Health & Welfare Plans Newsletter

February 24, 2017

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[Official Guidance]

Text of CMS Insurance Standards Bulletin: Extension of Transitional Policies Through Calendar Year 2018 (PDF)
"States may permit issuers that have renewed policies under the transitional policy continually since 2014 to renew such coverage for a policy year starting on or before October 1, 2018; however, any policies renewed under this transitional policy must not extend past December 31, 2018.... This approach will facilitate smooth transitions from transitional coverage to [ACA-compliant] coverage, which requires a calendar year policy year in the individual market." [Editor's note: a 'transitional' policy sometimes is called a 'grandmothered' policy.]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Administration Allows States to Extend Transitional Policies Again
"These plans will continue to be exempt from most of the ACA's insurance reform provisions which otherwise became effective on January 1, 2014, including the ban on health status underwriting; the guaranteed availability and renewability requirements; the essential health benefits, annual out-of-pocket limit and actuarial value requirements; the ban on preexisting condition exclusions; and the requirement that all individual and small group market plans of an insurer be part of a single individual or small group risk pool."
Timothy Jost, in Health Affairs

[Guidance Overview]

Not Ready to File the Forms 1094-C and 1095-C? How to Request an Extension from the IRS
"An employer who has elected to, or is required to, file electronically will have until March 31, 2017 to file the Forms 1094-C and 1095-C. If an employer is not prepared by the requisite deadline, the employer may receive an automatic 30 day extension by filing a Form 8809 with the IRS. This extends the paper deadline until March 30, 2017 and the electronic deadline to May 1, 2017. This article provides basic instructions regarding how an employer should complete the Form 8809."
Accord Systems, LLC

[Guidance Overview]

Administration Moves to Stabilize Marketplace for 2018
"[HHS has] issued a Proposed Rule designed to stabilize the individual and small group markets by addressing some of insurers' concerns in hopes of keeping them in the marketplace. The Proposed Rule would change the standards relating to special enrollment periods (SEPs), guaranteed availability, the timing of the annual open enrollment period (OEP) in the individual market for the 2018 plan year, network adequacy and essential community providers for qualified health plans (QHPs), and the rules around actuarial value requirements. It also announces upcoming changes to the qualified health plan certification timeline."
Wolters Kluwer

Fewer Small Employers Offering Health Insurance
"[T]he total percentage of employers offering insurance fell to 45.7 percent in 2015, a 1.8 percentage point drop from 2014. Larger employer offers of insurance increased by 1.2 percentage points to 96 percent in 2015 compared to 2014. But that was offset by small employers -- only 29.4 percent of them offered insurance, a 2.8 percent drop."
Washington Examiner

[Advert.]

Online Learning Course: HIPAA Security

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Health plans and business associates must comply with the HIPAA Security Rule. Topics covered include: Administrative Safeguards; Physical Safeguards; Technical Safeguards; and Organizational Requirements.


Jury to Decide Whether Police Sergeant's Protest of FMLA Policy Warranted Denial of Promotion
"A police sergeant who was initially denied his request to use his accrued sick leave to care for his wife following childbirth complications due to the employer's erroneous belief that he sought 'paternity' leave, and also was denied his request not to have the leave designated as FMLA leave, avoided summary judgment on his FMLA interference claim. The federal court in Nevada also allowed him to advance his retaliation claim ... because whether his protected activity was carried out in such a manner that it became a legitimate reason for the decision should be decided by a jury[.]" [Browett v. City of Reno, No. 16-181 (D. Nev. Feb. 17, 2017)]
Wolters Kluwer

A Factor in Higher Healthcare Costs: When Evidence Says No, but Doctors Say Yes
"For all the truly wondrous developments of modern medicine ... it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous.... In 2014, two researchers ... found that typical adults attributed about 80 percent of the increase in life expectancy since the mid-1800s to modern medicine. 'The public grossly overestimates how much of our increased life expectancy should be attributed to medical care,' they wrote ... This perception, they continued ... 'may also contribute to overfunding the medical sector of the economy and impede efforts to contain health care costs.' "
The Atlantic

Justice Department Joins Whistleblower Suit Accusing UnitedHealth Group of Overcharging Medicare by 'Hundreds of Millions'
"The suit accuses United of operating an 'up-coding' scheme to receive higher payments under [Medicate Advantage's] risk adjustment program ... The complaint alleges that United fraudulently collected 'hundreds of millions -- and likely billions -- of dollars' by claiming patients were sicker than they really were."
Sheppard Mullin

[Opinion]

ECFC Letters to Congress in Support of Proposed Health Savings Act (PDF)
"Enhancing access to Health Saving Accounts (HSAs) by expanding eligibility rules and increasing the maximum contribution limit and allowing their funds to be used for evolving health care needs and services, helps American families save for and manage their growing health care expenses. [ECFC believes] that the provisions of this bill should be included in any effort made by Congress to reform the health care system."
Employers Council on Flexible Compensation [ECFC]

[Opinion]

ECFC Letter Requesting Guidance for Qualified Small Employer Health Reimbursement Arrangements Under the 21st Century Cures Act (PDF)
"[G]uidance is needed for employers to understand whether they are currently offering a disqualifying group health plan.... We would like confirmation that an employer could, in fact, offer a QSEHRA that limits reimbursements to premiums for health insurance.... [A] QSHRA that reimburses at the maximum for individual and family coverage should be considered as providing coverage under the same terms for all eligible employees regardless of the difference in price between a health policy with single coverage and one with family coverage.... An employer's involvement with after-tax payroll deduction for any excess cost of a QSEHRA funded policy (i.e., amounts in excess of the statutory limits) should not cause the employer to become ineligible to offer a QSEHRA ... It would be helpful ... for the Agencies to provide a model notice that will satisfy the requirements for the notice."
Employers Council on Flexible Compensation [ECFC]

Benefits in General

Supreme Court Will Not Review Enforceability of Forum Selection Clauses in ERISA-Governed Benefit Plans
"While the only two U.S. appellate courts to rule on the issue of forum selection clause enforceability as it relates to ERISA benefit plans (i.e., the 6th and 8th Circuits) have upheld their validity, ... several U.S. district courts within other circuits have found these clauses unenforceable ... [W]hile forum selection clauses within ERISA-governed benefit plans may continue to be enforced in the 6th and 8th Circuits, other circuits are still free to adopt the opinion that such clauses are invalid and thus unenforceable."
Butterfield Schechter LLP

Press Releases

PBGC Customer Contact Center Additional Saturday Operating Hours
PBGC [Pension Benefit Guaranty Corporation]

TIAA Joins the Retirement Advisor Council
Retirement Advisor Council

ECFC Announces New Board Members
ECFC [Employers Council on Flexible Compensation]

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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

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