Health & Welfare Plans Newsletter

October 3, 2017

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Established Regional TPA
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Independent Retirement
in OR

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Pentegra
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Heartland Financial USA
in CA, IA, IL, KS, MN, NM, WI

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[Official Guidance]

Text of HHS Withdrawal of Proposed Regs for Certification of Compliance for Health Plans
"This document withdraws the January 2, 2014, proposed rule that would have required a controlling health plan (CHP) to submit information and documentation demonstrating that it is compliant with certain standards and operating rules under [HIPAA]. This proposed rule would have also established penalty fees for a CHP that failed to comply with the certification of compliance requirements."
U.S. Department of Health and Human Services [HHS]

[Advert.]

Certified Government Benefits Administrator (CGBA)

Sponsored by SALGBA [State and Local Government Benefits Association]

CGBA program serves as a benchmark in the pursuit of excellences in public sector benefits management, professional development, and continuing education. For more information on SALGBA visit www.salgba.org.


[Guidance Overview]

To Audit or Not to Audit? A Good Question for Self-Funded Group Health Plans
"[M]any advisors assume that, so long as self-funded health plan benefits are paid out of an employer's general assets, and not a trust or VEBA, no reporting or fiduciary audit obligations exist. In reality, with respect to most self-funded health plans existing in workplaces today, this assumption is dead wrong."
Jackson Lewis P.C.

[Guidance Overview]

Form W-2 Reporting Under the ACA
64 presentation slides. Topics: [1] Employers; [2] Health coverage; [3] Calculating the cost of coverage; [4] Reporting the cost of coverage; [5] Transition relief; [6] Penalties; and [7] Action steps and more information.
Arthur J. Gallagher & Co.

[Guidance Overview]

California State and City Paid Sick Leave Laws (PDF)
12-page chart, summarizing and comparing rules imposed by the State of California and seven of its municipalities, including Los Angeles. Updated Oct. 2017.
Fox Rothschild LLP

How Mid-Year Plan Reviews Help Avoid Benefits Renewal Bombshells
"The factors that feed program costs are complex, which can make predicting the renewal rate all the more difficult. However, the broker's underwriting staff can provide a window into the benefits plan performance and help the employer prepare for changes to mitigate rising costs and meet the budget."
Corporate Synergies

Ninth Circuit Faults Retiree Plan's Disclosure of Lifetime Maximum
"The ACA's detailed amendments to the Public Health Service Act (PHSA) included a prohibition on group health plans or their insurers setting lifetime limits on benefits for any participant or beneficiary.... [A] blanket provision [stated] that the amended PHSA provisions would apply to ERISA group health plans 'as if included in this subpart.' This part of ERISA (Part 7) includes an exception for certain plans with fewer than two active employees. However, King argued that the ACA superseded this provision, especially since it eliminated a similar PHSA provision for certain retiree-only plans. The court ruled that the ACA ban did not apply to retiree plans ... Any inconsistency that was created between PHSA and ERISA is not so drastic that plans cannot comply with both, [the judge wrote]." [King v. Blue Cross and Blue Shield of Ill., No. 15-55880 (9th Cir. Sept. 8, 2017)]
HR Daily Advisor

New Expectations for Vocational Assessments of 'Any Occupation'
"[M]ost ERISA [disability] plans require an assessment, say after 24 months, whether the claimant can perform 'any occupation.' This review usually involves a Vocational Assessment examining what 'other occupations' and earnings are available given the claimant's education, skills and experience.... Courts are placing higher burdens on vocational experts when establishing what 'other occupations' the claimant can assume. For example, using median wage data may not be sufficient in certain circumstances." [Flaaen v. Principal Life Insurance Co., No. 15-5899 (W.D. Wash. Sept. 27, 2017)]
Lane Powell PC

Super Spending: U.S. Trends in High-Cost Medication Use
"An estimated 576,000 Americans spent more than the median household income on prescription medications in 2014. This population of patients grew an astounding 63% from 2013. Further, the population of patients with costs of $100,000 or more nearly tripled during the same time period, to nearly 140,000 people. The total cost impact to payers from both patient populations is an unsustainable $52 billion a year."
Express Scripts

[Opinion]

Is Paid Family and Medical Leave Inevitable? Perhaps, But There's a Long Way to Go
"The Trump administration and lawmakers on both sides of the aisle in Congress have released competing paid-leave proposals this year. Additional states have enacted paid-leave laws. More large employers have expanded paid-leave benefits. And public support continues to grow."
Health Affairs

Benefits in General

Who Is Entitled to Death or Survivor Benefits from an ERISA Plan or from a Federal Employee Benefit Plan?
"Designations may be effective even if there are ambiguities about the benefit shares of each beneficiary and/or the form of payment. An effective designation must be authenticated ... The signature may not need to be the participant's name or even be legible. The federal (Phoenix) substantial compliance doctrine ... creates benefit entitlements enforceable against the plan. The Amara equitable relief principles ... principles may create benefit entitlements enforceable against the plan administrators using those unauthorized procedures or forms."
Albert Feuer, via SSRN

Help! I Found a Mistake in My Employee Benefit Plan!
"Because mistakes in plans are so common, the laws that govern such plans and the regulatory agencies that enforce them generally favor prompt, voluntary correction. Although every plan is different and every mistake is different, (so every situation will need to be evaluated based on its own unique facts and circumstances), certain common themes and risk mitigation strategies run throughout. This article outlines some of these common themes and related steps that can (and, in most cases, should) be taken when a mistake is found in an employee benefit plan."
Boutwell Fay LLP

The Impact of a Mobile-First HR Strategy on Employee Engagement
"The first steps in building out a mobile strategy should center around data security and ensuring an exceptional user experience. Choosing a platform and identifying features are the easy parts. Companies should enlist clients and partners to help drive the roadmap and ensure the development team can execute the project and workflow, and meet the agreed upon organizational objectives."
HR Dive

Discussions
on the BenefitsLink Message Boards

Outside Health Insurance Cheaper, So Can Participant Have a 'Change in Status'?
"We have a participant in a premium-only plan who is asking to drop his dependent group coverage due to qualifying for cheaper individual coverage through the State of Oklahoma (Sooner Care). I have looked at our language (Sungard / Corbel/ FIS) post-[ACA] and it appears this is not a change of status and would not be allowed. Any thoughts?"
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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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