Health & Welfare Plans Newsletter

December 3, 2018

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Deconversion Account Manager
Nova 401(k) Associates
in AZ, TX, Telecommute

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Morgan, Lewis & Bockius LLP
in PA

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Steidle Pension Solutions, LLC
in NJ

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[Official Guidance]

Text of CMS Final Regs: Elimination of Internal Agency Process for Implementation of the Federally-facilitated User Fee Adjustment

"[T]his final rule removes the language that refers to an exception under OMB circular A-25R as an aspect of reducing a participating issuer's [Federally-facilitated Exchange (FFE)] user fee obligation. This rule does not affect the ability of an issuer to obtain an applicable reduction in FFE user fee obligations, amend the calculation of the FFE user fee credit provided to a participating issuer, change the application of the monthly user fee adjustment, or alter any of the other standards that participating issuers must meet to qualify for the user fee adjustment."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Advert.]

Final Day to Register at Early Bird Rate! Join us next month.

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Attend to learn more about best practices in apprenticeship programs! This conference will help you manage your program as you explore key topics like recruitment and retention, fiduciary responsibility, addressing mental health and AI. Register now.


[Guidance Overview]

IRS Announces Filing Extension for Furnishing 2018 Forms 1095-B and 1095-C Along with Continued Good Faith Transition Relief

"[R]eporting entities will not be subject to reporting penalties for incorrect or incomplete information if they can show that they have made good faith efforts to comply with the 2018 Form 1094 and 1095 information-reporting requirements. This relief applies to missing and incorrect taxpayer identification numbers and dates of birth, and other required return information. However, no relief is provided where there has not been a good faith effort to comply with the reporting requirements or where there has been a failure to file an information return or furnish a statement by the applicable due date."
Jackson Lewis P.C.

[Guidance Overview]

IRS Requests Comments on Application of Employer Shared Responsibility and Nondiscrimination Requirements to Individual Coverage HRAs

"The [IRS] recently released proposed regulations regarding the ability to integrate health reimbursement arrangements and other account-based group health plans (HRAs) with individual health insurance coverage. IRS Notice 2018‑88 sets forth anticipated guidance and requests comments on the application of the employer shared responsibility requirements in Internal Revenue Code Section 4980H and the nondiscrimination requirements of Code Section 105(h) to such HRAs. The Notice states that it cannot be relied upon by taxpayers with regard to Code Sections 4980H or 105(h), but gives an indication as to the IRS guidance that can be expected on these topics."
Winston & Strawn LLP

[Guidance Overview]

Overview of CMS' 1332 Waiver Concepts

"[T]he four concepts now clearly demonstrate that CMS is serious about giving states large amounts of flexibility in offering health insurance. And with that increased flexibility comes the rolling back of essentially all of the ACA requirements surrounding coverage and consumer protections. This can create the opportunity for more consumer options at a cheaper cost, but in turn it also allows actual coverage of services and consumer protections to decrease or vanish."
Mintz

[Guidance Overview]

Annual Tradition Continues: 2018 Employee Statement Deadline Extended along with Good Faith Effort Standard

"[T]he permissive extension discussed in the instructions to the Form 1095-C no longer applies to the individual statement deadline. Therefore, the March 4, 2019 deadline for furnishing the Form 1095-C statements is now a hard deadline. The Notice states the Service will not even respond to employers requesting an extension beyond the March 4, 2019 deadline."
Accord

Georgia Chamber's SMART Health Plan Provides a New Option for Small Employers

"[The Georgia Chamber of Commerce] SMART Health Plan is available to eligible small employers with between 2 and 50 total employees effective 1/1/2019. The SMART Health plan will be available to small businesses domiciled in Georgia that are members in good standing with the Georgia Chamber or a local participating Chamber[.]"
Cobb Business Journal

Economic Analysis of 'Medicare for All'

"As of 2017, the U.S. was spending about $3.24 trillion on personal health care -- about 17 percent of total U.S. GDP. Meanwhile, 9 percent of U.S. residents have no insurance and 26 percent are underinsured -- they are unable to access needed care because of prohibitively high costs. Other high-income countries spend an average of about 40 percent less per person and produce better health outcomes. Medicare for All could reduce total health care spending in the U.S. by nearly 10 percent, to $2.93 trillion, while creating stable access to good care for all U.S. residents."
Political Economy Research Institute, University of Massachusetts Amherst [PERI]

Don't Walk Back on Your HSA Strategy

"[One recent study] showed that 65% of participants use [HSA] funds on immediate expenses, resulting in 45% of accounts with balances less than $5,000.... [Another study] showed that diabetics who were involuntarily switched from a traditional to a high deductible plan, were more likely to delay necessary care. So if HSAs are a good idea, how do we make this a better experience without patients avoiding necessary care?"
Frenkel Benefits

Texas Court of Appeals Rules Austin's Paid Sick Leave Ordinance Unconstitutional

"The court observed that ... [the] result of the ordinance is that an employer must pay its employees who use sick leave for hours they did not work, such that employees who take sick leave are paid the same for fewer hours worked than employees who do not take paid sick leave.... Because the ordinance required the payment of 'wages' in violation of the TMWA, the court found that the ordinance violated the Texas Constitution's prohibition of city ordinances containing any provision inconsistent with the laws enacted by the legislature." [Texas Ass'n of Business, et al. v. City of Austin, No. 3-18-00445-CV (Tex. 3d App. Nov. 16, 2018)]
Ogletree Deakins

Seventh Circuit: Medical Provider Entitled to Third Party Fee Schedules

"[T]he court reasoned that requiring Dr. Griffin to name a specific plan provision entitling her to higher reimbursement, was not necessary, since she clearly alleged she was not paid the usual, reasonable and customary amounts, consistent with section 1109 of the plan.... [The court further stated:] 'An assignee designated to receive benefits is considered a beneficiary and can sue for unpaid benefits under section 1132(a)(1)(B) ... It follows that Dr. Griffin also must be a beneficiary able to sue when she is denied requested information.' " [Griffin v. TEAMCARE,No. 182374 (7th Cir. Nov. 26, 2018)]
AVYM Healthcare Revenue Consultants

Voluntary Benefits: From 'Nice-To-Have' to 'Must-Have'

"[S]ome younger workers want help with student loans just as much or more than they want a match on a 401(k).... By offering identity theft protection services as a voluntary benefit, you provide [employees] the means to safeguard their finances and digital presence.... Offering progressive benefits like pet insurance can communicate to your employees that you respect their personal lives ... Over a third of employees surveyed ... expressed that [gym or fitness center memberships are] on their voluntary benefits wish list."
bswift

[Opinion]

Trump Administration's New ACA Waiver Guidelines

"The administration is clearly signaling with these additions that even if states redistribute the strength and affordability of the coverage so that some of the most vulnerable people are disadvantaged, they would entertain the waivers that cover the same number of people."
Henry J. Kaiser Family Foundation

Benefits in General

[Official Guidance]

Text of AICPA Statement on Auditing Standards: Forming an Opinion and Reporting on Financial Statements of Employee Benefit Plans Subject to ERISA (PDF)

Final Balloted Draft; 104 pages. "This Statement on Auditing Standards (SAS) addresses the auditor's responsibility to form an opinion and report on the audit of financial statements of employee benefit plans (EBPs) subject to [ERISA], hereinafter referred to as ERISA plans. It also addresses the form and content of the auditor's report issued as a result of an audit of ERISA plan financial statements.... When issued as final, this SAS is effective for audits of ERISA plan financial statements for periods ending on or after December 15, 2020. Early adoption is not permitted."
American Institute of Certified Public Accountants [AICPA]

Fifth Circuit Opinion Clarifies Legal Claims Distinction Under ERISA

"[T]he Fifth Circuit reiterated the standing rule that a claim for relief cannot be brought under the Equitable Relief Provision when an adequate remedy is afforded under Section 502(a)(1)(B) of ERISA (the 'Plan Terms and Benefits Provision').... The Fifth Circuit confirmed that ... problems with administrative claims procedures under ERISA, such as those alleged [here], are redressable under the Plan Terms and Benefits Provision and not the Equitable Relief Provision." [Manuel v. Turner Industries Group, LLC, No. 17-30835 (5th Cir. Oct. 1, 2018)
Haynes and Boone, LLP

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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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