Health & Welfare Plans Newsletter

April 6, 2017

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Midwest US Regional Sales Director
Fringe Benefit Group
in IA, IL, KS, MO, NE, NV, OK, WI

Enrolled Actuary
Actuarial Data Inc.
in PA

Actuarial Analyst
Actuarial Data Inc.
in PA

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Webcasts and Conferences

Identifying Common-Law Employees: Implications for Employer Group Health Plans
April 20, 2017 WEBCAST
Thomson Reuters / EBIA

Pay Me Now or Pay Me Later: How Not to Run an Employee Benefit Plan
May 16, 2017 WEBCAST
American Bar Association [ABA]

Fundamentals of 401(k) and Other Qualified Plans
June 19, 2017 in IL
FIS Relius Education

Group Health Plans Quarterly Update - Q2 2017
June 21, 2017 WEBCAST
Thomson Reuters / EBIA

QDROs Boot Camp
July 12, 2017 WEBCAST
National Business Institute

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[Guidance Overview]

CRS Report: Resources for Frequently Asked Questions about the Affordable Care Act (PDF)
35 pages. "This report provides resources to help congressional staff respond to constituents' frequently asked questions about the law. The report lists selected resources regarding consumers, employers, and other stakeholders, with a focus on federal sources. It also lists CRS reports that summarize the ACA's provisions." [Report R43215, updated Apr. 3, 2017]
Congressional Research Service [CRS]

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[Guidance Overview]

Can an Employee Take FMLA Leave to Care for a Sibling? Before You Say 'No,' Read This
"[C]ourts have quickly shut the door on employees seeking FMLA protection to care for their siblings ... Therefore, the courts still clearly need to be convinced that the FMLA somehow affords leave rights to employees to care for their siblings. They don't appear at all ready to enlarge the FMLA to cover brothers and sisters.... the only sliver of hope for the employee is to shoehorn themselves into the category of 'parent' ... by establishing that they stand in loco parentis to the adult sibling they are asking to care for."
FMLA Insights

[Guidance Overview]

IRS Explanation: Types of ACA Employer Payments and How They Are Calculated
"[1] Employer Shared Responsibility Payment for Failure to Offer Minimum Essential Coverage. Which Employers Will Owe this Payment? ... How is This Payment Calculated? ... [2] Employer Shared Responsibility Payment for Failure to Offer Affordable Minimum Essential Coverage that Provides Minimum Value. Which Employers Will Owe This Payment? ... How Is This Payment Calculated?"
Internal Revenue Service [IRS]

FMLA Intermittent Leave and Interference Claims Per the Eleventh Circuit
"The fact that the employee got all the leave he or she actually requested doesn't foreclose an interference claim. How you grant the leave can make a difference.... You can request documentation but make sure it goes to the need for leave. You should always require medical certifications but you can't require a doctor's note for every absence.... Be careful when addressing performance issues with employees taking intermittent FMLA as it can look like interference." [Diamond v. Hospice of Florida Keys, Inc., No. 15-15716 (11th Cir. Jan. 27, 2017; unpub.)]
Bradley Arant Boult Cummings LLP

Illinois Catches the Paid Sick Leave Bill Bug
"Under the proposed law ... employees would be entitled to a minimum of five 'paid sick days' each year to: [1] care for their own physical or mental illness, injury, or health condition, or seek medical diagnosis or care; [2] care for family member for the same reasons; [3] attend a medical appointment for themselves or family members; [4] miss work due to a public health emergency; or [5] miss work because the employee or a family member has experienced domestic violence abuse."
Seyfarth Shaw LLP

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Health Insurance Provider's Fee 2017 Moratorium
"There is no requirement for covered entities to file a Form 8963, Report of Health Insurance Provider Information, in April 2017 based on 2016 data.... [T]he suspension of the fee is for the 2017 calendar year only. As it currently stands, the filing of a Form 8963 and payment of the fee by a covered entity will be required in April, 2018 reporting data related to the 2017 year."
WithumSmith+Brown, PC

House Passes Bill to Protect Access to Stop-Loss Insurance by Self-Insured Health Plans
"The House [on April 5] passed the Self-Insurance Protection Act (H.R. 1304) ... by a bipartisan vote of 400 to 16.... The legislation would amend [ERISA], the Public Health Service Act, and the Internal Revenue Code to clarify that federal regulators cannot redefine stop-loss insurance as traditional health insurance." [Fact Sheet also available.]
Committee on Education and the Workforce, U.S. House of Representatives

Invisible High-Risk Pools
"Maine also used a form of invisible risk pools when it began transitioning away from a strict community-rating/guaranteed issue requirements in 2011 ... This experiment illustrates that Republicans have numerous tools and states have many ways to experiment to make their insurance markets less dysfunctional.... The results in Maine were that young peoples' premiums fell by about $5,000, while those much older saw their premiums fall even more."
National Center for Policy Analysis Health Policy Blog

Pence Presents New Healthcare Offer to Freedom Caucus
"Vice President Pence ... presented an idea at the Freedom Caucus meeting to allow states to choose to apply for waivers to repeal two Obamacare regulations ... [1] Obamacare's essential health benefits, which mandate which health services insurers must cover, and [2] 'community rating,' which prevents insurers from charging sick people higher premiums. Conservatives had previously called for the bill to repeal those regulations outright, but the deal now being discussed would give states a choice by allowing them to apply for a waiver from the federal government."
The Hill

Benefits in General

Some Standing Issues Under ERISA (PDF)
"The U.S. Supreme Court has defined standing as 'whether the litigant is entitled to have the court decide the merits of the dispute or of particular issues.' Subject matter jurisdiction in ERISA litigation involves both constitutional limits on federal courts and prudential limitations on its exercise. Even if a plaintiff has a cause of action arising under a given statute, 'federal courts ... have only the power that is authorized by Article III,' which enforces the Constitution's case or controversy requirement."
Barry L. Salkin, The Wagner Law Group, via Benefits Law Journal

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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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