Health & Welfare Plans Newsletter

February 22, 2019

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[Guidance Overview]

Deadline Nears for New San Francisco Minimum Healthcare Expenditure Requirements

"Starting in 2018 100% of employer expenditures must be irrevocable to count toward the minimum spending requirement -- that is, they must be payments that the employer has not retained and cannot recover, even if the employee leaves the job.... The annual reporting form ... which must be submitted by April 30 ... is usually available on the HCSO website around April 1. Employers can register with the city to receive an email notification when the form is available."
Buck

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[Guidance Overview]

New Jersey Puts Family First with Paid Family Leave Expansion

"New Jersey Governor Phil Murphy signed an expansive paid family leave bill which provides for increased leave time and pay while on leave beginning in 2020, a broader definition of covered employers and family members, and a right to reinstatement for more employees. The benefits remain employee-funded under the law."
Seyfarth Shaw LLP

[Guidance Overview]

New Jersey Expands Family Leave Laws to Provide Greater Benefits to Employees

"Previously, the law permitted employers to require employees to use up to two weeks of existing PTO, vacation or other employer-paid leave benefits in lieu of [family temporary disability leave]. The amendment now prohibits this action, and allows only the employee to elect whether to use PTO or other similar benefits. Furthermore, under the law, an employee's use of PTO or similar benefits will not reduce the amount of state [family temporary disability leave] benefits available to the employee."
FordHarrison

Massachusetts Announces Contribution Rates Effective July 1 for Paid Family Leave

"Employers with 25 or more employees in Massachusetts may deduct the entire amount of the payroll tax from an employee's wages for family leave and up to 40 percent of the payroll tax for medical leave. The total contribution of .63 percent of payroll is split between the medical leave contribution (.52 percent of payroll) and the family leave contribution (.11 percent of payroll)."
Lockton

Hartford Gets Pro-Insurer Ruling on Late-Filed Benefit Appeals

"New Hampshire's 'notice-prejudice' rule -- which makes it harder for insurers to deny late-filed claims -- doesn't apply to benefit claims under [ERISA], the U.S. Court of Appeals for the First Circuit held Feb. 20. The court followed decisions of the Seventh and Ninth circuits, adding that 'no federal court has applied any state's common law notice-prejudice rule' to a late-filed appeal made to an ERISA plan." [Fortier v. Hartford Life & Accident Ins. Co., No. 18-1752 (1st Cir. Feb. 20, 2019)]
Bloomberg BNA

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CMS Data Match Reporting Suspended

"Although the IRS-SSA-CMS Data Match process has ended, CMS encourages employers to consider entering into an Employer Voluntary Data Sharing Agreement (VDSA) with CMS to exchange GHP and Medicare entitlement data. Some large employers have already entered into VDSAs with CMS to share coverage information."
HUB International

Feds Want Input on Extending Grandfathered Group Plans

"The agencies are particularly interested in collecting additional data on grandfathered group coverage and understanding whether additional flexibility is needed to allow employers and insurers to maintain grandfathered status. Comments are due within 30 days."
Katie Keith, in Health Affairs

Do Consumer-Directed Health Plans Plans Really Work?

"[CDHPs], paired with a health savings account (HSA) are trending higher among many employers with growth of 11.2% from 2017 to 2018. These plans with lower premium costs are coupled with a new philosophy which brings comparison shopping and savvy consumerism into the healthcare space.... It sounds good in theory, but does it really work? Some actuaries say yes."
HealthEquity

2018-2027 Projections of National Health Expenditures

"National health expenditure growth is expected to average 5.5 percent annually from 2018-2027, reaching nearly $6.0 trillion by 2027... [CMS] projects the health share of GDP to rise from 17.9 percent in 2017 to 19.4 percent by 2027.... Spending growth for prescription drugs is projected to generally accelerate over 2018-2027 (and average 5.6 percent) mostly as a result of faster utilization growth."
Office of the Actuary, Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Employer-Based Coverage Experienced Short-Term Increase, But Trends Downward Long-Term

"Employer-based coverage continues to be the largest source of insurance coverage for Americans (156.3 million), but a recent analysis ... shows that employer-sponsored plans decreased by 9 percent from 1999 to 2017. Lower income employees were less likely to have employer-sponsored coverage, and households with incomes under 400 percent of poverty experienced the most significant decline."
Wolters Kluwer; free registration required

House of Representatives Holds Hearing on Recent ACA Policy Changes

"There have been at least five hearings on the [ACA] in the House.... Last week, the Energy and Commerce Health Subcommittee held a major hearing on efforts to undermine the ACA.... Many Democratic members of Congress focused on the limitations of short-term plans for people with preexisting medical conditions.... Republican members of Congress focused more on the need for choice in the individual market and a belief that short-term plans offer more choice to consumers."
Katie Keith, in Health Affairs

[Opinion]

American Benefits Council Comment Letter to HHS on Notice of Benefit and Payment Parameters for 2020

"The Council supports the proposal to allow plans to treat a brand prescription drug as not an EHB where there is a medically appropriate generic equivalent available on the plan's formulary. This proposal, in particular, would provide group health plans the necessary flexibility to design pharmacy benefits to encourage enrollees to use a lower-cost generic equivalent drug, when medically appropriate, and positively impact a plan's prescription drug costs and premiums."
American Benefits Council

Benefits in General

Sixth Circuit Finds Insurance Agents Properly Classified as Independent Contractors, Dealing Fatal Blow to ERISA Class Action

"[A] divided Sixth Circuit reversed a district court's finding that the agents were 'employees' in an ERISA class action suit brought on behalf of several thousand current and former insurance agents, instead finding that a proper weighing of the Supreme Court's Darden factors established that the insurance giant properly classified them as independent contractors. In particular, in the 'legal context' of ERISA eligibility, 'control and supervision is less important' than the financial structure of the parties' relationship." [Jammal v. American Family Ins. Co., No. 17-4125 (6th Cir. Jan. 29, 2019]
Wolters Kluwer; free registration required

Press Releases

Most Popular Items in the Previous Issue

Text of Agency Request for Information: Grandfathered Group Health Plans and Grandfathered Group Health Insurance Coverage
U.S. Department of the Treasury, Internal Revenue Service [IRS]; Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; and U.S. Department of Health and Human Services [HHS]

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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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