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Health & Welfare Plans Newsletter May 24, 2018 |
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Jobs
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Webcasts, Conferences Mental Health Parity and Addiction Equity Act Workshop
ERISA Compliance: Implementing Effective Claims Procedures Under Section 503 and DOL Regulations
Fraud Prevention Institute for Employee Benefit Plans
Benefit Communication and Technology Institute
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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Retirement Planning Consultant|
[Official Guidance]
From IRS: 'Understanding Your Letter 227' "The various Letters 227 are acknowledgement letters sent to close an ESRP inquiry or provide the next steps to the Applicable Large Employer (ALE) regarding the proposed Employer Shared Responsibility Payment (ESRP). There are five different 227 letters ... Read your letter and attachments carefully. These documents explain the next steps available and provide information on how the case will be resolved.... The IRS used Forms 1094/5-C filed and the income tax returns of your full-time employees to identify if they were allowed a premium tax credit. If changes to that information were submitted in response to a Letter 226-J, the IRS considered that information and, if needed, updated the proposed ESRP."
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[Advert.]
Employee Health, Benefits, & Well-Being Congress | July 30-31
Who is moving the needle on employee health care? This event convenes HR, benefits, and wellness executives, TPAs, Brokers, Payers, and Providers to learn and discuss strategies to enhance employee health and improve outcomes while reducing costs. |
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[Guidance Overview]
Affordability Threshold Set to Jump Significantly in 2019 "In order to avoid a potential |
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DOL Annual Report to Congress on Self-Insured Group Health Plans (PDF) 17 pages; March 2018. "Along with this Report, the Department is submitting two detailed appendices ... [1] Appendix A, Group Health Plans Report: Abstract of 2015 Form 5500 Annual Reports Reflecting Statistical Year Filings, provides detailed statistics describing group health plans that file a Form 5500. [2] Appendix B, Self-Insured Health Benefit Plans 2018: Based on Filings through Statistical Year 2015, presents a study that explores statistical issues associated with Form 5500 health plan data and analyzes available data on the financial status of employers that sponsor group
health plans filing the Form 5500. Approximately 54,500 health plans filed a Form 5500 for 2015, an increase of nearly 6 percent from the health plans that filed a Form 5500 for 2014.... Self-insured plans that filed a Form 5500 covered approximately 34 million participants in 2015 and held assets totaling about $84 billion."
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Pros and Cons of High Cost Sharing for Employer Health Plans "Employers pay roughly 56 percent of an individual's total medical costs.... Overall, employer subsidies increased by 3.5 percent from 2017 to 2018 while employee contributions grew by 5.4 percent from 2017 to 2018.... Seventy-nine percent of participants said they are anticipating higher costs within the next two years -- more than 80 percent said they feel that they are getting less value for the dollar as costs increase."
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DOL Health Plan Audits: Checklist of Commonly Requested Documents (PDF) "This checklist includes documents that are commonly requested by the DOL during an audit of an employer's health plan. In addition to maintaining these documents in an easily accessible location, employers should keep records showing that participant notices and other required disclosures are provided in a timely fashion."
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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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Failure to Renew FMLA Request Leads to Dismissal of Claims "[The court] found that the plaintiff's performance had been declining before her discharge and that the plaintiff had not renewed her intermittent FMLA leave request after 12 months expired, even after the school district warned her that her leave was ending." [Feistl v. Luzerne Intermediate Unit, No. 14-0491 (M.D. Pa. April 6, 2018)]
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Anthem to Acquire Aspire, Joins Plans Purchasing Providers "Anthem Inc. announced plans ... to acquire Aspire Health, a non-hospice advanced care provider ... Aspire currently contracts its services to 20 health plans in 25 states, relying on what it describes as 'predictive clinical and claims-based patient algorithms' to assist patients with serious illnesses. The move is Anthem's entry into an industry trend of health insurers acquiring service providers[.]"
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New Guideline Would Dramatically Increase Number of Americans with Hypertension "The number of US adults who have high blood pressure could grow by as much as 31 million -- and the number of adults who will be recommended for antihypertensive treatment could increase by 11 million -- if full implementation of the American Heart Association's 2017 hypertension guideline is reached."
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Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2018 to 2028 "This report describes the basis for CBO's baseline projections of the federal costs for those subsidies under current law for the 2018-2028 period. Those projections of costs are built upon estimates of the number of people with health insurance of various kinds. During the coming year, CBO and JCT will use the projections presented here as the benchmark for assessing proposed legislation's effects on the subsidies."
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Outdated Medicare Marketing Strategies Likely to Cost Health Plans Millions "Health plans are likely foregoing millions in potential revenue by halting marketing efforts to potential Medicare enrollees if they don't opt in by their 65th birthday.... 48% of consumers intend to delay Medicare enrollment beyond the age of 65; 70% of those nearing Medicare age have performed at least one health activity online; 53% say they will shop for their Medicare plan online."
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[Opinion]
The Case Against Employer-Sponsored Health Insurance "About half of Americans get their health insurance through their employer. In round numbers, the figure equates to about 163 million people. This group is, on average, healthier than the cohort buying ACA plans. If employer-sponsored health insurance were eliminated, risk in the health insurance market would be spread over a broader group of healthier consumers. As a result, rates should come down significantly."
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Benefits in General |
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Sixth Circuit Highlights Importance of 'Firestone' Language "A reviewing court would still apply the contra proferentum doctrine when determining whether the plan contains Firestone language, but once the court has identified such language, the doctrine ceases to apply. The court would then defer to the plan administrator's interpretation of any other disputed plan provision -- so long as that interpretation is not arbitrary and capricious." [Clemons v. Norton Healthcare Inc. Ret. Plan, Nos. 16-5063 and 16-5124 (6th Cir. May 10, 2018)]
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The Gig Is Up: California Supreme Court Rewrites Rules for Independent Contractors "Dynamex applies for purposes of California wage orders only; it does not mandate changes to employee benefit plans. Employers with a California workforce affected by this decision, however, should consider ... some possible benefit plan implications.... Worker reclassification can affect [retirement] plan eligibility.... Reclassification can affect whether an employer will satisfy [ACA shared responsibility] standards as well as the extent of an ALE's liability for failing to satisfy them."
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Executive Compensation |
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To Require Arbitration or Not to Require Arbitration "One of the most common arguments in favor of arbitration to resolve disputes is that it is less expensive than litigation. Litigation is expensive and time consuming.... Another argument in favor of arbitration is that an employment, severance, or other agreement could require, or the parties could agree, that all aspects of the arbitration proceeding and results are confidential."
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Press Releases |
Connect
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BenefitsLink.com, Inc.
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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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