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Health & Welfare Plans Newsletter November 21, 2018 |
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ESOP Administrator|
Guiding Your TPA to Do the Right Thing for Your Employees "[1] Have a health plan advisory board that includes employees.... [2] Make sure the TPA is instructed to treat employees fairly.... [3] Avoid endorsing a TPA mindset of, 'The more money my TPA saves for the employer, the better the employer will like my TPA.' ... [4] Create a policy for pre-authorization.... [5] Remember, the TPA works for you."
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Engaging Employees in Health Benefit Design Increases Satisfaction With Coverage Options "[E]mployees were more willing to have less robust coverage in areas like dental, vision, and diagnostic benefits so that the group could have access to more comprehensive mental health and maternity services."
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"The FAQs do not specifically establish a penalty for failing to meet the annual November 30 deadline. There is also a possibility that a court could determine that [ERISA] preempts the HIRD requirement, meaning that employers would no longer be required to file the form if the requirement were challenged in court."
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ACA Litigation Round-Up: Texas, Maryland, Short-Term Plans, and Contraceptive Coverage Mandate "This post discusses the latest developments in litigation over the individual mandate in Texas and Maryland, as well as separate litigation over recent federal regulations that expanded access to short-term plans and allowed for broadened religious and moral exemptions to the contraceptive mandate."
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Deposit Interest Rates in Health Savings Accounts "Recent averages suggest providers may not be feeling much pressure to raise HSA deposit rates, with the largest providers feeling even less pressure as they focus on creating account value through other means."
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Genomic Medicine and Employers: Separating the Hope from the Hype (PDF) 13 pages. "Employers usually provide benefits coverage for standard forms of genetic testing -- screening for Down syndrome in high-risk mothers, for example -- but in general, benefits consultants don't recommend coverage of consumer genetic tests.... Employers should ask how testing will be integrated with health-care delivery and make sure doctors ordering the tests do not have financial relationships with genetic testing vendors."
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The Market Disruptor of Health Plans "Managing supply chains to control cost is critical to the overall health of a business. That principle applies in the context of healthcare costs, too. Implement an effective, long-term healthcare cost solution and the CFO can then refocus on the rest of the business. Fully-insured plans offer a CFO few, if any, meaningful cost control options."
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ACA: Limits, Fees and Penalties Through 2019 "The [ACA] contains a number of limits and penalties that apply to employers.... Employers use one of the three allowable safe harbor compensation methods to determine affordability ... Penalties for failure to comply with the Employer Shared Responsibility provision.... Flexible Spending Accounts ... Health Savings Account (HSA) ... Transportation Fringe Benefits ... Patient-Centered Outcomes Research (PCORI)".
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"To gain control over the ever-increasing cost of employee health insurance, more and more employers are discontinuing their fully insured coverage and switching to self-funded models. Basically, this is an unbundled approach that separately hires all of the required functions -- medical provider networks, carrier or third-party administrator (TPA), pharmacy benefit manager (PBM), stop-loss insurer, and consultants -- subject to competitive bidding. Significant cost reductions in the neighborhood of 5% to 10% are typical."
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Potential Cure Coming for Local Paid Sick Leave in Texas "[T]he Third District noted that because the Austin PSL Ordinance increases the pay of employees using paid sick leave, it establishes a TMWA-defined wage. As such, the Third District held the TMWA preempts the Austin PSL Ordinance as a matter of law, thereby making it unconstitutional.... [O]utside the judicial arena, Texas State Legislators have developed a potential paid sick leave cure of their own."
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[Opinion]
"While the credit is only available for 2018 and 2019 under current law, we believe it is possible Congress may extend the credit in future years. Accordingly, we think it is valuable for the IRS and Treasury to issue proposed regulations that are consistent with Congress' intent to encourage adoption of paid family and medical leave programs."
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Benefits in General |
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[Official Guidance]
"The Department recognizes that these wildfires may impede efforts by plan fiduciaries, employers, labor organizations, service providers, and participants and beneficiaries to comply with [ERISA] over the next few months.... [Guidance now being issued addresses this topics:] [1] Verification procedures for plan loans and distributions ... [2] Participant contributions and loan repayment ... [3] Blackout notices ... [4] ERISA claims compliance guidance ... [5] Filing relief."
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Selected Discussions |
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Protected Health Information Included in Bills to Participants Is emailing a bill for COBRA, FSA and HRA with the names of the participants in violation of the rules against disclosure of Protected Health Information? Do we need to send the bills in a secure mode of communication?
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Press Releases |
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Federal Court Orders Cleveland Business Owner to Pay Restitution, Serve 24 Months in Prison for Fraud and Theft of Employee Benefit Plan
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Most Popular Items in the Previous Issue |
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Text of EBSA FAQs for Participants and Beneficiaries Following the 2018 California Wildfires (PDF)
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Connect
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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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