Health & Welfare Plans Newsletter

March 4, 2019

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[Official Guidance]

Text of IRS Q&As on Information Reporting by Health Coverage Providers (Section 6055)

  • Basics of Provider Reporting: Questions 1-3
  • Who is Required to Report: Questions 4-14
  • What Information Must Providers Report: Questions 15-18
  • How and When to Report the Required Information: Questions 19-28
  • Extended Due Dates and Transition Relief: Questions 19-35
[Updated Mar. 2, 2019, replacing prior version of Feb. 9, 2018.]
Internal Revenue Service [IRS]

[Advert.]

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[Official Guidance]

Text of IRS Q&As on Reporting of Offers of Health Insurance Coverage by Employers (Section 6056)

"Certain employers are required to report to the IRS information about whether they offered health coverage to their employees and if so, information about the coverage offered. This information also must be provided to employees. These FAQs address these reporting requirements."

  • Basics of Employer Reporting: Questions 1-3
  • Who is Required to Report: Questions 4-11
  • Methods of Reporting: Questions 12-16
  • How and When to Report the Required Information: Questions 17-24
  • Designated Government Entity: Questions 25-28
  • Other Third Party Service Providers: Questions 29
  • Extended Due Dates and Transition Relief for 2015 and 2016 Reporting: Questions 30-34
  • Additional Information
[Updated Mar. 2, 2019, replacing prior version of Nov. 3, 2016.]
Internal Revenue Service [IRS]

[Official Guidance]

Text of IRS Q&As on Corrected, Incorrect or Voided Forms 1095-A

"The information provided on this page relates to corrected or voided Forms 1095-A for tax years 2014 through 2017. There are differences amongst the years, be sure to refer to the information for the year that affects you." [Updated Mar. 2, 2019, replacing prior version of Feb. 5. 2018.]
Internal Revenue Service [IRS]

IRS Provides Examples for Employer to Recover Mistaken HSA Contributions (PDF)

"[IRS Information Letter] 2018-0033 further confirms that where there is clear documentary evidence showing there was an administrative or process error, the employer may request the return of the contributed amounts -- with any correction placing the parties in the same position as if the error had never occurred."
EPIC

Tech's Costly Health Benefits Pay Dividends

"Tech companies that don't yet turn a profit are doling out benefit packages worth over $100,000 per employee.... Costly benefits may seem a net negative for investors who typically focus on traditional measures like earnings and cash flow. But a growing number of investors are substituting net present value for social value, including nonfundamental attributes like employee satisfaction in their analyses."
The Wall Street Journal; subscription may be required

Editor's Pick Expanding Access to Public Insurance Plans (PDF)

32 pages. "[T]his issue paper examines four general approaches for incorporating or expanding public plan availability in the health insurance system -- including a government-facilitated plan in the ACA marketplaces, allowing individuals to buy into Medicaid, allowing individuals to buy into Medicare, and expanding Medicare to more or to all."
American Academy of Actuaries

Will 'Grandmothered' Plans Terminate This Year?

"Grandmothered plans, also known as transitional plans, were purchased after the passing of the PPACA but before October 1, 2013. These plans usually offered coverage at a lower premium than PPACA-compliant plans because they were medically-underwritten and/or did not include all of the PPACA required services. Transitional plans were meant to have a short shelf-life and were required to terminate at their first renewal after the implementation of the PPACA in 2014. However, the final decision on when the plans would have to be terminated was left to individual states and insurance carriers offering such plans."
Hill, Chesson & Woody

Provider-Sponsored Health Plans Can Be At the Forefront of the Changing Health Care Market

"By controlling both the delivery of care and the financing of it, [provider-sponsored plans] have the potential to break some of the constraints that health plans and health systems have traditionally faced."
Deloitte

Lessons for Employers from Recent Fiduciary Litigation Involving Health & Welfare Benefit Plans

"These lawsuits should prompt you to question how your ERISA-covered welfare benefit plans are being administered and craft new approaches to limit potential breach of fiduciary duty claims.... [1] Maintain legally compliant plan documents and summary plan descriptions (SPDs) ... [2] Distribute SPDs and other ERISA-required disclosures to employees on a timely basis ... [3] Maintain oversight of plan administrators and regularly assess plan operations for fiduciary compliance."
Fisher Phillips

Comparison of Federal and New York State Family and Medical Leave Laws

"In addition to the federal FMLA, New York has laws regarding pregnancy leave, adoptive parents leave, blood donation leave, bone marrow donation leave, military spouse leave and paid family leave (effective Jan. 1, 2018). [A] comparison chart [details] the types of employers covered, employees eligible and leave amount."
Strategic Benefit Services

Could 2019 Be the Year of MLR Rebates for ACA Issuers in the Individual Market? (PDF)

"For issuers projecting a favorable 2018 loss ratio, now is the time to consider the implications and strategies for 2019 and beyond. [1] Track and optimize QI expenses.... [2] Set 2020 premium rates with a potential MLR rebate in mind.... [3] Consider how the MLR is affected by long-term investments.... [4] Consider offering a 'premium holiday' to reduce member premiums while avoiding some of the tedious logistics of distributing M LR rebate checks.... [5] Ensure an expert is familiar with the details of the federal and state MLR guidelines so that reporting forms are appropriately and accurately filled out.... [6] Revisit risk contracts with the MLR in mind."
Milliman

[Opinion]

ERIC Submits Comments on Massachusetts Paid Family and Medical Leave Program

"[ERIC's] comments focused on the following issues within the preliminary draft regulations: [1] Insufficient regulatory development timeline; [2] Expanded administrative and reporting requirements; [3] Reduced employer flexibility to design and operate tailored paid leave benefits; [4] Extended definition of 'family member' beyond that used by federal law."
The ERISA Industry Committee [ERIC]

Benefits in General

[Official Guidance]

Text of EBSA Information Letter: Application of the Authorized Representative Provisions of DOL Benefit Claims Regs (PDF)

"Although a plan may establish reasonable procedures for determining whether an individual has been authorized to act on be half of a claimant, the procedure cannot prevent claimants from choosing for themselves who will act as their representative or preclude them from designating an authorized representative for the initial claim, an appeal of an adverse benefit determination, or both. The plan must include any procedures for designating authorized representatives in the plan's claims procedures and in the plan's summary plan description (SPD) or a separate document that accompanies the SPD." [Feb. 27, 2019 letter to Jonathan Sistare.]
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Press Releases

Most Popular Items in the Previous Issue

DOL Is Rejecting Form 5500 Filings from Professional Employer Organizations
NAPEO [National Association of Professional Employer Organizations]

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Lois Baker, J.D., President  loisbaker@benefitslink.com
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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