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Health & Welfare Plans Newsletter November 9, 2018 |
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Jobs
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Webcasts, Conferences Annual Holiday Social
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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Pension Administrator|
[Official Guidance]
18 pages, Rev. Nov. 2018. "If you do not use the official IRS form to furnish statements to recipients, you must furnish an acceptable substitute statement. Information presented in substitute statements should be in a point size large enough to be easily read by recipients. To be acceptable, your substitute form(s) and recipient statement(s) must comply with the rules in this publication. Generally, information returns may be furnished electronically with the consent of the recipient."
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[Advert.]
Nondiscrimination Testing for Health Plans: Code Section 105(h) and Post-ACA Design Alternatives
Dec. 5 webinar. Understand rules and develop cost effective strategies to meet the compliance obligation, avoid lawsuits, and develop health benefit offerings that are both facially and operationally nondiscriminatory. BenefitsLink discount. |
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[Official Guidance]
Text of CMS Final Administrative Order: Basic Health Program 20 pages. "This notice serves to announce that a Final Administrative Order related to the Basic Health Program (BHP) was issued to the States of New York and Minnesota on August 24, 2018.... The modification involves the application of a Premium Adjustment Factor (PAF) that considers the premium increases in other states that became effective after [CMS] ... discontinued payments to issuers for cost-sharing reductions (CSRs) provided to enrollees in qualified health plans (QHPs) offered on health insurance Exchanges.... [CMS is] publishing the Final Administrative Order as an addendum to this Notice."
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[Guidance Overview]
Proposed Rule Would Require Separate Transaction for Abortion Coverage in Exchanges "The proposed rule is largely technical in nature and focuses primarily on exchange and subsidy eligibility. However, ... the rule would require insurers to send -- and consumers to pay -- two entirely separate bills for the amount of the premium attributable to certain abortion services and the amount of the premium for all other services. The rule could result in significant burdens on insurers and consumers as well as consumer confusion."
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Legal Considerations for Employers in Value-Based Contracting "[1] Data privacy issues ... [2] State insurance and licensing laws ... [3] [ERISA] fiduciary considerations ... [4] Coordination with existing plan design ... [5] Design incentives and employee communication strategy."
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Employers Stepping Up, Not Stepping Away from, CDHPs "Instead of pulling back on CDHPs that may have been rushed to market, employers are more likely retrenching, moving to improve the tools the consumers need to use to work CDHPs properly, not abandoning the model. Today, new technologies and 'point solution' vendors are filling the market with approaches to optimizing the employee experience and employees' comfort level with even high-deductible plans."
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[Advert.]
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Big Change Ahead for Medicare -- and Employers Will Feel It, Too "The Trump Administration is considering a proposal that is a major shake-up in the way Medicare reimburses for infused drugs paid under Medicare Part B, which ... could have a major ripple effect on employer plans.... In the Medicare program today, ... [p]hysicians are reimbursed the cost of the drug plus an add-on fee--typically 6% of the drug's cost.... Simply stated, if physicians and/or pharma companies make less money off these products they will look to replace that revenue. And that will very likely result in massive cost shifting to the private sector."
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HRS Proposal Raises Questions Regarding Existing Retiree HRA Arrangements "As part of the proposal, the [DOL] for the first time is 'clarifying' whether an HRA combined with private individual health insurance will be a plan subject to ERISA. It is crucial for employers that only the HRA, and not the individual insurance coverages, be considered part of an ERISA plan.... The DOL leaves unanswered significant questions and issues ... Many employers have already moved, or are seriously considering moving, to HRA-based medical coverage for retirees.... [T]he major retiree health insurance exchange providers typically fail to identify any potential issue relating to the ERISA plan status of the HRA and exchange."
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[Opinion]
Association Health Plans & Private Exchange Mania "The ability to successfully establish and administer an AHP is significantly more difficult than it is assumed to be.... The marketplace is, once again, running faster than underwriting can (or wants to) keep up.... At the end of the day, ... the key difference between AHPs and Private Exchanges is that AHPs actually are a viable product that has and will have an impact on our industry. The challenge is that, much like 2012, market interest is outpacing market abilities."
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Benefits in General |
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[Official Guidance]
Text of Treasury Department Priority Guidance Plan, 2017-2018 (PDF) 28 pages. Starting on page 13 are 23 items relating to Retirement Benefits, followed by 16 items for Executive Compensation, Health Care and Other Benefits, and Employment Taxes.
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Fifth Circuit Opines on Claim for Benefits vs. Claim for Equitable Relief under ERISA "In this wide-ranging opinion, the Fifth Circuit highlighted the importance of identifying the underlying purported injury to understand whether an ERISA Section 502(a)(3) claim (a claim for equitable relief) is duplicative of a claim that could have been brought under ERISA Section 502(a)(1)(B) (a claim to recover benefits or enforce a right under the terms of a plan), in which case it should be dismissed." [Manuel v. Turner Industries Group, LLC, No. 17-30835 (5th Cir. Oct. 1, 2018)]
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Federal Court Argues for Right to Jury to Pursue ERISA Claims "Although Cunningham involved a claim for breach of fiduciary duty in relation to excessive investment fees imposed on participants in retirement plans, rather than a benefit claim, the court's expansive discussion of the right to trial by jury is instructive in relation to all ERISA cases.... The justification generally used to deny jury trials is the assertion that ERISA claims ... are equitable in nature. However, the claims themselves are contractual and the remedy sought is always a legal remedy ... Were it not for ERISA, the identical claims, if brought either in state or federal court, would unquestionably be actions for breach of contract that juries hear and decide every day." [Cunningham v. Cornell Univ., No. 16-6525
(S.D.N.Y. Oct. 11, 2018)]
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Plaintiffs Must Do More Than Claim a Breach of Fiduciary Duty to State an ERISA Claim "[W]ithout deciding whether plaintiffs' allegations regarding the misappropriation of funds constituted a breach of fiduciary duty, the court found that plaintiffs had not alleged sufficient facts to show the involvement of a plan covered by ERISA, which was necessary to make an ERISA claim plausible." [Dixon v. Washington, No. 18-2838 (E.D. Pa. Oct. 17, 2018)]
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Most Popular Items in the Previous Issue |
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DOL Lawsuits Show Increased Enforcement of HIPAA Wellness Rules
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Healthcare After the 2018 Midterm Election: As Control Shifts, Certainty Settles In (PDF)
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David Rhett Baker, J.D., Editor and Publisher
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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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