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April 16, 2018 logo logo
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Carlson Capital Management
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Segal Group
in CT, DC, GA, MA, TX

Onboarding Specialist 401K
Alliance Benefit Group WI
in WI

Assistant Director - Payroll / WFA / Benefits Operations
University of California Office of the President
in CA

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[Official Guidance]

Text of CMS Corrections to 2019 Final HHS Risk Adjustment Coefficients (PDF)
"The 2019 benefit year final HHS risk adjustment model factors included in the HHS Notice of Benefit and Payment Parameters for 2019 final rule contain a few errors in the adult risk adjustment model factors and the infant risk adjustment model factors. This document reflects the correct final adult and infant risk adjustment model factors for the 2019 benefit year with the amended factors highlighted."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


Employer Health Care Cost & Quality Congress | Washington DC

Sponsored by World Congress

4/29-5/2/2018 in Washington DC. This event brings together Employers, Brokers, and TPAs. Qualified HR & Benefits Professionals may attend as our guest - See website for details/restrictions & to apply.

[Guidance Overview]

IRS Issues Initial Guidance on Paid FMLA Tax Credit
"[T]he FAQs clarify that the wages used for the Section 45S credit may not be used for other business credits and that an employer must reduce its deduction for any wages related to credit by the amount of the credit. (In other words, if an employer pays $50,000 in wages, which includes $5,000 of paid FMLA leave for which the employer received a $1,250 credit, the employer may only deduct $48,750 of the wage expense.)"
Winston & Strawn LLP

[Guidance Overview]

DOL Issues Opinion Letter Allowing Employers to Avoid Payment for Excessive 15-Minute FMLA Breaks; Employers Yawn
"In a situation where an employee requires eight 15-minute breaks per day as a result of the employee's serious health condition, the DOL determined that the breaks were primarily for the benefit of the employee. Therefore, they are not compensable.... The DOL reminded employers that these employees must be compensated for the same number of breaks taken by co-workers."
FMLA Insights

San Francisco Employer Annual Reporting for 2017 Due in Two Weeks
"San Francisco employers must pay a certain amount toward the healthcare costs of their employees who work in the city. Covered employers must submit an Annual Reporting Form to the city summarizing compliance with this requirement for 2017 by April 30. Also, new minimum healthcare expenditure rules are effective starting with the first quarter of 2018, and employers with self-insured healthcare plans will need to follow these rules."

Whirlpool Retirees Get Union Support in Health Care Dispute
"The unions are urging the U.S. Court of Appeals for the Sixth Circuit to affirm a district court ruling that blocked Whirlpool from raising health insurance costs to retirees, according to a friend-of-the-court brief filed April 12 by unions that represent approximately 1.3 million auto workers and steelworkers. The unions' support for the retirees comes three months after the Michigan attorney general filed a brief in the same case criticizing the 'uncertainty and inconsistency' of the Sixth Circuit's recent case law." [Zino v. Whirlpool Corp., 6th Cir., Nos. 17-3851, 17-3860, amicus brief filed Apr. 12, 2018]
Bloomberg BNA

Health Plans and Pharmacy Benefit Managers
"Owned jointly by pharmacies and PBMs, SureScripts helpfully relays medication eligibility, patient drug histories, and prescriptions between and among providers, PBMs, and pharmacies. SureScripts earns significant fees for these services, historically from PBMs and pharmacies. But, SureScripts has arguably held back innovative efforts by plans and alternative pharmacy delivery systems to have real time input with providers on prescription decisions. As a result, communications between plans, their contracted PBMs, providers, and pharmacies, though electronic in part, have remained limited."
Sheppard Mullin

New Jersey Legislature Passes Paid Sick Leave Bill
"The Act.... requires businesses of all sizes to provide up to 40 hours of paid sick leave to employees during an employer-established benefit year. The Act ... expressly preempts municipal paid sick leave ordinances passed in cities and towns such as Newark, Morristown, and Paterson, in an effort to provide uniform obligations to businesses operating within the State."
Jackson Lewis P.C.

How Fear of Catastrophic Health Care Expenses May Cause Retirees to Inefficiently Self-Insure (PDF)
"[M]edian cumulative out-of-pocket medical expenses for the long-lived elderly is quite modest at $27,000. At the same time, it is true that some long-lived elderly report very high cumulative out-of-pocket medical expenses: 10 percent of this older cohort say they racked up more than $172,000 in out-of-pocket medical expenses, and 5 percent report spending more than $269,000 in out-of-pocket medical expenses.... While most (61 percent) long-lived elderly do enter a nursing home, less than one-third (32.2 percent) incur out-of-pocket nursing home expenses."
Employee Benefit Research Institute [EBRI]

State Reinsurance Programs Aimed at Stabilizing Marketplaces Could Impact Employers
"State programs are designed to address the impact of high-risk individuals in the marketplaces, and, in some cases, involve section 1332 waivers under ACA to establish a reinsurance program. These reinsurance programs could involve increased costs for employers if states look to them as a source of tax revenue to boost the marketplaces."


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Effects of the ACA on Health Behaviors After Three Years
"Using data from the Behavioral Risk Factor Surveillance System and an identification strategy that leverages variation in pre-ACA uninsured rates and state Medicaid expansion decisions, [the authors] show that the ACA increased preventive care utilization along several dimensions, but also increased risky drinking. These results are driven by the private portions of the law, as opposed to the Medicaid expansion."
National Bureau of Economic Research [NBER]; purchase required for full document

Benefits in General

Financial Conflict of Interest in the Eighth Circuit: Trigger of a Less Deferential Standard of Review or Mere Factor in Determining Plan Administrator Abuse of Discretion?
"The [Eighth Circuit] noted that ... a financial conflict of interest is merely a factor that a court should consider in determining whether a plan administrator has abused its discretion -- not a basis for applying a less deferential standard of review. The Court explained that -- although apparently substantially similar -- a less deferential standard of review versus consideration of financial conflict of interest in conjunction with an abuse of discretion standard of review were distinct concepts." [Boyd v. ConAgra Foods, Inc., No. 16-1763 (8th Cir. Jan. 5, 2018)]
Jackson Lewis P.C.

Employers and Employees Embrace Automation But Fear Loss of Workplace Humanity
"More than half (56 percent) of employers have a positive view of automation technologies that can help companies do human jobs, compared with 20 percent who are pessimistic ... On the employee side, nearly half (49 percent) are optimistic, while only a quarter (24 percent) are pessimistic.... Still, both employers and their workers have trouble reconciling their optimism around automation with their desire for human connection. About half of both groups (46 percent of employees, and 51 percent of employers) worry the workplace is becoming less human."

Executive Compensation
and Nonqualified Plans

California (Re)Introduces Pay Ratio Corporate Tax Bill with Unique Calculation
"California Senate Bill 1398, introduced by Democrat State Senator Nancy Skinner, would increase corporate taxes for public companies from the base rate of 8.84 percent to a high of 13 percent for companies with pay ratios exceeding 300. Significantly, the tax rate would increase by an additional 50 percent if a company reduces its U.S. full-time workforce by 10 percent or more during the [previous tax] year."
HR Policy Association

Stock Awards Behind Most CEO Pay Hikes
"More CEOs at large money managers or banks with large asset management units received total compensation increases in 2017 compared with the previous year, and most increases came via stock awards -- a practice that sources said would continue as managers tie chief executive pay to long-term performance."
Pensions & Investments

Press Releases

CalPERS Names Elisabeth Bourqui Chief Operating Investment Officer
CalPERS [California Public Employees' Retirement System]

NAPA Welcomes Jeffery Acheson as President
National Association of Plan Advisors [NAPA]

Cindy Hounsell Receives PSCA Lifetime Achievement Award
PSCA [Plan Sponsor Council of America]

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2018, 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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