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[Official Guidance]

Text of Draft Instructions for 2017 IRS Form 1095-A (PDF)
"Form 1095-A is used to report certain information to the IRS about individuals who enroll in a qualified health plan through the Health Insurance Marketplace. Form 1095-A also is furnished to individuals to allow them to take the premium tax credit, to reconcile the credit on their returns with advance payments of the premium tax credit (advance credit payments), and to file an accurate tax return."
Internal Revenue Service [IRS]


ACA Reporting Requirements and Lessons Learned

Sponsored by Lorman and BenefitsLink

Sept. 15 webinar. Despite the uncertainty of the ACA's future it remains the law of the land. This webinar covers lessons learned from the past two years and identifies focus areas to prevent problems next year. CE credits. Discount for BenefitsLink readers.

11th Circuit Provides Reminder of the Importance of Carefully-Drafted Assignment of Benefits Clauses
"[T]he Court ... explained that interpreting the [assignment of benefits clause] to include self-funded plans would not thwart ERISA's purposes of protecting the interests of employees and their beneficiaries in employee benefit plans and uniformity in plan administration. Instead, the Court underscored that such an interpretation may further those purposes by enabling providers -- who may be 'better situated and financed' than patients themselves -- to challenge insurer reimbursement decisions." [BioHealth Medical Laboratory, Inc. v. CIGNA Health and Life Ins. Co., No. 16-10978 (11th Cir. Aug. 14, 2017)]
K&L Gates LLP

HSAs to Lead the Way After ACA
"If President Trump signs into law any form of an ACA repeal/replace bill, it is likely to put HSAs in an even greater spotlight than they have already earned since their introduction roughly a decade ago.... At a minimum, [this] will create a major new incentive to use HSAs as a long-term savings vehicle. But the possibilities are far larger than that.... [T]he proposed HSA changes could be no less than the end of the employer-sponsored group health plan as we know it."
ABD Insurance & Financial Services

HHS Advisory Committee Reiterates Recommendation to Eliminate Mandatory Use of HPIDs in HIPAA Transactions
"Although it appears that mandatory use of the HPID for HIPAA transactions may never take effect, NCVHS notes that the HPID may still have other purposes. For example, the ACA requires health plans to certify compliance with HIPAA's electronic transaction standards and operating rules, and NCVHS noted that HPIDs could be used to track plans' certifications. However, even the future of the certification requirement seems uncertain, since proposed regulations implementing the requirement were published in January 2014, and have yet to be finalized."
Thomson Reuters / EBIA

CMS Issues Part D Premiums for 2018
"The average premium for a basic Medicare Part D prescription drug plan in 2018 will be $33.50 per month, which is a decrease from $34.70 in 2017 ... The decline in the average premium comes despite the fact that spending for the Part D program continues to increase faster than spending for other parts of Medicare, largely driven by spending on high-cost specialty drugs."
Wolters Kluwer Law & Business


2017 Health Savings Accounts Facts

Sponsored by The National Underwriter Company

Turn to the new 2017 Health Savings Accounts Facts to obtain vital HSA questions and answers right at your fingertips. Use code BENLINK for 10% discount.


A Way Forward for Bipartisan Health Reform?
"Republican and Democratic state legislators differ in their priorities for health care but agree on the importance of reducing costs for individuals and families, as well as for payers, like government and employers. Republicans prioritize reducing costs and limiting the size of government. Democrats place improving health and equity outcomes and reducing costs at the top of their agenda.... About 30 percent of Republicans surveyed gave high priority to improving overall health and lower priority to reducing government involvement in health care; 40 percent said the opposite.... Overall, Republicans ranked reducing the role of government as their second-most important priority, while Democrats ranked it lowest out of 13 possible goals."
The Commonwealth Fund

Benefits in General

DOL to Review Disability Claims Procedure Regs
"DOL recently announced that it will review ERISA's disability claims procedures regulations for questions of law and policy to determine if they should be amended, delayed, or withdrawn. The regulations ... were finalized in December 2016 and slated to take effect for claims made on or after January 1, 2018 ... An announcement of this nature is fairly uncommon so it is likely, but not a certainty, that DOL will delay and/or amend the final regulations."
The Wagner Law Group

The DOL's Final Rule on Disability Claims Procedures: What Changes Do You Need to Make?
"[1] [D]enial notices must contain specific reasons for an adverse determination and basis for departing from previous rulings... [2] [C]laimants must be informed of their right to request and obtain the entire file upon denial of a claim, not just upon denial of an appeal.... [3] [B]enefit denial notices must be updated to include the plan's internal rules, guidelines, protocols and criteria used to adjudicate the claim[.]"
Graydon Head & Ritchey LLP

Simply Enclosing SPD with Benefit Denial Notice Was Insufficient Claims Procedure
"[T]he court noted that the initial denial letter did not describe the plan's review procedure or time limits for filing an appeal (or the right to sue following a final adverse benefit determination). The [SPD] enclosed with the letter did set forth this information ... The court explained that merely enclosing the 36-page SPD, with no express mention of the appeal procedures in the letter itself, was insufficient to satisfy ERISA's requirement that the denial notice be calculated to be understandable." [Turner v. Volkswagen Grp. of America, Inc., No. 16-6570 (S.D. W. Va. July 18, 2017)]
Thomson Reuters / EBIA

Discussions on
the BenefitsLink Message Boards

Medical Election by Each Employee: Can We Require It Once Each Year?
"Normally, medical plan elections can roll over from year to year. However, the last couple years our company required employees to elect or decline medical coverage at open enrollment. I believe they wanted to get an affirmative answer, one way or another, with the advent of [ACA] requirements. Given some of the uncertainties at the time, I was okay with forcing people to make an OE election. However, does anyone know of a reason or rule where by we should continue to do this practice? I would prefer to revert back to roll over elections again, but I want to be sure I'm not missing anything. Required? Good practice or bad?"
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017, 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, 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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