Health & Welfare Plans Newsletter

February 20, 2018

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401(k) Relationship Manager
MVP Plan Administrators, Inc.
in NC, Telecommute

Senior Pension Plan Consultant
Cottage Health
in CA

Defined Benefit Plan Administrator
United Retirement Plan Consultants
in MD, NC, RI, TX

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[Official Guidance]

Text of Agency Proposed Regs: Short-Term, Limited-Duration Insurance
40 pages. "This rule contains proposals amending the definition of short-term, limited-duration insurance for purposes of its exclusion from the definition of individual health insurance coverage. This action is being taken to lengthen the maximum period of short-term, limited-duration insurance, which will provide more affordable consumer choice for health coverage."
Internal Revenue Service [IRS]; Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; and U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Proposed Regs on Short-Term Health Insurance Provide Relief to Americans Facing High Premiums, Fewer Choices
"The rule proposes to expand the availability of short-term, limited-duration health insurance by allowing consumers to buy plans providing coverage for any period of less than 12 months, rather than the current maximum period of less than three months. The proposed rule, if finalized, will provide additional options to Americans who cannot afford to pay the costs of soaring healthcare premiums or do not have access to healthcare choices that meet their needs under current law."
U.S. Department of Health and Human Services [HHS]

Administration Proposes to Loosen Restrictions on Short-Term Health Plans
"The new rule is expected to entice younger and healthier people from the general insurance pool by allowing a range of lower-cost options that don't include all the benefits required by the federal law -- including plans that can reject people with preexisting medical conditions. In addition, according to the proposed rule, the plans would not be required to sell to everyone, so people with medical problems may not be able to get this coverage."
Kaiser Health News

Supreme Court Again Tells Sixth Circuit to Rethink Retiree Health Benefits
"The justices once again rejected the U.S. Court of Appeals for the Sixth Circuit's way of handling these disputes, which the justices said was rooted in inferences and assumptions and not the text of the applicable collective bargaining agreements. The result is a victory for CNH Industrial, which was sued for its attempt to modify the health-care benefits it provides for union retirees." [CNH Industrial N.V. v. Reese, No. 17-515 (U.S. Feb. 20, 2018, per curiam)]
Bloomberg BNA

Making Dependent Verification More Than a One-and-Done Project
"Dependents can represent up to 70% of your company health care costs ... 72% of [employers] never reverify dependents after an initial audit.... Reverifying your enrolled dependents every three years will ensure your organization is compliant with eligibility guidelines and can free up funds for new or enhanced benefit programs."
Alight Solutions

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Back to the Future: Making Sense of the Election Timing Rules for Cafeteria Plans
"[E]lections based on these events can be made on a retroactive basis: birth, adoption, placement for adoption of a child.... Correcting elections based on mistakes of fact has become a standard practice.... You can allow the election to take effect retroactively and allow employees to pay for the retroactive period on a post-tax basis.... An employer can simply waive payment for the retroactive period.... An employer can encourage employees to make anticipatory (a.k.a. springing) elections.... Employers have some flexibility when it comes to annual open enrollment."
HR Daily Advisor

Is Enrollment in HSA-Eligible Health Plans Growing or Not? (PDF)
"Recent low health insurance premium increases combined with low unemployment may have caused employers to hold off on plans to move to HSA-eligible health plans.... Recent research has found that HSA-eligible health plans may be associated with a reduction in appropriate preventive care and medication adherence.... Growth in HSA-eligible health plans may be held back because what constitutes an HSA-eligible health plan does not provide employers their desired level of flexibility around the design of the health plan."
Employee Benefit Research Institute [EBRI]

Section 1557 Rule on the Horizon; Focus on Employer Mandate
"HHS continues to make progress, however slowly, in revisiting the Section 1557 rule.... Because Section 1557 includes a private right of action, covered entities -- such as hospitals, clinics, or state Medicaid programs -- that fail to comply with the regulations could be sued by someone that has faced discrimination and makes a claim under Section 1557.... [S]ome members of Congress are considering an additional push to repeal or delay the employer mandate ... In the meantime, the IRS continues to implement the employer mandate and recently submitted an information collection request to [OMB] regarding reporting requirements under the employer mandate."
Health Affairs

Benefits in General

[Guidance Overview]

April 1, 2018 Is Fast Approaching -- Are Your Disability Claims Procedures Ready?
"To avoid claimants being deemed to have exhausted the plan's claims procedures, enabling them to sue the plan with the favorable de novo standard of review, the claims procedures of all plans providing a disability benefit must be reviewed against these final regulations. This includes disability, pension, defined contribution plans (401(k) and 403(b)) and nonqualified deferred compensation plans."
Foley & Lardner LLP

Selected Discussions
on the BenefitsLink Message Boards

Pros and Cons of In-House Medical Claims Administration
Appreciate any insight on the merits of in-house claims administration vs. using outsourcing to a TPA vs. using a medical vendor for larger (Fortune 500 size) corporations.
BenefitsLink Message Boards

Your Experience with Pharmacy Tourism?
Any comments appreciated as to whether pharmacy tourism works.
BenefitsLink Message Boards

Clergy Housing Allowance Included for Contributions? For HCE Determination?
Is the clergy housing allowance included for contributions? For the HCE determination?
BenefitsLink Message Boards

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David Rhett Baker, J.D., Editor and Publisher
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2018 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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