Health & Welfare Plans Newsletter

February 26, 2019

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ERISA Litigation Associate
Robinson+Cole
in New York NY / Stamford CT

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Empower Retirement
in Greenwood Village CO

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ftwilliam.com, Wolters Kluwer
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[Guidance Overview]

New IRS Technical Advice Memorandum Says 'No Free Lunch' In Some Cases

"The IRS found that the employer had no policies for any employee positions related to the discussion of confidential business information, demonstrated no link between its desire for innovation and collaboration and the furnishing of meals, no factual support regarding safety-related policies or issues, and no policies related to employee health that would have required employer-provided meals. The IRS clarified that general goals and objectives of improving employee health do not qualify as a substantial noncompensatory reason for furnishing meals."
Dickinson Wright PLLC

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[Guidance Overview]

New Interoperability Rule Extends to QHP Insurers

"CMS lays out a vision where a patient's health information can move seamlessly between health plans, providers, and post-acute care settings.... The rule applies to payers that offer QHPs through and outside of the federal marketplace, Medicare Advantage plans, Medicaid and CHIP managed care organizations, and state Medicaid and CHIP agencies that offer fee-for-service programs. The rule would not extend to insurers that offer employer-sponsored health insurance or insurers that offer stand-alone dental plans."
Katie Keith, in Health Affairs

Departments Ask for Advice from Health Plan Sponsors: Preserving 'Grandfathered Status' Under the ACA

"The specific questions include: [1] Do any of the requirements for maintaining grandfathered status create particular challenges, and how could these requirements be modified to reduce these challenges? [2] Why do plan sponsors choose to retain grandfathered status? [3] What are the costs and benefits that plan sponsors consider in deciding whether to retain grandfathered status? [4] Is preserving grandfathered status important to plan participants? [5] What changes in benefits typically trigger a loss of grandfathered status?"
Segal Consulting

Editor's Pick How an Employer Can Check Its Service Provider's Work on the Forms 1094-C and 1095-C

"Is the 'Yes' box checked on line 23 (or, alternatively, on lines 24 through 35) of the Form 1094-C? ... Make sure line 14 is completed on all 12 months for each Form 1095-C.... Is line 15 completed properly? ... Are there any months in which line 16 is left blank? ... [If] an employer received a Letter 226J for 2015 or 2016 (the IRS has not started to send out the Letter 226J for 2017 yet), it is likely the service provider has fallen short of its obligation to the employer."
Accord

ACA Landscape Shifts Again: What's an Employer to Do?

"[E]mployers with 50 or more full-time or full-time equivalent employees must continue to provide minimal essential overage that is affordable and provides minimum value to their full-time employees, or risk penalties under the ACA's 'employer mandate'. (Similarly, the ACA's insurance mandates for coverage of dependents until age 26, no exclusions for pre-existing conditions, etc. also remain in place.) Certain states also have their own individual mandates that remain in effect."
Jackson Lewis P.C.

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In Florida, Drug Re-Importation from Canada Finds New Champions, Old Snags

"Florida is joining the growing ranks of states that, squeezed by climbing drug prices, are eyeing the Canadian fix.... Legislation has been advanced this year in about a dozen states that would advance wholesale drug importation programs ... While statehouses may be abuzz, in Washington, national politics impedes feasibility. And skeptics question how much relief these initiatives could actually provide."
Kaiser Health News

Michigan Attorney General and Supreme Court Asked to Issue Opinions on Constitutionality of Paid Medical Leave Law

"If the Michigan Supreme Court declines to issue an Advisory Opinion and the Attorney General issues an opinion that passage of the amendments was unlawful or unconstitutional, ... the original ballot initiatives will take effect, unless a court rules otherwise.... If the original ballot initiatives become law, employers will need to comply with a paid sick leave law and a minimum wage law that are more burdensome than those approved by the Legislature and Governor Snyder."
Warner Norcross & Judd LLP

ERISA-Exempt Government Health Plans Under Attack by Plaintiffs' Bar

"On November 19, 2018, a group of current and former employees filed a lawsuit against The Charlotte-Mecklenburg Hospital Authority. The hospital, doing business as Atrium Health, managed several employee benefit plans for workers at the Hospital under the ERISA 'governmental entity' exemption. The lawsuit alleges that Atrium does not satisfy the requirements for that exemption."
Hall Benefits Law

Claims Denials and Appeals in ACA Marketplace Plans

"Together [130] issuers reported 229.8 million in-network claims received, of which 42.9 million were denied, for an average in-network claims denial rate of 19% ... [D]enial rates by issuers were highly variable, ranging from 1% to 45% of in-network claims. Overall for 2017, 40 of the 130 reporting Healthcare.gov major medical issuers had a denial rate for in-network claims of 10% or lower."
Henry J. Kaiser Family Foundation

Press Releases

SGR Merges with Mazursky Constantine
Smith, Gambrell & Russell, LLP [SGR]

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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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