Health & Welfare Plans Newsletter

April 19, 2017

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[Guidance Overview]

Be Wary of Wellness Plan Designs Purporting to Avoid Income and Employment Taxes
"[IRS Chief Counsel Memo (CCM) 201622031] addresses the tax treatment of three different situations in which wellness benefits result in taxable income to employees.... [CCM 201703013] addresses the tax treatment of fixed indemnity cash payments paid by a wellness plan without regard to the amount of medical expenses incurred by the employee, where the employee is paying premiums to participate in the wellness program."
Jackson Lewis P.C.

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[Guidance Overview]

The Final Market Stabilization Rule: What's There, What's Not, and How It Might Work
"Although the rule addresses market stability, it nowhere mentions the two greatest current threats to the stability of the individual market. The first is the ongoing confusion as to whether Congress will appropriate, or the administration will continue to pay, the $7 billion to $9 billion in cost-sharing reduction (CSR) payments it owes to insurers ... The second threat to market stability not mentioned in the rule is the administration's mixed messages about enforcement of the individual responsibility requirement."
Timothy Jost, in Health Affairs

[Guidance Overview]

Changes to Stabilize HealthCare.gov Have Implications for Employer Sponsored Health Plans
"[T]hese regulations are designed to stabilize the individual insurance market and limit special enrollment opportunities on the federal marketplace through HealthCare.gov and limit the annual enrollment period ... [W]hen access to other coverage is limited or more restricted, then employers may find an increase in requests for enrollment in their group health plan coverage."
Winstead PC

[Guidance Overview]

Market Stabilization Rule: Assessing the Trump Administration's First ACA Market-Related Regulation (PDF)
Chart summarizes the draft and final regulations, with analysis of the impact of each of the final regulation's provisions.
Faegre Baker Daniels

[Guidance Overview]

HHS and CMS Move Ahead on Regs Despite ACA Uncertainty
"[HHS and CMS] have moved ahead with finalizing their proposed changes to ACA rules.... [T]he final rules make a number of discreet changes to improve the risk pool, including: [1] Open enrollment period.... [2] Special enrollment in HealthCare.gov.... [3] Premium debt.... [4] Actuarial value."
Seyfarth Shaw LLP

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Health Insurance Companies Respond to Opioid Epidemic
"According to a September 2016 study ... the total annual cost of the U.S. opioid epidemic is $78.5 billion, most of which is attributed to insurance coverage. The impact of this crisis is having a significant effect on benefit claim costs and more so on overall productivity of the private employer workplace. With this in mind, this document outlines the posture and reformative contractual changes being taken by insurers in the health insurance industry."
EBCG

Price Shopping Could Cut Employer Health Costs by 20%, But There's a Catch
"Reference pricing ... caps the amount the purchaser will reimburse for an identified procedure or test, typically at the midpoint price charged by providers in the region.... [C]overed employees are motivated to price shop, and many shift to lower-priced providers. Second, high-priced providers come back to the negotiating table and lower their prices. The researchers estimated that if all employers implemented reference pricing for just eight procedures, the U.S. would save nearly $20 billion, or almost 20% of the cost of those procedures."
Forbes

Insurance Companies Meet with CMS Administrator, Push for ACA Payments
"Insurance executives, as well as the head of the trade group America's Health Insurance Plans, met with [CMS Administrator] Seema Verma ... Insurers have been pressuring administration officials and lawmakers to fund the ACA's cost-sharing reduction payments."
Morning Consult

HHS Documents Reveal Serious Behind-the-Scenes Security Concerns About Healthcare.gov
"[An] unsigned 'Authorization to Operate' prepared just five days before Obamacare's launch, indicates that the site's 'validation contractor' was 'unable to adequately test the confidentiality and integrity of the [Federally Facilitated Marketplace] system in full.' That contractor, Blue Canopy, noted that they were able to access data 'that should not be publically [sic] accessible.' "
Judicial Watch

[Opinion]

Addressing Pre-Existing Conditions and Encouraging Continuous Coverage
"Health insurance rules must be crafted in a way that encourages individuals not only to get, but also to maintain coverage. Obamacare destabilized the market by enabling (and even encouraging) individuals to pay for coverage only when they expected to incur claims. Policymakers should link the ban on exclusions for pre-existing conditions to a requirement of continuous coverage."
The Heritage Foundation

[Opinion]

Moving Toward a Fair Federal Tax Treatment of Health Insurance (PDF)
"The federal tax exclusion on [employer-provided health] insurance is the major policy-driven contributor to increased cost growth.... [It] drives over-insurance, and thus the excessive reliance on third-party payment for medical services."
The Heritage Foundation

Benefits in General

Effective Employee Communication: The Benefits of Best Practices
"[M]any employers who spend millions of dollars to offer a benefit or workplace style only spend a surprisingly small amount to ensure that employees understand and appreciate it. Communications -- what you say, how you say it, when you say it, who you say it to -- is vital to inform and influence how employees think about their benefits, workplace, and employer.... Five best practices: [1] Plan before you launch.... [2] Don't sugarcoat bad news.... [3] Stick to your message.... [4] Make sure the managers and supervisors are on board.... [5] Rinse and repeat."
Milliman

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Lois Baker, J.D., President  loisbaker@benefitslink.com
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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