Health & Welfare Plans Newsletter

September 8, 2017

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University of California Office of the President
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Sikich LLP
in WI

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Webcasts, Conferences

Quarterly Group Health Plans Update
September 28, 2017 WEBCAST
Cowden Associates, Inc.

Introduction to HSAs 2017
October 12, 2017 WEBCAST
Ascensus

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►See 1250 Recorded


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[Guidance Overview]

2018 Annual Open Enrollment Is Here: Are Your Health and Welfare Plans Ready?
"[A] plan may not impose a requirement to try an intensive outpatient program before admission for inpatient treatment unless a comparable limitation also applies to medical/surgical benefits in the same classification.... if an individual loses coverage under an individual plan ... for reasons other than the failure to timely pay premiums or for cause, such individual must be afforded a 'special enrollment right' by a group health plan ... [T]he new [SBC] template revises and updates the coverage examples and provides more information about cost-sharing.... For disability benefit claims filed on or after January 1, 2018, disability benefit plans must comply with recently finalized regulations"
Trucker Huss

[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.


2018 Open Enrollment: Active vs. Passive Benefits Election
"The consensus view among employee benefit advisors is that active open enrollment is the superior way to prod employees to make appropriate decisions about the benefits that will best suit their own -- and their families' -- needs. Active enrollment, however, requires that HR benefit managers engage directly with employees to ensure that no one inadvertently misses their opportunity to elect coverage for the new year.... The possibility of inattentive employees being left without health and other benefits -- and the outcry from those who might find themselves in this predicament -- keeps most employers on the passive enrollment track."
Society for Human Resource Management [SHRM]

Individual Supervisor May Be Liable Under FMLA
"In denying the supervisor's motion to dismiss the claims against him, the court first noted that FMLA liability may attach to any 'employer' and that the statute provides a broad definition of 'employer' that includes any individual who acts directly or indirectly in the interest of an employer to any employees of such employer.... Massachusetts supervisors must now face the possibility of personal liability for violating the FMLA rights of their subordinate employees." [Eichenholz v. Brink's Inc., No. 16-11786 (D. Mass. May 9, 2017)]
The Wagner Law Group

EEOC Sues Estee Lauder Over Paid Parental Leave Policy
"The paid parental leave policy at issue in this case ... provides 'primary caregivers' six weeks of paid parental leave for child bonding and only offers 'secondary caregivers' two weeks of paid leave for child bonding.... On its face, this policy does not appear to provide different benefits to new mothers or female employees and new fathers or male employees; however, in practice, the company only allows male employees to receive 'secondary caregiver' leave benefits under this policy." [EEOC v. Estee Lauder Companies, Inc., No. 17-3897 (E.D. Penn)]
Seyfarth Shaw LLP

DOL Opposes UnitedHealth's Cross-Plan Offsetting Practice
"The Labor Department opposes a health insurance practice called 'cross-plan offsetting,' in which insurers like UnitedHealth reduce payments owed to medical providers for services rendered to specific patients. The reductions are meant to offset overpayments the providers previously received on account of different patients who participate in other plans insured by the same company. This practice violates [ERISA], the DOL said in a brief filed Sept. 5 in the U.S. Court of Appeals for the Eighth Circuit."
Bloomberg BNA

[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.


Tax Relief Available for Leave Donations to Aid Victims of Hurricane Harvey
"Because the emergency declaration for Tropical Storm Harvey in Louisiana does not authorize individual assistance, storm victims in that state apparently are not eligible for the loan and hardship distribution relief. They may, however, be able to benefit from charitable assistance made possible by this leave-donation relief."
Thomson Reuters / EBIA

IRS Releases Draft Instructions for 2017 Forms 1094 and 1095
"The draft instructions for the [1094-B/1095-B] Forms do not include any substantive changes that will affect completion of the forms. The draft instructions for the [1094-C/1095-C] Forms are largely unchanged, although references to transition relief available to non-calendar-year plans for certain months in 2016 have been eliminated now that this relief has expired."
Thomson Reuters / EBIA

Reviewing Contracts: An Essential Part of Health Plan Management
"[C]heck the principal plan terms against the plan proposal.... Self-insurance contracts take a lot more vigilance to review.... Should you terminate your plan, how will incurred-but-unpaid claims be processed? ... Generally, the TPA wants to share savings for out-of-network claims when less than the billed cost is paid, and it's important to understand how this works.... Usually the TPA retains a portion of the recovery for third-party liability and may bill costs associated with collecting these payments."
Frenkel Benefits

New York State Guidance Reminds Health Insurers They Cannot Deny Coverage Based on Gender Identity
"The New York Department of Financial Services (DFS) has sent a circular letter to health insurers in New York stressing that they cannot discriminate or deny coverage based on gender identity. New York ... The letter instructs health insurers to take reasonable steps, including requesting additional information, to determine whether the insured is eligible for the services prior to denying a claim."
Wolters Kluwer Law & Business

Governors Press Congress for Fast Bucks to Secure Obamacare Market in 2018
"A bipartisan succession of state governors and insurance commissioners told the [Senate Health, Education, Labor and Pensions (HELP) Committee] that there is no time for them to get their own reinsurance programs up and running in order to stabilize the market. What would help in the short term, they said, would be for the federal government to step in and do it -- temporarily.... Governors testified [on September 7, 2017] that reinsurance would lower premiums, thereby bringing young, healthy people into the risk pool and providing stability to the marketplace."
Kaiser Health News

Benefits in General

Proving Loss Causation in Breach of Fiduciary Claims: The Split Widens (PDF)
"[M]ost circuit courts of appeals agree that ERISA requires that causation between the alleged breach and the claimed loss must be established before any liability may be imposed upon a breaching fiduciary. The courts are split, however, as to whether an ERISA plaintiff or the defendant-fiduciary bears the burden of proving the causal link between breach and loss. In other words, does the burden compose an element of the claim and thus fall upon the plaintiff, or does the burden constitute an affirmative defense and thus fall upon the defendant-fiduciary?"
Jackson Lewis P.C.

Hurricanes Harvey and Irma: What Kind of Relief May Employers Offer to Affected Employees? (PDF)
"Qualified Disaster Relief Payments ... Paid leave and working condition fringes ... Charitable contributions ... Leave sharing programs ... Traps for employers ... Retirement plan relief."
Epstein Becker Green

Addressing Disasters and Emergencies, Widespread to Individual (PDF)
"While many plan sponsors will focus on the immediate impact of Hurricane Harvey, plan sponsors might also take this time to plan for the future or to refine existing policies designed to assist employees year-round.... [C]onsider changes that will position your plans and human resources policies to meet workers' everyday needs.... [C]onsider the precedent-setting nature of any extraordinary actions you take today to respond to Harvey -- will you be in position to take similar action in the future?"
Plan Sponsor Council fo America [PSCA]

Helping Employers Become Age-Ready (PDF)
15 pages; a working paper. "This paper will ... examine how living longer is likely to influence working longer, how the nature of changes to work itself will influence future generations of work, workers and workplace, and ultimately, the paper will dive deeply into what employers can do to achieve a competitive advantage from the changing demographics. In short -- how do employers become age-ready?"
Pension Research Council, The Wharton School of The University of Pennsylvania

Executive Compensation
and Nonqualified Plans

[Guidance Overview]

Nonqualified Plans May Need to Be Updated for New Disability Claims Procedure Regs
"While nonqualified deferred compensation plans are generally exempt from most of the substantive provisions of [ERISA], Nonqualified Plans are still subject to ERISA's enforcement provisions, including claims regulations implementing section 503 of ERISA. For that reason, a Nonqualified Plan must contain claims procedures that comply with the ERISA claims regulations for resolving participant claims under Nonqualified Plans."
Trucker Huss

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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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