Health & Welfare Plans Newsletter

March 3, 2017

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[Guidance Overview]

Transit Plan May Require Use of Debit Card Even If Cash Reimbursement Is Permissible
"[IRS Information Letter 2016-0085] reinforces a fundamental point about qualified transportation plan design, namely, that after assuring that the minimum requirements are met for favorable tax treatment, employers are free to impose additional restrictions.... [T]here are no tax nondiscrimination rules for qualified transportation plans, so employers do not need to consider, for example, whether the restrictions tend to favor more highly compensated employees."
Thomson Reuters / EBIA

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[Guidance Overview]

CMS Extends Through 2018 Transition Policy Allowing Renewal of Individual and Small Group Noncompliant Policies
"Any policies renewed under this transition policy will not be considered to be out of compliance with the statutory reforms listed in the guidance -- which are the same reforms listed in the prior guidance. For individual and small group policies, they include premium rating rules, guaranteed availability and renewability, and the requirement to provide essential health benefits."
Thomson Reuters / EBIA

Where Does Your Health Insurance Premium Dollar Go?
"Your premium, or how much you pay for your health insurance each month, covers the costs of providing your insurance as well as the medical care you might receive -- everything from prescription drugs and doctors' visits to health improvement programs and customer service. Here is a visual breakdown of where your premium dollar really goes."
America's Health Insurance Plans [AHIP]

Employers Gear Up for Next Fight After Cadillac Tax
"Since World War II, both an employer and employee's contribution to the cost of health insurance have been excluded from federal income and payroll taxes. That's a major incentive for employers to provide insurance. But employers argue that taxing health benefits would require them to scale back on the benefits they offer, pass more costs onto employees, or even quit providing insurance altogether."
Crain's Chicago Business

Invisible High-Risk Pools: How Congress Can Lower Premiums and Deal with Pre-Existing Conditions
"Maine faced similar challenges in 2011 as it sought to unwind failed experiments that pushed its market into a long-term death spiral. But by creating an invisible high-risk pool and relaxing its premium rating bands, Maine policymakers were able to cut premiums in half while still guaranteeing those with pre-existing conditions access to plans.... Maine's experience provides federal policymakers with key lessons as they work to repeal and replace the ACA."
Health Affairs

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Fact Sheet: Preserving Employee Wellness Programs Act (PDF)
"The Preserving Employee Wellness Programs Act (HR 1313) reaffirms existing law to allow employee wellness programs to be tied to responsible financial incentives.... HR 1313 would bring uniformity to the regulation of wellness programs and clarify that such programs are consistent with the Americans with Disabilities Act and the Genetic Information Nondiscrimination Act."
Committee on Education and the Workforce, U.S. House of Representatives

Fact Sheet: The Self-Insurance Protection Act (PDF)
"Part of a broader effort to advance free-market, patient-centered health care solutions, the [Self-Insurance Protection Act (HR 1304)] would amend [ERISA], the Public Health Services Act, and the Internal Revenue Code to clarify that federal regulators cannot redefine stop-loss insurance as traditional health insurance.... Stop-loss insurance is not health insurance, and it has never been considered health insurance under federal law."
Committee on Education and the Workforce, U.S. House of Representatives

Mastering Tough FMLA Issues: Employees Who Don't Have Restoration Rights
"Employees who cannot perform an essential function of their job aren't entitled to restoration, although they may be entitled to protection under the Americans with Disabilities Act, state leave laws, or a collective bargaining or other agreement.... Key employees, defined as eligible salaried (executive, administrative, professional, and computer) employees who are among the highest-paid 10 percent of all employees within 75 miles of the worksite, are not entitled to reinstatement under the FMLA.... An employee on FMLA leave has no greater right to reinstatement or other terms and conditions of employment than if he hadn't taken leave. But if you deny reinstatement for a reason like a reduction in force, you will have the burden of showing that he wouldn't otherwise have been employed at the time he requested reinstatement."
HR Daily Advisor

Benefits in General

District Court Finds Insurer's Failure to Establish 'Special Circumstances' for Extension of Time to Decide LTD Appeal Warrants De Novo Review
"[A] District Court judge held that the LTD insurer had failed to establish special circumstances warranting an extension of the time frame for deciding the claimant's appeal during the administrative review process. The Court determined that this constituted a violation of the claims processing regulations under ERISA, thereby warranting a de novo review of the insurer's decision rather than the arbitrary and capricious standard of review that otherwise would apply." [Salisbury v. Prudential Ins. Co. of America, No. 15-9799 (S.D.N.Y. Feb. 28, 2017)
Robinson & Cole LLP

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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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