Health & Welfare Plans Newsletter

July 13, 2017

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Webcasts and Conferences

GASB Statement No. 68 - In-Depth Government Pension Accounting & Auditing
RECORDED
AICPA

Saving the Bottom Line with HSAs
RECORDED
ConnectYourCare

Surviving Spouse’s Options with Respect to Their Spouse’s IRA
July 20, 2017 WEBCAST
Collin W. Fritz & Associates, Ltd.

Inherited IRAs for Non-Spouse Beneficiaries
July 20, 2017 WEBCAST
Collin W. Fritz & Associates, Ltd.

Chicago Health Care Summit
July 25, 2017 in IL
Midwest Business Group on Health

Governmental Pensions: Prepare for a Changing Landscape
August 3, 2017 WEBCAST
AICPA

ERISA Basics National Institute
October 25, 2017 in IL
American Bar Association Joint Committee on Employee Benefits [JCEB]

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[Official Guidance]

Text of CMS MLR Annual Reporting Form Instructions for the 2016 MLR Reporting Year (PDF)
61 pages. "[S]ignificant changes [include]: ... [1] ICD-10 expenses may no longer be included in quality improvement activity expenses.... [2] allow an issuer to defer reporting of experience of all policies newly issued in 2016 ... if 50% or more of the issuer's total earned premium for 2016 is attributable to such policies; ... [3] provide issuers the option of limiting the total rebate payable with respect to a given calendar year.... [4] Clarified instructions for reporting the experience of newly issued policies and Basic Health Plans, taxes on Part 1, and claims liabilities and cost-sharing reductions on Part 2." [Also issued: Revised MLR 2016 Calculator and Formula Tool (XLSM)]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Advert.]

Join ECFC in KC for the CDH Education Event of the Summer

Sponsored by ECFC [Employers Council on Flexible Compensation]

Symposium is THE premier networking and professional development event for employers, plan sponsors, TPAs and other service providers in the CDH space, and is your annual opportunity for practical advice, technical education, and Congressional and regulatory updates from industry leaders.


[Official Guidance]

Text of CMS Guidance on Annual Eligibility Redetermination and Re-Enrollment for Exchange Coverage for 2018 (PDF)
"[A] Health Insurance Exchange has three options to redetermine eligibility for enrollment in a qualified health plan (QHP) through the Exchange and insurance affordability programs on an annual basis.... [including] a set of alternative procedures specified by the Secretary for the applicable benefit year. This guidance describes these alternative procedures for benefit year 2018, which are largely the same as the alternative procedures specified by the Secretary for benefit year 2017.... All Exchanges using the federal eligibility and enrollment platform will use the procedures specified in this guidance for benefit year 2018." [Unnumbered document, July 13, 2017]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Washington Becomes Fifth State to Guarantee Paid Family Leave
"Employees are eligible under the law if they have worked at least 820 hours during what the law defines as a 'qualifying period,' or the first four of the last five completed calendar quarters or, if eligibility is not established, the last four completed calendar quarters immediately preceding an employee's application for leave.... Both employers and employees will pay into the state program based on percentages of the employee's wages and the state's weekly average wage."
Dorsey & Whitney LLP

Beware: Cat's Paw May Shred Your Defense of Employees' FMLA Claims
"A decision maker weighing an adverse action against an employee should be wary of relying too heavily on the mere insights of a subordinate supervisor. In the end, the subordinate may be biased. While the decision maker may eventually decide that adverse action is warranted, he must be able to show that the decision was made at the conclusion of a thorough, unbiased investigation and wasn't merely the product of a subordinate's influence. Otherwise, the employer may be on the hook for liability." [Marshall v. Rawlings Co. LLC, No. 16-5614 (6th Cir., Apr. 20, 2017)]
HRDailyAdvisor

Updated SBC Templates Apply for 2018 Open Enrollment
"Given the current House and Senate 'repeal and replace' ACA legislation, many employers are wondering if they need to take the time to revise their SBCs to comply with the new template and requirements. The short answer is use of the new SBC templates are still required. Both the House-passed legislation and the current legislation in consideration by the Senate have no effect on the SBC requirements."
Kilpatrick Townsend

[Advert.]

Online Learning Course: COBRA

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Even with ACA coverage easier for individuals to obtain, group health plans must continue to offer COBRA coverage. This course explains technicalities of COBRA, including who is entitled and how to administer. Code BL2017 for 15% discount, through July 31.


How a Mid-Year Change of Status Affects HSA Contributions
"[An] HSA-eligible individual who has a mid-year status change will have his new annual contribution limit determined by whichever of the following two options results in the highest amount: [1] The maximum annual contribution limit based on his or her actual HDHP coverage (individual or family) for each month of the tax year, calculated monthly, combined and then divided by 12; or, [2] The maximum annual contribution limit for the tax year based on his or her actual HDHP coverage (individual or family) as of December 1 of that year."
DataPath

Senate GOP Leaders Unveil Revised Health Care Bill
"Senate Republican leaders on [July 13] unveiled a fresh proposal to repeal and replace the [ACA] ... [T]he bill would allow insurers, under certain conditions, to offer health plans that did not comply with standards in the [ACA].... If an insurer offered 'sufficient minimum coverage' on the exchange that remains subject to federal mandates in the [ACA], it could also offer coverage outside the exchange that would be exempt from many of those mandates.... Policies that comply with the [ACA] would provide more extensive coverage but would also attract sicker people with higher medical costs. To address this concern, the Republican bill would create a fund to make payments to insurers for the costs of covering high-risk people enrolled in health plans on the exchanges."
The New York Times; subscription may be required

GOP Health Bill Would Ease Rules for Some Small-Business Plans
"[The proposal] would exempt insurance sold through 'associations' from most [ACA] mandates and state regulations. That means the plans could offer lower-cost coverage that does not include a broad range of medical services or sets premiums based on the health of the businesses' employees.... Critics counter that the provision creates two markets, a lightly regulated one with skimpier and less expensive coverage that would attract businesses with younger or healthier workers and a second market left with mainly older, sicker consumers and rapidly rising premiums."
Kaiser Health News

AHIP Rejects Proposed Cruz Amendment to Senate's Health Care Bill
"The insurance industry is pushing back against a proposal from Sen. Ted Cruz (R-Texas) that would let health insurers sell plans that don't adhere to the consumer protections created under the [ACA] ... AHIP's cautious opposition was not enough to sink the House-passed version of the bill to repeal and replace the ACA, but the group's skepticism may hold more weight with senators, who are awaiting the [CBO's] cost estimate of the market impact of Cruz's amendment."
Morning Consult

[Advert.]

Save $50 – use promo code BLINK2 (not valid for webcast)

Sponsored by World Congress

Executive Forum on On-Site and Near-Site Employee Health Clinics. Employers and health system executives involved in on-site/near-site clinic operation/management, worksite health services, and employee wellness meet to discuss developments and innovations.


Challenges to ACA Final Rule Involving Gender Identity Halted While HHS Reconsiders Rulemaking
"Although HHS did not confess error, identify new evidence, or cite any intervening events to support its remand request, the court found HHS identified 'substantial and legitimate concerns' in support of a remand and stay -- namely, that the court and the parties could waste limited resources litigating issues that may be mooted by HHS' impending review of the rule." [Franciscan Alliance, Inc. v. Price, No. 16-108 (N.D. Tex. July 10, 2017)]
Wolters Kluwer

Whichever Way 'Repeal and Replace' Blows, Pharma Is Due for Windfall
"The pharmaceutical industry could see windfall profits from a little-noticed tweak to the insurance market tucked into the Trump administration's draft executive order on drug prices ... The short, technical paragraph calls for the [IRS] to allow patients with high-deductible health plans to receive care for chronic diseases, including drugs, before meeting their deductibles."
Kaiser Health News

2018 Health Insurance Exchanges Issuer County Map
"This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through July 12, 2017.... 40 counties are projected to have no issuers ... [As] many as 1,334 counties -- over 40 percent of counties nationwide -- could have only one issuer in 2018. This could represent nearly 2.4 million Exchange participants that will only have one choice[.]"
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Benefits in General

The Full Fifth Circuit Will Re-Visit the Standard of Review in Denial of Benefits Cases
"[It] is not the least bit surprising that the Fifth Circuit has decided to re-examine the standard of review it applies in ERISA denial of benefits cases. And it is probably not too difficult to guess that the Court, en banc, will reverse Pierre, and align with other circuits holding that a de novo review is called for when reviewing decisions made by retirement and health plans[.]"
Jackson Lewis P.C.

Why Do More New Englanders Receive Disability Insurance Benefits for Mental Disorders?
"A greater share of people in New England states receive Social Security Disability Insurance (DI) benefits for mental disorders than the share nationwide.... [E]vidence suggests that demographics and economics play a large role, as does greater access to health insurance and health care."
Urban Institute

Executive Compensation
and Nonqualified Plans

Reminder on CEO Pay Ratio Disclosure for 2018
"[T]he process for a company to identify its median employee, calculate that employee's annual total compensation, calculate the pay ratio, and prepare any accompanying narrative disclosure can be a significant and time-intensive undertaking. Since a repeal or delay of the pay ratio rule appears increasingly less likely, [the authors] recommend that companies continue to prepare or, for those that have not yet started, begin the process of preparing the methodology they will use to develop their CEO pay ratio disclosure ... In addition, companies may want to consider the impact on its workforce of disclosing the compensation of the company's median employee."
Ropes & Gray LLP

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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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