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Health & Welfare Plans Newsletter November 14, 2018 |
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Jobs
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Webcasts, Conferences Benefits and Breakfast: Post-Acquisition Integration of Benefit Plans
Benefits and Breakfast: Post-Acquisition Integration of Benefit Plans
Contracts 101: Creating Simple, Compliant Service Provider Agreements
Health Savings Account Basics
Tips to Maximize your Health Savings
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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Associate Director of Pension Benefits|
[Guidance Overview]
"[T]he most significant conditions that an employer must satisfy in order to maintain one of these HRAs integrated with individual health coverage [ICHRA] ... [1] An employee cannot be eligible for both a group health plan and an [ICHRA].... [2] The employer must offer the [ICHRA] on the same terms for all employees in a specific class.... [3] The employer must verify that employees actually incurred expenses for individual health coverage before reimbursing such expenses.... [4] The employer must distribute a specific notice to employees eligible for the [ICHRA] ... 90 days before the beginning of each plan year."
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[Guidance Overview]
Is Your Company Eligible for a Credit for Wages Paid under FMLA? "The Tax Cuts and Jobs Act enacted late last year created an employer credit for paid leave provided under [FMLA]. The credit is equal to 12.5% of wages paid to a qualifying employee during any period in which he or she is on leave under FMLA, provided the employee's pay during this period is 50% of the wages normally paid to him or her."
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ACA Penalty Notices Are in the Mail "Officially known as Letter 226-J, the notices inform employers of a preliminary employer mandate penalty calculation under Section 4980H. In late 2017, the IRS began mailing notices for 2015 -- with a reported 30,000 applicable large employers receiving Letter 226-J. Now the IRS has progressed to issuing Letter 226-J for 2016. The move to issuing 2016 penalty notices is significant because the pool of employers that may be subject to employer mandate penalties is much wider."
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Branded Prescription Drug Prices Continue to Rise "Prescription drug spending among branded specialty and patent-protected drugs continues to outpace generic drugs at $79.5 billion ... Branded prescription drugs comprise only 17 percent of total prescriptions filled but account for 79 percent of overall drug spending at $79.5 billion.... While generic drug spending has declined 3 percent since 2016, it hasn't kept pace with the rapid rise in specialty branded drugs."
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Prescription Drug Importation: New Federal Initiatives and the Case for State Action "While the administration recently floated the idea of Medicare using international reference pricing for drug purchasing, ... the FDA is proposing drug importation to stimulate price competition among biologics and certain small molecule generics. This is a significant development that could change decades-old federal policy, and it is predictably generating industry pushback."
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In the Absence of Drug Rebates, New Alternatives Are Likely to Emerge "Rebate alternative #1: Point-of-sale (POS) rebates ... generated when the consumer fills a prescription. A portion of the negotiated rebate between the manufacturer and the PBM/health plan is used to offset the consumer's out-of-pocket expense at the pharmacy.... Rebate alternative #2: Negotiated discount price ... [P]harmacies would likely continue to acquire products from wholesalers and distributors using today's list price. PBMs and plan sponsors would then pay the pharmacies based on the negotiated discount price, which would be less than their acquisition cost."
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Realizing the Promise of Telemedicine for Employers "The high availability and low utilization of telemedicine by employees, as compared to its potential, means both employers and employees are spending far more on healthcare for non-emergency, primary care treatment and receiving that care less conveniently at a physical location.... With a minimum of 200 million visits annually capable of being diverted to telemedicine, and with First Stop Health's average savings of $216 per visit, telemedicine can deliver ever-increasing value to employers and the healthcare system as a whole."
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What Fees Reveal About Your HSA Provider "Friction is caused by the degree of difficulty to access HSA investments, which could be in terms of excess fees, non-integrated trading platforms, unnecessary forms, or other red tape. The easier it is for your employees to invest their HSA is an indication of a provider's understanding of and alignment with your employee's long-term HSA investment success."
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Ten Essential Contract Provisions for Service Provider Agreements "Common service provider agreements include those with: an insurance company; TPA; claims & billing administrator; COBRA partner; stop loss carrier; financial institutions; and vendors who provide software services that handle Protected Health Information 'PHI'.... Whether your existing agreements are up for negotiation or you're on the threshold of signing a new one, ... consider including these provisions in your agreements."
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The New California Regulatory Scheme for Pharmacy Benefit Managers "PBMs will have to register with the California Department of Managed Health Care (DMHC) and provide new disclosures to the purchasers of their services. The bill will also establish a new pilot project and task force run by the DMHC to analyze how PBMs are affecting the pharmaceutical market."
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Some Are Skeptical of North Carolina's Reference-Pricing Move "North Carolina is shifting its health plan for state employees and teachers to a reference-pricing model that ties payments for health care services to Medicare rates. The new rates for various categories of services will average out to 177% of Medicare's fees, down from a current average of 213%[.]"
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ERIC Remains Confident in Lawsuit Against City of Seattle "Seattle hotels with at least 100 rooms must offer the affected employees (even if they have other coverage) coverage in an employer-sponsored group health plan with benefits that are the equivalent of gold-level medical policy on the Washington State insurance exchange at a cost of no more than five percent of their monthly gross taxable earnings or else provide additional compensation based, in part, on the cost of such coverage. ERIC's lawsuit seeks to halt enforcement of Part 3 of the Initiative because it requires, uniquely for Seattle, a specified level of health plan benefits and precludes uniform plan administration governed by federal law."
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"Finding the right recognition vendor, solving the pay gap, working with compensation committees, and finding the right performance management are all challenging puzzles but solving them will reap great rewards for the company."
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Benefits in General |
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[Official Guidance]
Agencies Release Advance Copies of Form 5500 Annual Return/Report for 2018 "[EBSA, IRS and PBGC have] released advance informational copies of the 2018 Form 5500 Annual Return/Report and related instructions. The 'Changes to Note' section of the 2018 instructions highlights important modifications to the Form 5500 and Form 5500-SF, and their schedules and instructions.... The advance copies of the 2018 Form 5500 are for informational purposes only and cannot be used to file a 2018 Form 5500 Annual Return/Report." Schedule A --
Insurance Information Form 5500-SF Annual Return/Report of Small Employee Benefit Plan, and Instructions. Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] |
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[Official Guidance]
Text of IRS Disaster Relief Notice CA-2018-13, for Victims of November 8 Wildfires in California "Victims of Wildfires that took place beginning on Nov. 8, 2018 in California may qualify for tax relief ... Individuals who reside or have a business in Butte, Los Angeles and Ventura counties may qualify ... [C]ertain deadlines falling on or after Nov. 8, 2018 and before April 30, 2019, are granted additional time to file through April 30, 2019."
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"As the end of the year approaches, employers should be aware of important year-end deadlines and considerations related to their retirement, health and welfare plans. [The authors] have compiled a list of these deadlines and provide guidance on how to comply with recent changes."
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Press Releases |
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Walmart Honored by National Alliance of Healthcare Purchaser Coalitions for Efforts to Improve Healthcare Delivery System
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Fidelity Introduces Industry-First Global Retirement Savings Guidelines
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Most Popular Items in the Previous Issue |
Connect
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BenefitsLink.com, Inc.
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Lois Baker, J.D., President
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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