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November 28, 2017 logo logo
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[Official Guidance]

Text of CMS Draft 2019 Letter to Issuers in the Federally-Facilitated Exchanges (PDF)
23 pages. "This Letter provides updates on operational and technical guidance for the 2019 plan year for issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs). Issuers should refer to these updates to help them successfully participate in any such Exchange in 2019."
Center for Consumer Information & Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


States & Localities Pose Serious Threat to Employee Benefits

Sponsored by The ERISA Industry Committee [ERIC]

Join The ERISA Industry Committee and corporate compensation executives for analysis of what to expect at the state and local level and how proposed rules could be shaped or reversed to allow your company to retain benefits flexibility. Register now.

[Guidance Overview]

CMS Fact Sheet: Draft Annual Letter to Issuers for 2019
"The 2019 Draft Letter outlines key dates for the QHP certification process in the FFEs for plan years beginning in 2019.... [T]he timeline for 2019 is similar to the timeline for the 2018 plan year.... The 2019 Draft Letter describes our proposed approach in the 2019 Payment Notice Proposed Rule to expand the role of States in the QHP certification process for FFEs, including FFEs where the State performs plan management functions."
Center for Consumer Information & Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

HHS Releases Proposed Notice of Benefit and Payment Parameters for 2019 (PDF)
"The Proposed Rule addresses a range of issues and proposes greater state flexibility in a number of areas, including essential health benefits (EHB), medical loss ratio (MLR), rate review, and state certifications of qualified health plans (QHPs) in the Federally-facilitated Exchanges (FFEs) and State-based Exchanges using the federal platform. The Proposed Rule also proposes changes to risk adjustment and risk adjustment data validation (RADV) programs, special enrollment periods (SEPs), Exchange user fees, the annual limitation on cost sharing levels for 2019, and Exchange programs, including changes to the Small Business Health Options Program (SHOP)."
Groom Law Group

[Guidance Overview]

The Taxman Cometh: IRS Begins Assessing Employer Mandate Penalties
"Because of data quality issues, many employers will be assessed amounts they do not owe. However, employers have only 30 days to appeal the assessment, and because of the timing of the notices, and the manner in which they are addressed, it is likely that many notices will not reach the right individuals in time for employers to respond. Your first challenge in appealing an assessment is receiving the notice in the first place."
Alston & Bird

[Guidance Overview]

ACA Reporting Will Be Even Less Forgiving for 2017
"In previous years, the IRS allowed forms to be filed beyond the normal deadline without penalty. Not anymore. In the past, the IRS has also refused to assert a penalty against an employer who furnished missing or inaccurate information -- including Social Security numbers -- provided the employer made a 'good faith' effort to comply with the rules.... As of yet, the IRS has not established any good-faith exception applicable to the 2017 tax year. Finally, the IRS has established a process by which employers can solicit tax identification numbers (TINs), such as Social Security numbers, and not be liable if the TIN is missing or inaccurate. Unfortunately, this safe harbor remains somewhat confusing."


Changes to Cafeteria Plans: What You Need to Know

Sponsored by Lorman and BenefitsLink

Dec. 7 webinar. Whether deciding to offer a health FSA or a health savings account (or both), or preparing for an upcoming merger, learn to identify and mitigate risks to keep your cafeteria plan legally compliant in 2018 and beyond. BenefitsLink discount.

The IRS Is Ready to Collect on ACA Employer Penalties
"Large employers ... should be prepared to quickly access paper or electronic copies of their 2015 Form(s) 1095-C and 1094-C. Employers who used vendors to assist with these filings should contact the vendor now to ensure they will have access to copies if and when needed.... In determining whether the assessment is accurate, employers should consider whether any transition relief or safe harbors apply, including relief for non-calendar year plans, limited non-assessment periods, or multi-employer plans."
Ice Miller LLP

Consumers with High-Deductible Health Plans Could Be Smarter Shoppers
"Even when consumers have health plans that require them to pay a high amount out-of-pocket for care, they often don't talk to doctors about the price of treatments or shop around to get the best deal[.]"

Boost Open Enrollment Efficiency by Killing Voice Mail
"You will effectively destroy any customer experience and goodwill by using voicemail as part of your open enrollment strategy.... Most open enrollments are completed during the fourth quarter of the year. During this time, call volumes typically increase 60% or more. Instead of hiring additional staff that increases costs, voicemails are used as the low-cost equivalent. Is it really a lower cost alternative?"
Employee Benefit Adviser

Benefits in General

Disability Claims Procedure Regs Delayed ... for the Last Time?
"EBSA currently remains unconvinced that the revised claims procedures are overreaching. In the preamble regarding the delay, it states that based on information and data provided to date, no substantive changes or delay past April 1 is warranted. However, through December 11, 2017 interested parties may submit comments, data and 'convincing factual support' for EBSA's review."
Mayer Brown

Focus on Employees' Motivations to Help Them Understand and Maximize the Value of Their Benefits (PDF)
16 pages. "Today, employees are expected to fully understand which benefits will serve them best -- now and in the future -- and then effectively allocate their benefit dollars across a vast range of choices ... [T]hree key strategies for employers ... [1] Speak clearly about the coverage; [use] a simple four-point formula. [2] Communicate in multiple ways ... [3] Focus on motivations that most impact decision-making[.]"
Lincoln Financial Group

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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