Health & Welfare Plans Newsletter

November 5, 2018

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Senior Pension Administrator - Combo DB/DC Plans
Primark Benefits
Telecommute

Retirement Specialist II
Alerus Financial
in MN, ND

Retirement Plan Services Conversion Coordinator
Dubuque Bank and Trust
in CO, IA, IL, MN, WI

Relationship Manager
HORAN
in OH

Experienced 401(k) Distribution Account Manager
Nova 401(k) Associates
Telecommute

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[Official Guidance]

Text of IRS Notice 2018-85: Insured and Self-Insured Health Plans -- Adjusted Applicable Dollar Amount for PCORTF Fee (PDF)

"The applicable dollar amount that must be used to calculate the [Patient-Centered Outcomes Research Trust Fund (PCORTF)] fee imposed by Sections  4375 and 4376 for policy years and plan years that end on or after October 1, 2018, and before October 1, 2019, is $2.45. The increase from the prior amount is calculated by multiplying the adjusted applicable dollar amount for policy years and plan years ending in the previous Federal fiscal year, $2.39, by the percentage increase of the projected per capita amount of National Health Expenditures published by HHS on February 14, 2018."
Internal Revenue Service [IRS]

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[Guidance Overview]

Key Changes under the Proposed Rule for Health Reimbursement Arrangements

"[1] Remove the current prohibition on integrating an HRA with individual health insurance coverage. [2] Expand the definition of 'limited excepted benefits' to include HRAs that meet certain requirements.... [3] Clarify that integration of an HRA or a QSEHRA with individual health insurance coverage does not cause the individual health insurance coverage to become subject to ... [ERISA] if certain requirements are met. [4] Create a special enrollment period in the individual health insurance market that enables individuals to enroll when they become eligible for HRA or QSEHRA coverage that can be integrated with individual health insurance coverage."
Ogletree Deakins

[Guidance Overview]

Drug Pricing Plan Would Tie Medicare Part B Reimbursement to International Prices

"[The International Pricing Index (IPI) Model] would: [1] Pay a new IPI Model vendor directly for Part B drugs at a benchmarked international price. [2] Pay physicians and hospitals a per-month or per-dispense administration fee, which ... would not be tied in any direct manner to the cost of the drug administered.... [O]ne of the primary effects of the IPI Model would be to remove health systems and hospitals from billing for certain Part B drugs altogether."
K&L Gates

[Guidance Overview]

Amended Rules Issued Under NYC Earned Safe and Sick Time Act

"The amended rules clarify that employers may not rely upon the required Notice of Employee Rights to satisfy its obligation under the law to maintain a written ESSTA policy.... [D]istribution must occur personally to each employee, either in hard copy form or via electronic means, such as email.... The amended rules also expand upon the required elements of a compliant written ESSTA policy."
Proskauer

[Guidance Overview]

It's Back from the Grave: New HIRD Form to Haunt Massachusetts Employers

"[A]ny employer that reported six or more employees (includes all employment categories) in any Massachusetts unemployment wage report during the past 12 months must file the form.... The new HIRD disclosure will help Massachusetts identify persons with access to employer health insurance that may qualify for premium assistance.... MassHealth will pay the subsidy directly to the employee."
Lockton

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Estimating the Potential Health Care Savings of Reference Pricing (PDF)

40 pages. "[O]ur analysis suggests that significant savings through a reference pricing program could be possible. For that potential to be realized, however, higher-priced providers would need to lower their prices; consumers would need to switch to lower-priced providers; price and quality transparency would need to be available; quality providers at or below the reference price would need to be available in sufficient numbers; and legal, regulatory, or contractual barriers to reference price programs would need to be addressed."
American Academy of Actuaries

The Effect of Employer-Provided Telemedicine Benefits on Employee HSA Eligibility

"[1] Clearly communicate to employees enrolled in an HDHP that use of the telemedicine benefit will prohibit contributions to the HSA bank account. [2] Include telemedicine program in any COBRA offer of coverage. [3] If offering benefits through a cafeteria plan, offer telemedicine contributions as pre-tax elections. [4] Prepare and file a Form 5500 for any telemedicine plan with 100 or more participants ... [5] Discontinue the offer of telemedicine services to those enrolling in the HDHP and who have, will have, an HSA bank account, until the time that any new regulatory guidance is rendered."
OneDigital Health and Benefits

Idaho to Move Ahead With State-Based Health Plans Without CMS Waiver

"Idaho insurance officials have decided not to wait for CMS and are letting insurers sell health plans that don't fully comply with the [ACA].... In February, Blue Cross of Idaho unveiled 5 state-based plans it hoped to sell alongside ACA-complaint plans, including those that would subject consumers to medical underwriting. CMS rejected Idaho's approach[.]"
American Journal of Managed Care

District Court: Disability Claim 'Administrative Record' Cannot Include Post-Lawsuit Evidence Obtained by Insurance Company

"Plaintiff moved to strike from the administrative record all documents generated after the date on which she filed suit, while Unum sought partial summary judgment that the documents generated as a result of the post-litigation administrative appeal are part of the administrative record, or in the alternative, summary judgment dismissing the suit for failure to exhaust administrative remedies. The court explained that to determine the proper scope of the administrative record, the court must determine whether Plaintiff exhausted her administrative remedies prior to filing suit." [Wittmann v. Unum Life Ins. Co. of America, No. 17-9501 (E.D. La. Oct. 31, 2018)]
Kantor & Kantor

[Opinion]

To Control Health Care Costs, Employers Should Form Purchasing Alliances

"To achieve the kind of gains in controlling health care costs that employers want, they will ... need to band together in local purchasing alliances, come to agreement on common features of health insurance products, and then, working with local insurers, wrangle price and delivery concessions from local providers."
Harvard Business Review

Benefits in General

Will Your Fiduciary Insurance Cover You When You Need It?

"[1] Get a qualified independent review.... [2] [T]he commitment may become worthless in the event of bankruptcy or other financial distress. [3] Understand the exclusions in your policy and find out whether endorsements are available to eliminate some of them. [4] Consider whether your policy limits should be increased.... [5] Understand and follow the notice requirements in your policies."
Carol Buckmann, via Pension360

Ohio Law Recognizes Safe Harbor in Data Breach Litigation

"On November 1, 2018, the Ohio Data Protection Act establishes a safe harbor from state tort actions in data breach cases for entities that have developed an information security program with 'administrative, technical, and physical safeguards for the protection of personal information and that reasonably conforms to an industry recognized cybersecurity framework.' Without establishing minimum cybersecurity standards, the Ohio law affords defendants an 'affirmative defense' against state tort actions and establishes an important precedent that may serve as a model for other states and the federal government to follow."
Data Matters, by Sidley Austin LLP

Press Releases

Federal Court Orders Defunct Las Vegas Airline to Pay Former Employees $219,716 to Restore Health Plan Losses
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Applications Now Open for Steven H. Sandell Grant Program
Center for Retirement Research at Boston College

Applications Now Being Accepted for Dissertation Fellowship Program
Center for Retirement Research at Boston College

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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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