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[Guidance Overview]

The Affordability Test Is More Restrictive on Employers in 2018
"[F]or the first time, the affordability threshold has decreased in 2018 all the way back to 9.56 percent. The significant drop in the affordability threshold compared to 2017 places employers who are toeing the line of the affordability threshold in danger of being subject to a potential section 4980H(b) penalty if the price of coverage is not reduced for self-only coverage."
Accord Systems, LLC


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[Guidance Overview]

California's Surprising New 'No Surprise' Health Care Billing Law (PDF)
"Despite its nickname, the law includes many surprises: it is the first law to impose pricing terms on private health care providers, dictating that [individual health professionals (IHPs)] who are not contracted with their patients' health care service plans and insurers must accept discounted rates as payment in full.... In essence, the law permits health plans and insurers to pay discounted rates to IHPs without a bargained-for exchange of benefits. Thus, payers now have no incentive to contract with IHPs."
King & Spalding

Court Tells EEOC to Reconsider Wellness Program Rules
"Based upon the court's decision, it seems that you can continue as is with your company's wellness programs for 2017, but anything beyond that is uncertain. As for 2018, it may be best to take a wait-and-see approach. It is unclear at this point whether and how the EEOC will act to correct the new rules or whether the agency will appeal the decision. If this issue is not resolved in time for 2018, you may want to consider being very conservative with any incentives offered after the turn of the new year."
Fisher Phillips

Lessons Learned from Katrina, and Hurricane Harvey Relief Guidance to Date
"In the past some employers have permitted employees to donate their paid time off or leave to a pool that can be used by the affected employees. Donation of leave is possible as long as one carefully structures the leave donation program in compliance with existing guidance so that there is no constructive receipt of the donated leave by the donating employee.... Employers can establish a disaster assistance funds and provide certain limited assistance for qualifying expenses of their employees who live or reside in a Presidentially declared disaster area. If the payments are to qualified individuals for qualified expense, these funds can be paid to the employee without taxing the employees on the assistance as income."
Winstead PC

After Years of Erosion, Mid-Size and Some Small Employers Added Health Coverage in 2016 (PDF)
12 pages. "[O]ver the last year ... there is evidence of what may be a rebound in employment-based coverage offer rates among firms with 10-999 employees. More specifically, from 2015-2016: [1] For employers with 10-24 employees, those offering health benefits increased from 48.9 percent to 49.4 percent. [2] For employers with 25-99 employees, those offering health benefits increased from 73.5 percent to 74.6 percent. [3] For employers with 100-999 employees, those offering health benefits increased from 95.1 percent to 96.3 percent. For these employers, this trend actually began a year earlier, when the offer rate increased from 92.5 percent in 2014 to 95.1 percent in 2015."
Employee Benefit Research Institute [EBRI]


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Using Voluntary Benefits to Attract and Keep Part-Time Employees
"Only 25 percent of part-timers have an employer-sponsored medical plan (compared to 80 percent of full-timers). Just 32 percent of part-timers have an employer-sponsored retirement plan (compared to 69 percent of full-timers). Less than 20 percent of part-timers have dental, disability or life insurance benefits at work (compared to more than half of full-timers).... Providing access to voluntary benefits can ease part-time workers' financial stress, reduce turnover and differentiate employers from competitors in the talent market[.]"
Society for Human Resource Management [SHRM]

Are Outplacement Benefits Taxable?
"While employer-provided outplacement services would be taxable under general tax principles, they are typically excludable under Code Section 132(a)(3) as a working condition fringe benefit.... [Offering] employees a choice between nontaxable outplacement assistance and taxable severance pay ... would make the outplacement benefit taxable."
Thomson Reuters / EBIA

How Price Transparency Can Lower Healthcare Costs
"Drug prices are expected to increase by 9.9 percent this year ... One of the main causes of frustration among consumers is in their inability to see a clear rationale for why prices are rising and what exactly they are paying for.... With the changing climate in healthcare policy, price transparency has come to the forefront as people consider how to manage their medical spending. Price transparency can help drive down healthcare costs in by increasing pressure on providers to control costs and ensure that patients receive the highest quality of care possible for the price they pay."
Jeffrey Sanginiti, for HFMA

How to Keep ACA Stabilization Narrow
"[W]hen people read headlines or hear about 'premiums soaring' in the ACA marketplaces, most Americans -- 76% -- they think they are hearing about their own premiums, even though the vast majority of Americans are not in the individual insurance market and are not affected.... In fact, the rest of the health system where most Americans get their coverage looks very different from the non-group market."
Drew Altman, via Axios


Our Next Health Care Debate
"There is a night and day difference between financing health care in the marketplace through private insurance and financing it through a government national health program. One is framed around businesses and the other is framed around patients. Today the conservatives and neoliberals are offering us only the business approach supervised by the medical-industrial complex."
Physicians for a National Health Program [PNHP]

Benefits in General

Seventh Circuit: Forum Selection Clause Enforceable Under ERISA
"Inclusion of a forum selection clause in an ERISA plan document is consistent with best practices, and, as the Appeals Court noted in its decision, may reduce plan administrative costs and promote uniformity in plan administration. While a minority of district courts have ruled in favor of participants as it relates to the enforceability of forum selection clauses, the only two Circuit Courts of Appeals to rule on the matter (and the majority of district court cases) have held that these clauses will be enforced by a court of law." [In re Mathias, No. 16-3808 (7th Cir. Aug. 10, 2017)]
King & Spalding

ERISA Advisory Council Reviews Mandated Disclosures
"Recommendations have included requiring fewer disclosures and notices and making notices simpler to understand. Reduced disclosure notices would lessen the burden on plan providers and help ensure plan participants are not overloaded with confusing plan information that does not require action on their part."
Butterfield Schechter LLP

Open Enrollment for Employees: How to Get the Most Out of Your Benefits in 2018
"[S]ome employers don't include retirement benefits on the menu of available health and welfare benefit options during open enrollment season ... [Y]ou might have to take matters into your own hands when it comes to your employer-sponsored retirement plan during open enrollment season.... [E]mployees who are saving for retirement, with access to a HDHP, should consider participating in their employer's HDHP, so that they can take advantage of the HSA offered with it.... [C]onsider critical illness coverage, if offered by your employer ... [M]any employers offer incentives around open enrollment for participation in health screenings, health risk assessments, and wellness activities -- this can essentially put more money back into the employee's pocket, with the added benefit of helping the employee to better understand and manage health risks."

Press Releases

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