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April 30, 2017 in DC
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[Official Guidance]

Text of CMS Proposed Regs: ACA Market Stabilization
71 pages. "[W]e propose changing the dates for open enrollment in the individual market for the benefit year starting January 1, 2018, from a range of November 1, 2017, to January 31, 2018 (the previously established open enrollment period for 2018), to a range of November 1, to December 15.... [W]e propose increasing pre-enrollment verification of eligibility for all categories of individual market special enrollment periods for all States served by the platform from 50 to 100 percent of new consumers who seek to enroll in Exchange coverage.... [W]e propose revising our interpretation of the guaranteed availability requirement to allow issuers to apply a premium payment to an individual's past debt owed for coverage from the same issuer enrolled in within the prior 12 months.... [W]e propose to increase the de minimis variation in the actuarial values (AVs) used to determine metal levels of coverage for the 2018 plan year.... We are not proposing a modification for the de minimis range for the silver plan variations."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


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[Guidance Overview]

Proposed FMLA Legislation in the 114th Congress (PDF)
16 pages. "[T]he 114th Congress considered several proposals to amend the [Family and Medical Leave Act] in various ways: [1] Additional leave entitlements.... [2] New FMLA-qualifying uses of the existing leave entitlement.... [3] Broader application of existing FMLA-qualifying uses of leave.... [4] Less-restrictive eligibility requirements, generally, and separate requirements for certain worker groups." [Report R44693, Feb. 9, 2017]
Congressional Research Service

[Guidance Overview]

In Brief: Health Insurance Premium Tax Credits and Cost-Sharing Subsidies (PDF)
15 pages. "Certain individuals without access to subsidized health insurance coverage may be eligible for premium tax credits ... Individuals who receive premium credits also may be eligible for subsidies that reduce cost-sharing expenses. The ACA established two types of cost-sharing subsidies. One type of subsidy reduces annual cost-sharing limits; the other directly reduces cost-sharing requirements (e.g., lowers a deductible). Individuals who are eligible for cost-sharing subsidies may receive both types." [Report R44425, Feb. 10, 2017]
Congressional Research Service

Aetna Chief Executive Says Obamacare Is in 'Death Spiral'
"Aetna chief executive Mark Bertolini said ... his company has not decided whether to continue selling insurance in the exchanges in 2018, but it already has exited most of the markets where it previously sold plans, remaining in only four states this year.... He said that Aetna's heaviest utilizers of health care -- the top 1 percent to 5 percent -- are driving half of the costs in the exchanges."
The Washington Post; subscription may be required

Major Blow to ACA Individual Mandate: IRS Won't Reject Tax Returns That Don't Answer Health Insurance Question
"Earlier this month, the IRS quietly altered its rules to allow the submission of 1040s with nothing on line 61. The IRS says it still maintains the option to follow up with those who elect not to indicate their coverage status, although it's not clear what circumstances might trigger a follow up. But what would have been a mandatory disclosure will instead be voluntary. Silent returns will no longer be automatically rejected. The change is a direct result of the executive order President Donald Trump issued in January directing the government to provide relief from Obamacare to individuals and insurers, within the boundaries of the law."


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Cigna Sues Anthem Over Merger Agreement, Seeks Termination and $15 Billion
"Cigna Corporation [on Feb. 14] announced it has exercised its right to terminate the proposed merger agreement with Anthem, Inc. ... To effect this termination, Cigna has filed suit against Anthem in the Delaware Court of Chancery.... The complaint seeks payment by Anthem of the $1.85 billion reverse termination fee contemplated in the merger agreement, as well as additional damages in an amount exceeding $13 billion."

Anthem Sues Cigna Over Action to Terminate Merger Agreement, Seeks Enforcement of Merger Plus Recovery of Damages
"Anthem believes that there is still sufficient time and a viable path forward potentially to complete the transaction that will save millions of Americans more than $2 billion in annual medical costs and deliver significant value to shareholders. In addition to filing this lawsuit, Anthem is pursuing an expedited appeal of the District Court's decision and is committed to completing this value-creating merger either through a successful appeal or through settlement with the new leadership at the Department of Justice."
Anthem, Inc.

Creditable Coverage Disclosures Are Due to CMS by March 1
"Plan sponsors generally must disclose creditable coverage status to CMS within 60 days after the beginning of each plan year.... An entity that does not offer outpatient prescription drug benefits to any Part D-eligible individual on the first day of its plan year is not required to complete the CMS disclosure form for that plan year."
Society for Human Resource Management [SHRM]

The Communication Crisis Facing Your Health Plan
"63% of employees said they don't know the benefit of an HSA. 50% don't know how to predict current or future out-of-pocket healthcare expenditures and can't select the best savings vehicle or rate. 26% of HSA accountholders don't know they can use HSA funds beyond the immediate plan year, and 41% of HSA accountholders were unaware they could invest HSA funds."
HR Benefits Alert

The Future of Essential Health Benefits
"[C]ritics of the EHB cite them as a cause of high health insurance costs and as an example of federal overreach. They say the EHB are too expansive and too prescriptive.... Because the principal changes to private insurance mandated by the EHB were to increase availability of coverage for maternity, mental health and substance use disorders, and habilitative care, one possible goal of modifying the EHB rule would be to restrict these benefits."
Health Affairs

Employee Loses Wellness Plan Challenge
"An employee who temporarily stopped receiving health insurance coverage due to a refusal to submit to a wellness plan assessment test but who then received retroactive coverage did not have a valid claim to challenge the legality of the plan ... The court also found that the company voluntarily ceased its program at issue and therefore was not likely to resume it in the same way as before." [EEOC v. Flambeau, Inc., No. 16-1402 (7th Cir. Jan. 25, 2017)]
Society for Human Resource Management [SHRM]

Humana to Pull Out of Obamacare Exchanges in 2018
"Humana cut back its [ACA] exchange participation to 11 states last July, when the Department of Justice sued to block its deal with Aetna. The insurer said that despite efforts to mitigate losses on its exchange plans in 2017 through narrower networks and selective market participation, it is seeing early signs of high pharmacy utilization among its new members."

Aetna-Humana Merger Agreement Ends by Mutual Agreement
" 'While we continue to believe that a combined company would create greater value for health care consumers through improved affordability and quality, the current environment makes it too challenging to continue pursuing the transaction,' said Aetna Chairman and CEO Mark T. Bertolini. 'We are disappointed to take this course of action after 19 months of planning, but both companies need to move forward with their respective strategies in order to continue to meet member expectations.... [We] remain committed to a shared goal of helping drive the shift to a consumer-centric health care system.' "


How High-Deductible Health Plans Hurt Consumers
"Health plan deductibles accounted for 10 percent of the annual wages for the lowest-wage workers in [a recent] study ... Low-wage workers didn't get as much care.... Low-wage workers received less primary and preventive care and much more hospital care.... Despite receiving the least amount of care, low-wage workers had just as high of health care costs as the highest-wage workers who received the greatest amount of care."
Families USA


Proposal to Tax Employees and Retirees on Cadillac-Level Health Coverage Threatens a Nasty Tax Hit
"Proponents of the tax plan will disguise the event, and the tax hit -- when it arrives -- will be gentle at first, but will grow over time. In the end, the result will be a tax increase on many workers, retirees and their families. 'Like your plan and want to keep it?' Well, you may have to pay more taxes in order to keep it, if the plan is even offered at all.... This is really less about tax equity than it is about grabbing additional tax revenue, and a lot of it, longer term."

Benefits in General

Settlement Amounts in DOL Enforcement Suits Declined Substantially in 2016
"Federal government enforcement lawsuits brought by the [DOL] -- including those centered on [ERISA] violations -- continued at an aggressive pace in 2016 but were less effective in terms of number of filings and recoveries when compared with previous years ... [C]lass action dynamics increasingly were shaped and influenced by recent rulings of the U.S. Supreme Court, including in the retirement plan arena.... [T]he monetary value of the top employment-related class action settlements declined significantly in 2016."
HR Daily Advisor

Press Releases

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017, 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, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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