Health & Welfare Plans Newsletter

August 6, 2018

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[Official Guidance]

Text of CMS Insurance Standards Bulletin: Offering Plans Not QHPs Without CSR Loading (PDF)

"To address increases in premiums of qualified health plans (QHPs) on account of the cessation of federal funding for cost-sharing reduction (CSR) payment to issuers, or 'loading,' and its effect on unsubsidized enrollees, [CMS] is encouraging states to allow Exchange issuers to offer individual market plans that do not include this load, and that will only be available outside the Exchange. Thus, CMS encourages the offering of unloaded silver plans outside the Exchange in states where the issuer has placed the load on silver QHPs on the Exchange, and encourages the offering of unloaded plans of all AV levels outside the Exchange in states where the issuer has placed the load on all AV level plans."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Administration Allows for Longer 'Short-Term' Health Insurance Policies, But Coverage Stays the Same

"The Final Rule also requires insurers to display a notice in their insurance coverage contracts alerting consumers that the short-term policies are not intended to comply with the coverage requirements under the ACA. For short-term policies with coverage dates commencing prior to January 1, 2019, the notice also contains a statement informing consumers that short-term policies do not meet the ACA's minimum essential coverage requirements, meaning consumers may be forced to pay tax on any months during 2018 for which they have a short-term plan and no other coverage."
Sheppard Mullin

How Will EDGE Affect Your 2019 ACA Risk Adjustment Transfer?

"This paper and the accompanying interactive exhibits allow the reader to review the coefficients from the 2019 model and compare how the EDGE data incorporated into the 2019 model will affect risk scores (which have a direct impact on an issuer's risk adjustment transfer)."
Milliman

Value Innovations by Employers: Examples Beyond Cost Sharing (PDF)

11 pages. "Employers are seeking new ways to manage rising health care costs and improve employee health. Many feel they have reached the limits they can achieve with existing strategies like high deductible health plans.... While some employers are implementing new approaches themselves, many more are relying on third parties to manage population health and care for people with chronic diseases, develop and implement payment reforms, and identify high-value providers and help patients navigate the system. The employer sector has several advantages for health care transformation, including more regulatory flexibility than public payers, but questions remain as to how this sector will evolve as competition increases."
Robert J. Margolis, MD, Center for Health Policy at Duke University and Robert W. Johnson Foundation

Cost-Saving Strategies: When Employees Fill Prescriptions

"[1] Patients trust pharmacists. Consider an independent, HIPAA-compliant on-site pharmacy.... [2] Copays can be counterproductive. Assess eliminating copays for generic drugs that treat chronic conditions ... [3] Engage separately with high-cost employees. Investigate employing a HIPAA-compliant chronic care management firm[.]"
First Stop Health

[Advert.]

New ERISA Regulations for Disability Claims and Appeals

Sponsored by Lorman and BenefitsLink

August 13 webinar will explain what new practices to follow, how to change past practices to become compliant with the new regulations, and the risks of non-compliance. Discount for BenefitsLink readers.


Editor's Pick The Ineffectiveness of Employer Wellness Programs, and the Importance of Randomized Trials

"Wellness programs sometimes claim to save money by reducing health care spending. The observational analysis supports this belief.... The randomized controlled trial showed that the wellness program had little effect on spending compared with the control group [.]"
The New York Times; subscription may be required

Tax Treatment of Employer-Provided Fringe Benefits for International Assignees

"[IRS Chief Counsel Memorandum 201810007 [addressed] ... [1] Whether the value of tax equalization services is included in employee income; [2] Whether the value of tax preparation services is included in employee income; [3] Whether such taxable benefits are subject to income tax withholding; [4] Whether such taxable benefits are subject to [FICA] tax withholding; [5] How taxable benefits are valued."
Ogletree Deakins

Drafting a Parental Leave Policy? Learn from the Estee Lauder Story or Your Scent May Become an Odor

"Here are a few nuggets you might consider to ensure your parental leave policies are up to snuff: [1] You choose eligibility requirements, not some federal agency.... You are not obligated to provide these benefits on day one of employment.... [2] You can treat women who give birth better than men. Really, you can.... Based on its June 2015 pregnancy discrimination guidance, the EEOC agrees.... [3] Although the EEOC makes clear that you can treat mom better to allow her to recover from childbirth, employers cannot treat the sexes differently when it comes to bonding leave."
FMLA Insights

Editor's Pick Health Savings Accounts (HSAs) (PDF)

16 pages. "This report summarizes the principal rules governing HSAs, covering such matters as eligibility, qualifying health insurance, contributions, withdrawals, and tax advantages. It concludes with a discussion of HSA data limitations and recent research findings on HDHP enrollment and HSA utilization trends." [R45277 July 31, 2018]
Congressional Research Service [CRS]

[Opinion]

Health Savings Accounts: What's the Problem? What's the Solution? Part 1

"None of the current proposals offer changes that would address the real issue: access to HSA-qualifying coverage and HSA savings rates. Simply put, most American workers are missing out on the most valuable benefits tax preference offered in the tax code!"
Plan Sponsor Council of America [PSCA]

Benefits in General

[Official Guidance]

Text of IRS 2018 General Instructions for Certain Information Returns (Forms 1096, 1097, 1098, 1099, 3921, 3922, 5498, and W-2G) (PDF)

29 pages. "What's New: [1] Online fillable forms Copies 1, B, 2, C, and D.... [2] New mailing address for Kansas City, MO.... [3] Backup withholding rate change.... [4] Form 1096.... [5] Form 1099-H.... [6] Reportable policy sales and reportable death benefits."
Internal Revenue Service [IRS]

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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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