Health & Welfare Plans Newsletter

November 29, 2018

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Jobs

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

Defined Contribution Analyst
Findley
in KY, OH, TN

Relationship Manager / Consultant
The Retirement Plan Company (TRPC)
in TN, Telecommute

Retirement Account Administrator I
Alerus Financial
in MI, MN, NH

Retirement Account Administrator II
Alerus Financial
in MI, MN, NH

Relationship Manager
Aspire Financial Services LLC
in FL

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[Official Guidance]

Text of CMS FAQs for Enhanced Direct Enrollment (PDF)

"What is enhanced direct enrollment? ... What will happen when enhanced direct enrollment begins? ... How does enhanced direct enrollment change the current direct enrollment process? ... Will the process work the same for consumers with complex situations? ... Why create a new option for consumers? ... How can consumers trust enhanced direct enrollment partners? ... How can consumers know whether the website they are enrolling on is an approved partner?"
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Advert.]

Nondiscrimination Testing for Health Plans: Code Section 105(h) and Post-ACA Design Alternatives

Sponsored by Lorman and BenefitsLink

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.


[Guidance Overview]

Administration Proposes Strategies to Lower Pharmaceutical Prices in Medicare Part D

"As set out in the proposed rule, the plan has three major new provisions: [1] providing Part D plans with more flexibility to manage protected classes, [2] updating existing e-prescribing systems to make patients' costs visible when a prescription is ordered, and [3] requiring pharmacy price concessions for drugs at the point of sale."
Health Affairs

[Guidance Overview]

CMS Issues Proposed Rule on Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses

"Key provisions of the Proposed Rule are ... [1] Providing plan flexibility to manage Part D protected classes ... [2] Prohibition on gag clauses in pharmacy contracts ... [3] E-prescribing and the Part D prescription drug program: updating Part D e-prescribing standards ... [4] Part D explanation of benefits ... [5] Medicare advantage and step therapy for Part B drugs ... [6] Pharmacy price concessions in negotiated price."
Sheppard Mullin

[Guidance Overview]

Massachusetts Employers Must Complete New HIRD Form by November 30

"Unlike the older version of the form, this new HIRD form collects only employer-level information about the company's group health plan and does not require any personal information individual Massachusetts employees.... The Massachusetts Department of Revenue has stated that no new fines or penalties will be imposed based on information reported in the HIRD form."
Winston & Strawn LLP

'Tis the Season: FMLA and Holidays

"When a holiday occurs within a week in which an employee takes a full week of FMLA leave, the entire week is counted as FMLA leave. If, however, an employee is taking FMLA leave in increments less than one week, the holiday is not counted as FMLA leave, unless the employee was scheduled and expected to work on the holiday and used FMLA leave for that day."
Jackson Lewis P.C.

[Advert.]

Now is a great time to join Worldwide Employee Benefits Network (WEB)

Sponsored by WEB - Worldwide Employee Benefits Network

Worldwide Employee Benefits Network provides me a forum for education and information exchange with other Benefits Executives. Join today.


[Opinion]

Follow the Leaders: How to Support Employer Health Care Innovation

16 pages. "[W]hen the total amount employers paid for group health insurance in 2016 ($691.3 billion) is compared to the value of the tax expenditure that same year ($155.3 billion), we can calculate that employees received $4.45 worth of benefits for every dollar of forgone tax revenue -- a more than four-to-one return on investment.... [This article] provides a handful of suggestions about ways to make it easier for employers to continue providing affordable, quality coverage to over half the country and drive innovation that improves the health care system as a whole."
American Benefits Council

[Opinion]

Administration Side-Stepped Rulemaking Processes on ACA's State Innovation Waivers; New Section 1332 Guidance May Be Invalid

"A recent guidance document ... claims to make significant new policy, primarily by loosening the standards for comprehensive, affordable coverage. But importantly, the agencies chose to release it as guidance, rather than as a rule subject to the typical notice and comment rulemaking process. There are serious questions about whether the policy articulated in the guidance is a permissible interpretation of the underlying statute, but, at the very least, it is likely invalid for the agency to attempt to make this policy without a full rulemaking process."
The Brookings Institution

Selected Discussions
on the BenefitsLink Message Boards

Biometrics Wellness Plan Credits: Effect on Screenings in Remote Work Locations

My question is about the alternative wellness credit rule and how that impacts biometric screenings in remote work locations. We would like to use a national Lab to do our Biometric Screenings. Unfortunately, some of our job locations do not have a national retail lab nearby them. The national lab could send electronic interfaces that would allow wellness credits to be provided to employees without using to much of the benefit department staff. Are we required to provide an alternative solution for biometric screenings for remote work sites that would not have a national lab near them or could those employees be excluded, unless they are willing to drive several hours to a lab retail location, to avoid manual payroll credit entries. In other words, possibly avoiding giving credits for each employee doctors lab work with manual upload files for small town remote locations. At some point we would like to maybe do mail order kits, but not right now.
BenefitsLink Message Boards

ACA ESR Penalty Abatement Due to Financial Hardship?

I have a client ALE who has not offered coverage to any of its FTEs or FTE equivalents. Of course they have now received a 226-J letter for 2016 because 8 employees have received a PTC on the Exchange. Their argument is that they could not afford to offer coverage because 2018 is the first year they turned a profit (they took over a company in 2015 and never offered coverage). Has anyone successfully made a hardship argument on behalf of a client that's never offered coverage to their employees? Of course I am requesting W-2s from the client to make sure the IRS did not mistakenly offer the PTC to these employees, but I'm afraid they're going to get hit with penalties for the past 3 years and likely go out of business.
BenefitsLink Message Boards

Press Releases

Riptide Software 401k Plan Certified for Fiduciary Excellence
Centre for Fiduciary Excellence [CEFEX]

Most Popular Items in the Previous Issue

New CMS Online Tool Displays Cost Differences for Certain Surgical Procedures
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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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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