Health & Welfare Plans Newsletter

December 16, 2016

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[Official Guidance]

Text of DOL Final Regs: Claims Procedure for Plans Providing Disability Benefits
98 pages. "This document contains a final regulation revising the claims procedure regulations under [ERISA] for employee benefit plans providing disability benefits. The final rule revises and strengthens the current rules primarily by adopting certain procedural protections and safeguards for disability benefit claims that are currently applicable to claims for group health benefits pursuant to the [ACA]. This rule affects plan administrators and participants and beneficiaries of plans providing disability benefits, and others who assist in the provision of these benefits, such as third-party benefits administrators and other service providers."
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

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[Guidance Overview]

DOL Fact Sheet: Final Rule Strengthens Consumer Protections for Workers Requesting Disability Benefits from ERISA Employee Benefit Plans (PDF)
"[T]he final rule includes the following improvements in the requirements for the processing of claims and appeals for disability benefits: [1] Improvement to basic disclosure requirements.... [2] Right to claim file and internal protocols.... [3] Right to review and respond to new information before final decision.... [4] Avoiding conflicts of interest.... [5] Deemed exhaustion of claims and appeal processes.... [6] Certain coverage rescissions are adverse benefit determinations subject to the claims procedure protections.... [7] Notices written in a culturally and linguistically appropriate manner."
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Guidance Overview]

IRS Summary of Information Reporting by Applicable Large Employers
"Applicable large employers (ALEs) must report to the IRS information about the health care coverage, if any, they offered to full-time employees.... ALEs also must furnish to employees a statement that includes the same information provided to the IRS. Employees may use this information to determine whether, for each month of the calendar year, they may claim the premium tax credit on their individual income tax returns.... ALEs that file 250 or more information returns during the calendar year must file the returns electronically."
Internal Revenue Service [IRS]

[Guidance Overview]

IRS Summary of Information Reporting by Providers of Minimum Essential Coverage
"[The IRS has] extended the 2017 due date for providing 2016 health coverage information forms to individuals. Insurers, self-insuring employers, other coverage providers, and applicable large employers now have until March 2, 2017 to provide Forms 1095-B or 1095-C to individuals, which is a 30-day extension from the original due date of January 31."
Internal Revenue Service [IRS]

[Guidance Overview]

Holiday Present for Small Employers: HRAs Can Be Used for Reimbursement of Health Insurance Premiums
"[T]he arrangement must: [1] Be provided on the same terms to all eligible employees of the eligible employer; [2] Be funded solely by an eligible employer (i.e., no salary reduction contributions); [3] Mandate provision of 'proof of coverage' before the payment or reimbursement of benefits; [4] Limit the amount of payments and reimbursements for any year to no more than $4,950 ($10,000 in the case of an arrangement that covers family members of the employee); and [5] No later than 90 days before the beginning of a year in which the arrangement will be adopted, issue a specific written notice to all eligible employees."
Michael Best & Friedrich LLP

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[Guidance Overview]

Small Employers May Resume Offering Premium Reimbursement HRAs to Employees
"[C]ertain small employers may resume offering their employees [Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs)], and employees may use funds in such arrangements to purchase individual health insurance.... General requirements.... Employer eligibility requirements.... Minimum essential coverage requirement.... Notice requirements."
The Wagner Law Group

[Guidance Overview]

21st Century Cures Act Provisions That Relate to Group Health Coverage
"The 21st Century Cures Act tasks the HHS, DOL and Treasury with coming up with additional guidance on compliance with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The guidance is supposed to help health plans, patients and health care providers identify compliant and non-compliant plan designs with a particular focus on determining parity in non-quantitative treatment limitations such as standards for medical necessity, preauthorization, provider reimbursement rates, fail-first therapy and step therapy. The guidance will include 'clarifying information and illustrative examples' of how a health plan should provide individuals and their representatives access to plan information to verify a plan's compliance with the MHPAEA."
Vorys, Sater, Seymour and Pease LLP

[Guidance Overview]

ACA Final Rule Omits Opt-Out Payment Provisions; CMS Extends Coverage Deadline
"On December 14, the IRS released final rules [for ACA premium tax credits,] clarifying issues raised by and filling gaps in its previous rules. The rules finalize proposed rules published in July, However, ... the IRS decided not to finalize the most controversial provisions of its proposed rule, which dealt with employer opt-out payments (through which an employer pays an employee to decline employer-offered coverage), choosing to leave in place for now earlier guidance."
Health Affairs

[Guidance Overview]

New Leave Laws in Illinois
"Illinois employers should be aware of four new leave laws that may require revisions to leave policies and procedures: Illinois Employee Sick Leave Act: Effective January 1, 2017 ... Illinois Child Bereavement Leave Act: Effective July 29, 2016 ... Chicago Paid Sick Leave Ordinance: Effective July 1, 2017 ... Cook County Earned Sick Leave Ordinance: Effective July 1, 2017."
Bryan Cave LLP

DOL Ramps Up Mental Health Parity Investigations
"MHPAEA violations can result in a breach of fiduciary duty under [ERISA] and an IRS excise tax of $100 per covered individual per day.... The final regulations specify that parity analysis should be performed within each of six classifications of benefits: [1] Inpatient, in-network. [2] Inpatient, out-of-network. [3] Outpatient, in-network. [4] Outpatient, out-of-network. [5] Emergency care. [6] Prescription drugs."
Society for Human Resource Management [SHRM]

Small Business Health Care Tax Credit: IRS Releases 2016 Form 8941 and Offers Transition Relief for Certain Small Employers
"The 2016 Form adds a new Line C that implements the two-consecutive-year limitation for the credit that became effective in 2014 ... If the taxpayer confirms on line C that it claimed a credit in 2014, a Form 8941 cannot be filed in 2016.... The instructions have been updated to incorporate the Notice 2016-75 transition relief for the three Wisconsin counties, and still include the transition relief for employers in certain Iowa counties without 2015 SHOP coverage[.]"
Thomson Reuters / EBIA

Telehealth Alone Will Not Increase Health Care Access for the Underserved
"Providing high-quality care requires access to ancillary diagnostic services and in-person follow-up. Introducing telehealth into underserved communities generates new demand for services such as procedures or tests that can't be done through video conferencing.... Telehealth requires integration into a well-functioning health care system that has the capacity to address all the additional patient needs that telehealth generates."
Health Affairs

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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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