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Health plan admin - misc

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Cybersecurity Hot Topics for Closely Held Businesses (PDF)
"Cyberattacks are not exclusively a threat to companies of a particular size.... [1] Users can be your greatest risk or your best security ... [2] Multifactor authentication and a password management solution can help keep you secure ... [3] Use security software and create access barrier ... [4] Image-based backups with an offsite copy ... [5] Consider cyber liability insurance." (Journal of Pension Benefits)
[Official Guidance] System Validations for the 2017 MLR Reporting Year (PDF)
"When an issuer uploads the annual MLR reporting form into the Health Insurance Oversight System (HIOS), the submission undergoes several automated validations. Some of the validations result in an error message and the issuer must resolve the problem before they can attest to their submission." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Official Guidance] Text of CMS Medical Loss Ratio (MLR) Annual Reporting Form Filing Instructions for the 2017 MLR Reporting Year (PDF)
55 pages. "These are the filing instructions for the report to the Secretary required by section 2718 of the Public Health Service Act (PHSA), which includes elements that make up the medical loss ratio (MLR) and the calculation and provision of rebates to enrollees. The data included in the MLR Annual Reporting Form (MLR Form) are the exact data that will be used to calculate an issuer's MLR and rebates, if any ... The MLR Form has been updated to incorporate provisions in 45 CFR Part 158 that are effective for the 2017 MLR reporting year." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
IRS Doubles Down on Employer Mandate Enforcement (PDF)
"In addition to assessment notices in connection with an employer's failure to offer minimum essential coverage to at least 70% of its full-time employees and their dependents, the IRS is now sending assessments for 2015 coverage that was 'unaffordable' or failed to provide minimum value. If timing is like last year, IRS will start releasing assessment notices for the 2016 calendar year later this year." (Conduent)
ERISA Advisory Council to Meet August 14-16
"[T]he 192nd meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on August 14-16, 2018.... The purpose of the open meeting is for Advisory Council members to hear testimony from invited witnesses and to receive an update from [EBSA]. The EBSA update is scheduled for the morning of August 16, subject to change." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
Insurers Offer Tools to Dig Into Health Costs
"Three of Michigan's largest health insurers developed various software and support tools that provide employers with detailed reports on how their workforces spend health care dollars and where they access care.... 97 percent of human resource practitioners believe they need better tools to evaluate health care cost and use data to make better decisions on benefit plans." (Crain's Detroit Business)
[Guidance Overview] Telehealth Reimbursement May Be Coming to Medicare: CMS Proposes Medicare Payment for Virtual Visits and Review of Pre-Recorded Images
"[CMS], for the first time, has proposed payment for virtual visits to established patients regardless of such patients' location, effective January 1, 2019.... CMS is seeking comment on the types of communication technology that may be used in furnishing the virtual services, including whether audio-only telephone interactions are sufficient compared to interactions that are enhanced with video or other kinds of data transmission." (Drinker Biddle)
CMS Halts ACA Risk Adjustment Transfers
"CMS' decision presents two sets of issues for payers. One is an immediate question of cash flow for payers that were expecting to receive, in some cases, millions of dollars in payments ... for example, one Florida insurer was set to receive $666 million ... Longer term, for payers, the decision creates a large amount of uncertainty about the viability of remaining in the ACA markets." (PwC)
Upcoming July 31 Deadline for PCORI Fee Payment
"The 2017 PCORI fee for calendar year plans is equal to the average number of lives covered under the plan for 2017 multiplied by $2.39. This is a slight increase from last year. Self-insured plan sponsors should use IRS Form 720 (Quarterly Federal Excise Tax Return) to report and pay the fee. Insurers are responsible for paying the PCORI fee for insured plans." (Winston & Strawn LLP)
[Official Guidance] Text of CMS Memo: Implications of the Decision by U.S. District Court for the District of New Mexico on the Risk Adjustment and Related Programs (PDF)
"CMS will not collect or pay the specified amounts [for the 2017 benefit year] at this time. CMS will inform stakeholders of any update to the status of collections or payments at an appropriate future date.... CMS will not collect or pay any specified amounts remaining for the 2014-2016 benefit years at this time.... CMS will collect 2017 benefit year risk adjustment user fees in the August 2018 payment cycle ... Issuers must continue archiving and maintaining 2014, 2015, 2016, and 2017 EDGE data consistent with normal operations.... CMS will cease issuing any further discrepancy resolution decisions at this time." [Unnumbered document, July 12, 2018] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
IRS Releases Draft Forms 1094-C and 1095-C for 2018 But Not Much Has Changed
"The only thing that appears to have changed on the Form 1094-C is the year switched from 2017 to 2018.... After reviewing the draft Form 1094-C there are no other obvious differences compared to prior years. However, this could change upon the release of the draft instructions." (Accord)
Bullet Proofing Your Claims Procedures
"When there is a request for documents related to a claim or appeal pay close attention to what is requested ... and carefully assess what is relevant in light of the applicable court decisions. Given the change in the disability claim and appeal procedure requirements that became effective ... on April 1, 2018, and the regular litigation over disability claims, it may be prudent to carefully review the forms being used, the process being followed, how document requests are addressed, and how those match with the current requirements." (Winstead PC)
[Opinion] Freezing Risk-Adjustment Payments Will Cause More Instability in the Individual and Small-Group Insurance Markets
"The court ruled in February that the formula is arbitrary and capricious because CMS did not adequately justify key assumptions. The court left open that the formula may be allowed, if justified through notice and comment rulemaking.... CMS could have waited for the court to issue an opinion on a motion to reconsider the decision ... then appeal and request a stay to keep the formula in place through the appeals process. Reversal on appeal may not be a long shot given that a court in Massachusetts upheld the formula in a similar case." (The Commonwealth Fund)
[Guidance Overview] Recent New Jersey Legislation Affects Out-of-Network Health Services
"If a [self-insured plan subject to ERISA] opts in, its members would not be balance billed for out-of-network charges for emergency care in excess of the deductible, copayment, or coinsurance amount applicable to in-network services, and the plan can take advantage of the act's binding arbitration provisions. The opt-in plan must provide each primary insured with a health insurance identification card indicating that the plan has elected to be subject to the act." (Morgan Lewis)
[Official Guidance] Text of Draft 2018 IRS Form 1095-C: Employer-Provided Health Insurance Offer and Coverage (PDF)
July 11, 2018. "The 'Plan Start Month' box will remain optional on the 2018 Form 1095-C." Also released: Draft 2018 Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns. (Internal Revenue Service [IRS])
Time to 'Tune Up' Your Employee Benefit Service Provider Agreements
"[A]reas of potential concern with service provider agreements that may warrant a closer look. [1] Use of employee data ... [2] Indemnification.... [3] Agreement term." (Wilkins Finston Friedman Law Group LLP)
PCORI Fee: Long Story for Short Plan Years
"The PCORI fee applies to short plan years. The fee due for a short plan year is based on the average number of plan participants during the short plan year. There are three methods for self-insured plans to choose from when calculating the average number of participants." (International Foundation of Employee Benefit Plans [IFEBP])
[Official Guidance] Text of OPM Final Regs: Federal Employees Health Benefits Program and Federal Employees Dental and Vision Insurance Program: Expiration of Coverage of Children of Same-Sex Domestic Partners
"Understanding that we have provided agencies with additional time for compliance given that overseas federal employees may not have been able to marry immediately following the Supreme Court decision, OPM is issuing a final rule removing references to domestic partners and domestic partnerships from the regulations. Based on the Supreme Court decision and the two additional year's lead time for domestic partners overseas to marry, the current language in the CFR is not needed and may be somewhat confusing. There is no change in coverage for children whose same-sex partners are married." (U.S. Office of Personnel Management [OPM])
Insurer: ACA Risk Payments Use 'Flawed' Methodology
"Health Connections' CEO Marlene Baca said the [CMS suspension of risk-adjustment payments] was a positive development for both the company and the industry, particularly for small insurers who had been penalized by the program.... A CMS report released Monday showed New Mexico Health Connections would have had to pay a net sum of about $5.6 million[.]" (
[Guidance Overview] CMS Issues New Funding Opportunity Announcement for the Federally-Facilitated Exchange Navigator Program
"[CMS issued] the Funding Opportunity Announcement (FOA) for the Federally-facilitated Exchange (FFE) Navigator Program for plan year 2019... CMS expects to award up to $10 million for a 1-year period of performance. A minimum of $100,000 will be awarded in each of the 34 FFE states to provide assistance to Exchange consumers, starting in the fall of 2018. Awards will go to eligible grantees, such as chambers of commerce, small businesses, trade associations, and faith-based organizations." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Guidance Overview] Sections 4980H(a) and 4980H(b) Penalty Amounts Set for Historic Increase in 2019
"The Code explains that the original $2,000 amount associated with the section 4980H(a) penalty and the original $3,000 amount associated with the section 4980H(b) penalty would be adjusted for calendar years beginning after 2014 ... [T]he correct numbers to use when calculating the potential section 4980H penalties for 2019 are: Section 4980H(a) penalty amount = $2,500; Section 4980H(b) penalty amount = $3,750. The penalty amounts have increased significantly compared to 2018." (Accord)
[Official Guidance] Text of IRS Disaster Relief Notice TX-2018-05, for Victims of Severe Storms and Flooding in Texas
"Victims of severe storms and flooding that began on June 19, 2018 in parts of Texas may qualify for tax relief from the [IRS].... Individuals who reside or have a business in Cameron and Hidalgo counties may qualify for tax relief.... certain deadlines falling on or after June 19, 2018 and before Oct. 31, 2018, are granted additional time to file through Oct. 31, 2018." (Internal Revenue Service [IRS])
Three Things About the ACA Employers Need to Focus on Now
"[1] The IRS is currently assessing employer penalties using '226-J' Letters ... [2] ACA reporting requirements still apply ... [3] The 'Cadillac Tax' is still looming." (Hanson Bridgett LLP)
District Court Finds Two-Decade Pattern of Insurer's 'Extraordinary' Steps to Deny Disability Claims
"The court queried whether Reliance based its denial on substantial evidence. Its answer: No.... The court then queried whether Reliance has a conflict of interest. Its answer: Yes. The court found over 100 decisions in the last 21 years criticizing Reliance's disability decisions.... [T]he court noted that Reliance submitted no evidence showing that it has taken steps to mitigate its conflict of interest.... [T]he court found that Reliance abused its discretion by denying Nichols' benefits." [Nichols v. Reliance Standard Life Ins. Co., No. 17-42 (S.D. Miss. June 29, 2018). (Kantor & Kantor)
How Employers Should Respond to ACA Penalty Letters
"Letter 226-J gives employers the opportunity to refute the assessed penalty amount by filing Form 14764. Depending on the applicable large employer's response the IRS has begun to issue one of five versions of IRS Letter 227 as a response to the action the employer chooses to take on Letter 226-J.... [T]he IRS is already preparing to send out the next wave of 226-J letters for the 2016 fiscal year." (Employee Benefit News)
[Official Guidance] Text of CMS 2019 Guidance on Annual Eligibility Redetermination (PDF)
"For benefit year 2019, the alternative procedures ... are the same as the alternative procedures specified by the Secretary for benefit year 2018, as described in the published guidance titled Guidance on Annual Redeterminations and Re-enrollments for Exchange Coverage for 2018, with all references to years advanced by one.... These procedures will be used by all Exchanges using the federal eligibility and enrollment platform." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Circuit Split About ERISA Proper Party Defendants and Service of Process May Be Resolved by Supreme Court
"The Colorado Supreme Court's decisions upholding the dismissal of claims against two separate disability plans under ERISA may be under review by the [U.S.] Supreme Court, following submission of the joint petition for a writ of certiorari ... Petitioners asked the Supreme Court to review the following two issues: [1] a Circuit split regarding whether and when an ERISA benefit plan is a proper defendant in a benefit claim; and [2] whether an ERISA plan's agent for service of process must be an actual human or can be a group, corporation or other entity." (Robinson & Cole LLP)
Court Allows Provider to Proceed With Claim That Plan Violated Cost-Sharing Limit
"The hospital asserted that the plan essentially established a reference price when it reimbursed all of the hospital's services at 140% of Medicare's allowed charge. Because the plan's network did not include any hospitals or otherwise ensure access to hospitals that would accept the reference price, the hospital contended that the plan was required to count out-of-pocket expenses for charges over the reference price toward the maximum annual cost-sharing limit[.]" [Salinas Valley Memorial Healthcare Sys. v. Monterey Peninsula Horticulture, Inc., No. 17-7076 (N.D. Cal. May 31, 2018)] (Thomson Reuters / EBIA)
PCORI Fee Deadline Fast Approaching
"The fee and the related IRS Form 720 are due no later than July 31st. If your plan year ended on or before September 30, 2017, the fee is $2.26 per covered life. If your plan year ended between October 1, 2017 and December 31, 2017, the fee is $2.39 per covered life." (Graydon)
[Guidance Overview] IRS Releases ACA Affordability Rates for 2019
"For 2019, the required contribution percentage has increased to 9.86% (up from 9.56% in 2018). This means that if an employee's share of the premium for employer-provided coverage in 2019 is more than 9.86% of his or her household income, the coverage is not considered affordable for that employee and the ALE may be liable for a penalty if that employee obtains a premium tax credit through a Marketplace." (The Wagner Law Group)
How to Show on Form 5500 That a Welfare Benefit Plan Is Going Above or Dropping Below the 100-Participant Threshold
"Plans going under and over the threshold like this should not, in Part I of the main body of the Form, check the 'final return/report' or 'first return/report' boxes on line B. And do not confuse this exemption with the so-called '80-120' rule, which permits a plan that is not exempt from filing Form 5500 to continue filing the same financial Schedule (Schedule H for large plans or Schedule I for small plans) so long as it has at least 80 covered participants but not more than 120." (Thomson Reuters / EBIA)
[Guidance Overview] Association Health Plans: A New Frontier?
"Pros: [1] Exemption from various [ACA] requirements ... [2] Reduced reporting and disclosure requirements ... [3] Economies of scale ... Cons: [1] AHPs are MEWAs ... [2] AHPS are subject to ERISA and other laws that apply to group health plans ... [3] Small employers may become subject to Mental Health Parity, COBRA, and other requirements that apply to large employers ... [4] Taxation of health coverage and benefits ... [5] Liability concerns ... [6] Legal uncertainty." (Snell & Wilmer L.L.P.)
Healthcare Calculators, AI Enhance Employee Benefit Understanding
"There is a disconnect between what employers think they're doing and how employees feel they're being engaged ... 83% of employers believing they do a good job in benefits education, where only 75% of workers would agree.... Decision support during open enrollment ... can help workers feel they're making the right choice.... [D]ecision support can be classified into three buckets: communication, tech tools and using a hands-on approach." (Employee Benefit News)
The Exchanges Trends Report 2018 (PDF)
12 pages. "Data from the call center shows that the consumer satisfaction rate remained at an all-time high -- averaging 90 percent -- throughout the entire Open Enrollment period. This is up from 85 percent last year. 63 percent of uninsured consumers who have visited Federal platform Exchanges in the past year indicate they didn't purchase a health plan through the Federal platform because the health insurance premium was too expensive, which is up from 52 percent from the end of last year's Open Enrollment Period." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
IRS Publication 5172: Facts About Health Coverage Exemptions (PDF)
Rev. May 2018. "You obtain exemptions from either the Marketplace or IRS depending on the type. All exemptions are reported on the tax return. If you don't have to file a return, because your income is below your filing threshold, you are automatically exempt. Here are the types of exemptions available along with information about how to obtain them[.]" (Internal Revenue Service [IRS])
Preparation for an Outsourcing Renegotiation
"The first question is whether or not the outsourcing should continue.... All options available in the market should be considered before beginning a renegotiation.... Clients should review the relationship that exists with the service provider to develop an understanding of what is going well and what needs improvement.... It is important to calendar upcoming expiration and potential termination dates to avoid surprises and provide for adequate time to properly prepare." (Morgan Lewis)
Is Arbitration the Future for ERISA Claims?
"Absent further legislation by Congress amending the Federal Arbitration Act or state legislation permitting private attorney general actions such as California's Private Attorneys General Act, the enforceability of mandatory arbitration programs with class waivers can be assured. Employers and plan sponsors who do not have such arbitration programs need to be aware of this significant development and at least consider whether an arbitration program with a class waiver is appropriate for them" (Seyfarth Shaw, via Lexology)
Key Themes on Benefit Administration
"Today's workforce now spans five generations ... Employers, especially those facing a shortage of skilled labor, must prepare for an influx of all-new values, characteristics and behaviors.... To win the battle for employees' attention, to connect with them and guide them to smart benefit decisions, employers need to take a fresh approach to communication. One approach that makes a lot of sense is treating benefits like any other consumer good that employees 'buy,' and using marketing strategy and tactics to 'sell' them to employees." (Benefitfocus)
[Opinion] DOL Publishes Comments on Proposed MHPAEA FAQs Part 39
The DOL has begun posting comments on the proposed MHPAEA FAQs published in April of 2018. As of this date, 38 comments have been posted. The comment period ended June 22. (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
[Opinion] DOL Publishes Comments on Proposed MHPAEA Model Disclosure Request Form
The DOL has begun posting comments on the revised Model Disclosure Template published in April of 2018. As of this date, 5 comments have been posted. The comment period ended June 22. (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
IRS Releases Reporting Form for Plan Sponsors of Limited Wraparound Coverage
"The reporting requirement is intended to help CMS determine whether the exception for limited wraparound coverage is allowing employers to provide employees with benefits comparable to the employer's group health plan without eroding employer-sponsored coverage. In addition to required reporting, limited wraparound coverage must satisfy strict criteria to be considered an excepted benefit." (Thomson Reuters / EBIA)
[Official Guidance] Text of IRS Disaster Relief Notice HI-2018-03, for Victims of Storms, Flooding, Landslides and Mudslides in Hawaii
"Victims of severe storms, flooding, landslides and mudslides that occurred starting on April 13, 2018 in Hawaii may qualify for tax relief ... Individuals who reside or have a business in the City and County of Honolulu and Kauai County may qualify for tax relief.... [C]ertain deadlines falling on or after April 13, 2018, and before Aug. 15, 2018, are granted additional time to file through Aug. 15, 2018." (Internal Revenue Service [IRS])
[Guidance Overview] MEWAs and AHPs: What You Need to Know About the Association Health Plan Final Rule
"This Legal Alert provides brief background on the Final Rule's single-employer AHP criteria, and includes a chart that outlines some of the key differences between the requirements for MEWAs, single-employer AHPs established pursuant to existing guidance, and single-employer AHPs according to the alternative criteria established under the Final Rule." (Eversheds Sutherland)
[Guidance Overview] Final Association Health Plan Regs Provide Opportunity for Small Employers ... Maybe
"[We] now know that the DOL does not intend to alter existing ERISA preemption rules, which authorize State insurance regulation of AHPs ... We now also know that existing AHPs that meet current sub-regulatory guidelines to be considered an AHP do not need to satisfy these new rules to maintain that AHP status. The nondiscrimination provisions in the new rule also limit the opportunity for new AHPs to engage in risk selection by effectively eliminating the ability to medically underwrite individual employer members." (Porter Wright Morris & Arthur LLP)
New Plaintiffs' Firms Bring Increased ERISA Litigation Risks for Employers (PDF)
"Until recently, a small group of specialized plaintiffs' firms has dominated the ERISA class action space, beginning with untested theories of liability that are eventually leveraged into portfolios of lawsuits. Those portfolios (and the plaintiffs' attorneys who created them) have become well-known. But an interesting trend has emerged in the day-to-day ERISA litigation docket: new plaintiffs' firms have begun to enter the space in a significant way. This development, which has significant implications for plan sponsors and fiduciaries, has been picking up significant speed in the last several months." (Jenner & Block, via Employee Relations Law Journal)
[Guidance Overview] The Five Flavors of Employer Mandate Acknowledgment Letters
"[T]hese IRS acknowledgment letters still aren't bills. Even though some of the letters say how an employer can pay the penalty, if the employer owes something, the employer will get a separate CP220J once the penalty has been assessed.... The appeals process for these letters is more formal than the process for the Letter 226J, which usually just involves providing information." (HUB International)
[Guidance Overview] Garden State Plants Individual Healthcare Mandate; Insurance Market Harvest Uncertain
"The New Jersey mandate for individual health coverage basically follows the structure of the federal healthcare mandate -- it requires individuals to have coverage or pay a tax penalty, with certain exceptions. There are, however, some notable differences. [1] Grandfathered plans do not count ... [2] Association/MEWA plan coverage may not count: ... [3] Allocation of penalty revenue: ... [4] NJ penalty conditioned on federal tax credits." (HUB International)
[Official Guidance] Text of CMS Enrollment Manual for Federally-Facilitated Exchange (FFE) and Federally-Facilitated Small Business Health Options Program (FF-SHOP) (PDF)
195 pages, June 26, 2018. "This manual provides operational policy and guidance on key topics related to eligibility and enrollment activities within the FFEs and FF-SHOPs, as well as within the SBEs-FP, which use the federal platform for eligibility and enrollment platforms.... The information provided in this document applies to organizations and entities that may be involved in or assist with enrolling a QI into a QHP and/or QDP using the FFE eligibility and enrollment functions.... The information provided in this document applies beginning with plan year 2019[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Cyber Liability Insurance for Employee Benefit Plans
"Many [plan sponsors] are purchasing cyber liability insurance coverage to supplement their data security measures.... [M]any policies vest the decision to retain legal counsel in the insurer, rather than the policyholder.... Plan sponsors should also identify the plan's service providers who have access to PII and PHI and ensure that the plan's cyber liability policy covers those providers, or that those providers have their own cyber liability policies." (Spencer Fane)
Is Your Plan's IRS Form 5500 Complete, Accurate, and Ready for Filing?
"[I]ssues to look out for include: [1] Reporting the incorrect plan name, employer name, and/or plan number.... [2] Reporting of late deposits and/or qualification failures in an appropriate manner. [3] Misreporting on 'Schedule C.' ... [4] Entering incorrect codes describing the plan characteristics. [5] Reporting that there is no 'ERISA fidelity bond' in place ... [6] Misreporting the use or nonuse of leased employees. [7] Misreporting relating to controlled group, affiliated service group, multiple employer, or multiemployer status." (Hawley Troxell)
[Official Guidance] Text of CMS Reporting Form for Plan Sponsors Offering Limited Wraparound Coverage (PDF)
"[This] Reporting Form ... is used by Plan Sponsors of Limited Wraparound Coverage to satisfy the reporting requirement that must be met for the Limited Wraparound Coverage to qualify as an excepted benefit under [ERISA], the Internal Revenue Code, and the Public Health Service Act ... Who Must File ... When to File ... Where to File ... Instructions for the Form ... Form Questions: Part I -- Identification Information ... Part II -- Background Information ... Part III -- Attestation and Signature." [OMB Control No. 0938-1351, published online June 25, 2018, expiration date June 30, 2021] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Text of IRS Publication 4557: Safeguarding Taxpayer Data -- A Guide for Your Business (PDF)
21 pages, rev. June 2018. "Data security is now a necessity for every tax professional, whether a partner in a large firm or a sole practitioner, and every Authorized IRS e-File Provider. Every employee, both professional and administrative staff, should be educated about security threats and safeguards.... According to the FTC Safeguards Rule, tax return preparers must create and enact security plans to protect client data. Failure to do so may result in an FTC investigation." (Internal Revenue Service [IRS])
Text of IRS Publication 5293: Data Security Resource Guide for Tax Professionals (PDF)
"The Data Security Resource Guide for Tax Professionals is intended to provide a basic understanding of minimal steps to protect client data. All tax professionals are encouraged to work with cybersecurity professionals to ensure secure systems. Protecting taxpayer data from theft and disclosure is your responsibility." [Rev. May 2018] (Internal Revenue Service [IRS])
[Guidance Overview] Green Light for AHPs
"The final rule [requires] that a group or association of employers have at least one substantial purpose other than the provision of health benefits to its members. This is defined quite broadly, and could include simply offering conferences, classes or educational material on business issues to members or conducting public relations activities such as advertising and education on business issues. The primary purpose of the group can be the provision of health insurance." (Kilpatrick Townsend)
[Official Guidance] Text of CMS HIOS Portal User Manual (PDF)
99 pages. Version 28.00.00, June 2018. "The Health Insurance Oversight System (HIOS) is a federal system of record and provides a centralized, multi-user interface for insurance issuers and state/territory regulators to submit, and CCIIO to store information on individual and small group major medical insurance. Information submitted to HIOS is transferred in accordance with CCIIO regulations to provide data updates to" [Also available:Quick Reference Guide.] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Opinion] American Benefits Council Comments to EBSA on Proposed FAQs About MH/SUD Parity Implementation and the 21st Century Cures Act
"The Departments should clarify that a plan only violates MHPAEA where it cannot demonstrate that the processes, strategies, evidentiary standards, or other factors considered by the plan in implementing the NQTL are comparable to and applied no more stringently to MH/SUD benefits as compared to M/S benefits." (American Benefits Council)
[Opinion] American Benefits Council Comments to OMB on MHPAEA Draft Model Disclosure Request Form
"While a model form could be helpful, it is important that it not be imposed on plans as a requirement for individuals to request information with respect to NQTLs.... Any model form ... should be targeted to specific NQTLs, rather than framed as a general request for plan information related to MH/SUD benefits, which is how the form is currently drafted." (American Benefits Council)
[Guidance Overview] A New Pathway to Healthcare Delivery: Association Health Plans
"At least two states (Massachusetts and New York) are threatening to sue the Trump administration over this new rule.... In several states, group health insurance laws will need to be revised to permit individuals and small groups to participate in AHPs if they are not otherwise members of pre-existing tax-qualified bona fide associations.... [M]any states do not permit the inclusion of sole proprietors and individuals in group insurance arrangements." (Winston & Strawn LLP)
[Guidance Overview] DOL Issues Final Rule on Association Health Plans
"The new rule does not supplant existing guidance, so association health plans that existed prior will not be required to comply with the new rule unless they choose to expand the membership of the plan as permitted under the new rule. Additionally, association health plans can choose between satisfying the new rule or following the old requirements. The old requirements are more restrictive with respect to qualifying as a bona fide association, but more flexible on permitting experience rating for employer groups within the plan." (Stinson Leonard Street)
[Guidance Overview] J, K, L, M and N: What's In a Letter?
"If you responded to a Letter 226-J, the reply from the IRS will come in the form of one of the following four 227 letters: ... [1] If you submitted a completed Form 14764, ESRP Response agreeing to the ESRP amount proposed in your Letter 226-J, the IRS will acknowledge its receipt using Letter 227-J and provide instructions for making the ESRP.... [2] Letter 227-K. You want this letter.... [3] The IRS acknowledges receipt of your response to Letter 226-J and notifies you of the revised ESRP amount, using Letter 227-L.... [4] Letter 227-M ... acknowledges receipt of the information you provided disputing the proposed ESRP amount in Letter 226-J but provides that the amount of the ESRP remains unchanged." (Benefits Bryan Cave)
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