Health & Welfare Plans Newsletter

January 16, 2019

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[Guidance Overview]

IRS Releases Guidance on Nonprofit Transportation Benefits and Parking Tax

"This new tax applies to amounts a tax-exempt organization paid or incurred for [qualified transportation fringes (QTFs)] after December 31, 2017.... What if my organization has less than $1,000 in UBTI and expenses for QTFs? ... We pay a third party for employee parking. How do we determine our parking UBTI? ... We own or lease a parking facility. How do we determine our parking UBTI? ... What does the IRS consider to be a 'reasonable method'? ... How can we reduce the burden of this tax? ... This tax is already in effect. What if we haven't been making estimated tax payments?"
Gray Plant Mooty

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Starting an Onsite Clinic Program: Questions to Consider

"Is now the right time? ... What is my workplace trying to improve? ... How do I choose the right vendor? ... How do I know my vendor will deliver?"
Healthstat

HHS Secretary Raises Possibility of Allowing Drug Importation to Help Rein in Drug Prices

"[HHS] Secretary Alex Azar ... expressed support for the safe importation of drugs from other countries as a means to spur competition in the prescription drug market and prevent manufacturers from imposing price hikes -- a significant turning point in the administration's approach to drug costs ... Unlike other proposals to reduce drug costs, such as Medicare negotiation or allowing the government to manufacture drugs, importation has bipartisan support."
Morning Consult

It's Not FMLA Unless I Say So!

"[An employee] cannot decline to use FMLA (even if the leave qualifies for FMLA) and then try to hide behind FMLA protections after the fact.... Because the FMLA does not require that an employee expressly ask for 'FMLA leave' to fall under its protections, ... the employer should inquire of the employee if it is necessary to determine whether FMLA is being sought by the employee and obtain the necessary details of the leave to be taken."
Liebert Cassidy Whitmore

Editor's Pick Bringing 'Transparent Thinking' to PBM Management (PDF)

50 presentation slides. Topics: [1] What is a PBM? [2] Who are the parties to a PBM contract? [3] Why do PBMs have so much power? [4] How do PBMs make money? [5] Contract terms -- the need for solid terms in a contract. [6] A push for transparency. [7] Policy news. [8] A real life example: PBGH's Waste-free formulary study.
Trucker Huss

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Two District Courts Block Trump Administration's Final ACA Contraceptives Rules

"Although the two district court injunctions put a hold on the Trump Administration's final regulations for the time being, they will not be the final word on the exemptions. Both orders have already been appealed -- to the Ninth and Third Circuits, respectively -- so entities that were planning to take advantage of the expanded exemptions must wait and see how the litigation plays out in the courts."
Thomson Reuters Practical Law

Drug-Pricing Transparency, Vertical PBM Deals Are Top of Mind for Employers in 2019

"As they look to win over employer clients this year, PBMs should be prepared to face stiff competition and embrace emerging trends such as value-based formularies and rebate-free models ... Companies are also considering how the vertical integration in the PBM space is 'reshaping the landscape' ... [M]any of the same themes that employers are focused on will apply, including greater transparency around drug pricing and rebates, and even rebate-free models[.]"
AISHealth

Federal Appeals Court Sides with Out-Of-Network Doctors Against UnitedHealth

"[This] decision ... should act as a wake-up call to all self-insured health plans for potential rewards in the trillions of dollars in plan assets recovery for all self-insured ERISA plans nationwide, from cross plan overpayment recoupments and offsets done by all plan TPAs.... The appeals court [stated]: 'To adopt United's argument that the plan language granting it broad authority to administer the plan is sufficient to authorize cross-plan offsetting would be akin to adopting a rule that anything not forbidden by the plan is permissible.' " [Peterson v. UnitedHealthcare, No. 17-1744 (8th Cir. Jan. 15, 2019)]
AVYM Healthcare Revenue Consultants

Benefits in General

[Official Guidance]

Text of DOL Annual Adjustments to Civil Penalties for 2019 (PDF)

"This final rule sets forth the Department's 2019 annual adjustments for inflation to its civil monetary penalties, effective [on the date published in the Federal Register]." Penalties under various ERISA provisions begin on page 31; FMLA penalties are on page 34. This pre-publication version is being made available by DOL. It will be published in the Federal Register when normal government operations resume.
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Press Releases

Welcome to Our New Partner Jason S. Luter
Drinker Biddle & Reath LLP

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2019 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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