Health & Welfare Plans Newsletter

April 27, 2018

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[Official Guidance]

Text of OPM Final Regs: Federal Employees Health Benefits Program Flexibilities

"To correct an asymmetry in the insurance market for Federal employees and annuitants, this Final regulation provides all Federal Employees Health Benefits (FEHB) Program carriers the ability to offer the same number and types of plan options. Currently, OPM regulations defining minimum standards for health benefits plans allow certain plans to have two options and a high deductible health plan, while other plans may have three options of any type or two options and a high deductible health plan, creating an asymmetry between the potential offerings of health benefits plans. We have revised the regulations so all health benefits plans are able to offer three options or two options and a high deductible health plan. This final rule will give FEHB enrollees more choices in selecting a health plan that best meets their family's health care needs."
U.S. Office of Personnel Management [OPM]

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[Guidance Overview]

IRS Provides Relief for HSA Family Limit

"[The IRS] acknowledged that the costs of modifying systems to reflect the reduced maximum, as well as the costs associated with distributing a $50 excess contribution (and earnings) (which in some cases exceeded $50), would be significantly greater than any tax benefit associated with an unreduced HSA contribution. [Rev. Proc. 2018-27] also provides guidance for individuals who may have already taken a distribution from their HSA in 2018 based on the earlier published maximum limit of $6,850."
Winston & Strawn LLP

[Guidance Overview]

Agencies Issue Proposed FAQs on Mental Health Parity Implementation

"Among other things the proposed FAQs clarify that under MHPAEA ... [1] An exclusion of all benefits for a particular condition or disorder is not a treatment limitation for purposes of the definition of 'treatment limitations' in the MHPAEA regulations.... [2] If a health plan uses a provider network, its SPD must provide a general description of the network along with a listing of providers that is up-to-date, accurate and complete.... [3] Health plans that utilize provider networks can satisfy applicable disclosure requirements by providing a hyperlink or URL address in enrollment and plan summary materials for a provider directory where information related to MH/SUD providers can be found."
The Wagner Law Group

Agencies Release Additional FAQs Clarifying Mental Health Parity and Addiction Equity Act

"The FAQs give examples of the following plan terms that are permissible under the MHPAEA: [1] Exclusions for treatments that are experimental or investigational as defined in the plan ... [2] Limitations on medication dosages following professionally-recognized treatment guidelines.... [3] Exclusions that apply to all treatment for a specific condition, for example, bipolar disorders."
Compliance Dashboard

Court Allows Terminated Employee to Pursue ERISA Section 510 Claims Tied to Son's Large Medical Expenses

"[A]ctions justifiable under the FMLA proved the employer's undoing ... under ERISA.... [C]autious employers should take care to separate employment decisions from employee benefit plan considerations. In fact, this separation is mandatory under HIPAA's privacy rule for employers receiving protected health information from their health plan." [Stein v. Atlas Industries, Inc., No. 17-3737 (6th Cir. Apr. 9, 2018)]
Thomson Reuters / EBIA

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Employee Handbook Leads to Dismissal of FMLA Claims Against Tennessee Employer

"SCI's employee handbook outlined the procedure--employees needing leave were to contact the SCI Leave and Disability Center.... The court explained that despite the fact that Everson had received, read, and signed SCI's employee handbook, he never requested FMLA leave or asked anyone at SCI for FMLA leave. He also did not identify any unusual circumstances that would have prevented him from complying with SCI's notice requirement. Because Everson failed to comply with SCI's policy for requesting FMLA leave, the court ruled that he could not establish a prima facie case for FMLA interference." [Everson v. SCI Tennessee Funeral Services, LLC, No. 15-1478 (M.D. Tenn. Apr. 20, 2018)]
Bradley

Well-Being in the Workplace Is Now More Important Than Ever

"Thirty five percent of large and midsize companies are bringing in some form of mindfulness and meditation ... Aetna ... saved $2,000 per employee in healthcare costs and improved productivity by $3,000 per employee through the introduction of mindfulness programs."
The Alliance

Rethinking Your Organization's Health Care Plan? Consider These Factors in Consumer Health Care

"If you are offering CDHPs to your employees, you need to consider offering tax-advantaged benefits. They provide a means of financing out-of-pocket health care costs and help many Americans afford critical health care expenses. For nonprofit organizations, it's often difficult to compete with for-profits when it comes to employee benefits -- affordable health care, in particular. These tax-advantaged accounts help your organization manage the cost of health care as an employer while helping employees do the same."
Martin Trussell, in Forbes

Association Health Plans, Part 3

"In this installment ... [the authors] examine the qualification requirements for AHPs under current law.... Benefit programs maintained by employers with no common industry affiliation or effectively controlled by a self-perpetuating board with no voice provided to the participating employers are not considered to be a bona fide association of employers. Practically speaking, very few association plans are treated as a single ERISA-covered plan under the current sub-regulatory framework, but instead are treated as a collection of plans each sponsored by individual employers."
Benefits Bryan Cave

Is Your Employer Health Plan Coverage Creditable?

"Creditable drug coverage should 'meet or exceed' what Medicare's Part D plan minimums are for that current year. Puzzling, I know. Medicare does not regard discount prescription drug cards or low-cost generics programs as 'creditable coverage.' These types of plans cannot keep you from the Late Enrollment Penalty. BUT ... Medicare does consider receiving your prescription drugs from the VA as creditable coverage."
Houston Chronicle

Ingredients for a Successful Voluntary Benefits Strategy

"[1] A heaping helping of data-driven insights. [2] Technology platform with defined data integration standards. [3] Rich set of educational content and decision support."
Benefitfocus

[Opinion]

Reference-Based Pricing -- Coming to a Health Plan Near You?

"Reference-based pricing seems more rational, transparent and can be a more cost-effective method for paying for healthcare, and with an open network there are no networks to manage.... Unfortunately, not only is healthcare very confusing but the more significant costs are often borne at a vulnerable time -- when illness or injury takes precedence over cost considerations.... [Providers] can -- and often will -- aggressively pursue excess charges from the patient. This is causing friction between the patients, the plan sponsors and the providers."
Frenkel Benefits

Benefits in General

Voluntary Severance Plans: From Success to Backfire

"[T]he benefits of an ERISA severance plan generally include ... [1] no litigation until there has been an exhaustion of the plan's claims procedures, which may foreclose claims that are not promptly asserted; [2] judicial review under highly deferential standards, rather than de novo; [3] litigation in federal court under well-defined ERISA rules applied by a judge, instead of before a jury in state court; and [4] damages that ERISA limits to plan benefits and potential attorneys' fees, rather than the full panoply of damages recoverable through tort claims outside ERISA."
The Wagner Law Group

Executive Compensation
and Nonqualified Plans

[Guidance Overview]

2018 Update for Internal Revenue Code Section 162(m) Changes

"Be careful to examine shareholder-approval issues before amending a plan that previously received such approval.... To preserve corporate deductions, consider increased use of deferred compensation and restricted stock (with longer vesting schedules), and less use of stock options. Likewise, draft new severance plans and employment agreements to provide for installment payouts, as well as to allow severance bonus payouts at target[.]"
The Wagner Law Group

Press Releases

Former Financial Executives Sentenced in $179 Million Loan Scam
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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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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