Health & Welfare Plans Newsletter

June 10, 2016

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[Guidance Overview]

Clarifying Two Separate ACA Appeals: HHS Appeals and IRS Appeals
"The fabled section 4980H(a) and section 4980H(b) penalties should begin to be assessed against employers in July or August based on, among other things, the information an applicable large employer (ALE) member submitted on its Form 1094-C and Form 1095-Cs.... This article is intended to describe the two separate appeals options associated with the employer mandate." (Health Care Attorneys P.C.)  


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[Guidance Overview]

DOL Flags Plan Provisions That May Violate Mental Health Parity Requirements
"This guidance provides a useful checklist of provisions that may be problematic under the mental health parity rules ... [W]hile the provisions described do not automatically violate the nonquantitative treatment limitation requirements, the DOL reminds plans and insurers that they must be prepared to provide evidence to substantiate parity compliance." (Thomson Reuters / EBIA)  

[Guidance Overview]

EEOC Issues Important New Standards for Wellness Programs
"The EEOC/ADA rule sets new requirements for wellness programs that ask employees to provide medical information (whether through health-risk assessment questionnaires or medical exams/tests). The EEOC/ADA rule applies to any such program whether it is offered as part of a group health plan or outside of the plan.... The EEOC/GINA rule permits employers and plan sponsors to offer limited incentives for an employee's spouse to provide medical information." (Segal Consulting)  

[Guidance Overview]

Expatriate Health Plan Rules Address ACA Information Reporting, Code Section 162(m)(6), and More
"The proposed regulations address: [1] How information reporting rules under the [ACA] apply to expatriate health plans. [2] Standards for travel insurance and supplemental health insurance coverage to be considered excepted benefits ... [3] A notice requirement for hospital indemnity and other fixed indemnity insurance in the group health insurance market to be considered excepted benefits." (Practical Law Company)  

[Guidance Overview]

Administration Acts to Stabilize Marketplaces, Implement Expatriate Coverage Legislation
"The proposed rule would amend the definition of short-term coverage [to provide that] insurers would only be able to offer short-term policies for periods of less than three months, and coverage could not be renewed at the end of the three-month period.... CMS intends to propose that, beginning in 2017 the risk adjustment program include an adjustment factor to account for partial-year enrollees.... CMS intends, beginning in the 2018 benefit year, to incorporate prescription drug utilization data into risk adjustment, as a source of information about individuals' health status and the severity of their conditions." (Health Affairs)  


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[Guidance Overview]

The Ever-Evolving Obligations of California Employers to Provide Paid Sick Leave
"This month, the Cities of Los Angeles and San Diego passed paid sick leave and minimum wage ordinances to go into effect soon. While all California employers have been required to provide paid sick leave to employees since July 1, 2015, these new local ordinances create an increasingly complicated web for compliance, particularly for employers with multiple locations." (Fisher Phillips)  

[Guidance Overview]

San Diego Earned Sick Leave Ordinance Approved by Popular Vote
"The Ordinance is expected to take effect immediately following certification of the election results.... Employees begin to accrue earned sick leave upon hire, and existing employees will begin accruing earned sick leave immediately. Employees may begin using earned sick leave on their 90th day of employment." (Jackson Lewis P.C.)  

[Guidance Overview]

San Diego Voters Approve Ordinance to Provide Paid Sick Leave
"The ordinance ... provides for employers to begin providing paid sick leave for employees who perform at least two hours of work in San Diego per year. Eligible employees will be entitled to accrue one hour of paid sick leave for every 30 hours worked in the city with no cap on total accrual, though employers may cap usage at 40 hours per year." (Proskauer Rose LLP)  

Even If You Have Health Insurance, You May Want to Pay Cash
"Tests that were billed to Blue Shield at a rate of about $80 each carried a cash price of closer to $15 apiece.... Cash prices are intended for uninsured patients -- and are frequently still much higher than insured rates. But cash prices for many common procedures have come down thanks to changing regulations and consumers increasingly being able to shop around for cheaper providers." (Los Angeles Times)  

IRS Online Tools Help Individuals and Employers Estimate Health Care Law's Effect on Taxes
"The Employer Shared Responsibility Provision Estimator helps you understand how the provision works and how it may apply to your organization.... The Small Business Health Care Tax Credit Estimator helps determine if you might be eligible for the Small Business Health Care Tax Credit and how much credit you might receive.... The Premium Tax Credit Change Estimator helps estimate how your premium tax credit will change if your income or family size changes during the year.... The Individual Shared Responsibility Payment Estimator helps you estimate the amount you may have to pay if you did not have minimum essential coverage during the year." (Internal Revenue Service [IRS])  

Remarks of CMS Acting Administrator Andy Slavitt at the Marketplace Innovation Conference
"[T]he Marketplace is succeeding by almost any benchmark, but it is still in its early trial and error stage. Progress won't be even and for the first five years, we will continue to be in a learning and experimentation period ... [T]he Marketplace ... is a highly strategic opportunity for those who see health care evolving into a more B2C market to create new competitive advantages.... [E]ven though we are in the learning and experimentation stage, we are confident we have the tools to make sure the market is stable and succeeds for the long term." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

DOJ Sues Carolinas HealthCare Over Steering Restrictions
"Federal and state officials in North Carolina on [June 8] filed a civil suit ... alleging that the state's largest healthcare system used its market power to dictate 'steering restrictions' in contracts with commercial health insurance companies that ultimately led to higher costs for consumers.... 'These provisions,' the complaint [states], 'have prevented insurers from, among other things, introducing health plans that encourage patients to use medical providers that offer lower-priced, higher-quality services.' " (HealthLeaders Media)  

Benefits in General

Form 5500 Preparation: Ten Quick Considerations (PDF)
"Use the correct plan name and plan sponsor name ... Obtain appropriate proof of the Form 5500 filing ... [Perform] a close review of the audit reports in addition to the Form 5500 itself ... Properly identify, report, and correct late deposits ... Was a Form 8955-SSA appropriately prepared? ... Are you filing for all plans that must file, such as flexible savings accounts and/or health reimbursement accounts? Have 'top hat' statements been filed with the DOL to avoid filing Form 5500s for any nonqualified deferred compensation plans?" (The ERISA Law Group)  

Press Releases

AHIP Board of Directors Announces Chairs for 2017, 2018
Americaís Health Insurance Plans [AHIP]

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 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 that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

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