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Health & Welfare Plans Newsletter May 3, 2018 |
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Jobs
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Webcasts, Conferences |
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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Qualified Retirement Plan Investment Advisor|
[Guidance Overview]
New Guidance on Group Health Plan MHPAEA Compliance "This self-compliance tool may be helpful for health plan administrators to work through plan exclusions and policies that may violate the MHPAEA. A plan administrator may use it to evaluate its TPA's or insurer's policies and procedures related to MH/SUD benefits... [The authors] have seen a recent focus on reviewing coverage for autism and ABA therapy, residential treatment center benefits, and sufficiency of MH/SUD provider networks, and many other plan terms may be implicated as well."
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[Advert.]
Health Savings Accounts (HSAs): Compliance Obligations Under the Internal Revenue Code and ERISA
May 30 webinar. Complex employer health care offerings can make it difficult to determine HSA eligibility. This webinar will help health plan administrators navigate this sometimes treacherous terrain. Discount for BenefitsLink readers. |
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[Guidance Overview]
Feds Update Mental Health and Substance Abuse Parity Guidance "The new MHPAEA guidance suggests plan sponsors may wish to dialogue with their insurers or third-party administrators to ensure they're supplying adequate explanation of a claim denial ... [DOL] investigators at this point are permitting noncompliant plans to reassess claim denials and make the participants whole without additional enforcement penalties, so employers will likely find cooperation with the investigators to be a manageable course of action."
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[Guidance Overview]
New Jersey Enacts Statewide Paid Sick Leave Law "New Jersey has had a patchwork of 13 local paid sick leave ordinances. That will end in October 2018 when New Jersey's newly enacted statewide paid sick leave law takes effect which will preempt all local sick leave ordinances. In return for uniformity, all employers in New Jersey -- regardless of size -- must now provide paid sick leave to their employees."
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[Guidance Overview]
IRS Tax Tip: How the Employer Credit for Family and Medical Leave Benefits Employers "The credit is a percentage of the amount of wages paid to a qualifying employee while on family and medical leave for up to 12 weeks per taxable year.... Any wages taken into account in determining any other general business credit may not be used toward this credit. The credit is generally effective for wages paid in taxable years of the employer beginning after December 31, 2017. It is not available for wages paid in taxable years beginning after December 31, 2019." [IRS Tax Reform Tax Tip 2018-69]
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Supreme Court's Inaction Establishes That Post-FMLA Medical Leave Is Not Required Under ADA "The U.S. Supreme Court's decline of a Seventh Circuit appellate decision solidifies that where an employee is medically unable to return to work within a very short time period following a leave of absence, the employer has no additional federal legal obligation to provide additional leave, or hold the employee's job open." [Severson v. Heartland Woodcraft, Inc., No. 15-3754 (7th Cir. Sept. 20, 2017; cert. pet. denied Apr. 2, 2018)]
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[Advert.]
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Clawbacks: Recent Litigation Targeting Insurers and Pharmacy Benefit Managers "There have been frequent media reports on the practice of prescription drug clawbacks and federal lawsuits have been filed against insurance companies and PBMs ... The theories of liability being asserted include breach of fiduciary duty under [ERISA], violations of the Racketeer Influenced and Corrupt Organizations Act, as well as under various state laws.... [In one recent case,the ] court found plaintiffs alleged facts sufficient to assert a plausible claim of fiduciary status based on the argument that Cigna's conduct was in violation of plan terms and thus necessarily required the exercise of discretion." [Negron v. Cigna Health and Life Ins. Co., No. 16-1702, consol. with No. 16-1904 (D. Conn. Mar. 12, 2018)]
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CMS Proposed Regs Would Require Hospital Price Transparency "[T]he proposed rule ... would require hospitals to post their pricing lists online, accessible to patients in a 'consumer-friendly' way ... CMS is also ... asking stakeholders to comment on ... what information stakeholders would find most useful, and how best to help hospitals create patient-friendly interfaces to make it easier for consumers to access relevant data to more readily compare providers. CMS is considering making information on hospital noncompliance public."
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EBSA Health Investigations Remained Steady Last Year, More Than Half Involved Mental Health Parity "EBSA closed 347 health investigations in FY 2017 (compared to 330 in FY 2016) ... Of these 347 closed investigations, 187 involved plans subject to MHPAEA and were, therefore, reviewed for MHPAEA compliance.... [Of] these 187 investigations where MHPAEA applied, EBSA cited 92 violations for MHPAEA noncompliance."
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Federal Requirements on Private Health Insurance Plans (PDF) 26 pages. "The first part of this report provides background information about health plans sold in the [private health insurance] market and briefly describes state and federal regulation of private plans. The second part summarizes selected federal requirements and indicates each requirement's applicability to one or more of the following types of private health plans: individual, small group, large group, and self-insured. The selected market reforms are grouped under the following categories: obtaining coverage, keeping coverage, developing health insurance premiums, covered services, cost-sharing limits, consumer assistance and other patient protections, and plan requirements related to health care providers. Many of the federal requirements described in this report were established under the [ACA]; however, some were established under federal laws enacted prior to the ACA." [Report
R45146; May 1, 2018]
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Employers Continue to Expand Well-Being Programs and Increase Financial Incentives for Employees "Nearly nine out of ten employers (86 percent, up from 74 percent in 2017) offer financial incentives as part of their well-being platform, and the average employee incentive amount increased to $784 for 2018, up from $742 in 2017, and a 50 percent increase from the average of $521 in 2013."
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Majority of Large Employers Offer Financial Assistance for Fertility Treatment "[A]mong 497 U.S. employers with at least 100 employees -- employers that collectively represent 7 million employees and operate in all major industry sectors -- 55 percent offer fertility benefits.... [T]hat number is expected to grow to 66 percent by 2019.... Of the employers currently offering fertility benefits, 65 percent offer coverage for fertility services to same-sex couples. That percentage is expected to increase to 81 percent by 2019."
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[Opinion]
Fiduciary Responsibility in Healthcare Plans "An employer's management of the payment part is what raises fiduciary issues under ERISA. We know plan sponsors have fiduciary responsibilities for ERISA retirement plans like 401(k)s and 403(b)s but what's not as well understood is that, speaking very broadly, employers offering healthcare plans are obligated to act reasonably and prudently, to engage only necessary services, and not enter into unreasonable arrangements or pay unreasonable fees."
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[Opinion]
Wellness Programs Don't Work, So Why Is Congress Pressuring Employers? "Since wellness programs have not demonstrated any meaningful cost savings or outcomes improvement, the [ACA] policy allowing financial coercion by employers to force employees into unlicensed, unregulated, wellness programs should be reconsidered. And, yet, a bill currently awaiting a floor vote in Congress would allow greater financial coercion by employers."
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Benefits in General |
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[Guidance Overview]
DOL's Final Rule on Disability Claim Procedures Take Effect "The Disability Claims Regulations deem a claimant to have exhausted all administrative remedies if a plan fails to strictly adhere to all of the DOL claims regulations, so it is vital for the plan administrator or follow these requirements.... The special rules require [a plan] to provide oral language services ... that would answer questions in the applicable non-English language and provide assistance with filing claims and appeals in such language; provide, upon request, a notice written in such language; and include in the English versions of all notices, a written statement prominently displayed in any applicable non-English language clearly indicating how to access the language services provided by the plan."
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Selected Discussions |
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Quick question about the Plan Characteristic code 2A for DC Pension Features. If the plan has an integrated allocation, would you list 2A as a characteristic code on the 5500? The description seems to suggest that you would since the allocation method provides for an additional rate on comp above the TWB threshold.
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Press Releases |
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Wilkins Finston Friedman Law Group LLP is Pleased to Welcome Angela M. Stockbridge to the Firm
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Pinkerton Retirement Services, LLC is Certified for Fiduciary Excellence
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Midwest Business Group on Health Releases Free Resource to Help Employers Address Pain Management and Opioid Use / Abuse
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Marsh & McLennan Agency Launches Human Resources and Benefits Administration Digital Platform for Small Employers
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Connect
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BenefitsLink.com, Inc.
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Winter Park, Florida 32789
(407) 644-4146
Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager
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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