Health & Welfare Plans Newsletter

January 3, 2017

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[Official Guidance]

Text of CMS State Innovation Waiver Approval Letter for Hawai'i (PDF)
"Hawai'i's application sought waiver of the ACA requirement that a [SHOP] operate in Hawai'i and other related provisions relevant to SHOP Exchanges. Under this waiver ... [certain enumerated] provisions of the ACA are waived in Hawai'i ... The Departments deny Hawai'i's request to waive section 131 l(t)(3)(B) to seek flexibility to permit state agencies other than the State Medicaid Agency to have a role in an Exchange ... Given that a Federally-facilitated Marketplace operates in Hawai'i, this provision will not be a part of the waiver."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Santa Monica Employers Ring in the New Year With Paid Sick Leave
"The paid sick leave accrual rate is the same as the state law's accrual rate -- requiring employers to provide employees with 1 hour of paid sick leave for every 30 hours worked.... In 2017, small businesses (i.e., those with 25 or fewer employees) will be required to provide employees with at least 32 hours of leave. Large businesses (defined as those with 26 or more employees) will be required to provide at least 40 hours. As of January 1, 2018, those numbers will increase to 40 hours for small business and 72 hours for large businesses."
Ogletree Deakins

District Court Rejects Retirees' Claim for Lifetime Healthcare Benefits
"[T]he court first observed that the agreements were for three-year terms and did not expressly state that the healthcare benefits vested, whereas the pension plan documents stated that Plaintiffs' pension benefits were lifetime benefits. Next, the court observed that several of the agreements restated and sometimes redefined the healthcare benefits available going forward, which would be unnecessary if the benefits had vested." [Sloan v. BorgWarner, Inc., No. 9-10918 (E.D. Mich. Dec. 5, 2016)]
Proskauer's ERISA Practice Center

ACA Pregnancy Termination, Gender Identity Protections Blocked; Wellness Program Incentives Survive
"Yesterday, January 1, 2017, several [ACA] rules were scheduled to go into effect. On December 31, however, a [Texas federal District Court] judge granted a preliminary injunction blocking parts of a nondiscrimination rule issued under ACA section 1557. On December 30, [a D.C. District Court] judge refused to block a rule allowing employers to offer significant incentives for employees to disclose medical information in connection with workplace wellness programs."
Health Affairs

The 2017 Watch list for Healthcare
"Watch for [1] refreshed approaches to privatizing Medicare ... [2] changes in how anti-trust issues and competition is regulated by the U.S. Department of Justice and the Federal Trade Commission ... [3] privatization to be injected into the Veterans Health and Indian Health programs ... [4] healthcare officials to relax reporting requirements for physicians and hospitals ... [5] pressures to be exerted toward drug manufacturers to reduce prices ... [6] private insurers to recover.... [7] consumer responsibility to become a key theme in health reform ... [8] employers to stay in the employee health benefits game."
Paul Keckley

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Separate vs. Combined Leave Policies
"To further evaluate whether to have a single PTO policy or separate policies for vacation, personal days and sick leave, [this article describes] some of the pros and cons of each.... Payout of Leave upon Termination ... Carryover of Accrued Leave ... Tracking of Leave ... How and When Leave is Earned ... Waiting Periods for Accruing and Using Leave ... Flexibility and Morale ... Privacy Issues ... Employers' Bottom Line."
Ford & Harrison LLP

[Opinion]

Stop Small Businesses from Getting Hit with Obamacare Tax Increases
"Making changes to the nearly seven-year-old, 2,000 page [ACA] -- Obamacare -- involves a lot of moving parts. One item that can't fall through the cracks is eliminating Obamacare taxes ... [The Health Insurance Tax] is a tax on health plans sold in the fully-insured market, 86% of these plans are purchased by small businesses. Since they bear much of the brunt of the tax, many small business owners feel they're being punishing for offering health insurance to their employees.... Repealing the Health Insurance Tax, the Medical Device Tax and the Cadillac Tax must be the first order of Congressional business to help our country's businesses, as well as individuals and families."
U.S. Chamber of Commerce

[Opinion]

Uncertainty Around Obamacare Will Cause Insurers to Bolt Exchanges
"If the uncertainty of this market was large before with the ACA, it is almost unknowable under whatever comes next. Thus the initial exit of some latecomers, including United Healthcare, and undercapitalized minor entrants, such as nonprofit co-ops, is almost certain to become a flood of firms leaving the exchanges. They have little choice since the risks are too large and the actuarially appropriate rates are still not obvious given the political turmoil and changing rules."
Newsweek

Benefits in General

[Official Guidance]

Text of IRS Form 5434-A: Joint Board for the Enrollment of Actuaries -- Application for Renewal of Enrollment (PDF)
"All individuals enrolled before January 1, 2017, are required by 20 CFR 901.11(d) to renew their enrollment in order to maintain active enrollment to perform actuarial services. To file and pay electronically, visit www.pay.gov. As an alternative to filing and paying electronically, you may enclose with this form your check or money order for $250 payable to the [IRS]." [Rev. Jan. 2017]
Internal Revenue Service [IRS]

[Official Guidance]

Text of IRS Publication 15 (Circular E): Employer's Tax Guide, for Use in 2017 (PDF)
69 pages. "What's New: ... New certification program for professional employer organizations ... Leave-based donation programs to aid victims of the severe storms and flooding in Louisiana ... Leave-based donation programs to aid victims of Hurricane Matthew ... Reminders: ... [T]he credit for COBRA premium assistance payments can't be claimed on Form 941, Employer's QUARTERLY Federal Tax Return (or Form 944, Employer's ANNUAL Federal Tax Return). Instead, after filing your Form 941 (or Form 944), file Form 941-X, Adjusted Employer's QUARTERLY Federal Tax Return or Claim for Refund (or Form 944-X, Adjusted Employer's ANNUAL Federal Tax Return or Claim for Refund), respectively, to claim the COBRA premium assistance credit."
Internal Revenue Service [IRS]

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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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