Health & Welfare Plans Newsletter

August 14, 2017

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Employee Benefits Jobs

Retirement Plan Services Compliance Specialist
Associated Bank
in WI

401(k) Administrator
Blue Ridge ESOP Associates
in VA, Telecommute

External Retirement Sales Consultant (salary + commission)
Ascensus
in VA

Senior Retirement Plan Administrator
Goldberg, Swedelson & Associates
in CA

Defined Contribution Compliance Analyst
Transamerica
in NY

Retirement Plan Administrator
American Pension Benefits
in PA

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Webcasts and Conferences

New Developments in Military Pension Division: Yesterday, Today, and Tomorrow
August 17, 2017 WEBCAST
American Bar Association [ABA]

Benefit Plan Best Practices: Error Correction & EPCRS
August 22, 2017 in TN
KraftCPAs PLLC

Mastering Form 5500 Preparation and Avoiding Audit Triggers
August 30, 2017 WEBCAST
Clear Law Institute

Employer Impacts from Alternative Payment & Delivery Models
September 13, 2017 in TX
Worldwide Employee Benefits Network [WEB] - Houston Chapter

HIPAA Business Associate Contracts: Due Diligence, Upstream Liability, and More
September 14, 2017 WEBCAST
Thomson Reuters / EBIA

Ascend 2017 Education Conference
September 18, 2017 in LA
Ascensus

Flexible Spending Account: Legal Requirements
September 29, 2017 WEBCAST
Clear Law Institute

Retirement (In)Security Summit: State and Local Governments Tackle Retirement Preparedness and Workforce Challenges
October 2, 2017 in DC
Center for State and Local Government Excellence

Half-Day Benefits Symposium
October 11, 2017 in AZ
PSCA [Plan Sponsor Council of America]

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Discussions

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New Comments and Topics

All Topics, Grouped by Forum


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Opt-Out Payments Can Create Overtime Liability in the Ninth Circuit
"If you are an employer within the jurisdiction of the Ninth Circuit Court of Appeals and offer cash payments to employees who opt out of group health coverage ('opt-out payments'), what you don't know about the court's 2016 opinion in Flores v. City of San Gabriel may hurt you. Specifically, the Ninth Circuit court held that opt-out payments had to be included in the regular rate of pay used to calculate overtime payments under the federal Fair Labor Standards Act (FLSA). In May 2017 the U.S. Supreme Court declined to review the opinion, making it controlling law within the Ninth Circuit[.]"
E is for ERISA

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Making Sense of Employee Health Record Privacy Regs (PDF)
"As employers become more involved in the overall management of employee wellness and healthcare expenditures, there is a strong interest in effective management and utilization of this employee data for a growing range of employer interests. Employers and other entities are becoming more involved in Big Data initiatives, offering new opportunities to gather information that will promote more effective and efficient workplaces. However, employers need to consider carefully their approach to employee healthcare information and act intelligently."
Wiley Rein LLP, via Journal of the American Health Information Management Association [AHIMA]

Attempting to Avoid the High Cost of a Reported HIPAA Breach
"In the last 24 months, 349 breaches of unsecured protected health information affecting 500 or more individuals have reported to [HHS Office of Civil Rights]. Nearly 175 of those breaches occurred in 2017 alone, affecting over 3.2 million individuals in just seven months. From January to July this year, the OCR entered into settlement resolutions related to reported HIPAA breaches for a combined total of approximately $17 million.... Three of the largest settlement amounts paid this year resulted from failure to develop and implement policies to prevent, report and correct breaches."
Dickinson Wright PLLC

The HSA in Your Future: Defined Contribution Retiree Medical Coverage
"[O]nly 24% of employers with 200 or more employees offer retiree health coverage ... The percentage of smaller employers offering retiree medical coverage is much, much less.... [L]ess than 5% of America's workers have access to and save on a tax-favored basis for future medical expenses -- including HSA-qualifying expenses[.]"
Plan Sponsor Council of America [PSCA]

Insurance Premium Volume in U.S. Grows 4 Percent in 2016
"Overall insurance industry premiums in all lines rose 4 percent to $2.2 trillion in 2016 over 2015 ... Of the $2.2 trillion in premiums, $914 billion went to health, $665 billion to life and annuity, ... $2.5 billion to risk retention groups and $7.3 billion to other types of premium[.]"
InsuranceNewsNet.com

Health Insurers Get More Time to Calculate Increases for 2018
"The Trump administration is giving health insurance companies more time to calculate price increases for 2018 because of uncertainty caused by the president's threat to cut off crucial subsidies paid to insurers on behalf of millions of low-income people. [CMS said] the deadline for insurers to file their rate requests would be extended by nearly three weeks, to Sept. 5.... It was the clearest evidence to date that the politics of health care in Washington could disrupt planning for 2018."
The New York Times; subscription may be required

Freedom Caucus Brings Petition to House Floor in Attempt to Repeal Obamacare
"Among other things, the bill would remove language in IRC Sec. 223(d)(2) that requires drugs to be prescribed or to be insulin to be HSA-qualified medical expenses, and change the additional tax on HSA distributions not used for qualified medical expenses from the current 20 percent to 10 percent."
Ascensus

[Opinion]

Re-Thinking Employer-Provided Health Benefits
"Employer-sponsored coverage is shrinking.... What's covered and who is covered is shrinking.... Employees are paying more of the cost.... Employers blame hospitals and drug companies for excess costs.... Employers are implementing new strategies to rein in their costs.... Two issues have regulators' attention: Disparity in employee access ... Contracts with providers ... But beyond these issues, cost is the overriding employer concern that's likely to define the future for employer sponsored health benefits."
Paul Keckley

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Benefits in General

Insurance Agents as Employees? Court Breaks Independent Contractor Precedent
"[The federal district court] held that insurance agents working under independent contractor agreements with an insurer were employees for purposes of pursuing pension and other employment benefits under [ERISA] ... [The decision] ... is notable for its departure from industry practice and prior legal precedent treating many insurance agents as independent contractors. It also notable in that many of the factors the court found convincing are customary, sensible and expected business practices for an insurer ensuring that its agents meet minimum standards for services conducted under its brand." [Jammal v. American Family Insurance Group, No. 13-437 (N.D. Oh. Aug. 1, 2017)]
Eversheds Sutherland (US) LLP, via Lexology

Seventh Circuit: Caterpillar Health Plan Can Limit Court Choice
"In upholding a forum selection clause in Caterpillar Inc.'s health plan, the U.S. Court of Appeals for the Seventh Circuit on August 10 became the second federal circuit court to say that these clauses -- which require litigation over plan benefits to be brought in the employer's preferred court -- don't violate [ERISA]. The Sixth Circuit reached the same conclusion in a 2014 decision[.]" [In re Mathias, No. 16-3808 (7th Cir. Aug. 10, 2017)]
Bloomberg BNA

Seventh Circuit Upholds ERISA Plan's Forum Selection Clause
"As the Seventh Circuit noted, ... only one other appellate court (the Sixth Circuit, covering Kentucky, Michigan, Ohio, and Tennessee) has ruled on this question ... Moreover, neither the Sixth Court's Smith decision nor this one were unanimous, and the DOL continues to challenge the validity of forum selection clauses.... As a result, employers in jurisdictions outside the Sixth and Seventh Circuits should bear in mind that there is less certainty regarding whether their plan venue provisions will be enforced." [In re Mathias, No. 16-3808 (7th Cir. Aug. 10, 2017)]
Thomson Reuters Practical Law

Discussions on
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What's a Reasonable Fee for Assistance with RFP for New PBM?
"Looking for opinions on reasonable fee range for one of the big consulting houses to conduct an RFP to help us select a new PBM. We are a 40,000+ employee company operating in almost all states. Pharmacy is currently carved in with medical. Also need reasonable fee for implementation and ongoing oversight of PBM."
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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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