Health & Welfare Plans Newsletter

March 8, 2019

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IRS Offers Detailed Look Into Examinations of Employer-Provided Meals and Snacks

"[Technical Advice Memorandum 201903017] is valuable ... for its insight into the amount and types of information the IRS may require as substantiation that an employer policy exists, is enforced, and sufficiently relates to the provision of meals to support an income exclusion. The TAM's lengthy (and heavily redacted) analysis of the employer's claim that meals were furnished so employees could be available to handle emergencies shows the difficulty in proving just how many meals are excludable."
Thomson Reuters / EBIA

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Wellness Programs: EEOC Enforcement Actions and Complying with Federal and State Laws

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DOL Explains ERISA Claims Procedure Rules for Patient-Authorized Representatives

"A plan's procedure for authorized representative designations may include requiring a written authorization signed by the claimant on a form specified by the plan.... [B]ecause information disclosed to an authorized representative during the claims process will likely contain PHI, it is advisable for the plan to obtain a HIPAA-compliant authorization from the claimant."
Thomson Reuters / EBIA

Lawmakers United Against High Drug Prices Bare Partisan Teeth

"The Doggett-Brown proposal is based on a concept known as compulsory licensing, which would allow the government to use its power to issue patents as a lever if manufacturers are seen as not operating in good faith.... Republicans at the hearing maintained that this government market muscle would discourage research and development of new medicines and treatments, echoing industry representatives who say the strategy is not only costly but also doesn't always lead to a breakthrough."
Kaiser Health News

ACA Developments: House Subcommittee Hearing, CMS RFI on Health Care Compacts

"[L]awmakers discussed three bills that would help strengthen the individual market through additional federal funding for reinsurance programs, navigators, and new state-based marketplaces.... [CMS] released its second request for information (RFI) in two weeks on the ACA.... This RFI asks for comment on ways to promote the sale of individual health insurance coverage across states lines, primarily through a 'health care choice compact' under Section 1333 of the ACA. Comments on the RFI are due within 60 days."
Katie Keith, in Health Affairs

Lockton Spinoff Mylo Aims to Be 'Amazon' of Insurance

"In three years, Mylo ... has sold more than 20,000 policies to more than 14,000 clients.... Mylo is a digital insurance broker that collects client information and then shops the market to find the best combination of coverage and price to meet a client's needs. Technology to do this has been available for a while, but typically it has been deployed internally, by brokers themselves. Mylo created an easy-to-use client-facing system."
The Business Journals

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[Opinion]

Partnership for Employer-Sponsored Coverage Comments to Senate HELP Committee on Rising Health Costs

"Eliminating or capping the tax exclusion of employer-sponsored coverage for individuals has been seen as a way to raise federal revenue and/or offset the cost of other federal reforms or programs ... A cap on the exclusion does not address rising health system costs or utilization and will stifle private-sector innovation and delivery designs ... There is no one-size-fits-all employer health plan nor should the federal government enact or implement laws that stifle an employer's ability to develop benefits offerings that meet the needs of their specific workforce[.]"
Partnership for Employer-Sponsored Coverage [P4ESC]

Benefits in General

[Guidance Overview]

Plans Cannot Prevent Participant from Appointing an Authorized Representative

"[The DOL] has reiterated that an ERISA-covered plan cannot prevent a plan participant from appointing an authorized representative for initial claims and for claims appeals.... The DOL letter only refers to the appointment of an authorized representative and does not discuss the assignment of benefits.... An assignment transfers ownership of a claim to a third party, giving it standing to assert those rights and to sue on its own behalf. The appointment of an authorized representative, on the other hand, does not transfer an ownership interest in the claim."
The Wagner Law Group

2018 in Review: DOL-Issued Guidance under ERISA

"DOL continued in 2018 a very limited advance guidance program, with an output roughly comparable to that of 2017.... This trend of limited guidance dates to at least 2013 and thus cannot be wholly attributed to the regulatory proclivities (or lack thereof) of the current Administration. For a variety of reasons, DOL has simply become less engaged in delivering advance guidance to the regulated community."
Eversheds Sutherland

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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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