Health & Welfare Plans Newsletter

November 2, 2018

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[Guidance Overview]

New York's Westchester County Enacts Earned Sick Leave Law

"[T]he Law requires that covered employees of an employer with five or more employees earn, at a minimum, up to 40 hours of paid sick time in a year. Employers with fewer than five employees must provide up to 40 hours of unpaid sick leave. The Law becomes effective on April 10, 2019.... The Law does not specify whether the employee threshold is based only on employees working in Westchester County, but the obligation to provide leave is solely for those working within the county."
Epstein Becker Green

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New Jersey Publishes Mandatory Paid Sick Leave Notice in 12 New Languages

"New Jersey's Department of Labor and Workforce Development (NJ DOL) created a webpage concerning the state's paid sick and safe time law, which took effect on October 29, 2018. Available online resources on the page include the mandatory notice in English and 12 other languages: Arabic, Chinese (simplified and traditional), Guajarati, Haitian Creole, Hindi, Italian, Korean, Polish, Portuguese, Spanish and Tagalog."
Littler

Proposed Regs Would Expand the Use of HRAs

"Key features of the proposal include: [1] Allowing HRAs to be used to reimburse the cost of individual market premiums on a tax-preferred basis ... [2] Allowing employers that offer traditional group coverage to provide an HRA of up to $1,800 per year to reimburse certain qualified medical expenses that are 'excepted benefits'; and [3] Allowing employers with HRAs that are integrated with individual health insurance to permit their employees to pay any portion of their individual insurance premiums not covered by the HRA, on a pre-tax basis through the cafeteria plan."
Burnham Benefits

Checklist of Key 2019 Requirements for Health and Welfare Benefit Plan Sponsors (PDF)

"This list focuses on key federal requirements affecting most health and welfare plans and is subject to legislative or regulatory changes. Additional requirements, or exceptions, may apply under state insurance laws which vary from state to state. Administrators should also remember that the [ACA] remains in effect despite certain recent legislative and regulatory changes."
EPIC

'Appointment of Claim Fiduciary' Form Sufficient to Confer Discretionary Authority

"The court distinguished the Amara decision, in which the Supreme Court ruled that a grant of discretion that appears in an SPD but not in the underlying plan is insufficient to warrant deferential review. In this case, the court explained, the SPD did not purport to confer discretion -- it simply communicated to participants the grant of discretion that was properly conferred by the Appointment of Claim Fiduciary Form (ACF)." [Colvill v. Life Ins. Co. of North America, No. 17-1290 (E.D. Wis. Aug. 27, 2018)]
Thomson Reuters / EBIA

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Employers Becoming More Active in Healthcare Claims Management

"When Amazon, JPMorgan and Berkshire Hathaway announced their healthcare partnership, it was a part of a wave of employers taking a more active role in medical cost management.... [L]ast week, Morgan Stanley announced that they have hired a high-level executive responsible for healthcare management and data analytics. And many employers are cutting out insurers completely and contracting directly with providers and/or creating near-site or on-site health clinics for primary care."
Frenkel Benefits

IRS Releases Final 2018 ACA Reporting Forms and Instructions (PDF)

"The IRS recently released final 2018 Forms 1094-C and 1095-C and Instructions for Forms 1094-C and 1095-C. The 2018 forms are substantially similar to the 2017 versions. The Instructions include minor updates. Employers must furnish and file required forms in early 2019."
EPIC

ACA Penalties Are Coming

"Within the last few months, employers have [been] assessed fines by the IRS in Letters 226J for not complying with employer shared responsibility payments (ESRPs) dating back to 2015. Employers have 30 days to challenge or accept an ESRP penalty. While there is nothing they can do to prevent penalties from 2015, employers should make sure to submit all applicable 2018 tax forms in a timely manner to not repeat prior mistakes."
Corporate Compliance Insights

Health Savings Account Balances, Contributions, Distributions, and Other Vital Statistics, 2017

"Enrollment in high-deductible, HSA-eligible health plans was estimated to be between 21.4 and 33.7 million policyholders and their dependents and covered nearly 3 in 10 employees in 2017. The HSA market did not exist until 2004.... 95 percent of HSAs with individual or employer contributions in 2017 ended the year with funds to roll over for future expenses.... One-half of HSA owners contributed to their account in 2017, and 36 percent of HSAs did not receive any contributions (individual or employer) in 2017."
Employee Benefit Research Institute [EBRI]

Some States Hostile, Some Friendly, on New Small Business Health Plans

"States taking a more stringent approach to the new association health plans often apply existing state rules ... to association plans operating in the state. Insurance departments in Vermont and Connecticut, for example, increased their minimum coverage requirements for association health plans, among other additional requirements.... States choosing to welcome the expanded plans either have issued guidance that supports the final rule or approved new association health plans under the new rule. State insurance departments in Louisiana, Illinois, and Michigan, for example, issued supportive bulletins to assist groups with the wanting to establish an association health plan or notify them of the change."
Bloomberg BNA

Centene Expands ACA Exchange Offerings for 2019

"Centene Corp.... will offer [ACA] exchange plans in four new states in 2019, as well as expand existing coverage options to new counties in six of its other markets. Centene is already the exchange market leader, with 1.76 million enrollees nationwide ... The news may be another sign things are turning around for the marketplaces, as individual premium rates have also declined nationwide, and fewer counties have just one participating marketplace insurer compared to 2018."
AISHealth

Selected Discussions
on the BenefitsLink Message Boards

MEWA Exception for Plans with At Least 85% Participants in CBAs -- As of What Date?

Section 3(40)(A) of ERISA provides that "multiple employer welfare arrangement" does not include an employee welfare benefit plan that is established or maintained under or pursuant to one or more agreements that the Secretary of Labor finds to be collective bargaining agreements. One of the requirements (generally speaking) is that at least 85% of the participants in the plan are employed under one or more CBAs. I can't find any guidance as to exactly when during the year this 85% test should be conducted, e.g. first day, last day, etc. Does anyone know?
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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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