Health & Welfare Plans Newsletter

December 11, 2018

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OPEB Plans - Claims Cost by Age
January 9, 2019 WEBCAST
Conference of Consulting Actuaries

Essentials for the Benefits Practitioner: Experts' Guide to Employee Benefits Research
January 29, 2019 WEBCAST
American Bar Association Joint Committee on Employee Benefits [JCEB]

Wellness Everything - Health, Wealth, Life and Everything In-Between
February 13, 2019 WEBCAST
Conference of Consulting Actuaries

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[Official Guidance]

Text of 2018 Instructions for IRS Form 8941: Credit for Small Employer Health Insurance Premiums (PDF)

30 pages, Dec. 6, 2018. "Certain small employers whose principal business address is in a county with no qualified health plan through a Small Business Health Plan Options Program (SHOP) Marketplace may be able to claim the credit for small employer health insurance premiums."
Internal Revenue Service [IRS]

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[Official Guidance]

Text of 2018 Instructions for IRS Form 8839: Qualified Adoption Expenses (PDF)

Nov. 26, 2018. "What's New: The maximum credit and the exclusion for employer-provided benefits are both $13,810 per eligible child in 2018. This amount begins to phase out if you have modified adjusted gross income in excess of $207,140 and is completely phased out for modified adjusted gross income of $247,140 or more."
Internal Revenue Service [IRS]

[Guidance Overview]

Departments Propose Expanding Employers' HRA Options

"To facilitate access to individual coverage HRAs, employees and their dependents would have new marketplace special enrollment opportunities ... where an employer begins offering an individual coverage HRA mid-year, as well as where an employee becomes eligible for an individual coverage HRA mid-year. An individual would have 60 days before and after becoming enrolled in an individual coverage HRA or QSEHRA in which to enroll in marketplace coverage."
Buck

Proposed Rules Would Expand Access to HRAs (PDF)

"[T]he plan sponsor could offer a group health plan to one group of participants and an Individual Coverage HRA to other groups.... Individual Coverage HRAs would have to be offered to all participants within a designated class on the same terms. However, the amount a plan sponsor contributes to an Individual Coverage HRA could vary based on age, family size or both."
Segal Consulting

Handling Health Claims: Traditional Carriers vs. TPAs

"[F]or the lion's share of claims, the TPA is still leasing a large carrier network in order to secure the negotiated discounts with doctors and hospitals. But ... there are some services for which the carrier's network rates are egregiously high -- and for those services the TPA will simply apply Medicare reimbursement levels instead.... The projected impact of carving out administration to this more aggressive TPA would purportedly save clients in similar networks 4‑8% on total claims spend."
Frenkel Benefits

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IRS Releases Guidance on Qualified Transportation Benefit Deductions

"[Notice 2018‑99] breaks the treatment of parking expenses into two separate categories: [1] Employer pays a third party for employee parking spots.... [2] Employer owns or leases all or a portion of a parking facility.... The notice then provides for allocating the expenses... The employer reasonably allocates the percentage of the total costs to the reserved employee spaces and this percentage of the total costs is nondeductible. The employer reasonably determines the percentage of the total costs for spaces reserved for non-employees and this percentage of the total costs is deductible."
RSM US

Lessons from Recent FMLA and ADA Decisions, Part 2 (PDF)

"[1] Employers may be able to stop the clock on lengthy leaves of absence.... [2] Tread carefully when asking employees on FMLA leave to do anything that could be construed as work.... [3] Overzealous surveillance can land an employer in the hot seat."
Dechert LLP

Recent Development on Wilderness Therapy Treatment

"The plaintiffs brought a putative class action ... alleging that BCBS improperly denied claims for the costs of treating their children's mental health issues in wilderness therapy programs.... BCBS stressed to the court that the language in the plan specifically excludes coverage for residential or other care that is 'custodial care,' which includes services that are performed in educational, vocational, or recreational settings, and outward bound-type, wilderness, camp, or ranch programs." [Cotten v. Blue Cross & Blue Shield of Mass. HMO Blue, Inc., No. 16-12176 (D. Mass. Dec. 6, 2018)]
Winston & Strawn LLP

Health Insurer, Employer Groups Call on Congress to End Surprise Billing

"The groups -- which include powerful lobbyists like the Blue Cross and Blue Shield Association, America's Health Insurance Plans, the National Business Group on Health, and Consumers Union -- called on Congress to prohibit providers from billing patients for costs not covered by the health plan when the out-of-network visit isn't the patient's fault. But they also said Congress should ensure any policy enacted doesn't increase premiums or discourage providers from joining a health plan's network."
Modern Healthcare Online; free registration required

Benefits in General

Ninth Circuit Recognizes Cat's Paw Liability in ERISA Retaliation Case; Fiduciary Claims Fail

"Applying the but-for cause standard, the Ninth Circuit stated that but for the trustee's orchestrating of a vote to place the director on administrative leave, the board would not have done so. In reaching this conclusion, the court recognized a 'cat's paw' theory of liability for retaliation and noted that at least four circuit courts have concluded that the theory is compatible with but-for causation[.]" [Acosta v. Brain, No. 16-56529 (9th Cir. Dec. 4, 2018)]
Thomson Reuters Practical Law

Tweaked Year-End Tax Relief Package Includes Retirement and Health Care Provisions

"Items in this legislation include ... [1] Provisions from the House-passed Family Savings Act -- including expansion of 529 savings accounts -- as well as the Senate Finance Committee-passed Retirement Enhancement and Savings Act.... [2] Delays the Medical Device Tax for five years, delays the Health Insurance Tax for two years, delays the Cadillac Tax for one year, and permanently repeals the Tanning Tax."
Committee on Ways and Means, U.S. House of Representatives

Ramp Up Employee Engagement in 2019

"With the amount of time and budget employers expend to give the best benefits, it's imperative for HR make benefits as accessible as possible. And as the millennial workforce has shown us, the way to do that is make accessing benefits faster, less complicated and more relevant. The short answer? Utilize technology to streamline benefits."
Hodges-Mace, LLC, via BenefitsPro (free registration required)

Press Releases

Most Popular Items in the Previous Issue

Text of CMS Appendix B: Sample Translated Taglines (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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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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