Health & Welfare Plans Newsletter

December 15, 2016

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[Official Guidance]

Text of IRS Final Regs: Premium Tax Credit Regulation VI
56 pages. "The Treasury Department and the IRS continue to examine the issues raised by opt-out arrangements and expect to finalize regulations on the effect of opt-out arrangements on an employee's required contribution at a later time.... [U]ntil the applicability date of final regulations on opt-out arrangements, individuals may treat opt-out payments made available under unconditional opt-out arrangements ... as increasing the employee's required contribution for purposes of sections 36B and 5000A."
Internal Revenue Service [IRS]

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[Official Guidance]

Text of IRS Publication 5165: Guide for Electronically Filing ACA Information Returns for Software Developers and Transmitters (PDF)
60 pages; rev. Dec. 2016. "[This publication] outlines the communication procedures, transmission formats, business rules and validation procedures for information returns transmitted electronically through the AIR System.... The procedures in this publication should be used when the following information returns are transmitted electronically for TY2015 and TY2016 in PY2017: Form 1094-B, Transmittal of Health Coverage Information Returns; Form 1095-B, Health Coverage; Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns; Form 1095-C, Employer-Provided Health Insurance Offer and Coverage.... This publication does not contain information or procedures for filing Forms 1095-A."
Internal Revenue Service [IRS]

[Guidance Overview]

New Law Permits Stand-Alone HRAs for Small Employers
"Small employers who do not wish to offer their own health plan to employees can now provide employees a pre-tax subsidy of individual health insurance premiums by establishing a Qualified Small Employer Health Reimbursement Arrangement [QSEHRA] beginning on or after January 1, 2017.... These programs will not be subject to the COBRA notice requirements or the extension of coverage after the employee's coverage would end."
Stinson Leonard Street

[Guidance Overview]

Small Businesses Can Now Reimburse Employee Medical Expenses
"Notice 2015-17 granted excise tax relief for certain other arrangements offered by both large and small employers that reimburse: [1] Individual health insurance policies for more than 2 percent shareholders of S corporations; [2] Premiums for Medicare and Medicare supplemental policies; [and] [3] Medical expenses for employees covered by TRICARE.... [T]he new law does not specifically address the status of these types of reimbursement arrangements and is unclear if they can be continued after 2016 by large employers. In addition, it is unclear whether small employers can continue the above arrangements for select employees rather than establishing a QSEHRA."
RSM US

[Guidance Overview]

Departments Issue FAQs Part 34 on the MHPAEA and Request Comments on Tobacco Cessation Products
"Before providing additional guidance on what [tobacco cessation] items and services must be provided without cost sharing, the Departments seek comments on whether the plan may use medical management techniques to determine which categories of FDA-approved pharmacotherapy interventions must be covered without cost sharing, and whether plans can use medical management techniques to, for example, limit the number of quit attempts per year or limit the types of behavioral interventions that are covered without cost sharing.... The Departments seek comments on issuing model forms that could be used by participants to request information on [nonquantitative treatment limitations (NQTLs) for mental health benefits] and introduce a Parity Consumer Web Portal that individuals can use to connect to the appropriate agency for help in obtaining documents or information ... The FAQs provide a number of examples of NQTLs applied inconsistently between mental health and medical and surgical conditions that would violate the MHPAEA."
Seyfarth Shaw LLP

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Considerations for Drafting a Parental Leave Policy
"You choose Eligibility Requirements, not some Federal agency.... Although the EEOC makes clear that you can treat mom better than dad when it comes to recovery from childbirth, employers cannot treat the sexes differently when it comes to bonding leave.... [Y]ou have every legal right to limit the benefit over a period of time.... Employers can require employees to use vacation/sick/PTO benefits before collecting parental leave pay.... [Y]our employees need to know parental leave is a benefit they actually can take and still move up within your organization."
FMLA Insights

Rising Deductibles Are Not Yet a Financial Burden, but Early Evidence Shows an Impact on Access to Care
"After remaining mostly flat since 1984, the average share of household after-tax income spent on premiums and out-of-pocket expenditures increased from 5.15% in 2009 to 7.18% in 2015 (a relative increase of 39%) ... [B]etween 2009 and 2015 the average family spent $1,216 more on health care, while take-home pay actually fell by $305."
Altarum Institute

U.S. Inpatient Emergency Department Cases May Lead to Surprise Medical Bills
"[In] 2014, 20 percent of US hospital inpatient admissions originating in the emergency department (ED), 14 percent of outpatient visits to the ED, and 9 percent of elective inpatient admissions likely led to a surprise medical bills. This is a decrease from 2007 when those rates were nearly 28 percent, 18 percent, and 14 percent, respectively."
Health Affairs

Health Insurers Get 1.6 Percent of $6 Billion They're Owed for Costly ACA Customers
"Hundreds of insurers selling health plans in [ACA] marketplaces are being paid less than 2 percent of nearly $6 billion the government owes them for covering customers last year with unexpectedly high medical expenses. The $96 million insurers will get is just one-fourth of the sum that provoked an industry outcry a year ago ... [CMS] posted an online notice the week before Thanksgiving that included 12 pages of insurers in the ACA marketplaces. Beside each name was a set of dollar amounts. The notice did not include a total."
The Washington Post; subscription may be required

Taxpayers Will Shell Out Nearly $10B More For ACA Rate Hikes
"[T]he cost of premium subsidies under the [ACA] will increase by $9.8 billion next year, rising from $32.8 billion currently to $42.6 billion. The average monthly subsidy will increase by $76, or 26 percent, from $291 currently to $367 in 2017."
InsuranceNewsNet.com

The Future of the ACA, Part 3: The Trump Plan, 'Healthcare Reform to Make America Great Again'
"The Trump/Pence plan is a useful outline that establishes high-level goals and a guiding political philosophy. But it is not all that clear how the individual planks address those goals.... It will be up to the legislative process to flesh it out and connect policy and law.... [T]he contours of a guiding, free-market political philosophy are unmistakable ... [At] least in broad strokes, this plan portends the future."
Mintz Levin

States Likely to Get More Authority to Implement Health Care
"The Obama administration gave states a number of options in setting up health insurance exchanges under the [ACA], and it delegated authority to states to set standards for essential health benefits that most individual and small group plans must cover ... Letting states decide how to implement health-care decisions is likely to be the model followed by President-elect Donald Trump and the Republican Congress in making changes to the ACA[.]"
Bloomberg BNA

GAO Report: Results of Enrollment Testing for the 2016 Special Enrollment Period
"The federal and selected state-based marketplaces approved health-insurance coverage and subsidies for 9 of 12 of GAO's fictitious applications made during a 2016 SEP.... The marketplaces instructed 6 of 12 applicants to provide supporting documentation, such as a copy of a recent marriage certificate, related to the SEP triggering event; the remaining 6 of 12 were not instructed to do so. For 5 applicants, GAO provided no documents to support the SEP triggering event, but coverage was approved anyway."
U.S. Government Accountability Office [GAO]

Press Releases

NAPA Announces its 2016 List of Top Women Advisors
American Retirement Association

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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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