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News Items, by Subject

Health plan admin - misc


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Questions Employees Are Asking in 2019 About ACA Form 1095s
"What is this form I'm receiving? ... Why are you sending it to me? ... What am I supposed to do with this 1095 form? ... What if I get more than one 1095 form? ... What if I did not get a Form 1095-B or a 1095-C? ... I thought the [ACA] requirement to have health insurance was repealed. Do I still need this form?" (International Foundation of Employee Benefit Plans [IFEBP])
Court Reconsiders Application of Colorado State Ban on Discretionary Clauses Based on Disability Policy Amendments and SPD
"Here, the court found that a document prepared by the policyholder impacted the rights the insurance company attempted to grant to itself in the policy that it drafted. But we've also seen the reverse play out in the context of state bans on discretionary clauses; specifically, in cases where courts have found that a grant of discretion in a Plan document overrides a state ban on discretionary clauses in disability policies." [Ellis v. Liberty Life Assurance Co. of Boston, No. 15-090 (D. Colo. Jan. 15, 2019)] (Kantor & Kantor)
Cross-Plan Offsetting Case Triggers Legal Concerns for Plan Sponsors
"[P]lan sponsors should ... fully understand the way in which offsets are occurring under their plan, especially with respect to how this practice could impact their plan participants. Plan sponsors should endeavor to reach a compromise that would allow the TPA to seek overpayment recoveries on behalf of the plan without authorizing the TPA to engage in cross-plan offsets.... Keep in mind that prudent overpayment recovery activities are a legitimate fiduciary requirement under ERISA." [Peterson v. UnitedHealth Group Inc., No. 17-1744 (8th Cir. Jan. 15, 2019)] (Winston & Strawn LLP)
[Official Guidance] Text of IRS Rev. Proc. 2019-11: Determination of W-2 Wages Under Section 199A (PDF)
"This revenue procedure provides methods for calculating W-2 wages... [1] for purposes of section 199A(b)(2) of the Internal Revenue Code which, for certain taxpayers, provides a limitation based on W-2 wages to the amount of the deduction for qualified business income (QBI); and [2] for purposes of section 199A(b)(7), which, for certain specified agricultural and horticultural cooperative patrons, provides a reduction to the section 199A deduction based on W-2 wages." (Internal Revenue Service [IRS])
[Official Guidance] Text of IRS Proposed Regs: Section 199A Qualified Business Income Deduction (PDF)
39 pages. "This document contains proposed regulations concerning the deduction for qualified business income under section 199A of the Internal Revenue Code.... The proposed regulations provide guidance on the treatment of previously suspended losses that constitute qualified business income. The proposed regulations also provide guidance on the determination of the section 199A deduction for taxpayers that hold interests in regulated investment companies, charitable remainder trusts, and split-interest trusts." (Internal Revenue Service [IRS])
[Official Guidance] Text of IRS Notice 2019-07: Section 199A Trade or Business Safe Harbor: Rental Real Estate (PDF)
10 pages. "This notice contains a proposed revenue procedure that provides for a safe harbor under which a rental real estate enterprise will be treated as a trade or business solely for purposes of section 199A of the Internal Revenue Code[.]" (Internal Revenue Service [IRS])
[Official Guidance] Text of IRS Final Regs: Section 199A Qualified Business Income Deduction (PDF)
247 pages. "This document contains final regulations concerning the deduction for qualified business income under section 199A of the Internal Revenue Code.... The regulations also contain an anti-avoidance rule under section 643 of the Code to treat multiple trusts as a single trust in certain cases, which will affect trusts, their grantors, and beneficiaries. This document also requests additional comments on certain aspects of the deduction." (Internal Revenue Service [IRS])
Evolving the Benefit Mindset: Responding to Employee Expectations for Choice and Personalization
"70% of employees who were offered the maximum level of choice in benefits (a true flex fund plus voluntary benefits) stated they were satisfied with their benefits. However, adding decision support technology to that that same level of choice increased the number of satisfied employees by 15%. This suggests that employers can fully realize the value of choice leading to increased employee satisfaction and engagement when they provide tools to help employees understand and appreciate those choices." (Willis Towers Watson)
2018 Year in Review: Plus What Lies Ahead in 2019 (PDF)
54 presentation slides. Topics include: [1] ACA Marches On During Appeals; [2] Appealing Employer Exchange Notices; [3] 2018 ACA Reporting Deadline Extended; [4]Insured Nondiscrimination Rules Indefinite Delay; [5] Association Health Plans; [6] Individual Policy and Excepted Benefit HRAs; [7] Tax Cuts and Jobs Act; [8] California Leave Law Updates; [9] San Francisco Ordinance Updates. (ABD Insurance & Financial Services)
Eighth Circuit Dials Back Cross-Plan Offsetting
"The court reasoned, however, that nothing in the plan documents "even comes close" to authorizing cross-plan offsetting. The court rejected the TPA's argument that plan language giving it "broad authority" to interpret the plan authorized cross-plan offsetting. Otherwise, the court noted, it would essentially be adopting a rule under which anything not expressly prohibited by the plan is allowed." [Peterson v. UnitedHealth Group Inc., No. 17-1744 (8th Cir. Jan. 15, 2019)] (Thomson Reuters Practical Law)
HHS Requests Public Input on Potential Changes to HIPAA Privacy and Security Rules
"The RFI includes questions about various aspects of the privacy rule's disclosure provisions, with the goal of promoting information sharing for treatment and care coordination.... The RFI notes anecdotal evidence suggesting that some covered entities are reluctant to disclose PHI to relatives of individuals facing health crises for fear of violating HIPAA.... The RFI asks whether the requirements for Notices of Privacy Practices can be made less burdensome, whether the model notices are being used, and whether there are better ways to inform individuals of their HIPAA rights." (Thomson Reuters / EBIA)
[Official Guidance] CMS Issues the Proposed Payment Notice for 2020 Coverage Year
"This rule proposes regulatory and financial parameters applicable to qualified health plans (QHPs) on the Exchanges, plans in the individual, small group, and large group markets, and self-funded group health plans. These changes proposed in the rule would further the Trump Administration's goals of lowering premiums, enhancing the consumer experience, increasing market stability, reducing regulatory burdens, and protecting taxpayers." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Michigan Repeals HICA Tax and Adds New Insurance Provider Assessment Tax
"Sponsors of self-insured plans will want to confirm with their TPAs that [Health Insurance Claims Assessment (HICA)] taxes are not included in any claims incurred on or after October 1, 2018, and discuss how to recoup any HICA taxes withheld after that date. They should also verify that the TPAs have complied with the final HICA tax payments and reporting obligations. The final quarterly return was due October 31, 2018, and the 2018 annual return filing deadline is February 28, 2019." (Willis Towers Watson)
[Guidance Overview] Implications for Employee Benefit Plans of California Consumer Privacy Act of 2018
"Even if the [California Consumer Privacy Act of 2018 (CCPA)] is ultimately determined to be preempted in the context of ERISA plans, it will still apply to data collection by an employer in its capacity as an employer, as well as data related to benefits and policies not covered by ERISA. This includes information collected by an employer in connection with administering vacation, sick leave, paid time off or leaves of absence. Other benefits that are generally not subject to ERISA include health savings accounts, dependent care flexible spending accounts, many short-term disability plans and certain voluntary benefits." (Hunton Andrews Kurth, via Lexology)
Form 5500 Schedule C Questionnaire Process
"Create a standard template questionnaire that will apply to most vendors.... Create a template for indirect compensation only that will be sent to plan trustees and plan employees.... Coordinate the service provider list with the Form 5500 preparer to verify its accuracy.... Review returned questionnaires to make sure they are fully completed by responders and if any questions need to be resolved." (Lindquist LLP)
Stats That Could Make You Re-Evaluate Your Benefit Administration Strategy
"[1] Benefits account for 31.7% of total compensation costs, on average.... [2] Four out of five employees enroll in the wrong health plan.... [3] Nearly 90% of employees feel technology improves their understanding of benefits.... [4] 26% of employees report having left a job or rejecting a job offer due to the benefits offered.... [5] 37% of employers say the ability to integrate benefits technology with HR functions is the most valuable outcome of implementing a benefits administration platform." (Benefitfocus)
Rising Penalties for Non-Compliant Employee Benefit Plans
"2019 penalties for the following violations reflect the increase from 2018: [1] Failure to file an annual report (Form 5500).... [2] Failure to provide blackout notices.... [3] MEWA's failure to file required report (M-1).... [4] Employer's failure to tell employees about Medicaid/CHIP coverage.... [5] Failure to furnish reports (e.g., pension benefit statements) to certain former participants and beneficiaries or to maintain records.... [6] Failing to comply with the Genetic Information Nondisclosure Act (GINA)." (Hall Benefits Law)
[Official Guidance] Text of DOL Annual Adjustments to Civil Penalties for 2019 (PDF)
"This final rule sets forth the Department's 2019 annual adjustments for inflation to its civil monetary penalties, effective [on the date published in the Federal Register]." Penalties under various ERISA provisions begin on page 31; FMLA penalties are on page 34. This pre-publication version is being made available by DOL. It will be published in the Federal Register when normal government operations resume. (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
Long-Awaited Employee Benefit Plan Audit Standard Final Balloted
"Changes to the form and content of the auditor's report on the financial statements and the ERISA required supplemental schedules are among the most significant changes resulting from the new standard.... Auditors are required to perform procedures sufficient to ensure that amounts received and disbursed as reported by the trustee or custodian were determined in accordance plan provisions.... Auditors are required to read the draft Form 5500 and identify material inconsistencies, if any, with the audited financial statements prior to dating the auditor's report." (Schneider Downs)
IRS Announces Opening Date for Electronic Filing of 2018 Forms 1094 and 1095
"The IRS has announced that electronic filing of [ACA] information returns (Forms 1094/1095) for the 2018 tax year will become available on January 15, 2019, at approximately 9 a.m. Eastern time.... Electronic filing through the IRS's ACA Information Returns (AIR) Program is mandatory for coverage providers and ALEs transmitting 250 or more individual information returns." (Thomson Reuters / EBIA)
ERISA Litigation Defendants Take Note: Burdens of Proof Are Becoming More Weighty
"Many parties to ERISA litigation and arbitration pay lip service to the burden of proof, put on their respective cases and leave it to the trier of fact to decide which side deserves the victory. Burdens of proof have become increasingly important, however, as procedural and substantive issues become more complex, and judges often have less time to deal with the subtleties in ERISA litigation.... Emphasizing burdens of proof can mean the difference between winning or losing, and potentially millions of dollars in damages." (Seyfarth Shaw LLP)
Insurer's Acceptance of LTD Insurance Premiums Does Not Guarantee Coverage
"[T]he court ruled that the insurer did not waive its right to deny coverage by accepting premiums and failing to notify him that coverage was not in effect.... [T]he employer had paid premiums to the insurer on an aggregate basis that did not provide data at the individual employee level. As a result, the insurer did not know what amount in premiums was being paid for which employees." [Ward v. Aetna Life Ins. Co., No. 17-331 (S.D. Miss. Dec. 20, 2018)] (The Wagner Law Group)
[Official Guidance] Text of Draft IRS Publication 502: Medical and Dental Expenses (Including the Health Coverage Tax Credit) for Use in Preparing 2018 Returns (PDF)
28 pages; Jan. 4, 2019. "This publication explains the itemized deduction for medical and dental expenses that you claim on Schedule A (Form 1040). It discusses what expenses, and whose expenses, you can and can't include in figuring the deduction.... This publication also explains how to treat impairment-related work expenses, health insurance premiums if you are self-employed, and the health coverage tax credit that is available to certain individuals." (Internal Revenue Service [IRS])
How Well Do Employees Understand and Engage with Their Health Accounts?
"Even the most financially literate employees struggle to understand the value of and differences between health accounts. While encouraging long-term saving to HSAs is important, employers cannot lose sight of the fact that HSAs are largely used as a spending account by most employees. Employees look to account providers for excellent customer service, enhanced decision support, personalized online tools and other services to help them better understand and use their health accounts." (Willis Towers Watson)
2019 Health Plan Compliance Calendar (PDF)
"Employers must comply with certain filing and disclosure requirements each year in connection with their group health plans. This chart summarizes some of the key requirements and is designed to be used as a tool to help facilitate annual compliance." (Cowden Associates, Inc.)
[Official Guidance] Text of GASB Exposure Draft: Implementation Guide -- Fiduciary Activities
37 pages. Includes amendments to existing Q&As, along with new Q&As covering: [1] Identifying fiduciary activities; ... [2] Reporting fiduciary activities in fiduciary funds ... [3] Statement of fiduciary net position ... [4] Statement of changes in fiduciary net position. (Governmental Accounting Standards Board [GASB])
Habits to Create an Effective Benefits Strategy and Open Enrollment, Part 1
"Share your vision with your executive team early in the process to make sure you are staying aligned with the overall objectives of the company and meeting their expectations to prevent misguided efforts and work.... Never underestimate the importance of designating time for planning and prep work to prevent the urgent crises in the future -- make communicating early and often a top priority." (Benefitfocus)
Court Awards Plaintiff's Attorney the Highest Rate Awarded in a Disability Case to Date: $900 per Hour
"[T]he court found that hourly rates of $450 for the associate on the case and $900 for the partner to be reasonable and within the prevailing rates in the market of ERISA attorneys. The court rejected Defendants' argument that [the plaintiff] should not get full fees because a few claims were dismissed early in the case. The court found that the claims arose from the same core of facts such that the work done on the dismissed claims was likely to have aided and overlapped with the successful abuse of discretion claim." [Dimry v. Bert Bell/Pete Rozelle NFL Player Ret. Plan, No. 16-01413 (N.D. Cal. Dec. 22, 2018)] (Kantor & Kantor)
Medicare Part D Disclosure to CMS (PDF)
"Employers with group health plans that provide prescription drug coverage to individuals who are eligible for Medicare Part D must disclose to [CMS] certain information about the coverage.... The disclosure to CMS is due within 60 days after the start of each plan year (March 1, for calendar year plans)." (EPIC)
[Official Guidance] Text of 2018 Instructions for IRS Form 8889: Health Savings Accounts (HSAs) (PDF)
"Use Form 8889 to: [1] Report health savings account (HSA) contributions (including those made on your behalf and employer contributions), [2] Figure your HSA deduction, [3] Report distributions from HSAs, and [4] Figure amounts you must include in income and additional tax you may owe if you fail to be an eligible individual." (Internal Revenue Service [IRS])
Class Action Challenging Insurer's Denial of TMS Treatment for Depression Proceeds to Trial
"The participants assert that the insurer improperly developed and implemented a policy to deny [Transcranial Magnetic Stimulation (TMS)] coverage as an experimental and investigational treatment ... Finding the testimonial evidence sufficient to raise an issue of material fact as to whether the insurer ... [denied] TMS benefits based on requirements not found in the class members' plans, the court denied the insurer's motion for summary judgment[.]" [Meidl v. Aetna, Inc., No. 15-1319 (D. Conn. Oct. 11, 2018)] (Thomson Reuters / EBIA)
Does Loss of Eligibility for Short-Term, Limited-Duration Health Insurance Trigger HIPAA Special Enrollment Rights?
"The preamble to the regulations indicates that loss of eligibility for short-term, limited-duration coverage gives rise to a HIPAA special enrollment right with respect to group health plan coverage ... [L]oss of eligibility does not include loss of coverage resulting from the failure to pay timely premiums or voluntarily dropping coverage. Thus, special enrollment rights under your plan will not be triggered ... solely because an employee becomes dissatisfied with the short-term, limited-duration coverage and decides to drop the coverage." (Thomson Reuters / EBIA)
How Will the Partial Government Shutdown Affect Employers?
"Unlike other recent government shutdowns, the instant closure affects only nine federal agencies [including] the Department of the Treasury ... In addition, certain smaller independent agencies, such as the Equal Employment Opportunity Commission (EEOC), will also be impacted. It will be business as usual for other agencies, including the [DOL] ... and [HHS], which have already been funded through September 2019." (Littler)
Ding Dong, the HPID Is Dead: HHS Proposes to Kill Health Plan Identifier Standard
"The employer registration process for obtaining a HPID turned out to be onerous, time-consuming and required multiple steps to complete.... Most health plans were already using the NAIC payer ID as its unique identifier and intended to continue using this identifier even if the HPID was required as well. NCVHS recommended that requiring use of the HPID would be both redundant and a significant disruption to administrative transactions." (Lockton)
Secrets Behind Comcast's Surprising Healthcare Success
"Comcast spends about $5,800 per person enrolled in its health plan. That number ... [is] just a hair above average employer spending. What's truly eye-popping are two things Comcast gets for its money: [1] Incredibly low employee cost-sharing. Employees only pay a $250 deductible on their care, compared to a $1,500 industry average. [2] Nearly flat cost growth.... Where other large employers see 3% year-over-year healthcare cost growth, Comcast's spending only goes up 1%. Clearly, Comcast is doing something right." (mpirica)
Court Rules that Payment and Acceptance of Long-Term Disability Insurance Premiums Does Not Guarantee Coverage
"The court found that Aetna did not waive its right to deny coverage by accepting premiums and failing to notify [the employee] that coverage was not in effect.... [T]he employer paid premiums under an aggregate billing method and did not provide Aetna with data at the individual employee level.... The employer is responsible for enrollment and collecting premiums." [Ward v. Aetna Life Ins. Co., No. 17-331 (S.D. Miss. Dec. 20, 2018)] (Kantor & Kantor)
[Official Guidance] Text of IRS Publication 15-A: Employer's Supplemental Tax Guide, for Use in 2019 (PDF)
73 pages. Topics include: [1] Who are employees? [2] Employee or independent contractor? [3] Employees of exempt organizations. [4] Religious exemptions and special rules for ministers. [5] Wages and other compensation. [6] Sick pay reporting. [7] Pensions and annuities. (Internal Revenue Service [IRS])
[Official Guidance] Text of CMS Guidance: Availability of Additional Special Enrollment Period for Certain Individuals Affected by Hurricane Michael in Florida and Georgia (PDF)
"Qualifying individuals in Florida counties that FEMA designated as eligible to apply for 'individual assistance' or 'public assistance' ... will have until February 16, 2019 to enroll in Exchange coverage (that is, 60 days following the end of the first SEP on December 18, 2018). Qualifying individuals in Georgia counties that FEMA designated as eligible to apply for 'individual assistance' or 'public assistance' ... will have until February 20, 2019 to enroll (60 days following the end of the first SEP on December 22, 2018)." [Unnumbered document; Dec. 21, 2018] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Under ERISA, Ignorance Is Bliss in the Ninth Circuit
"[T]he Ninth Circuit concluded that the statute of limitations was not triggered when the documents were made available to the plaintiff.... [T]he plaintiff was required to have actual knowledge that Intel increased the retirement funds' alternative investments and that those investments were imprudent." [Sulyma v. Intel Corp. Investment Policy Comm., No. 17-15864 (9th Cir. Nov. 28, 2018)] (Ogletree Deakins)
HHS Proposes to Rescind HIPAA Health Plan Identifier (HPID) Rules
"Based on both NCVHS's recommendation and 'overwhelming and persistent industry input,' HHS concluded... that the HPID and OEID do not, and cannot, serve the purpose for which they were originally adopted." (Thomson Reuters Practical Law)
[Official Guidance] Text of IRS Notice 2019-05: Individual Shared Responsibility Payment Hardship Exemptions for the 2018 Tax Year (PDF)
"This notice supplements Notice 2014-76, ... as supplemented by Notice 2017-14, ... by identifying additional hardship exemptions from the individual shared responsibility payment under Section 5000A of the Internal Revenue Code that a taxpayer may claim on a Federal income tax return for the 2018 tax year without obtaining a hardship exemption certification from the Health Insurance Marketplace." (Internal Revenue Service [IRS])
Cutting Employee Hours to Avoid ACA Requirements Costs Employer $7.4 Million
"[T]he employees claimed that Dave & Buster's discriminated against them 'for the purpose of interfering with the attainment' of their right to health coverage under the health plan because they were covered under the restaurant's health insurance plan prior to the enactment of the ACA.... On December 7, the court gave preliminary approval to Dave & Buster's $7.4 million proposed settlement, which also bars Dave & Buster's management from taking adverse employment actions against employees for the purpose of denying them health coverage." [Marin v. Dave & Buster's, Inc., No. 15-3608 (S.D.N.Y. Dec. 7, 2018)] (Davis Wright Tremaine LLP)
Are Medicare Part D Disclosure Notices Required for an HRA or Health FSA?
"The answer is probably yes for the HRA, and no for the health FSA. This assumes that your company's health FSA and HRA will offer prescription drug coverage to Part D-eligible individuals -- i.e., individuals covered under Medicare Part A or Part B, including active and disabled employees, COBRA participants, retirees, and their covered spouses and dependents who live in the service area of a Part D prescription drug plan." (Thomson Reuters / EBIA)
Merging of Payroll and Benefit Platforms Creates New Challenges, Opportunities
"The move toward integration of payroll and benefit management platforms exists for a relatively simple reason: it creates efficiencies and ease-of-use for both employees and HR departments. The actual process of finding seamless integration between payroll and benefit platforms has been less simple. But as technology and AI advances have opened new possibilities, integrated systems are becoming more common." (BenefitsPro)
Seventh Circuit: Plaintiffs Seeking Plan Benefits Need Not Cite Specific Plan Provisions to Survive Motion to Dismiss
"[T]he Seventh Circuit declared that '[P]laintiffs alleging claims under 29 U.S.C. Section 1132(a)(1)(B) for plan benefits need not necessarily identify the specific language of every plan provision at issue to survive a motion to dismiss under Rule 12(b)(6).' Dr. Griffin did not need to point to a particular plan provision specifying entitlement to 'greater payment,' as such a requirement would 'turn notice pleading on its head[,]' especially when the plan failed to provide Dr. Griffin with 'information necessary to allege with more detail where the plan's calculation of the usual and customary rate went astray.' " [Griffin v. TEAMCARE, No. 18-2374 (7th Cir. Nov. 26, 2018, amended Nov. 30, 2018)] (Arent Fox)
What Does the Recent Texas Court Decision Mean for the US Health Insurance Market and Employers?
"This decision, if ultimately upheld through the appeals process, would eliminate not only the Marketplaces, Medicaid expansion, premium subsidies, employer mandate, and other provisions governing individual insurance and employer-sponsored health plans, but also provisions that created the Center for Medicare and Medicaid Innovation, that apply the Mental Health Parity and Addiction Equity Act to individual and small group plans, that close the Medicare Part D donut hole, and that created an approvals process for biosimilar drugs, among numerous other provisions." [Texas v. U.S., No. 18-167 (N.D. Tex. Dec. 14, 2018)] (Epstein Becker Green)
Sixth Circuit Holds Employer Has No Duty to Notify of Conversion Options
"[T]he court held that the test is not whether the plan provider should know that the former employee might be interested in converting his group life insurance -- because he did not ask the question, the plan provider was not obligated to provide an answer.... [T]he court held that neither ERISA nor its implementing regulations required [the employer] to provide any more information about conversion options than what was found in the summary plan description." [Vest v. Resolute FP US Inc., No. 18-5046 (6th Cir. Oct.10, 2018)] (Carlton Fields)
ACA Employer Mandate Enforcement: 2016 Penalty Letters
"[The authors] have noticed significant differences between the employer's reported data and the data the IRS includes with the Letter 226J.... Because of these very significant data inaccuracies, you will need your 2016 Form 1094-C and relevant Forms 1095-C on-hand to audit and review the data you filed against the data included in the IRS's 226J Letter." (HUB International)
Domestic Partner Taxation and Benefits
"[P]lans offering domestic partner coverage are encouraged to require completion of a Domestic Partner Affidavit ... [wherein] the employee and domestic partner attest that certain requirements for domestic partnership under the plan, such as cohabitation, are satisfied.... [C]are should be taken to make sure they comply with any applicable state law.... Given the complexity and uncertainty around the taxation of domestic partner coverage, employers should also consult with their tax advisors to determine the best approach for valuing domestic partner coverage." (HUB International)
[Official Guidance] Text of HHS Proposed Regs Rescinding the Adoption of the Standard Unique Health Plan Identifier and Other Entity Identifier
39 pages. "This proposed rule would rescind the adopted standard unique health plan identifier (HPID) and the implementation specifications and requirements for its use and the other entity identifier (OEID) and implementation specifications for its use. The decision to propose to rescind the adopted standards was made following a careful assessment of industry input, as well as HHS's intention to explore options for a more effective standard unique health plan identifier in the future." (U.S. Department of Health and Human Services [HHS])
District Court Rules ACA Unconstitutional
"Besides determining whether to join one side or the other of this lawsuit (nearly two-thirds of states are now involved) and ongoing questions about the role to play in health insurance exchanges, many states are faced with determining the extent to which they will support association health plans and short-term, limited duration insurance, whether they will expand Medicaid coverage, and whether they will seek waivers of ACA requirements." [Texas v. U.S., No. 18-167 (N.D. Tex. Dec. 14, 2018)] (Ballard Spahr LLP)
[Official Guidance] Statement from the Department of Health and Human Services on Texas v. Azar
"The recent U.S. District Court decision regarding the [ACA] is not an injunction that halts the enforcement of the law and not a final judgment. Therefore, HHS will continue administering and enforcing all aspects of the ACA as it had before the court issued its decision." (U.S. Department of Health and Human Services [HHS])
ERISA Record Retention Requirements In Plain English
"A solid record retention policy allows you to quickly and easily respond to employee documentation requests or changes, deal with audits, and keep things compliant.... The 401(k)-related records you need to keep: [1] Fiduciary Plan Documents ... [2] Contracts & Agreements ... [3] Participant Notices ... [4] Compliance ... [5] Participant-Level Benefit Determinations ... [Y]ou can dispose of your physical copies once you've made and securely stored electronic copies ... However, there are requirements for correct electronic reporting." (ForUsAll)
Improper Delegation of Authority Could Cost a Plan its Deferential Standard of Review
"Review vendor contracts and plan documents to ensure that claims administrators have the final decision-making authority -- and do not include provisions allowing the employer (plan sponsor) to override those determinations. If a plan intends to delegate authority to a third party through a contract (such as an ASA), that contract should state that it is part of the plan documents.... [O]nce that document is considered a plan document, it must be disclosed to participants upon their request. Confidentiality provisions in an ASA may preclude such disclosure." (Trucker Huss)
[Official Guidance] Reminders to Qualified Health Plan Issuers: CMS QHP Requirements for Personally Identifiable Information Breach and Security Incident Reporting (PDF)
Unnumbered document; Dec. 14, 2018. "What happens if a QHPI fails to report a suspected or confirmed Incident or Breach involving PII? ... What happens if a QHPI fails to report a suspected or confirmed Incident or Breach involving PII?" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Official Guidance] Text of IRS Notice 2019-02: Standard Mileage Rates for 2019 (PDF)
"The standard mileage rate for transportation or travel expenses is 58 cents per mile for all miles of business use ('business standard mileage rate').... The standard mileage rate is 14 cents per mile for use of an automobile in rendering gratuitous services to a charitable organization under Section 170.... The standard mileage rate is 20 cents per mile for use of an automobile: [1] for medical care described in Section 213; or [2] as part of a move for which the expenses are deductible under Section 217(g).... For automobiles a taxpayer uses for business purposes, the portion of the business standard mileage rate treated as depreciation is 24 cents per mile for 2015, 24 cents per mile for 2016, 25 cents per mile for 2017, 25 cents per mile for 2018, and 26 cents per mile for 2019." (Internal Revenue Service [IRS])
[Guidance Overview] IRS Extends Transition Relief for 2018 ACA Statements
"[T]he IRS encouraged delinquent filers to file late if necessary and ... stated that an employer's voluntary correction of delinquent returns will be taken into consideration in determining whether the employer may be entitled to reasonable cause relief for filing late.... The IRS extended ... transition relief to returns filed in 2019 for 2018 coverage. This relief does not extend to non-filers of the 2018 return, but extends to 2018 returns that are timely filed in 2019 that contain incorrect or incomplete information." (Holland & Hart LLP)
2019 Planning for Health and Welfare Benefit Plan Operations (PDF)
"[This calendar] presents a schedule of activities that address important upcoming deadlines and [a separate] Reporting and Disclosure Guide will help you identify and address other activities that are event-based and participant-specific." (Buck)
Michigan HICA Tax Officially Repealed
"Michigan officially repealed the Health Insurance Claims Assessment (HICA) tax on June 11, 2018. However, that repeal was conditioned on the approval of its replacement -- the Investment Provider Assessment (IPA) -- by [CMS]. On December 11, 2018, CMS ... approved the IPA.... [S]elf-funded group health plans are not subject to the IPA. On the other hand, fully insured group health plans are subject to the IPA." (Miller Johnson)
[Guidance Overview] 2019 Health and Retirement Plans Reporting and Disclosure Calendar: Single Employer Plans (PDF)
"[This 24-page calendar summarizes] the annual compliance requirements and disclosure obligations that health and retirement plan sponsors need to know. The content in these calendars raise issues that may cause plan sponsors to check, change or consider their current approaches." (Sibson Consulting)
 
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