Health & Welfare Plans Newsletter

May 10, 2018

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Webcasts, Conferences

ACA Employer Assessment Letters
RECORDED
Proskauer Rose LLP

Staying Private: Liquidity Options for Equity Compensation Plans
May 15, 2018 WEBCAST
National Center for Employee Ownership [NCEO]

Convergence of Health and Wealth
May 17, 2018 in GA
Worldwide Employee Benefits Network [WEB] - Atlanta Chapter

Equity Compensation for LLCs
June 12, 2018 WEBCAST
National Center for Employee Ownership [NCEO]

Decision-Maker's Guide to Equity Compensation
July 24, 2018 WEBCAST
National Center for Employee Ownership [NCEO]

Health Savings Accounts: Convergence of Health and Wealth
August 21, 2018 WEBCAST
ASPPA [American Society of Pension Professionals & Actuaries]

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[Official Guidance]

Text of CMS Final Regs: Correction to Benefit and Payment Parameters for 2019

"The 2019 benefit year final HHS risk adjustment model factors included in the HHS Notice of Benefit and Payment Parameters for 2019 final rule include a few errors in the adult risk adjustment model factors and the infant risk adjustment model factors. This correction notice to the final rule amends the final adult and infant risk adjustment model factors for the 2019 benefit year. [CMS has] also made the final risk adjustment model factors for the 2019 benefit year for the adult, child and infant models, including corrections to the adult and infant model factors, [available in PDF and XLSX formats]."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Advert.]

ftwilliam.com -- Enhanced Welfare Documents Module!

Sponsored by Wolters Kluwer

Recent enhancements to our Welfare Plan Documents package provide additional features to our Cafeteria and POP Plan Docs. This includes extensive new options and a new Individually Designed Plan formatted version of the Cafeteria Plan. Learn more!


[Guidance Overview]

Beware: HIPAA Applies to the Health Plans You Never Knew You Had

"Most [employee assistance plans (EAPs)] are staffed by health care providers, such as licensed counselors, and assist employees who are struggling with family or personal problems that rise to the level of a medical condition ... Employers/plan administrators ... will need to enter into a HIPAA business associate agreement with the EAP vendor, amend the EAP plan document to include language required by the HIPAA Rules and develop and implement other compliance documents and policies and procedures under the HIPAA Rules."
Fox Rothschild LLP

[Guidance Overview]

Paid Sick Leave Now Mandatory Throughout the State of New Jersey

"Employers' violations of this sick leave law are treated as wage payment violations, for which penalties, damages, and other remedies are available against the employer. Moreover, employees who prevail in a civil action for violations of their sick leave rights are entitled to liquidated damages and may also be awarded costs and attorneys' fees."
K&L Gates

[Guidance Overview]

New Jersey Passes Laws on Sick Leave and Pay Equity

"[N]ot every employee in New Jersey is entitled to paid sick leave under the Act.... [T]he Act contains an anti-retaliation provision that creates a 'rebuttable presumption' of retaliation if an adverse employment action is taken against an employee within 90 days of engaging in any protected activity under the Act[.]"
Ballard Spahr LLP

Next Time Your Employee Requests FMLA Leave, Choose Sincerity with a Touch of Empathy

"The far, far majority of our employees utilize FMLA leave appropriately and for real medical needs.... Be empathetic. The words, 'How can I help you?' can go a long way.... All requests for leave should be treated as a request for a reasonable accommodation.... Train managers to help you achieve the kind of workplace you're trying to cultivate."
FMLA Insights

[Advert.]

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For over 20 years, we've helped employers find the best-informed candidates to fill their benefits job openings -- learn more!


Fiduciary Responsibility in Healthcare Plans, Part Two

"This post discusses the challenges employers must overcome to achieve sound, business-like management of their plans.... Many companies just assume they will be paying more each year and factor the increase into their budget.... Insurance carriers have little incentive to control costs.... Health care and claims data is in a black box that plan sponsors cannot see.... Over-treating and over-prescribing is another obstacle.... [P]rimary care providers are [incentivized] on a volume basis and often have no accountability for results.... 10% of our health care-spend is on criminally fraudulent claims."
Fiduciary Plan Governance, LLC

Are Healthcare Provider Mergers Motivated by Acquisition of More Data?

"The proposed merger between Partners HealthCare and Harvard Pilgrim Health Care is yet another response to pressure on all healthcare industry sectors to find innovative paths to success in a market where old business models aren't going to work. Data is the necessary element in any solution, healthcare leaders are concluding, so someone else who has more data, or a different kind of data, is an attractive partner."
HealthLeaders Media

Study Suggests One Explanation of Wage Mystery: Health Insurance Costs

"A study of [IRS] data finds average premiums for employer-sponsored health insurance plans are roughly $1,000 higher than previously thought using data from the Current Population Survey... The study found that the underestimate was concentrated among higher-income workers. In the top wage quintile, the mean premium was $12,012 using IRS data, and $10,624 using the CPS; in the fourth quintile, the premiums were $9,394 using IRS data and $8,080 using CPS data. Even in the middle quintile, there was a gap, as average premiums were $7,371 using IRS data and $6,625 using CPS data."
MarketWatch

How Have Healthcare Prices Grown in the U.S. Over Time?

"The average price paid by large employer plans for an inpatient admission for a laparoscopic appendectomy increased by 136% between 2003 and 2016, much faster than general price increases over the period (28%).... [T]he average price of a full knee replacement in the New York City area ($50 thousand) is more than twice the price of the same procedure in the Louisville, Kentucky area ($23 thousand). The national average was $34,063."
The Peterson-Kaiser Health System Tracker

Unum Offers Employer-Paid Plan for Out-of-Pocket Hospital Costs

"Unum Group's employer-paid hospital coverage offers workers a fixed cash benefit to cover out-of-pocket costs for events that require hospitalization such as childbirth, illness or accidents. But instead of contributing, say, $200 to an employee's health savings account across 10 employees every year to help offset rising deductibles, the employer offers a fixed cash benefit of $2,000 toward hospitalization"
InsuranceNewsNet.com

How Do Healthcare Prices and Use in the U.S. Compare to Other Countries?

"The U.S. has higher prices for most health care services and prescription drugs, according to available internationally comparable data. Meanwhile, utilization of several services, including physician consultations and hospital stays, is lower than in many comparable countries. Use of some services, such as C-sections and knee replacements, is higher in the U.S. than in similar countries. Despite having fewer office visits and shorter average hospital stays, the U.S. overall spends twice as much per person on healthcare than do comparable countries."
The Peterson-Kaiser Health System Tracker

[Opinion]

What Your Health Insurance Carrier Won't Tell You at Renewal

"While PPACA covered roughly 12 to 15 million of the nation's 40 million uninsured, it did nothing to actually reduce price. If anything, PPACA made healthcare more expensive by about 2% per year since its inception with its myriad of taxes, fees, penalties and robust benefit mandates. Alas, for the first time since its passage, we are finally starting to see costs moderate and carriers are back to the kind of record profits they enjoyed prior to 2010."
Benefit Revolution

Benefits in General

[Official Guidance]

Text of DOL Regulatory Agenda, Spring 2018

EBSA items in Proposed or Final Rule stage: [1] Amendment of Abandoned Plan Program; [2] Electronic Filing of Apprenticeship & Training Notices, and Top Hat Plan Statements; [3] Adoption of Amended and Restated Voluntary Fiduciary Correction Program; [4] Religious Exemptions and Accommodations for Coverage of Certain Preventive Services Under the ACA; [5] Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the ACA; [6] Definition of an 'Employer' Under Section 3(5) of ERISA -- Association Health Plans; and [7] Short-Term, Limited Duration Insurance.
U.S. Department of Labor [DOL]

[Official Guidance]

2017-2018 IRS Priority Guidance Plan, 3rd Quarter Update (PDF)

37 pages. "The 2017-2018 Priority Guidance Plan contained 198 guidance projects, 30 of which had been completed before its publication.... This third quarter update to the 2017- 2018 plan reflects 13 additional projects as well as guidance we published (or released) during the period from October 13, 2017 through March 31, 2018."
Internal Revenue Service [IRS]

[Official Guidance]

Text of IRS Disaster Relief Notice NC-2018-02, for Victims of Tornadoes and Severe Storms North Carolina

"Individuals who reside or have a business in Guilford and Rockingham counties may qualify for tax relief.... [T]he IRS gives affected taxpayers until August 15, 2018, to file most tax returns ... that have either an original or extended due date occurring on or after April 15, 2018 and before August 15, 2018."
Internal Revenue Service [IRS]

Third Circuit Severance Plan Decision Should Prompt Employers to be Proactive

"A recent 3rd Circuit Court of Appeals decision should remind employers to take the initiative -- in severance plans and agreements -- to affirmatively address whether ERISA will govern plan disputes, as well as how disputes will get resolved. This is because a well-drafted ERISA plan should expedite the resolution of employee claims in a cost-effective manner that involves a high level of deference to an employer's decisions." [Girardot v. The Chemours Company, No. 17-1894 (3d Cir. Apr. 30, 2018)]
The Wagner Law Group

Myths You Shouldn't Believe About Employee Benefit Packages

"Myth No. 1: Everyone wants a gym membership.... Myth No. 2: The biggest benefit is salary.... Myth No. 3: Additional benefits are too expensive for employees.... Myth No. 4: There is no return on investment.... Myth No. 5: My employees already know we provide great benefits."
Grooms Benefit Solutions

IRS Publication 5279: Your Pathway to Becoming an Enrolled Agent (PDF)

Rev. May 2018. "How do I become an Enrolled Agent? ... How do I prepare for the special enrollment examination? ... How do I maintain my Enrolled Agent credential?"
Internal Revenue Service [IRS]

Executive Compensation
and Nonqualified Plans

[Guidance Overview]

New Excise Tax on Excess Compensation Paid by Tax-Exempt Employers

"The new excise tax is effective for tax years beginning after 2017. There is no grandfather or transition rule for existing arrangements, such as Section 457(f) retirement arrangements."
Fox Rothschild LLP

Press Releases

Economic Group Pension Services Launches Official App
Economic Group Pension Services [EGPS]

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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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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