace fatalities are under review.

Greater SEZ accessibility for foreign insures

The Insurance Business Supervisory Board (IBSB) announced that it is easing restrictions for foreign insurers seeking to do business in Special Economic Zones (SEZ). A few Japanese insurers are currently allowed to operate in SEZs, which are viewed as a pilot project for eventually opening the entire Myanmar market to foreign insurers. The minimum capital requirement is cut from an initially set $3 billion to $1 billion and the companies must be in business at least 10 years and must have had local representative offices for at least three years. The IBSB also requires extensive financial disclosure from applicants. There are about 20 foreign companies in Myanmar now with representative offices but no licenses.

Nepal

Insurer capital requirements to quadruple.

The Insurance Board has decided to raise the minimum paid-up capital for life and nonlife insurers by 400% by mid-July 2018. The new thresholds will be NPR 2 billion and NPR 1 billion, respectively. Only one insurer in each category currently meets that minimum and several insurers are already under sanctions for falling short of the existing minimum. Once the new requirement takes effect, insurers will have a six-month grace period to reach the minimum.

Cabinet approves health reform plan.

The Cabinet has endorsed the national health insurance scheme (NHIS) legislation and is forwarding it to Parliament. The annual premium for a family of five is still set at NPR 2,500 (US $23) and the annual coverage cap is NPR 50,000. Both of those figures are expected to rise and regulators would be able to bypass the legislature to increase them. The premium will cover hospital care, surgery, medicine, preventive care, rehabilitation, outpatient treatment, and yoga. Primary care providers would provide referrals to hospitals. The public health system infrastructure would be bolstered for this program, but the government would also negotiate memoranda of understanding with private health care providers for reimbursing treatment of NHIS members.

Pakistan

Pension and health reform package

The National Financial Inclusion Strategy (NFIS), Technical Committee on Pension and Insurance has proposed a set of pension and health reform measures:

A new Regulatory Authority would stabilize the occupational pension sector, requiring regular financial reports from company saving and superannuation schemes.

Defined benefit schemes would develop funding strategies and would be obliged to make up any funding shortfalls promptly.

A health benefits scheme for formal-sector workers and their dependents would be financed by employers.

A voluntary pension system would be urged for the corporate sector as gratuity scheme and provident fund holdings are diverted into too many nonretirement needs.

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The civil servant defined benefit system would be replaced by a defined contribution scheme for new hires.

The NFIS steering committee is reviewing the package.

Philippines

Guidelines for accreditation of HMO products

The Philippines Insurance Commission (IC) has announced the release of new guidelines on the approval of Health Maintenance Organization (HMO) products as well as guidelines on accreditation of actuaries for HMOs. An HMO agreement must provide for a range of care, including pre-existing conditions, and it must specify any limitations. The documentation provided to the IC include marketing materials and a detailed report from an IC-accredited actuary. The guidelines on actuary accreditation set out the credentialing requirements and responsibilities of HMO actuaries.

South Korea

Government promotes wellness discounts.

The Financial Supervisory Service (FSS) has instructed the insurance sector on measures to optimize the wellness features commonly included in health and life insurance products. While premium discounts for good health are widely awarded, they are not well-promoted and there are often bureaucratic disincentives. The FSS will require insurers to explain their wellness discounts to new clients, streamline the application process, and discourage requirements for follow-up medical exams.

Measures to remedy excess care.

This is an update on a market change that took effect on April 1, 2017.

Background A. There are some medical treatments that have been excessively taken by some of local citizens, knowing those all can be covered under insurance.

B. It has raised a public concern as it is against the good faith of private insurance. In addition to the public concern, it is also true it has been a cause of increased medical loss ratios at the market level.

C. To prevent further abuse of those treatments as well as stabilize the medical loss ratios, the government has provided local insurers with guidance to reduce the coverage level of those treatments identified as “abused.”

Key Changes A. Coverage-Wise

I. The key change is that those treatments identified as “abused” would be detached from the current coverage scheme.

II. Under the “New” scheme, those treatments would rather be purchased as option and subject to different insured amounts, number of maximum treatments and coinsurance rules which are predetermined by the type of treatment; please refer to attached.

III. To those individuals who have ever benefited from those treatments under the current scheme, this change could be “negative” as it would reduce insured amounts and number of maximum treatments.

B. Cost-Wise

I. The rates are anticipated to stay similar or go down slightly.

Global Health Update | Aon | April-May 2017 12

Contracts placed before April 1, 2017 will not be affected by the change until expiration.

Once it becomes official, this would be a mandatory change applicable to all local “Outpatient and Hospitalization” products with no exception.

A client bulletin is available here.

Courtesy of Aon South Korea

Sri Lanka

VAT on some health services

A recent expansion of the value-added tax extended the 15% levy to a broad range of health care services. There was some confusion about its scope of coverage, so the Inland Revenue Department has issued guidelines. The VAT applies to:

Surgical and therapeutic treatment;

Laboratory and diagnostic services related to patient care;

Medicine administered in a hospital; and

Supply of other health care services by a medical institution.

There are VAT exemptions for outpatient department services, as well as pharmaceutical products and diagnostic tests provided outside of a hospital. The guidance went into effect on November 1, 2016, with some elements retroactive to much of 2016.

Taiwan

Copayment shift takes effect.

The Ministry of Health introduced a new copayment schedule on April 14 to better align patients with the appropriate health resources. People who go to medical centers or regional hospitals without referrals from primary care physicians or who go to their emergency rooms with relatively mild symptoms will now face sharply higher charges while those who are referred by their local clinics will pay significantly less. The medical centers and large hospitals are obliged to ensure adequate space is reserved for referrals so patients don't view the clinics as hurdles.

Uzbekistan

Universal health insurance scheme on the way.

The recent decree on tax relief for providers in the private health sector proves to be part of a more sweeping plan for a national mandatory health insurance plan. Under the draft legislation, "On Medical Insurance:"

Coverage would be compulsory for all citizens, but there would be a robust market for voluntary supplemental coverage from the private health sector.

There would be equal rights to high-quality care, but certain high-technology services would be reserved for the private sector.

Under both public and private systems, tariffs would be set for medical services.

The scope of coverage as well as premiums and copayments would be regulated.

The plan is expected to be delivered in October 2017.

Global Health Update | Aon | April-May 2017 13

Tax breaks for health providers

The Presidential Decree of April 2, 2017 established some tax incentives for the private health sector:

A tax exemption for private medical companies, including those with foreign investors, that was to have lapsed on January 1, 2018 is extended to January 1, 2022.

Foreign doctors and medical equipment technicians will pay no income tax on income derived from jobs with private medical companies and those companies are exempt from the unified social tax on their pay.

Foreign individuals in management positions in private medical companies are exempt from income tax.

Vietnam

Medical fees to rise for the uninsured.

The Ministry of Health (MOH) has recently drafted a circular that sets steep new fee increases for medical services for those who have not yet joined the state-sponsored health insurance scheme. Effective June 1, 2017, payments for 1,900 medical services will start to rise up to three-fold for the uninsured. The Circular specified the new fees applicable for hospitals in special-class, Class 1 (under management of the MOH or provincial/ municipal people’ committees), Class 2 and 3 (under management of provincial/ municipal people’ committees). The circular also raises payments for health insurance cardholders using treatments or medical services not covered by the Social Insurance Fund.

Life insurance rules streamlined, standardized.

The Ministry of Finance (MOF) and the Ministry of Industry and Trade (MOIT) have jointly announced new protocols on their coordinated supervision of life insurance products, which were added in the list of goods and services requiring registration of standard contract and terms & conditions with the MOIT in 2015. The joint effort will cut down on the cost of compliance and the administrative burden for the life insurance sector. Applications will be submitted to MOF which will review them with input from MOIT. Once approved by MOF, the product’s standard contract and terms & conditions will be approved and registered automatically at MOIT. Existing products are grandfathered, but insurers will still need them registered with MOIT under the Law on Consumer Protection.

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Europe

Estonia

Health promotion tax incentives adopted.

Legislation establishing tax deduction for benefits in kind affording an array of wellness and rehabilitation services has been enacted and will come into force on January 1, 2018. Among the benefits exempt from income tax and social security contributions up to EUR 100 per quarter (no carryover) per worker are:

Admission to sports events;

Costs of using a sports facility or maintaining a company's own facility;

Various qualified rehabilitation services including physical therapy, speech therapy, psychotherapy, and physiotherapy; and

Health insurance contract premiums.

Finland

Post-employment health services

An Occupational Health Act amendment that went into effect on January 1, 2017 obliges employers to maintain a range of post-employment health services for six months for qualifying dismissed workers. The amendment affects workers who have been with an enterprise of at least 30 employees for at least five years and are made redundant for economic reasons. The coverage extension includes the statutory preventive health services such as medical exams and group physical activities as well as commonly offered voluntary supplementary health coverage such as specialist services. The coverage extension ends when a person gets a new job.

France

PUMa coverage of foreign spouses

A recent decree from the Ministry of Social Affairs and Health clarifies the status of the spouses of foreign workers under the PUMa universal health system. From February 24, 2017, the three-month waiting period for PUMa is waived for inactive spouses arriving in France and they are subject to an 8% contribution. Spouses accompanying French workers who are posted abroad can have PUMa coverage retroactive to January 1, 2016, but they should register before leaving.

Ireland Private health insurance tax break challenged.

The Press has been previewing highlights of the final report from the Parliamentary Committee on the Future of Healthcare. The Committee reportedly brands tax relief for private health insurance as a subsidy for the health insurance sector and aims to either rescind or modify it. The Health Minister maintains that this proposal is a nonstarter. Other proposals include ending inpatient charges for public patients and cutting the prescription fee for medical card holders from EUR 2.50 to 0.50.

Global Health Update | Aon | April-May 2017 15

Italy Ruling on cell phone hazard

A court of first instance has issued a decision on cell phone safety that—if it stands—could prove a major precedent. An office worker who used mobile phones heavily on the job for 15 years developed a benign tumor that caused hearing loss. The court recognized a causal link between his phone use and the tumor and awarded partial disability payments from the state workers compensation scheme, INAIL. The plaintiff kept his job and is reluctant to say anything too harsh about cell phones but he has joined the initiatives calling for warning labels, safety training, and anti-radiation ear buds for workplace use of cell phones.

Kosovo

Implementation of universal health insurance law

Law No. 04/L-249, the law establishing universal health insurance for all citizens and foreigners with resident permits, was passed in April 2014 but the launch was delayed until this year. The requirement for both employers and employees to pay 3.5% of gross monthly income came into effect on January 1, 2017. Free medical treatment should become available approximately July 1, 2017. This basic package of health care services is mandatory for all and includes both inpatient and outpatient specialist care, rehabilitation, medicine, maternity care, and orthopedic devices. In addition, a market has been carved out for voluntary supplemental private health insurance products.

Netherlands

Working Conditions Act amendments clear Senate.

The Senate has passed a bill amending the Working Conditions Act to reinforce employee protection:

Content requirements would be set for the contract with the occupational safety service provider.

Workers would be entitled to second opinions.

The works council would have right of consent in the appointment of an occupational safety officer.

The company doctor could consult with the works council, including on development of an occupational safety policy.

The law is expected to go into effect on July 1, 2017 and employers would have a one-year transition period for compliance.

Poland

Disability rating system under review.

The Interdepartmental Group for Development of System of Assessment of Disability and Incapacity for Work was convened in February to review the disability rating system. Rather than measure the level of disability, it plans to determine which activities a worker is still able to perform. A person falling below a certain percentage in ability to work would qualify for a disability pension. The group will also propose a more effective rehabilitation/return-to-work process.

Workplace safety rules to narrow for women.

The Council of Ministers has published draft implementing regulations for a Labour Code amendment that limits a prohibition on "strenuous and harmful" work for women to apply only for expectant and breastfeeding women. It introduces a ban on manual lifting and restrictions on standing and exposure to computer screens. Final regulations should arrive by the May 1, 2017 target date for entry into force.

Global Health Update | Aon | April-May 2017 16

Russia

Ruling on tax treatment of hazardous work premium

The Supreme Court's Ruling No. 306-KG17-239 found that social levies should not be imposed on a premium for working in hazardous conditions. A company had failed to perform the workplace safety audit that would have determined that its workers were eligible for hazardous work premiums. The Court determined that it was legitimately subject to fines, but that the retroactive social levy was not legal.

Sweden

Inquiry into financial coordination on sick leave

The Health Ministry has tasked a special investigator with exploring better synergies of care for people on sick leave. The review will be centered on models of financial coordination for the autonomously functioning health care system and health insurance to improve assessment of needs and rehabilitation prospects. The report is due on November 30, 2018.

This coincides with an inquiry due March 15, 2018, on improving the job market for disabled workers. Options for a more flexible approach to accommodating and attracting disabled workers include the Danish "fleksjob" scheme for which the government tops up the salary paid by employers.

Ukraine

Health reform update

Parliament has approved in the first reading the bill On State Financial Guarantees of Medical Services and Medicine which outlines its health reform proposal:

The arrangement for funding a National Health Service from general revenues would transition from July 2017 to January 2019.

A guaranteed package of covered diseases and health services would be revised annually.

A copayment schedule, more modest than the current system, would also be up for yearly review.

A system for reimbursing essential medicines is already in pilot stage and should debut nationwide in 2019.

Diagnostic and treatment protocols would be established as well as standards for medical facilities.

Global Health Update | Aon | April-May 2017 17

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© 2017 Aon plc This document is intended for general information purposes only and should not be construed as advice or opinions on any specific facts or circumstances. The comments in this summary are based upon Aon Hewitt’s preliminary analysis of publicly available information. The content of this document is made available on an “as is” basis, without warranty of any kind. Aon Hewitt disclaims any legal liability to any person or organization for loss or damage caused by or resulting from any reliance placed on that content. Aon Hewitt reserves all rights to the content of this document.