Health & Welfare Plans Newsletter

June 7, 2017

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Employee Benefits Jobs

401k Service Administrator
Retirement Direct
in NC

Retirement Plan Analyst
Retirement Plan Solutions, Inc.
in NC, Telecommute

Fiduciary Advisor
PNC Bank
in PA

401k Account Manager
LT Trust
in CO

Retirement Plan Administrator
McCloud & Associates, Inc.
in MO

Administrative Consultant for Qualified Retirement
PenSys, Inc.
in CA, CO, NC

Pension Plan Administrator
National TPA
in AZ, CA, CO, GA, IL, NC, OH, TX

Executive Director
Connecticut Coalition of Taft-Hartley Health Funds, Inc
in CT

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Webcasts and Conferences

Structuring Cash Balance Pension Plans: Maximizing Tax Benefits and Limiting Risks
RECORDED
Strafford

DC-1 Exam Review: Tips and Traps
RECORDED
ASPPA [American Society of Pension Professionals & Actuaries]

Substance Abuse and Its Impact to Benefit Plans
June 21, 2017 in GA
ISCEBS - Georgia Chapter

Form 5500 Workshop
August 14, 2017 in NY
FIS Relius Education

ERISA Workshop
August 15, 2017 in NY
FIS Relius Education

36th Annual ISCEBS Employee Benefits Symposium
September 17, 2017 in CO
International Foundation of Employee Benefit Plans [IFEBP]

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Discussions

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New Comments and Topics

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[Official Guidance]

Medical Loss Ratio (MLR) Annual Reporting Form Instructions (PDF)
61 pages. "These Filing Instructions are to be used in completing the MLR Form by all health insurance issuers (issuers) offering health insurance coverage subject to section 2718 of the PHSA and the MLR implementing regulations.... An MLR Form must be prepared and submitted for each State in which the issuer has written direct health insurance coverage or has direct amounts paid, incurred, or unpaid for the provision of health care services." [Also available: MLR 2016 Calculator and Formula Tool (XLSM) and MLR 2016 Annual Reporting Form (XLSX).]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Official Guidance]

Risk Corridors Plan-Level Data Form Filing Instructions for the 2016 Benefit Year (PDF)
16 pages. "Each company with at least one health insurance issuer that offered a certified QHP through the Federal or State-based Marketplace during the 2016 benefit year will submit the Risk Corridors Plan-Level Data Form [XLSX] with plan-specific premium data for each of its QHP issuers in the individual or small group markets. This form is only required to be submitted by companies with at least one issuer with at least one plan that is certified and offered through either the Federal or State-based Marketplace."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Intermittent Leave Under the FMLA: The Basics
"Employers should ask the employee questions designed to determine whether the employee's request is one that would be FMLA-qualifying. Don't ignore an employee's seemingly simple or routine requests for time off.... If the request is for foreseeable leave, the employer should communicate with the employee about how it will consider the request pending the receipt of a medical certification and further investigation. Employers have a right to request a medical certification and should exercise that right.... [E]mployers should be mindful of the fact that the FMLA does not exist in a vacuum and that they are responsible for identifying all laws that apply to an employee's request for medical leave."
Mintz Levin

Supreme Court 'Church Plan' Decision and Pending Rule Will Affect Preventive Services Coverage by Group Health Plans
"The group health plan requirements of the [ACA] apply to church plans ... The government has consistently taken the position, however, that, because church plans are exempt from ERISA, it has no means of compelling the third party administrators of self-insured church plans to comply with the ACA, or at least its preventive services requirement.... The leaked contraceptive rule would effectively extend the exceptions that have excused self-insured church plans -- and churches -- from complying with the contraceptive [coverage] requirement ... If the rule that emerges from HHS is significantly narrower than the leaked version, more entities might rely on the Advocate Health Care ruling to claim the protection of the church plan exemption."
Timothy Jost, in Health Affairs

Top 10 Catastrophic Claims Conditions and Million-Dollar+ Claimants (PDF)
24 pages. "The total of all Sun Life Stop-Loss claims reimbursements from 2013 to 2016 was $2.7 billion. If those stop-loss claims reimbursements are added to first-dollar catastrophic claims costs (the amount that employers pay before reaching the stop-loss deductible), the overall cost for catastrophic conditions was $6.1 billion.... Million-dollar+ claimants were up 26% compared to 2012-2015. In 2016, this group represented only 2.2% of claimants but accounted for 23% of all stop-loss claims reimbursements."
Sun Life Financial

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CBO: Postal Reform Would Bring Cheaper Health Insurance Premiums to All Federal Employees
"A key component of the 2017 Postal Service Reform Act would be the creation of a new health benefits program just for postal employees and retirees, while also requiring all eligible annuitants to enroll in Medicare as their primary provider. Federal workers remaining in their current Federal Employees Health Benefits plans would see their costs shrink, as removing postal employees -- who are generally costlier to insure than the rest of the federal workforce -- from their pools would decrease the overall expenses associated with their insurance."
Government Executive

Anthem Will Exit Ohio's Health Insurance Exchange
"Anthem ... announced on [June 6] that it will stop offering policies in the Ohio marketplace next year. The decision leaves about a fifth of the state's counties potentially without an insurer for 2018, affecting some 10,500 people."
The New York Times; subscription may be required

[Opinion]

Paid Family and Medical Leave: The Time Has Come (PDF)
48 pages. "There is little or no disagreement in [this] working group that the time for the US to adopt such a policy has come.... It is in the spirit of compromise that we offer a plan ... that could help move the US forward on this issue.... Its key elements are benefits available to both mothers and fathers, a wage-replacement rate of 70 percent up to a cap of $600 per week for eight weeks, and job protection for those who take leave. It would be financed in part by a payroll tax on employees and in part by savings in other parts of the budget. Because too little is known about how this might work in practice, we called for an independent study of the consequences."
AEI-Brookings Working Group on Paid Family Leave

[Opinion]

Limiting the Employer Tax Exclusion for Healthcare Is the Wrong Idea
"[A]ltering the tax-favored status of employer-provided benefits will have the same effect as the Cadillac tax -- employers are going to plan around it.... If the employer exclusion is eliminated there would be little incentive for employers to continue to provide benefits -- and if they do, the pressure to reduce costs, and thus benefits, will be intense. The impact on lower-paid workers would be far greater than the more highly-compensated group."
Craig Hasday, via Employee Benefit Adviser

[Opinion]

No, Trump Didn't Cause Obamacare to Fail
"If we stay with Obamacare, within a few years tens of millions will have no insurance that is even remotely affordable. Republicans have to do a much better job of explaining their plan and providing Americans better and cheaper options. By the end of the year we could have nearly half the country without insurers if this spiral continues."
The Heritage Foundation

Benefits in General

[Official Guidance]

Text of IRS Disaster Relief MO-2017-01, for Victims of Severe Storms in Missouri
"Individuals who reside or have a business in the following counties: Bollinger, Butler, Carter, Douglas, Dunklin, Franklin, Gasconade, Howell, Jasper, Jefferson, Madison, Maries, McDonald, Newton, Oregon, Osage, Ozark, Pemiscot, Phelps, Pulaski, Reynolds, Ripley, Shannon, St. Louis, Stone, Taney, and Texas may qualify for tax relief.... [C]ertain deadlines falling on or after April 28, 2017, and before August 31, 2017, are granted additional time to file through August 31, 2017.... This relief also includes the filing of Form 5500 series returns, that were required to be filed on or after April 28, 2017, and before, August 31, 2017."
Internal Revenue Service [IRS]

[Guidance Overview]

DOL Final Rule Regarding Disability Claims and Appeals Now in Effect
"Plan sponsors should review health and welfare and pension plans to determine if they are subject to the final rule. Most plans will have already made this determination in response to the original regulations issued in 2000, but if the responsibility for making the disability determination has changed through the years, plan language [should] be reviewed and revised as necessary. Summary plan descriptions (SPDs) must be amended to add language implementing the new rules. In addition, a determination should be made as to whether document language and administrative practices remain in alignment."
Segal Consulting

Year-Round Engagement Breaks Barriers in Employee Benefits ROI
"To address the challenges of rising costs and the demands of a multi-generational workforce, employers and their brokers have been forced to deploy an increasingly diverse and often complex benefit strategy. In a world of 'connectedness' and employee self-service, these complex strategies often lead to more employee disengagement, undermining the success of the overall benefit program. There are three distinct underlying trends that are contributing to employee disengagement.... [1] Employee wants: convenience, simplicity and cost savings.... [2] Employer wants: productivity and benefit utilization.... [3] Mobile drives employee engagement."
Hodges-Mace, via Employee Benefit Adviser; free registration may be required

Federal Court Strikes Down PTIN Fees, Upholds PTINs
"According to the court, because the court in Loving found that Congress did not authorize a license requirement for tax return preparers, there are no longer any restrictions on who may obtain a PTIN. As a result, there is no 'special benefit' of being able to prepare tax returns for compensation (slip op. at 15). Therefore, PTINs are not a 'service or thing of value' and the IRS cannot charge a fee for issuing them. In a separate order accompanying the opinion, the court ordered the IRS to 'provide each class member with a full refund of all PTIN fees paid.' " [Steele v. U.S., No. 14-1523 (D.D.C. June 1, 2017)]
Journal of Accountancy

Discussions on
the BenefitsLink Message Boards

Starting HSA Contributions Mid-Year Due to Change of Status
"Employee opts out of medical coverage for 2017 but elects general purpose health FSA coverage during open enrollment because he is covered under spouse's plan. Spouse terminates employment mid-year. Due to the change in status, the employee enrolls himself and spouse under employer's HDHP starting June 1 and wants to contribute to HSA starting then. Employee has exhausted health FSA balance. Can employee terminate FSA effective May 31 and start contributing to an HSA thereafter?"
BenefitsLink Message Boards

Final DOL Rule for Disability Claims as Applied to Top Hat Plans
"I am confident that nonqualified top hat plans will need to address the final rule, specifically when disability is a payment trigger, but is the rule applicable if disability only accelerates vesting and is not a payment trigger? What if the plan only contains disability respective to the cancellation of a deferral election?"
BenefitsLink Message Boards

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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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