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Health & Welfare Plans Newsletter December 19, 2018 |
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Jobs
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Webcasts, Conferences Bringing "Transparent Thinking" to PBM Management
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
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Retirement Plan Administrator|
[Official Guidance]
Text of EEOC Final Rule: Removal of Court-Vacated Final ADA Wellness Rule "This final rule removes from the Code of Federal Regulations a section of the final rule published on May 17, 2016, entitled 'Regulations Under the Americans With Disabilities Act.' This action responds to a decision of the U.S. District Court for the District of Columbia that vacated the incentive section of the ADA rule effective January 1, 2019.... The action is effective on January 1, 2019."
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[Advert.]
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![Sponsored by International Foundation of Employee Benefit Plans [IFEBP]](https://benefitslink.com/bnrs/2017/IFEBP_ELearningSale_top.jpg "Sponsored by International Foundation of Employee Benefit Plans [IFEBP]")
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[Official Guidance]
Text of EEOC Final Rule: Removal of Court-Vacated Final GINA Wellness Rule "This final rule removes from the Code of Federal Regulations a section of the final rule published on May 17, 2016, entitled, 'Genetic Information Nondiscrimination Act.' This action responds to a decision of the U.S. District Court for the District of Columbia that vacated the incentive section of the GINA rule effective January 1, 2019.... The action is effective on January 1, 2019."
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[Guidance Overview]
New IRS Guidance Makes Employer-Provided Parking More Costly and Burdensome Than You Might Think "[Employers should] consider eliminating most, if not all, reserved parking, including spots reserved by places of worship for church staff or even spots reserved for employees as a reward on a rotating basis, such as for the 'employee of the month.' Any changes should be made by March 31, 2019 to take advantage of the retroactive effect.... [E]mployers should consider whether adopting an exemption for reserved parking for employees with special parking needs, such as handicapped parking, is a reasonable position under the Notice."
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ACA Preventative Services Updates for 2019 "[R]ecommendations that must be integrated into health plans for the 2019 calendar year: [1] Preeclampsia screening through blood pressure tests; [2] Obesity screenings for children and adolescents 6 years and older; [3] Vision screening in children ages 3 to 5 to detect amblyopia or its risk factors; [4] Influenza vaccine for adolescents; [5] Hepatitis B vaccine for adolescents; [6] Human papillomavirus (HPV) vaccine for adolescents."
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ACA Employer Mandate Enforcement: 2016 Penalty Letters "[The authors] have noticed significant differences between the employer's reported data and the data the IRS includes with the Letter 226J.... Because of these very significant data inaccuracies, you will need your 2016 Form 1094-C and relevant Forms 1095-C on-hand to audit and review the data you filed against the data included in the IRS's 226J Letter."
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[Advert.]
Now is a great time to join Worldwide Employee Benefits Network (WEB)
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Domestic Partner Taxation and Benefits "[P]lans offering domestic partner coverage are encouraged to require completion of a Domestic Partner Affidavit ... [wherein] the employee and domestic partner attest that certain requirements for domestic partnership under the plan, such as cohabitation, are satisfied.... [C]are should be taken to make sure they comply with any applicable state law.... Given the complexity and uncertainty around the taxation of domestic partner coverage, employers should also consult with their tax advisors to determine the best approach for valuing domestic partner coverage."
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Sixth Circuit Holds Employer Has No Duty to Notify of Conversion Options "[T]he court held that the test is not whether the plan provider should know that the former employee might be interested in converting his group life insurance -- because he did not ask the question, the plan provider was not obligated to provide an answer.... [T]he court held that neither ERISA nor its implementing regulations required [the employer] to provide any more information about conversion options than what was found in the summary plan description." [Vest v. Resolute FP US Inc., No. 18-5046 (6th Cir. Oct.10, 2018)]
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The HERO Health and Well-Being Best Practices Scorecard: 2018 Progress Report (PDF) 56 pages. "What will it take to uncover causal relationships that will allow us to confidently show how culture change, leadership influence, programming and other such factors can improve business performance and organizational and individual health and well-being? ... This progress report offers some of the most current and best examples of how a Scorecard, used with excellence in mind, can help inform practice improvements as well as fuel much-needed research."
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Democratic AGs Ready to Appeal Texas Decision: What Comes Next "On December 18, 2018, Judge Reed O'Connor ... asked the plaintiffs and federal government to respond, by December 21, to whether [1] his December 14 decision should be stayed; [2] whether the court should enter partial final judgment based on this decision; and [3] whether the court should certify the decision for immediate appeal to the Fifth Circuit Court of Appeals. All parties, including the intervenor states, must also propose how to treat the remaining four claims still at issue in the lawsuit in light of the states' motion. The intervenor states have until December 26 to file their response." [Texas v. U.S., No. 18-167 (N.D. Tex. Dec. 14, 2018; order to expedite briefing, Dec. 18, 2018)]
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What Does the Recent Texas Court Decision Mean for the US Health Insurance Market and Employers? "This decision, if ultimately upheld through the appeals process, would eliminate not only the Marketplaces, Medicaid expansion, premium subsidies, employer mandate, and other provisions governing individual insurance and employer-sponsored health plans, but also provisions that created the Center for Medicare and Medicaid Innovation, that apply the Mental Health Parity and Addiction Equity Act to individual and small group plans, that close the Medicare Part D donut hole, and that created an approvals process for biosimilar drugs, among numerous other provisions." [Texas v. U.S., No. 18-167 (N.D. Tex. Dec. 14, 2018)]
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Possible Steep Consequences for U.S. Pharmaceutical and Biologics Industries from ACA Decision "[T]he ruling could undo the entire U.S. biosimilars industry, because without the ACA, there is no statutory framework for biosimilar drug approval. Second, Judge O'Connor's opinion could potentially leave millions of patients without prescription drug insurance coverage, hurting both the patients themselves as well as the pharmaceutical industry's bottom line. The good news is that while the ACA has been declared unconstitutional, Judge O'Connor did not issue an injunction, so the act remains in force -- at least for now." [Texas v. U.S., No. 18-167 (N.D. Tex. Dec. 14, 2018)]
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Overview of Nondiscrimination Testing for Educational and Adoption Assistance Programs "This [article] describes the nondiscrimination tests that apply to both educational and adoption assistance programs to help employers understand how each test operates and what data they need to collect to conduct the tests."
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[Opinion]
"This analysis focuses on improving the current system through incremental steps that would maintain the structure of the ACA but increase insurance coverage, enhance affordability, and contain costs."
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Benefits in General |
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[Official Guidance]
Text of EBSA Updated FAQs: EFAST2 Form 5500 Electronic Filing for Small Businesses "Q1: Do I need to buy software to submit my Form 5500 or 5500-SF? ... Q2: If I want to use IFILE, what do I need? ... Q3: What do you mean by EFAST2 credentials and why do I need them? ... Q4: Is it easy to get EFAST2 credentials? ... Q5: If I don't want to get EFAST2 credentials so that I can personally file my plan's Form 5500 or Form 5500-SF, is there any way that I can have a service provider complete and electronically file the Form 5500/5500-SF for me? ... Q6: Once my completed and electronically signed Form 5500 or 5500-SF is transmitted, how do I confirm that it was received by EFAST2? ... Q7: Are there civil penalties for failure to electronically file the plans Form 5500 or Form 5500-SF? ... Q8: Is there a process to appeal civil penalties assessed for failing to e-file?"
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"[T]he Seventh Circuit declared that '[P]laintiffs alleging claims under 29 U.S.C. Section 1132(a)(1)(B) for plan benefits need not necessarily identify the specific language of every plan provision at issue to survive a motion to dismiss under Rule 12(b)(6).' Dr. Griffin did not need to point to a particular plan provision specifying entitlement to 'greater payment,' as such a requirement would 'turn notice pleading on its head[,]' especially when the plan failed to provide Dr. Griffin with 'information necessary to allege with more detail where the plan's calculation of the usual and customary rate went astray.' " [Griffin v. TEAMCARE, No. 18-2374 (7th Cir. Nov. 26, 2018, amended Nov. 30, 2018)]
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Press Releases |
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Plan Sponsor of the Year - Winners for 2018
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NAPA Names Nation's Top DC Advisor Teams
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Most Popular Items in the Previous Issue |
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Statement from the Department of Health and Human Services on Texas v. Azar
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What Just Happened to the ACA and What Happens Now?
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District Court Declares Entire ACA Unconstitutional: What That Could Mean for Employers and Plan Sponsors
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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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