Health & Welfare Plans Newsletter

May 25, 2017

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Webcasts and Conferences

Evaluating Target Date Funds
RECORDED
Multnomah Group

Healthcare Hot Topic of the Month
June 7, 2017 WEBCAST
University Conference Services

'Retiree Liabilities for Dummies' -- Solutions for Managing Pension, Healthcare and Life Obligations
June 20, 2017 WEBCAST
University Conference Services

Employee Benefit Plans for Partnerships
June 29, 2017 WEBCAST
ABA Joint Committee on Employee Benefits [JCEB]

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[Guidance Overview]

Paid Family Leave in the United States (PDF)
15 pages. "This report provides an overview of paid family leave in the United States, summarizes state-level family leave insurance programs, notes paid family leave policies in other advanced-economy countries, and notes recent federal proposals to increase access to paid family leave." [CRS Report R44835, May 24, 2017]
Congressional Research Service [CRS]

[Advert.]

Online Learning Course: HSA and HRA Basics

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

The requirements under HRA and HSA programs can differ greatly from an HCFSA program and from each other. This e-learning course will provide an in-depth look at HSA and HRA programs as well as how these programs interact with an HCFSA.


Come Fly with Me: The FMLA and a Grounded Flight Attendant
"[T]he more an employee exercises her FMLA rights, the more courts -- or at least the 10th Circuit -- will expect her to be aware of those rights and the less strictly the FMLA notification requirements will be enforced against her employer. Furthermore ... the FMLA does not necessarily stand as a bar to appropriate disciplinary action -- provided the discipline is justified and is not merely a pretext (excuse) to hide illegal interference. Indeed, as this case shows, an employee on 'Final Warning' who violates a notice-of-absence policy cannot use the FMLA to hide from appropriate discipline." [Branham v. Delta Airlines, No. 16-4092 (10th Cir. Feb. 3, 2017)]
HRDailyAdvisor

Best Practices for Managing Costs of Orphan Drugs (PDF)
"The overarching 'best practice' management approach for specialty drugs in the medical benefit is to: [1] pay only reasonable costs for drugs, administration, and related fees; and [2] pay only for drugs that are clinically appropriate for the patient.... [T]hese 'simple' objectives aren't easy to carry out for specialty drugs administered in medical sites of care for two reasons.... First, medical claims may be billed with limited information.... Second, drug pricing in the medical benefit is highly, and inappropriately, variable."
Archimedes, via Chelko Center for Benefits Management

Consumer Engagement in Health Care (PDF)
28 pages. "Fourteen percent of privately insured adults were enrolled in a consumer-driven health plan (CDHP) -- a health plan associated with [an HSA or HRA]; 14 percent also were enrolled in a high-deductible health plan (HDHP) ... not linked to an HSA or HRA; and 73 percent were enrolled in more traditional coverage.... More than half (56 percent) of CDHP enrollees opened an HSA, taking advantage of growing employer contributions.... Adults in a CDHP and those in an HDHP were more likely than those in a traditional plan to exhibit a number of cost-conscious behaviors."
Employee Benefit Research Institute [EBRI]

What Percentage of Health Insurance Coverage Does Your Construction Company Pay?
"[This] table may assist you in benchmarking the amount of health insurance coverage that your company provides.... [The chart] provides the 2017 averages for Preferred Provider Organization (PPO) plans."
Schneider Downs

[Advert.]

How to Survive an ACA Audit

Sponsored by Lorman and BenefitsLink

June 6 webinar. Ensure that your policies and procedures mitigate audit inquiries from various federal agencies. Documentation and record retention will be the key to minimizing potential penalties. Discount for BenefitsLink readers.


CBO Cost Estimate for H.R. 1628, the American Health Care Act of 2017, as passed by the House
"CBO and JCT estimate that, over the 2017-2026 period, enacting H.R. 1628 would reduce direct spending by $1,111 billion and reduce revenues by $992 billion, for a net reduction of $119 billion in the deficit over that period....

"CBO and JCT broadly define private health insurance coverage as consisting of a comprehensive major medical policy that, at a minimum, covers high-cost medical events and various services ... The definition excludes policies with limited insurance benefits (known as mini-med plans); 'dread disease' policies that cover only specific diseases; supplemental plans that pay for medical expenses that another policy does not cover; fixed-dollar indemnity plans that pay a certain amount per day for illness or hospitalization; and single-service plans, such as dental-only or vision-only policies. In this estimate, people who have only such policies are described as uninsured ...

"CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under H.R. 1628 than under current law. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 23 million in 2026. In 2026, an estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law. Under the legislation, a few million of those people would use tax credits to purchase policies that would not cover major medical risks."
Congressional Budget Office [CBO] and Joint Committee on Taxation [JCT]

CBO's AHCA Estimate: Decreases in Savings and Uninsured, Potential Market Instability for States with Major Waivers
"The most interesting and lengthy provisions of the report address the stability of nongroup insurance markets and the cost of premiums under the MacArthur Amendment EHB and community rating waivers.... Whether or not states obtained waivers and the extent of the waiver provisions would, the CBO projects, have a significant effect on the stability of the nongroup market and on nongroup market premiums. The $8 billion fund for waiver states would incentivize states to seek waivers, but it is not large enough to have a major effect on premiums."
Timothy Jost, in Health Affairs

American Health Care Act: Summary of Changes Affecting Employer and Group Health Plans (PDF)
"The changes in the Bill would not directly affect the plan design of employer-sponsored group health plans (GHPs), including multiemployer group health plans.... Contrary to some published reports, the Bill does NOT change the way that 'no annual/lifetime limits' rules apply. That is, the Bill does not change the way self-insured plans choose a benchmark state plan for determining compliance with the 'no annual limits on essential health benefits' rules."
United Actuarial Services, Inc.

Reporting Requirements Here to Stay Under AHCA, But May Become Simpler
"The AHCA modifies and then repeals the Code Sec. 36B premium assistance tax credit, and creates an advanceable, refundable tax credit for individuals to purchase state-approved, major medical health insurance and unsubsidized COBRA coverage. Eligible individuals must not have access to government health insurance programs or an offer of health insurance from any employer."
Wolters Kluwer Law & Business

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EEOC Final Rules on Employer Wellness Programs (PDF)
"The Final Rules became effective in January 2017 and apply to all workplace wellness programs, even if they are not offered as part of an employer-sponsored group health plan. However, the Final Rules are not always consistent with [HIPAA], leaving employers to face overlapping and conflicting federal regulations."
Weil Gotshal & Manges LLP, via Employee Relations Law Journal

Employers Are from Mars, Employees Are from Venus
"85% of employee respondents think that it's extremely or very important to be provided a choice of plans compared to only 67% of employers.... Sixty-six percent of employees believed that a vision benefit was a 'must-have' as compared to only 44% of employers, whereas employers put more emphasis on life insurance as being a 'must-have' (71% of employers) as compared to 57% of employees.... 60% of employees found that discount programs were very or extremely valuable (only 10% of employers believed it to be a 'must-have')."
Fidelity Health Marketplace

HIPAA Is Here to Stay
"Audits initiated by OCR and investigations resulting from reported violations reveal that HIPAA compliance continues to be a governmental priority under the new administration. Indeed, nine representative resolution agreements have been released by HHS thus far in 2017 ... Thus, it is as important as ever for employer-sponsored group health plans to ensure that they are complying with HIPAA's encompassing and technical requirements. As the various resolution agreements detail, failure to do so can have dire financial consequences on the group health plan (and correspondingly on the sponsoring employer)."
Fraser Trebilcock

Two HHS Settlements for HIPAA Violations Include Penalties Totaling Over $5 Million
"To prevent costly HIPAA enforcement actions, covered entities are advised to: [1] Conduct new risk analyses after all modifications to underlying technology; [2] Update policies and procedures to account for changes in technology or practices; [3] Regularly provide HIPAA training to employees; [4] Conduct HIPAA audits; [5] Monitor security breaches; and [6] Create and implement a breach response plan."
The Wagner Law Group

[Opinion]

ECFC Makes Recommendations to IRS for 2017-18 Priority Guidance Plan (PDF)
"Guidance on these issues would provide administrative certainty for ECFC members that design and administer employee benefit plans. [1] Qualified Small Employer Health Reimbursement Arrangements.... [2] [Updating] the regulations under Section 213 ... to reflect changes in the tax law and changes in the products, practices and procedures relating to medical care."
Employers Council on Flexible Compensation [ECFC]

[Opinion]

Key Takeaways from CBO's Scoring of the Republican Health Care Bill
"CBO finds that two million fewer people in 2020 and about one million fewer in 2026 would become uninsured under the AHCA. They cite that this is due to 'four million more people with employment-based coverage ... This is an interesting way to frame the effects of the AHCA, since reducing premium levels by rolling back regulations could actually have the effect of making plans more desirable for individuals looking to pay less. CBO lacks any real discussion of these positive effects."
The Heritage Foundation

[Opinion]

Employee Wellness Programs and the Law: Undermining Genetic Privacy?
"[N]early three quarters of large employers collect employee health information through wellness programs, and more than half of them provide incentives to employees to participate. Yet only 41% of workers agree to disclose health information.... H.R. 1313 ... would deem workplace wellness programs that comply with ACA standards ... to be compliant with ADA and GINA standards.... Employers could pressure employees to disclose information, and wellness programs could share identifiable information with employers. H.R. 1313 undermines the principle that genetic information needs the highest level of protection so that people can make decisions about obtaining their own information without fearing that it might be used against them."
Kathy L. Hudson, Ph.D. and Karen Pollitz, M.P.P., via New England Journal of Medicine

Executive Compensation
and Nonqualified Plans

Severance Plans and ERISA
"[Y]ou may want to make your severance plan subject to ERISA.... [I]ncentive plans generally would become subject to ERISA as an employee pension benefit plan, while severance plans generally would be subject to ERISA as employee welfare benefit plans. In fact, ERISA contains numerous advantages for the employer/plan sponsor[.]"
Winston & Strawn LLP

Discussions on
the BenefitsLink Message Boards

City-Sponsored Retiree Health Program Reimburses 'Health Care Premiums'
"The municipal code provides a retiree is entitled to obtain health care coverage under any city-sponsored plan, or any other health plan of their choice, and will be reimbursed for health care premiums subject to certain limits.... No plan document or summary is available to retirees that sets forth rules for what expenses might not be reimbursed, or how reimbursement amounts are calculated.... [C]ertain retirees are obtaining coverage through their working spouses' plans and are seeking reimbursement for the cost difference between employee-only coverage and employee plus spouse coverage. Is this allowed under the Code? ... What if the the spouse uses flex credits under a 125 plan to pay to add the retiree? Isn't this 'double-dipping' so the reimbursement would be income to the retiree? Shouldn't this all be explained to retirees in some sort of plan summary?"
BenefitsLink Message Boards

Press Releases

DOL, PBGC Partnership Recovers Almost $1.5M for Participants in two Chicago-based Pension Benefit Plans
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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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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