Health & Welfare Plans Newsletter

October 4, 2017

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OneAmerica
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Aspire Financial Services LLC
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[Official Guidance]

Text of 2017 IRS Instructions for Forms 1094-C and 1095-C (PDF)
17 pages. "Several forms of transition relief were available to some employers under section 4980H for 2016. No section 4980H transition relief is available for 2017. Therefore, these instructions have been revised to remove discussion of section 4980H transition relief, and Form 1094-C has also been revised.... Form 1094-C must be used to report to the IRS summary information for each ALE Member and to transmit Forms 1095-C to the IRS. Form 1095-C is used to report information about each employee to the IRS and to the employee. Forms 1094-C and 1095-C are used in determining whether an ALE Member owes a payment under the employer shared responsibility provisions under section 4980H. Form 1095-C is also used in determining the eligibility of employees for the premium tax credit."
Internal Revenue Service [IRS]

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[Official Guidance]

Text of CMS Publication: Health Insurance Oversight System -- Portal User Manual (PDF)
108 pages. "The Health Insurance Oversight System (HIOS) ... provides a centralized, multi-user interface for insurance issuers and state/territory regulators to submit, and CCIIO to store information on individual and small group major medical insurance. Information submitted to HIOS is transferred ... to provide data updates to Healthcare.gov. The Healthcare.gov website displays this information to provide assistance to consumers in locating health insurance coverage available in the market." [Version 24.00.00, Sept. 2017]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of CMS Publication: Health Insurance Oversight System -- Rates and Benefits Information System User Manual (PDF)
66 pages. "[T]he Health Insurance Oversight System (HIOS) allows the government to collect data from individual and small group market Issuers. The collected data is aggregated with other data sources and made public on a consumer-facing website. The Rate and Benefits Information System (RBIS) web site gathers detailed plan benefit and eligibility data. This user manual explains the features and other aspects related to the use of the RBIS web site." [Version 04.00.00, Aug. 2017]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

HIPAA Compliance Checklist for Employer-Sponsored Health Plans (PDF)
"Given recent high-profile HIPAA enforcement actions, employers should understand their compliance obligations. This checklist is intended to assist plan sponsors with HIPAA compliance for their plans."
Davis Wright Tremaine LLP

[Guidance Overview]

HHS Withdraws Proposed HIPAA Health Plan Certification Rules
"The proposed regulations would have required controlling health plans (CHPs) to submit information and documentation demonstrating that their data and information systems complied with standards and operating rules involving the use of standardized electronic transactions under HIPAA."
Thomson Reuters Practical Law

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Federal Employee Health Plan Insurers Score Another Win in Federal Court
"[A federal district court has] ruled a federal employee couldn't sue the Blue Cross Blue Shield Association for violating New York deceptive trade practices laws by allegedly misrepresenting the scope of its preferred provider network and the availability of in-network certified lactation consultants ... The court was one of the first to apply a U.S. Supreme Court decision from last term that took an expansive view of the ability of the Federal Employee Health Benefits Act (FEHBA) to prevent beneficiaries from pursuing state law claims against insurers for the way they run their federal employee benefit plans[.]" [Mahajan v. Blue Cross Blue Shield Ass'n, No. 16-6944 (S.D.N.Y. Sept. 22, 2017)]
Bloomberg BNA

Employee Challenges Change in Duties After FMLA Leave
"A former Pennsylvania school district employee may proceed with his claim that the district interfered with his rights under the federal Family and Medical Leave Act (FMLA) by failing to place him in the same position after he returned from leave, according to the U.S. District Court for the Western District of Pennsylvania. Further, the court held that the former business manager may continue with his claim that the school district did not provide a reasonable accommodation for his heart condition under the Americans with Disabilities Act (ADA)." [Kordistos v. Mt. Lebanon Sch. Dist., No. 16-615 (W.D. Pa. Aug. 21, 2017)]
Society for Human Resource Management [SHRM]

Value-Based Contracting for Drugs and Medical Devices: An Innovative Solution Impaired by Outdated Regs
"Payors, government and industry have all endorsed the concept of applying value-based contracting to prescription drugs and devices. Significant regulatory obstacles, however, stand in the way of fully recognizing the potential for value-based contracting in the prescription drug and device arena. The current federal regulatory scheme for medicines and devices, which was designed around traditional fee-for-services models, is ill-suited to value-based models."
Pepper Hamilton LLP

The 2017 ACO Survey: What Do Current Trends Tell U.S. About the Future of Accountable Care?
"[A] large number of ACOs are currently considering or have firm plans to participate in future risk-based contracts (47 percent planning for shared savings/shared risk and 38 percent planning for capitation), although care management strategies are largely unchanged.... ACOs are slowly becoming willing to accept increased financial risk, but they are largely still learning how to actually manage populations."
Health Affairs

[Opinion]

ERIC Submits Comments on Florida's Telehealth Advisory Council's Report of Recommendations
"ERIC encourages allowing the patient-provider relationship to be established via telehealth and applying the same standard of care to its practice as that of in-person care. Additionally, we like to see the adoption of technology-neutral requirements so that the service can be more readily available to the public. We also advise avoiding the imposition of additional requirements on telehealth services that are not imposed on in-person visits, as well as originating site restrictions that require patients to visit certain locations in order to access telehealth services."
The ERISA Industry Committee [ERIC]

[Opinion]

ECFC Letter to House Speaker Paul Ryan on Employee Benefits Provisions in the Unified Framework for Tax Reform (PDF)
"ECFC believes that any cap of the employer exclusion is bad for employees and will result in employers curtailing the maintenance of consumer-directed health accounts, particularly those accounts funded through employee salary deductions through a cafeteria plan.... [T]he enhanced Child Tax Credit could work in concert with the dependent care assistance FSAs to provide assistance in financing child care expenses for all working Americans.... While delay of the effective date of the Cadillac Tax is helpful in the short run, delay will only slow the trend of employers eliminating or curtailing employee contributions to FSA and HSA; only complete repeal of the Cadillac Tax or the exemption of employee contributions from the calculation of the tax will stop this trend."
Employers Council on Flexible Compensation [ECFC]

[Opinion]

Is an Employee's Health Really the Employer's Business?
"In the corporate world, employees have come to expect their employers to sponsor health insurance coverage.... While employer-sponsored health insurance is a valuable talent attraction and retention tool, is the health of employees really the business of companies? ... In efforts to improve employee well-being, ... employers can go wrong when perceived as being too paternalistic, such as when advocating their employees to do certain things."
Talent Economy

Benefits in General

[Guidance Overview]

DOL Final Regs on Disability Claims Procedures: January 1 Implementation May Be Best Practice
"Despite the pending OMB review, because January 1, 2018, is quickly approaching, ... plan sponsors [should] review their claims procedures, health and welfare plan documents, retirement plan documents, summary plan descriptions (SPDs), disability claims and appeals denial notices, and any other forms and documents containing claims procedure information, and update them to comply with the Final Rule. Although it might be possible to retroactively amend plan documents after January 1, 2018, [the authors] suggest completing any necessary updates by January 1, 2018, to ensure full compliance."
Nixon Peabody LLP

[Guidance Overview]

Disaster Relief Issued for Employee Benefit Plans (PDF)
"[This article] provides an overview of the federal agencies' employee benefit plan-related guidance to date, along with a summary chart. Although the guidance offers relief to those directly in the covered disaster areas, it also applies some relief to retirement plans with participants in other parts of the country with relatives in the disaster areas."
Milliman

Tax Reform Might Not Spare Employee Benefits
"The Republican framework for tax reform that the White House unveiled last week does not propose specific changes to how employer-sponsored benefit plans are taxed, but that doesn't mean Congress won't choose to do so when it crafts legislation.... While eliminating current deductions to offset lower tax rates could prove tempting to Congress, there also may be opportunities to improve the tax treatment of some employee benefits[.]"
Society for Human Resource Management [SHRM]

Executive Compensation
and Nonqualified Plans

The Trump/GOP Tax Reform Framework: What It Means for Stock Compensation
"[T]he proposed changes that are likely to have an indirect impact on stock compensation include: simplification of individual income tax rates; elimination of the AMT; [and] elimination of the estate tax. Notably, the framework proposes to give Congress the prerogative to create a higher top income tax rate for the wealthiest individuals, in addition to the three tax rates presented. That would almost certainly apply to executives with stock compensation."
myStockOptions.com

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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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