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<< Older News  |  September 25, 2020

News

All News > Health Plan Administration

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DOL's Proposed Rule Provides Framework for Employers to Classify Workers as Independent Contractors
Duane Morris LLP Link to more items from this source
[Guidance Overview]
Sept. 24, 2020

"The DOL's newly proposed regulations are intended to provide clarity to employers by adopting a simplified model framework for determining independent contractor status under the 'economic realities' test. The economic realities test, which often has been used by courts deciding worker classification issues, generally considers whether a person performing services for a potential employer as an independent contractor truly operates his or her own independent business that is not economically dependent on the employer."

Tags: Health Plan Administration  •  Health Plan Design  •  Retirement Plan Administration  •  Retirement Plan Design

Leasing Healthcare Employees? Don't Overlook the Benefits Traps, Part 2
Bradley Link to more items from this source
Sept. 23, 2020

"In the context of employee leasing, a self-funded group health plan is most likely to be deemed a MEWA if the employees are not respected as common law employees of the lessor. While the facts and circumstances of the arrangement are most likely to drive the determination on this point, the parties to the arrangement should ensure that the agreement clearly reflects the intent that the lessor be treated as the common law employer of the leased employees."

Tags: Health Plan Administration  •  MEWAs

October 14 Is the Last Day to Provide Medicare Part D Notice of Creditable (or Non-Creditable) Coverage
Fraser Trebilcock Link to more items from this source
Sept. 23, 2020

"[E]mployers offering group health plans with prescription drug coverage are required to disclose to all Part D-eligible individuals who are enrolled in or were seeking to enroll in the group health plan coverage whether such coverage was 'actuarially equivalent,' i.e., creditable.... This notice is required to be provided to all Part D eligible persons, including active employees over age 65."

Tags: Health Plan Administration  •  Medicare

IRS Announces Tax Relief for Hurricane Sally Victims
Internal Revenue Service [IRS] Link to more items from this source
[Official Guidance]
Sept. 23, 2020

"Victims of Hurricane Sally that took place on Sept. 14 now have until Jan. 15, 2021, to file various individual and business tax returns and make tax payments ... Individuals and households who reside or have a business in Baldwin, Escambia, and Mobile counties qualify for tax relief.... [C]ertain deadlines falling on or after Sept. 14, 2020, and before Jan. 15, 2021, are postponed through Jan. 15, 2021."

Tags: Health Plan Administration  •  Reporting to Government Agencies  •  Retirement Plan Administration

ACA Employer Mandate 2021
HUB International Link to more items from this source
[Guidance Overview]
Sept. 22, 2020

"In preparing a pay or pay analysis for the 2021 renewal, begin to use the updated Section 4980H(a) and (b) penalties. Remember when setting premium contributions for a 2021 renewal, to use the newly set affordability percentage to calculate premium contributions. If offering an ICHRA, be sure to determine affordability based on primary residence or primary work location."

Tags: Health Plan Administration

Answers to Common Employee Open Enrollment Questions
OneDigital Health and Benefits Link to more items from this source
Sept. 22, 2020

"Most employers believe they offer clear benefits communications, but many overestimate their efforts. The truth is that 30% of employees do not think their company's benefits communications are easy to understand. When employees approach open enrollment informed and in a proactive nature, they can make choices that fit them better. [This article provides] a list of the most commonly asked employee questions [with answers]."

Tags: Health Plan Administration

Aflac Survey: Pandemic Has 49% of Employees Rethinking Benefits
InsuranceNewsNet.com Link to more items from this source
Sept. 22, 2020

"[N]early half (49%) of employees said the pandemic has been a wake-up call to invest more time researching and selecting the best coverage options for their situation. This represents a significant shift in employee behavior considering a vast majority of employees (92%) choose the same benefits year after year and on average spend 33 minutes on the task -- statistics that haven't changed meaningfully over the years of the survey."

Tags: Coronavirus (COVID-19)  •  Health Plan Administration  •  Health Plan Design

Editor's Pick Key Decision Points in ACA Reporting Vendor Setup Questionnaires, Part 3: The Measurement, Administrative, and Stability Periods
ABD Insurance & Financial Services Link to more items from this source
[Guidance Overview]
Sept. 21, 2020

"Although the look-back measurement method (LBMM) in its most granular details is likely the most complex compliance aspect of employer-sponsored group health plans, the basics of the LBMM are quite simple: Employees' status as full-time or part-time is generally kept stable for the current stability period (typically the plan year) based on the prior-year measurement period."

Tags: Health Plan Administration

Portable Benefit Solutions: Financial, Health & Retirement (PDF)
Women's Institute for a Secure Retirement [WISER] Link to more items from this source
Sept. 18, 2020

16 pages. "One of the challenges in building an entrepreneurial ecosystem is that the new jobs created rarely offer employee benefits.... [This] project aimed to assess the feasibility of an online platform to serve as a virtual human relations department for entrepreneurs, self-employed workers, independent contractors, freelancers and other workers without access to benefit resources.... The use of online, fintech platforms hold great promise for bridging this gap and connecting independent workers with information, services and opportunities to build a stronger financial future."

Tags: Health Plan Administration  •  Health Plan Design  •  Retirement Plan Administration  •  Retirement Plan Design

Group Life Insurance and Clerical Errors: Court Finds Employer, Not Insurer, Liable for Death Benefit
HUB International Link to more items from this source
Sept. 18, 2020

"[Although] it was the third party that made the repeated verbal representations that the benefits were larger ... the court held the employer, as plan administrator in the context of its benefit program, responsible ... [It] is unclear from this case whether the coding error occurred on the employer's side or the third-party's side.... [A] check of payroll records may have avoided this issue." [Sullivan-Mestecky v. Verizon Communications Inc., No. 18-1591 (2d Cir. Jun. 1, 2020)]

Tags: Death Benefits & Life Insurance  •  Health Plan Administration

Tips for a Successful Remote Open Enrollment
HealthEquity Link to more items from this source
Sept. 18, 2020

"[1] Communicate benefits changes with real-world connections.... [2] Adapt your materials for a remote environment.... [3] Select and vet the technology you'll use.... [4] Engage with the whole family.... [5] Evaluate your performance for the future."

Tags: Coronavirus (COVID-19)  •  Health Plan Administration

IRS Announces Tax Relief for Oregon Wildfires and Straight-Line Winds Victims
Internal Revenue Service [IRS] Link to more items from this source
[Official Guidance]
Sept. 17, 2020

"Victims of Oregon wildfires and straight-line winds that began September 7 now have until January 15, 2021, to file various individual and business tax returns and make tax payments.... Individuals and households who reside or have a business in Clackamas, Douglas, Jackson, Klamath, Lane, Lincoln, Linn and Marion counties qualify for tax relief."

Tags: Health Plan Administration  •  Reporting to Government Agencies  •  Retirement Plan Administration

San Francisco Required Contribution for Healthcare Goes Up in 2021
HUB International Link to more items from this source
[Guidance Overview]
Sept. 16, 2020

"San Francisco recently released its updated contribution requirement for 2021.... The ordinance applies to any employer that has one or more employees working regularly at least 8 hours per week (104 hours per calendar quarter) within the City/County Limit of San Francisco. This is so, even if all of the employer's other workers are located outside of San Francisco "

Tags: Health Plan Administration  •  Health Plan Costs  •  Local Regulation

Allocation of Medical Loss Ratio Rebates and Premium Refunds
Verrill Dana LLP Link to more items from this source
[Guidance Overview]
Sept. 16, 2020

"Generally, rebates attributable to premium payments made by participants or out of trust assets will be considered plan assets, and rebates attributable to employer-paid premiums will not be considered plan assets.... [DOL] Technical Release 2011-04 recognizes three approaches to dealing with the allocation of the 'plan asset' portion of the rebate. The fiduciary can: [1] pay a direct cash refund to participants; [2] provide participants with a premium discount or premium holiday; or [3] use the assets to enhance plan benefits (e.g., add a disease management or wellness program)."

Tags: Health Plan Administration  •  Health Plan Costs

Amicus Brief of American Benefits Council to Tenth Circuit on Ruling That Deferential Standard of Review Requires Disclosure of Plan Administrator's Discretionary Authority
American Benefits Council Link to more items from this source
[Opinion]
Sept. 15, 2020

12 pages. "In a nationally unprecedented ruling, the panel majority held that, under ERISA, a deferential standard of review on judicial review of a benefits claim applies only where a plan administrator has disclosed 'its reservation of discretionary authority.'... The majority's requirement is counter to ERISA itself, the precedents addressing ERISA's standard of review, and [DOL] regulations. Furthermore, the majority's rule undermines the important interests that the standard of review protects: 'efficiency, predictability, and uniformity.' " [Lyn M. v. Premera Blue Cross, No. 18-4098 (10th Cir. Jul. 24, 2020)]

Tags: Health Plan Administration

Text of CMS Enrollment Manual for Federally-Facilitated Exchanges and Federally-Facilitated Small Business Health Options Program (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Official Guidance]
Sept. 14, 2020

177 pages. "This manual is effective as of September 2, 2020. All enrollments made on or after September 2, 2020, should be processed in accordance with the operational requirements set forth in this document."

Tags: Health Plan Administration

Editor's Pick Key Decision Points in ACA Reporting Vendor Setup Questionnaires, Part 2: The Affordability Safe Harbor
ABD Insurance & Financial Services Link to more items from this source
[Guidance Overview]
Sept. 14, 2020

"[T]he IRS provides three safe harbors for ALEs to determine whether an offer of coverage is affordable for purposes of avoiding B Penalty liability ... [T]he ALE may choose different safe harbors for any reasonable category of employees.... Employers should always use the federal poverty line affordability safe harbor where available because it [1] results in coverage automatically being deemed affordable with no calculations necessary, and [2] permits employers to take advantage of streamlined ACA reporting via the Qualifying Offer Method."

Tags: Health Plan Administration

ERISA Does Not Bar Medical Providers from Enforcing Health Plans' Payment Promises Under State Law
Arent Fox Link to more items from this source
Sept. 14, 2020

"Medical providers treating patients covered by ERISA-governed health plans on an out-of-network basis can assert state-law claims to hold plans to their payment promises without running afoul of ERISA's preemption provision ... So held the Third Circuit ... reversing the trial court's dismissal of a provider's state law claims for breach of contract and promissory estoppel.... [M]edical providers with claims arising from insurers' broken promises to pay set rates for specific treatments need not shy away from pleading these claims under applicable state law." [The Plastic Surgery Center, P.A. v. Aetna Life Ins. Co., No. 18-3381 (3d Cir. Jul. 17, 2020)]

Tags: ERISA Preemption  •  Health Plan Administration

Text of IRS Notice 2020-71: Special Per Diem Rates for 2020-2021 (PDF)
Internal Revenue Service [IRS] Link to more items from this source
[Official Guidance]
Sept. 14, 2020

"This annual notice provides the 2020-2021 special per diem rates for taxpayers to use in substantiating the amount of ordinary and necessary business expenses incurred while traveling away from home ... The special M&IE rates for taxpayers in the transportation industry are $66 for any locality of travel in the continental United States (CONUS) and $71 for any locality of travel outside the continental United States (OCONUS).... The rate for any CONUS or OCONUS locality of travel for the incidental expenses only deduction is $5 per day.... For purposes of the high-low substantiation method, the per diem rates ... are $292 for travel to any high-cost locality and $198 for travel to any other locality within CONUS."

Tags: Health Plan Administration  •  Retirement Plan Administration

Health Plans May Use PHI to Contact Recovered COVID-19 Participants Regarding Plasma Donation
Thomson Reuters / EBIA Link to more items from this source
[Guidance Overview]
Sept. 10, 2020

"Although it is unclear whether health plans will be interested in contacting participants for this purpose, this clarification will be welcome news for plans pursuing this type of case management. Plans relying on the guidance should fully document the justification for using and disclosing PHI of recovered COVID-19 patients, including determinations regarding whether a HIPAA authorization is required."

Tags: Coronavirus (COVID-19)  •  Health Plan Administration  •  Health Plan Design

Health Care Reform, 10 Years Later
Segal Benz Link to more items from this source
Sept. 10, 2020

"Ten years later and the ACA is still being debated by both sides of the political aisle.... [A] series of lawsuits have given us a lot to watch this year.... Here are several messages to consider relaying [to employees]: [1] Your health and well-being are important to us.... [2] We have a thoughtful approach.... [3] You can get a lot of value by using our benefits and taking steps to improve your health.... [4] If you have questions, here's where to go."

Tags: Health Plan Administration

Editor's Pick ERISA Ruling Shows Daunting Review Standard for Claimants
DeBofsky Sherman Casciari Reynolds P.C. Link to more items from this source
Sept. 10, 2020

"[T]he presence of a circuit split on the issue of whether a late appeal decision forfeits deferential review may invite Supreme Court review.... It is also somewhat surprising that the Eighth Circuit would buck a growing trend among the circuits to find gateways to de novo review.... For plan administrators, efforts need to be taken to strictly comply with the requirements of the claim regulations. While tardiness was excused in this instance, that may not happen the next time." [McIntyre v. Reliance Standard Life Ins. Co., No. 19-2367 (8th Cir. Aug. 25, 2020)]

Tags: Fiduciary Duties  •  Health Plan Administration  •  Retirement Plan Administration

Editor's Pick Key Decision Points in ACA Reporting Vendor Setup Questionnaires
ABD Insurance & Financial Services Link to more items from this source
[Guidance Overview]
Sept. 9, 2020

Part 1 of 4. "The three key inputs are the measurement method, affordability safe harbor, and -- for those employers utilizing the look-back measurement method [LBMM] -- the measurement and stability periods.... The [monthly measurement method (MMM)] is best thought of as the ACA's default measurement method for determining employees' full-time status. It is relatively simple and straightforward.... The IRS gave birth to the LBMM as an optional alternative to the default MMM particularly to address concerns for employers with largely variable hour workforces."

Tags: Health Plan Administration

A 'Vaccine' for COVID-19 ERISA Litigation
Constangy, Brooks, Smith & Prophete LLP Link to more items from this source
Sept. 4, 2020

"[An] employer-sponsored retirement plan ... is likely to suffer from market volatility.... [E]mployer-sponsored health and welfare plans will see upticks in claims issues ... and coverage (or no coverage) for novel treatments is sure to generate litigation.... Practice the 'Three Ds' = Deliberate, Decide, and Document.... Communicate responsibly with participants.... Review the distribution terms of your plans and stay in contact with your record keeper."

Tags: Coronavirus (COVID-19)  •  Fiduciary Duties  •  Health Plan Administration  •  Retirement Plan Administration

Eighth Circuit Jettisons Prior Circuit Precedent Holding That Procedural Irregularities Can Justify a De Novo Standard of Review
Kantor & Kantor Link to more items from this source
Sept. 2, 2020

"[A recent Eighth Circuit] decision ... clarified that when circumstances demand 'less deferential review,' this cannot mean de novo review.... [The panel ruled that] when faced with conflicting panel opinions, the law dictated the earliest opinion controlled. Thus, because 'all of our precedents' mischaracterized the [1998 holding in Woo v. Deluxe Corp.], it was Woo rather than the subsequent cases misstating (or misapplying) the holding in Woo that controlled. The review could not be de novo, but an abuse of discretion standard analysis that took into consideration the procedural irregularity." [McIntyre v. Reliance Standard Life Ins. Co., No. 19-2367 (8th Cir. Aug. 25, 2020)]

Tags: Health Plan Administration


<< Older News  |  September 25, 2020

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