Health & Welfare Plans Newsletter

September 17, 2018

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Jobs

Pension Plan Administrator
The Kenneth D. Anderson Company, Inc.
in MA

Retirement Account Administrator, Sr.
Alerus Financial
in MI, MN, NH

Pension Analyst
CS&L CPAs
in FL

Compliance Specialist III
ADP
in KY

Distribution and Loan Specialist
Independent Retirement
in OR

Compliance Specialist
LT Trust Company
in CO, Telecommute

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[Guidance Overview]

2019 Premium Tax Credit Quick Reference Chart (PDF)

"[1] Locate line where estimated 2019 household income and household size intersect. [2] First column shows household percentage of Federal Poverty Line -- if between 100% and 400% continue. [3] Second column shows percentage of household income required [to] purchase 2nd lowest cost Silver coverage in Marketplace. [4] 'CSR AV' column shows resulting Actuarial Value after Cost Sharing Reductions applied (otherwise standard 70%). [5] 'Monthly contribution' = contribution percentage x household income divided by 12."
Kaufman & Canoles, P.C.

[Guidance Overview]

ACA Numbers and Limits 2014-19: Reference Guide (PDF)

One-page chart lists various dollar limits for 2014‑2019, including: [1] 4980H Large Employer Shared Responsibility Penalty; [2] 5000A Individual Shared Responsibility Penalty; [3] 36B Marketplace Subsidies/Premium Tax Credits (PTC); [4] Health Insurance Reforms; and [5] Health Savings Accounts.
Kaufman & Canoles, P.C.

[Guidance Overview]

CMS Proposes to Lift Unnecessary Medicare Regulations and Ease Burden on Healthcare Providers

"Today, [CMS] announced a proposed rule to relieve burden on healthcare providers by removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements for healthcare facilities. Collectively, these updates would save healthcare providers an estimated $1.12 billion annually." [Also online: a CMS Fact Sheet outlining the proposed regulations.]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

2019 Health FSA Limit Projection, Final San Francisco HCSO Amounts for 2019

"ABD is projecting that for plan years beginning on or after January 1, 2019, the health FSA salary reduction contribution limit will increase to $2,700 (up from $2,650 currently).... The increase will not be official until the IRS releases its annual inflation-adjusted limits.... The San Francisco Office of Labor Standards Enforcement (OLSE) ... recently released the updated 2019 HCSO required health expenditure rates."
ABD Insurance & Financial Services

More Than Half of Consumers Don't Understand Basic Aspects of the Healthcare System

"52% ... don't understand coverage terms like 'premium,' 'deductible,' and 'copayment.' They also don't understand what it means to be in- or out-of-network or what a prior authorization is.... [T]his group is seven times more likely to contact their insurance company's customer service line one to three times per week, and three times more likely to use it one to three times per month."
FierceHealthcare

Obamacare and Big Employer Premium Rate Hikes Below 5%

"Several new studies are showing employer health premium increases generally below 5% depending on health plan choices while rate increases for individual coverage offered on the ACA's public exchanges will be even less on average. Those with employer-sponsored coverage are just beginning to examine their healthcare coverage options for 2019 during open enrollment that starts now and generally runs through November depending on employer."
Forbes

Leading PBMs Unveil Excluded Drugs

"Effective Jan. 1, CVS Health Corp. will introduce 23 new exclusions of brand medications from its 2019 Standard Control Formulary and UnitedHealth Group's PBM OptumRx will exclude 36 medications -- 33 brands and three generics -- from its Premium Formulary.... Some specialty drugs are being thrust out of major formularies as an increasingly competitive pharma marketplace begins to offer options, even for some rare diseases."
AISHealth

High Drug Prices and Promising Policy Proposals: What the Evidence Says

"High drug prices have been associated with market trends, patent protections, and lack of competition. While there are solutions that can be instated at the federal level, states are taking it upon themselves to pass certain policies to diminish the burden on consumers. Even with protective measures already in place, prices have been increasing at an exponential rate over the past decade, the main issue being the market."
AcademyHealth

Making Precision Benefit Design Patient-Centered

"Precision benefit design is an extension of the concept of value-based insurance design (VBID), which aims to link patient benefit design and coinsurance to the likely benefit of a treatment net of its cost. Whereas VBID measures the value of a treatment for the average patient, the advent of precision medicine raises the possibility of implementing a VBID-style approach but measuring a treatment's value--and concordant benefit design--based on the specific patient genotype information. While precision benefit design is conceptually appealing, to implement this approach in practice would require overcoming at least 3 key challenges."
Journal of Clinical Pathways

Benefits in General

[Official Guidance]

IRS Extends Upcoming Deadlines, Provides Tax Relief for Victims of Hurricane Florence

"Hurricane Florence victims in parts of North Carolina and elsewhere have until Jan. 31, 2019, to file certain individual and business tax returns and make certain tax payments ... The IRS is offering this relief to any area designated by [FEMA], as qualifying for individual assistance. Currently, this only includes parts of North Carolina, but taxpayers in localities added later to the disaster area, including those in other states, will automatically receive the same filing and payment relief."
Internal Revenue Service [IRS]

Editor's Pick Upcoming Key Compliance Deadlines and Reminders for Fourth Quarter 2018

"For many plan sponsors, particularly those with calendar year plans, the final months of the calendar year bring frenetic activity as the sponsors finalize next year's benefits offerings and prepare for open enrollment."
Lockton

Selected Discussions
on the BenefitsLink Message Boards

Off-Calendar Year for Dependent Care FSA

If a group offers a DCFSA plan having an off-calendar year (Feb. 1 through Jan. 31), can an employee change payroll contributions so that his entire election amount ($5,000) worth of contributions is reported on his W-2 for the calendar year, and then stop contributions for the last month of the plan year (January)? If allowed, would this impact the new plan year election amount?
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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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