Health & Welfare Plans Newsletter

December 20, 2016

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Senior ESOP Professional - Consulting & Review
Blue Ridge ESOP Associates
in VA, Telecommute

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Heartland Consulting Group, Inc.
in KS, MO

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LT Trust
in CO

Retirement Specialist
Nationwide Financial
in WA

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CBIZ
in PA

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[Official Guidance]

Text of CMS Bulletin: Timing of Submission and Posting of Rate Filing Justifications for the 2017 Filing Year for Single Risk Pool Coverage (PDF)
Unnumbered document, dated Dec. 16, 2016. "This bulletin provides guidance for purposes of establishing the uniform deadline under 45 CFR 154.220(b) for health insurance issuers to submit Rate Filing Justifications for proposed rates for single risk pool coverage in the individual and small group markets."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Breaking Down the Final 2018 Letter to Issuers
"The FFM has been in existence for three years now and has settled into a routine. The pace of development and change of regulations has slowed considerably. The 2018 letter therefore resembles very closely the 2017 letter, but picks up some changes from the 2018 payment notice."
Timothy Jost, in Health Affairs

[Guidance Overview]

Back from the Dead: Premium Reimbursement Arrangements for Small Employers Resurrected by 21st Century Cures Act
"The Cures Act allows small employers to set up HRAs in the form of [qualified small employer health reimbursement arrangement (QSEHRAs)].... [E]mployer payments through the QSEHRA are deductible and reimbursements from the QSEHRA are excludible from employees' income.... The new QSEHRAs may be a great option for small employers that have struggled to provide affordable health coverage options for their employees. However, unlike the pre-ACA HRAs, QSEHRAs are subject to many new requirements."
Proskauer's ERISA Practice Center

[Guidance Overview]

Unsuccessful Appeals of Section 1411 Marketplace Notices -- Are There Any Losers?
"[An] unsuccessful appeal to HHS does not necessarily mean the employer will be assessed a section 4980H penalty.... An unsuccessful HHS appeal will also spare the employer from the awkward position of making one of its employees ineligible for premium tax credits the employee thought he/she was entitled to receive.... [If] an employer loses its HHS appeal both the employee and the employer will win assuming the employer's offer of minimum value coverage was provided at an affordable price."
Accord Systems, LLC

[Guidance Overview]

Washington State Will Require All Employers to Provide Sick Leave for Full-Time and Seasonal Employees Beginning in 2018
"The new law entitles an employee to begin using accrued sick leave on the 90th day after his or her start of employment, and unused sick leave can carry over to the following year. However, an employer may limit an employee to a maximum of 40 hours of carry over."
Moss Adams LLP

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First Circuit Upholds Dismissal of Employer Challenge to Massachusetts Earned Sick Time Law (PDF)
25 pages. "[The Massachusetts Earned Sick Time Law (ESTL)] broke new ground in Massachusetts by providing that employers of a certain size must compensate their employees for the sick time that they use for specified purposes.... the employers seek 'a judgment declaring that [the ESTL] is preempted with respect to employers who are signatory [sic] to collective bargaining agreements.' ... [We] hold, as the United States contends as amicus, that this case, even if characterized as a facial challenge, is not ripe and thus must be dismissed for lack of jurisdiction." [Labor Relations Div. of Construction Industries of Mass. v. Healey, No. 15-1906 (1st Cir. Dec. 16, 2016)]
U.S. Court of Appeals for the First Circuit

D.C.'s Battle for Paid Family Leave
"D.C.'s proposed law would create a fund that would provide private-sector workers with up to 90 percent of their full wages for 11 weeks, capped at $1,000 a week. The leave would cover care for a newborn or adopted child, or provide eight weeks to care for a seriously ill relative.... [T]he mayor's office would be in charge of overseeing the program and doling out the funds, which would come from a 0.62-percent increase to employer payroll taxes."
The Atlantic

2016 ACA Changes
"The list [in this article] highlights the form 1095-C and 1094-C changes for 2016. [1] Aggregated ALE groups ... [2] Line 16 changes ... [3] New codes for conditional offers of spousal coverage ... [4] COBRA and other post-employment coverage ... [5] Multi-employer plan relief extended for 2016 ... [6] Expiration of certain 2015 transition relief."
Hodges-Mace

It's That Time of Year: Use It or Lose It!
"For participants that have more than expected left in their FSA accounts at this time of year, it's not too late to remind them of some of the ways they can spend their money. But remember, not all FSAs are created equal -- the IRS has rules for what expenses are considered qualified depending on what type of FSA account(s) your employee has in place."
Frenkel Benefits

Honeywell's Retiree Health Cuts Divide Federal Judges
"The planned benefit cuts have spawned at least four proposed class actions by retirees from Honeywell plants in Connecticut, Michigan and Ohio. In ruling ... that the cuts didn't violate the retirees' collective bargaining agreements, Judge James G. Carr of the U.S. District Court for the Northern District of Ohio broke from both of the other judges who have ruled on these cases." [Watkins v. Honeywell, No. 16-1925 (N.D. Ohio Dec. 16, 2016)]
Bloomberg BNA

Lawmakers Interested in Student Loan Repayment as Employee Benefit
"The average debt per borrower has nearly doubled since 2004, increasing from roughly $18,000 to more than $35,000 for a 2015 graduate. As millennials become a larger share of the workforce, the student loan debt dilemma is attracting more attention from employers. Legislative proposals would allow employers to establish a variety of tax-preferred student loan repayment assistance programs."
Willis Towers Watson

Benefits in General

[Guidance Overview]

Final DOL Disability Claims Regs Require Notice of Contractual Limitations Periods
"[A] benefit is a disability benefit subject to the disability claims regulations if a plan conditions the benefit's availability on a showing of disability (regardless of how the plan characterizes the benefit or whether the plan is a health or retirement plan).... [T]he final regulations: [1] Limit conflicts of interest by requiring independence and impartiality of plan decisionmakers. [2] Expand the content requirements for denial notices involving disability claims. [3] Provide claimants notice and an opportunity to respond prior to appeal-level denials based on new or additional evidence or rationales.... [4] Require that claims notices be provided in a culturally and linguistically appropriate manner."
Practical Law Company

[Guidance Overview]

DOL Issues Final Regs for Claims Procedure for Plans Providing Disability Benefits
"The keystone of the regulations ... is the requirement to allow the claimant to have the last word in the claims process and thus have the right to respond to adverse information developed during the claim appeal process.... The regulations are also intended to permit claimants to submit supporting evidence regardless of whether such evidence meets 'courtroom evidentiary standards.' "
DeBofsky & Associates, P.C.

[Guidance Overview]

ACA Facelift to Disability Claims Process Could Affect All Plans
"For insured disability plans, plan sponsors need to engage their insurance carriers in a discussion about how these procedures will apply to them and what changes are needed to the insurance contracts. Some insurers may be slow to adopt these new procedures, which could put plan sponsors in a difficult position. For self-funded disability plans, plan documents will need to be updated, and procedures put in place. For retirement plans, there are some decisions to make. Recall that the procedures only apply if a disability determination is required. One way to avoid this is to amend the definition of disability so that it relies on a determination by the Social Security Administration or the employer's long-term disability carrier. For defined contribution plans, this is likely to be the most expedient approach."
Benefits Bryan Cave

2017 Rates and Limits Guide
"This quick reference guide contains: [1] Summary of payroll tax limits; [2] Filing deadlines; [3] IRS standard mileage rates; [4] Summary of other limitations, including elective deferrals and benefits and contributions under qualified retirement plans; [5] ACA forms and deadlines."
Lindquist LLP

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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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