Health & Welfare Plans Newsletter

August 24, 2017

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[Guidance Overview]

New York Paid Family Leave: What Must Employers Do Now to Comply?
"Do you maintain an employee handbook? If so, the new law requires you to edit your handbook to include 'information concerning leave under PFL and employee obligations under PFL.' ... If You Do NOT maintain a handbook ... The state requires you to 'provide written guidance to each of your employees concerning all of the employee's rights and obligations under PFL, including information on how to file a claim for paid family leave.' ... Employers must decide by September 30, 2017 whether to provide PFL benefits to eligible employees through an insurance policy, the state insurance fund, or a self-insured plan.... [Y]ou must decide (if you've not already done so) whether to begin deducting premiums prior to January 1, 2018."
FMLA Insights

[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.


Federal Judge as the Benefits Whisperer: AT&T Health Plan Must Cover Girl's Horse-Based Therapy
"The health plan was wrong to deny more than $117,000 in medical claims for treatment the girl received at Utah-based Equine Journeys, a federal judge ruled Aug. 22. The plan said it denied coverage because the facility wasn't nationally accredited, but the judge rejected this rationale. 'Nowhere does the Plan state a provider must be nationally accredited for the treatment to be medically necessary,' the judge said." [Lynn R. v. ValueOptions, No. 15-362 (D. Utah Aug. 22, 2017)]
Bloomberg BNA

EEOC Must Reconsider Its Workplace Wellness Program Rules
"The court rejected the EEOC's May 2016 wellness program rules that 30 percent incentives for participation in wellness programs are permitted as 'voluntary' under the ADA and GINA.... Rather than vacating the rules altogether, however, the court remanded them to the EEOC for reconsideration. Employers that welcomed the EEOC guidance for creating clarity about permissible wellness program practices now face new uncertainty as the rules could change yet again." [AARP v. EEOC, No. 16-2113 (D.D.C. Aug. 22, 2017)]
Pepper Hamilton LLP

Judge Orders EEOC to Reevaluate Wellness Program Regs
"In siding with AARP and denying the EEOC's motion to dismiss the suit, Judge Bates concluded that the EEOC had failed to offer a reasoned explanation for its arrival at the 30 percent threshold -- nor had it offered concrete data, studies, or analysis that supported any particular incentive level as the threshold after which an incentive becomes involuntary. EEOC Chair Victoria A. Lipnic issued a statement that the agency is 'assessing the impact of the court's decision and order, and options with respect to these regulations going forward.' " [AARP v. EEOC, No. 16-2113 (D.D.C. Aug. 22, 2017)]
Ballard Spahr LLP

Court Keeps EEOC Wellness Regs in Place But Demands EEOC Reconsider Its Reasoning (PDF)
"[T]he court's ruling is restricted to the 30 percent incentive limit. The court did not consider, and therefore did not find a problem with, other portions of the final rules including the notice or consent requirements and the rule prohibiting employers from limiting access to certain health plan options only to wellness program participants." [AARP v. EEOC, No. 16-2113 (D.D.C. Aug. 22, 2017)]
Lockton

[Advert.]

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.


Why Employees Make Bad Open Enrollment Decisions
"If you want employees to select benefits that better meet their individual needs, give them the tools to make it happen. Here are three ways you can use technology to personalize your open enrollment experience and break the trend of bad benefits decisions: [1] Provide plan recommendations ... [2] Integrate claims data ... [3] Go mobile."
Benefitfocus

Wellness Programs Boost Employee Health, Productivity
"The researchers compared data for employees that participated in the health plan to employees at a different plant from the same company who weren't offered the wellness program.... Participating employees' productivity jumped by between 6 percent and 11 percent compared to those who didn't participate in the program, with the largest gains for those who improved their health. When further quantified, that figure equaled a 76 percent return on investment for the company after introducing its wellness program."
Wolters Kluwer Law & Business

Bereavement Leave: Does One Policy Fit All?
"94.2% of all responding member organizations provide some type of paid bereavement leave, either through a separate bereavement leave policy or a paid-time off (PTO) program for their workers. Although most organizations offer at least some type of paid bereavement leave, the number of paid days away from the office varies greatly among organizations and is dependent on the employee's relationship to the deceased. Policies may not address whether the deceased was the parent of the employee's children or the ages of the children."
International Foundation of Employee Benefit Plans [IFEBP]

Iowa's Proposed Stopgap Measure for the Individual Health Insurance Market (PDF)
33 pages. "Iowa proposes to provide the following: [1] a single, standardized plan to every eligible consumer from each participating carrier, [2] premium subsidies based on age and income, and [3] a reinsurance program for all plans offered under the Iowa PSM program.... Iowa estimates that the required APTC funding for 2018 would be approximately $304 million given higher expected premiums in 2018 under the current landscape. By dividing this total funding of $352 million between a reinsurance program and individual premium credits, Iowa will be able to provide an affordable and comprehensive health care program that is budget neutral to the federal government and is intended to improve market stability."
Iowa Insurance Division

[Advert.]

Sponsored by BenefitsLink.com

For over 20 years, we've helped employers find the best-informed candidates to fill their benefits job openings -- learn more!


2018 Projected Health Insurance Exchange Coverage Map, Updated Aug. 23, 2017 (PDF)
[CMS] has posted an update to the 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 August 23, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

If CSRs Cease, 'Silver-Gapping' Could Benefit Some
"The subsidies are based on the cost of second-highest silver plan, and if discontinuing the CSRs leads insurers to raise premiums on only those silver plans, there could be unintended consequences. The government could end up paying more through the premium tax credit, a refundable credit that helps eligible individuals and families cover the premiums for their health insurance."
HealthLeaders Media

[Opinion]

Curbing Prescription Drug Prices Through the PBM Model
"PBMs can play a critical role in keeping costs in check and ensuring affordable access for all beneficiaries.... [W]ithout PBMs, [Medicare] premiums would be 66 percent higher. Because of PBMs, the Part D program will save more than $1,800 per year per beneficiary ... The savings that PBMs generate for Part D are also highly encouraging for the employers, unions, health plans and others in the private sector working to keep prescription drug costs in check for their employees and members."
Meghan Scott, via Morning Consult

[Opinion]

Iowa's ACA Waiver Plan Would Redistribute Subsidies from the Poor to Wealthier People
"Does making health insurance premiums more affordable for healthier, wealthier people justify sharply increasing out-of-pocket costs for lower-income and sicker people? That's one of the key questions critics are raising about Iowa's sweeping new proposal to revamp its individual insurance market and abolish its federal exchange. The state submitted the plan -- called the Iowa Stopgap Measure -- to HHS and the U.S. Treasury Department [August 22] under Section 1332 of the [ACA]."
North Coast Association of Health Underwriters [NCAHU]

Benefits in General

Are Your Plans Impacted by the New Regs on Disability Claims?
"The Final Rule governs employee benefit plans subject to ERISA that offer disability benefits, not just disability plans. In addition to disability plans, it is not unusual for a retirement plan to provide disability benefits. It is also common for ERISA-covered benefit plans to waive premiums or provide some other form of benefit in the event of a disability."
Graydon Head & Ritchey LLP

ERISA Mediation Strategies: Hear 'Em Out
"In many cases, allowing the plaintiff to tell their side of the story may go a long way to facilitating a settlement. This may be the first time they get to talk face-to-face with someone representing the other side. After months of frustration dealing with a benefits administrator over the phone, through emails, or letters, getting the chance to be heard can be an important step in bringing their claim to a close."
Butterfield Schechter LLP

Retiree Health Costs Surge
"The estimate for retiree health care spending rises to an average of $275,000 per couple, excluding long-term care expenses. This is an increase of $15,000 from 2016. Health care continues to be one of the largest expenses in retirement.... And that applies only to retirees with traditional Medicare insurance coverage, and does not include costs associated with nursing home care."
Fidelity

Discussions
on the BenefitsLink Message Boards

How Does an Employer Substantiate What's Reimbusable Under a QSEHRA?
"To meet tax-law conditions for a qualified small employer health reimbursement arrangement within the meaning of Internal Revenue Code Section 9831(d)(2), a plan must provide its reimbursement only for medical care and only after the employee furnishes proof of minimum essential coverage. Further, imagine a QSEHRA plan that reimburses only purchases of individual health insurance, not other medical expenses. Following this, to be reimbursable the insurance contract must meet two conditions: it must include (i) minimum essential coverage within the meaning of IRC Section 5000A(f)(C) and (ii) no coverage beyond medical care within the meaning of IRC Section 213(d). If a small-business employer puts in a decent effort to apply those conditions, how does one discern that a contract meets them? Does a contract that provides minimum essential coverage recite that it does? If so, where in the contract would one expect to see that language? If there is no such recital, what language clues would one look for to find that a contract includes minimum essential coverage? Without reading the whole contract, what shortcut might one use to form a reasonable belief that a contract insures nothing beyond medical care?"
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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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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