Health & Welfare Plans Newsletter

July 28, 2017

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Webcasts and Conferences

What Employers Should Know About Their Health Plan
August 2, 2017 WEBCAST
Ohio State Bar Association

Chicago and Cook County, Illinois Paid Sick Leave Ordinances Take Effect
August 15, 2017 WEBCAST
Littler Mendelson

Whatís Happening with CDHPs and HSAs?
December 5, 2017 WEBCAST
Midwest Business Group on Health

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[Guidance Overview]

Agencies Issue New Guidance on Mental Health Parity and Addiction Equity Act
"Plan sponsors should ... [take] a detailed look at any treatment limitations or authorization rules to assure that they are not more restrictive than those applied to medical/surgical treatments. In addition, plan sponsors ... should be prepared to demonstrate that any treatment limitations or medical-management criteria, such as prior authorization or utilization review standards, are no more restrictive than those applied to medical or surgical benefits."
Segal Consulting

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[Guidance Overview]

Increase in 2017 Service Contract Act Health and Welfare Rate; Lower Rate for Contracts Covered by Federal Paid Sick Leave Executive Order
"The [DOL] has released its annual memorandum with the rate increase for Service Contract Act (SCA) Health and Welfare Fringe Benefits. The new rate of $4.41 per hour (up from the 2015-2016 rate of $4.27 per hour) is required in all government contract bids or other service contracts awarded on or after August 1, 2017."
Jackson Lewis P.C.

Fifth Circuit Recognizes ERISA Plan and SPD in One Document
"[P]lan sponsors should review the terms of their SPDs intended to also serve as the plan document to make sure that they contain sufficient information to serve in a dual capacity.... [P]lan sponsors should remove any reference in the SPD to a nonexistent plan document and have the SPD formally approved as the plan document through the proper corporate approval process." [Rhea v. Alan Ritchey, Inc., No. 16-41032 (5th Cir. May 30, 2017)]
Wilkins Finston Friedman Law Group LLP

Theft Was Gross Misconduct, But Inconsistencies May Make COBRA Ineligibility Less Clear
"An employer argued that COBRA coverage was not provided due to a qualified beneficiary's gross misconduct. However, the former employee countered that the real reason behind his termination and the COBRA coverage denial was the high cost of his medical expenses.... [T]he court denied a request to rule in the former employee's favor on a COBRA notice claim.... Given that the gross misconduct determination is based on the facts and circumstances, plan administrators considering whether to deny COBRA coverage should follow certain steps before making a final determination."
HR Daily Advisor

Second Circuit Lowers Bar for Causation in FMLA Retaliation Claims
"The Second Circuit agreed with the former employee, finding that she need only show that taking protected FMLA leave was a motivating factor in her discharge. The court found that ... deference should be given to the [DOL regulations, which] provide that FMLA leave cannot be used as a 'negative factor' in employment actions." [Woods v. START Treatment & Recovery Centers, Inc., No. 16-1318-cv (July 19, 2017)]
Ogletree Deakins

[Advert.]

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Open Enrollment Reminder: Use Updated Summary of Benefits and Coverage Forms
"Under the revised format, SBCs will be shorter, typically five pages in length. The DOL has tried to simplify the SBC to make some of the information easier to understand. It has also added a new coverage example dealing with a simple fracture."
Warner Norcross & Judd LLP

Provider Ordered to Return Millions to Health Plans
"[The DOL has reached an agreement with] a third-party administrator that provides employee health benefit plans with access to a network of doctors, hospitals and other medical providers ... in which the administrator has committed to improve its communications with health plans and to return certain fees.... Under the agreement, MagnaCare will return at least $14.5 million in network management fees to ERISA health benefit plans, 'with possible additional payments of $4.5 million based upon business volume through 2019.' "
PLANSPONSOR

Proposed New York City Council Legislation Would Add Private Right of Action to Earned Sick Time Act
"Under the new legislation, employees ... could file a civil action in any court with jurisdiction to enforce their rights under the ESTA.... The legislation also would give authority to the City's Corporation Counsel to initiate actions to correct violations of the ESTA, including to secure permanent injunctions, to enjoin certain practices, or to mandate compliance with the ESTA."
Jackson Lewis P.C.

McCain Votes No, Derails 'Skinny Repeal' in Marathon Session
"The Senate struggled late into the night to craft and then vote on a 'skinny repeal' of the health law, but came up empty as the bill was defeated in a 51-49 vote ... McCain's vote was unexpected and ends -- for now -- the Republican Party's effort to kill Obamacare."
Kaiser Health News

Rep. Mark Meadows: New Healthcare Bill Is Coming 'That Can Get to 51'
"Rep. Mark Meadows [R-NC], a key negotiator in the effort to repeal and replace Obamacare, said a new effort is underway to write a bill that can pass the Senate that would include proposals offered by Sens. Lindsey Graham, Bill Cassidy, Ted Cruz, and Rob Portman.... Meadows said he has talked to senators, including Graham, in the hours after this morning's failure to pass a 'skinny' repeal bill, and the mood is 'all hands on deck' to come up with a new deal."
Washington Examiner

Small Business Health Insurance and the ACA: Views from the Market 2017
"[W]hile trends in premium and offer rates have remained relatively stable, many of the ACA's goals have been stymied by an expanded set of health plan choices for small business owners. The authors further find that these new options provide more affordable coverage for employers with healthy employees, but pose a risk to the small-group market as a whole."
Urban Institute

[Opinion]

Free-Marketers Shouldn't Give Up on Health Care Reform
"None of the legislation under consideration offers a full-fledged, consumer-driven alternative to Obamacare. A genuinely free-market reform package would wipe out Obamacare's insurance regulations and expansion of Medicaid, transition to age-based subsidies for insurance, and strongly incentivize people to maintain continuous coverage. These reforms would produce a vibrant, competitive insurance market where a wide range of affordable coverage is available to all who want it."
The Heartland Institute

[Opinion]

Republicans Fail to 'Repeal and Replace' Obamacare
"[T]here are two pre-conditions for any Congressional bipartisan solution: [1] Democrats will have to admit the problems with Obamacare are more than 'imperfections' -- they will have to admit that Obamacare has been a dismal failure for those who have no choice but to buy their health insurance in the individual health insurance market and make too much money to qualify for a subsidy -- 40% of American households make more than 400% of the federal poverty level, which is the cutoff point for subsidies. [2] Republicans will have to admit that most American households not eligible for Medicare, employer-based health insurance, or the pre-2014 Medicaid program, cannot afford to buy health insurance on their own -- even if we had 2013 premium rate levels."
Bob Laszewski's Health Care Policy and Marketplace Review

[Opinion]

ECFC Comment Letter to DOL on Application of Fiduciary Rule to HSAs (PDF)
"ECFC members believe that to impose the same fiduciary requirements for HSAs as are imposed on [IRAs] is administrative overreach by the Department. The Department can justify its need to regulate IRAs under the Fiduciary Rule since IRAs frequently are a conduit for ERISA-covered retirement plans. The same cannot be said of HSAs.... If the Department does not agree with ECFC's re commendation that HSAs should not be subject to the Fiduciary Rule, the Department should permit HSAs to be eligible for the platform provider exception in the Prohibited Transaction Exceptions."
Employers Council on Flexible Compensation [ECFC]

Press Releases

DWC ERISA Consultants Rebrands
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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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