Health & Welfare Plans Newsletter

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Senior Pension Administrator
Primark Benefits
in CA

401(k) Retirement Plan Administrator
Nicholas Pension Consultants
in CA

Benefits Assistant
in AZ

Retirement Plan Relationship Manager
Heartland Financial USA
in IA, IL, WI

Retirement Plan Client Services Manager
Heartland Financial USA
in IA

Client Relationship Manager
The Retirement Advantage, Inc.

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[Official Guidance]

Text of IRS Publication 5258: ACA Information Returns (AIR) Submission Composition and Reference Guide (PDF)
126 pages, rev. Oct. 2017. "The purpose of this document is to provide guidance to all types of external transmitters about composing and successfully transmitting compliant submissions to IRS.... This document covers details on composing and submitting Form s 1094/1095-B and Forms 1094/1095-C by transmitters to IRS. The scope of the document addresses the A2A-application based via SOAP messages exchanged between client and exposed Web Service endpoints and the Web UI-browser-based requiring human initiation. This publication is a living document that will be amended and updated each Tax Year /Filing Season and as deemed necessary. When updates are made to the schema package for the A2A and UI channels, this publication will be updated accordingly."
Internal Revenue Service [IRS]


New COBRA Audit Guidelines

Sponsored by Lorman and BenefitsLink

Nov. 28 webinar. In addition to general COBRA compliance, we'll review the IRS Audit guidelines, to help you identify and prepare for the areas of focus in an IRS COBRA audit. Discount for BenefitsLink readers.

[Guidance Overview]

New York Paid Family Leave Law Update
"In advance of the January 1, 2018 effective date for the New York Paid Family Leave Law, the New York Workers Compensation Board has issued model paid family leave request, certification, and waiver forms ... The benefits under the program will be phased in starting on January 1, 2018, with employees eligible for leave of up to eight weeks; will escalate in 2019 with eligibility for leave of up to 10 weeks; and will then be fully implemented in 2021 with eligibility for up to 12 weeks of leave under the program."
Winston & Strawn LLP

[Guidance Overview]

Final Rules Issued on San Francisco's Health Care Security Ordinance Employer Spending Requirement
"The [Health Care Security Ordinance (HCSO)] requires employers to spend a minimum amount on health coverage ($2.83 per hour in 2018 for large employers) for their San Francisco employees who regularly work eight or more hours per week. The spending requirement rules, initially issued in 2007, were revised to address interim amendments to the HCSO and, in particular, the irrevocability requirement added to the HCSO in 2014. The irrevocability requirement was added to clarify that dollar-denominated accounts (such as HRAs) that were then being used to satisfy the employer spending requirement of the HCSO could not be forfeited."
Morgan Lewis

[Guidance Overview]

Executive Order on Health Care; Discontinuation of Cost-Sharing Subsidies in the Marketplaces (PDF)
"Although the executive order states obtaining coverage through an AHP will allow employers to avoid many costly ACA requirements, it does not list the specific requirements that will no longer apply.... [Anticipated agency] guidance should expand an employer's ability to offer HRAs and allow HRAs to be used with non-group coverage. The goal is to allow employees, especially those that work for small businesses, more options for financing their health care."
Marsh & McLennan Agency LLC

[Guidance Overview]

IRS Announces Increased Health FSA Maximums and Increased PCORI Fees (PDF)
"The indexed annual [health FSA] limit for 2018 plan years is $2,650.... [If] an employer wants to increase the maximum to $2,650 as of January 1, 2018, there are several options depending on the current stage of the open enrollment process[.]"
Marsh & McLennan Agency LLC


Online Learning Course: HSA and HRA Basics

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

This e-learning course will provide an in-depth look at HSA and HRA programs as well as how these programs interact with an HCFSA.

Zenefits' Provision of Free Software Did Not Constitute Improper Rebate But 'Full HR Integration' Did
"Zenefits' business model: offer to small businesses free software-as-a-service (SaaS) for human resources functions, like onboarding, payroll, benefits and vacation tracking, and make money on broker fees when users of the software choose to buy insurance from it.... The majority of states that have sounded off on this topic ... found that the practice does not amount to an improper rebate.... The Office of the Insurance Commissioner for the State of Washington, however, reached a different conclusion." [In re YourPeople, Inc. dba Zenefits FTW Insurance Services, No. 02-2017-INS-00009 (Admin. Hearings, Insurance Comm'r, State of Wash. Oct. 26, 2017)]
Akin Gump

Managing the Interplay Between the ADA, FMLA and Workers Compensation
"Analyze and evaluate the employee's circumstances under each law separately.... Understand what each law requires.... Apply the law that provides the most benefits to the employee."
Foley & Lardner LLP

Delays Likely for New Health Taxes as Companies Brace for Impact
"A fee on health care providers and a 2.3 percent tax on the sale of medical devices such as surgical equipment and MRI machines take effect in 2018. A 40 percent excise tax on parts of high-cost health plans -- the 'Cadillac tax' -- is to follow two years after. Those dates leave employers in a tricky limbo: preparing for a tax that may be delayed again."
Bloomberg BNA

Three Out of Four Americans Concerned About Potential Health Care Policy Changes
"[T]he three biggest fears among Americans include: [1] Loss of coverage for those with pre-existing conditions (42 percent); [2] Reduction in Medicare coverage for seniors (31 percent); and [3] No employer mandate to offer health care coverage (30 percent)."
Wolters Kluwer Law & Business

Insurer Participation Down, Premiums Up in Uncertainty-Plagued Marketplaces
"On October 30, 2017, the [HHS] Assistant Secretary for Planning and Evaluation (ASPE) released a report ... [which] documents ... [that] insurer participation in the exchanges is down for 2018 from 2017 and premiums, particularly the benchmark silver plan premiums, are up dramatically. Advance premium tax credits (APTC), however, are also up sharply, and most consumers who purchase coverage through the exchange may find that coverage costs less than last year after APTC are applied. There is evidence that individual insurance market performance has been stabilizing during 2017."
Timothy Jost, in Health Affairs

Status Reports in DC Cost-Sharing Reduction Case Highlight Stakes Going Forward
"The House of Representatives filed this case in 2014 to stop the Obama administration from reimbursing insurers for reductions in cost sharing that the insurers are required to provide individuals with incomes below 250 percent of the federal poverty level.... On October 30, the administration and the House filed a joint status report asking that the stay of the case be continued yet again while they continue to discuss the disposition of the case in hopes of filing a motion 'in furtherance of those efforts in the coming weeks.' They request, in essence, that the case be put off once again."
Health Affairs

S&P: ACA Exchange Enrollment Will Be 7 to 13 Percent Lower in 2018
"[A] new report from Standard & Poor's ... predicted that the upcoming enrollment period -- which begins Wednesday and ends Dec. 15 -- will conclude with 10.6 to 11.4 million signups. That's about 7 to 13% lower than the 12.2 million who signed up during the 2017 open enrollment period, which lasted about twice as long. Notably, the 2017 enrollment figures were lower than those seen in the 2016 signup period, the first time there was a dip in enrollment since the exchanges were established."

Benefits in General

District Court Highlights the Importance of Careful Adherence to ERISA Claim Procedures
"To the extent the participant failed to provide the necessary information, the court held it was the claim fiduciary's obligation to advise him of this fact in a timely and precise fashion, which the claims fiduciary failed to do.... Finding that the claims fiduciary failed to respond to the participant's communications in a meaningful way, the court ruled that the participant was excused from the requirement of administrative exhaustion, and further that is would not apply the deferential review standard, but would review the plaintiff's benefits claim 'de novo'." [Coleman v. Alcatel-Lucent USA, Inc., No. 16-108 (N.D. Ala., Sept. 1, 2017).
Hodgson Russ LLP


Joint Comment Letter to DOL on Proposed Extension of Applicability Date for Regs Governing Claims Procedure for Plans Providing Disability Benefits
"[We] strongly support delaying the applicability date of the Regulation for a period sufficient to allow the Department to consider the effects of the Regulation and any necessary changes. Not only does a 90-day delay provide insufficient time for insurance carriers and employers to implement changes to comply with the Regulation, but we also do not believe the Proposed Delay will provide sufficient time for the Department to review comments and data provided by stakeholders, determine next steps, and issue a proposed final rule consistent with the requirements of the Administrative Procedure Act."
American Benefits Council and 15 other employer organizations

Press Releases

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017, 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, 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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