Health & Welfare Plans Newsletter

March 26, 2019

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[Official Guidance]

Text of CMS Extension of Limited Non-Enforcement Policy through 2020 (PDF)

"The extended non-enforcement policy in this bulletin applies for policy years beginning on or before October 1, 2020, provided that all such coverage comes into compliance with the specified requirements by January 1, 2021.... [H]ealth insurance coverage in the individual or small group market that meets the criteria of the extended policy and associated group health plans of small businesses ... will not be treated as out of compliance with the market reforms ... Health insurance issuers that renew cover age under this extended non-enforcement policy, must, for each policy year, provide the relevant attached notice to affected individuals and small businesses [.]"
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

DOL Information Letter Provides Reminder About Plan Procedures for Designating Authorized Representatives

"[S]ponsors of employee benefit plans subject to ERISA should review the claim and appeal procedures to confirm that they include the procedure that claimants must follow to designate an authorized representative.... [Sponsors should also] confirm that the authorized representatives are receiving appropriate notices and disclosures, as directed by the claimant ... [and] verify that the current authorized representatives under their plans have been properly authorized by the claimants."
Epstein Becker Green, via Lexology; free registration required

An Employee Benefits Advocate Can Be First Defense Against Insurance Claims Errors

"Broker-provided employee advocacy serves as a first-to-call resource for plan participants. Rather than reaching out to an insurance carrier first, whose issue resolution success is measured based on the call time, employees contact their benefits advocate. This expert is trained to answer questions, deal with insurance claims and support employees on their medical journey."
Corporate Synergies

Eighth Circuit: When Malingering Justifies Disability Claim Denial

"When the claimant's neuropsychological testing is rendered invalid due to 'failed validity tests,' that may be enough to deny the claim. It is important that the record contain evidence how the tests were conducted, and how the tests objectively measured validity." [Johnston v. Prudential Ins. Co., No. 17-3415 (8th Cir. Feb. 25, 2019)]
Lane Powell PC

DOJ to Fifth Circuit: Entire ACA Is Unconstitutional (Not Just Individual Mandate)

"The Trump administration told a federal appeals court Monday it thinks all of Obamacare is unconstitutional, marking an escalation in its fight against the 2010 law. Justice Department lawyers previously had argued that if the courts found Obamacare's 'individual mandate' is no longer constitutional, then a narrow slice of the program -- consumer protections for people with pre-existing conditions -- could not stand, either."
InsuranceNewsNet.com

Congress Requests Industry Advice on Telehealth Legislation

"[L]eaders of the Congressional Telehealth Caucus and a bipartisan coalition of Senators published a request for information (RFI) asking for help in 'craft[ing] comprehensive telehealth legislation for the 116th Congress.' The caucus is seeking public input related to its goal of 'assembling a revised telehealth package that continues to expand access to vital, cost-efficient telehealth and remote monitoring services across the country.' Comments are due April 1, 2019."
Alston & Bird

CMS Fact Sheet: Health Insurance Exchanges 2019 Open Enrollment

"Approximately 11.4 million consumers selected or were automatically re-enrolled in an Exchange plan during the 2019 [open enrollment period (OEP)] in the 50 states, plus DC. This is a decrease from 11.8 million consumers during the 2018 OEP.... Among all consumers in the 39 states that use the HealthCare.gov platform, the average premium before application of the tax credit was $612 in the 2019 OEP. This is a decrease from $621 in the 2018 OEP.... Eighty-seven percent of consumers in states that use the HealthCare.gov platform received APTC in the 2019 OEP, compared to 85 percent in the 2018 OEP; the average premium after application of APTC for these consumers was $87 in the 2019 OEP, compared to $89 in the 2018 OEP."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Final Marketplace Data for 2019; CMS Extends 'Grandmothered' Policies Again

"Overall enrollment is down by about 3 percent from the 2018 open enrollment period when 11.8 million consumers selected or were automatically reenrolled in marketplace coverage.... Despite year-over-year stability, enrollment through HealthCare.gov is down from its peak of 12.7 million consumers in 2016.... The grandmothered plan policy was initially announced in November 2013 ... and has been extended each year since then.... While the marketplaces have stabilized, this policy likely did serious damage to the ACA-compliant individual market."
Katie Keith, in Health Affairs

Benefits in General

[Official Guidance]

Text of IRS Disaster Relief Announcement NE-2019-02, for Victims of Severe Winter Storm, Straight-Line Winds, and Flooding in Nebraska

"Victims of the severe winter storm, straight-line winds, and flooding that took place on March 9, 2019 in Nebraska may qualify for tax relief ... Individuals who reside or have a business in Butler, Cass, Colfax, Dodge, Douglas, Nemaha, Sarpy, Saunders, and Washington counties may qualify for tax relief.... [C]ertain deadlines falling on or after March 9, 2019 and before July 31, 2019, are granted additional time to file through July 31, 2019."
Internal Revenue Service [IRS]

[Official Guidance]

Text of IRS Disaster Relief Announcement IA-2019-02, for Victims of Severe Storms and Flooding in Iowa

"Victims of the severe storms and flooding that took place on March 12, 2019 in Iowa may qualify for tax relief ... Individuals who reside or have a business in Fremont, Harrison, Mills, Monona and Woodbury counties may qualify for tax relief.... [C]ertain deadlines falling on or after March 12, 2019 and before July 31, 2019, are granted additional time to file through July 31, 2019."
Internal Revenue Service [IRS]

[Official Guidance]

DOL Fact Sheet: Guidance and Relief for Employee Benefit Plans Impacted by Nebraska, Iowa and Alabama Storms in March 2019 (PDF)

"The [DOL] has published employee benefit plan compliance guidance and relief for victims of the 2019 Nebraska Severe Winter Storm, Straight-line Winds, and Flooding ... 2019 Iowa Severe Storms and Flooding ... and the 2019 Alabama Severe Storms, Straight-line Winds, and Tornadoes.... [Special rules are provided for:] [1] Verification procedures for plan loans and distributions ... [2] Participant contributions and loan repayments ... [3] Blackout notices ... [4] ERISA claims compliance guidance."
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Official Guidance]

DOL FAQs for Participants and Beneficiaries Following the Nebraska Iowa and Alabama Storms in March 2019 (PDF)

22 Q&As covering health and retirement plan benefits, including: [1] I think I may lose my health coverage because of a Covered Disaster. How can I obtain other health coverage? ... [2] I lost my spouse. My spouse's employer has agreed to pay the premiums for my health coverage for 12 months. Will that affect my future eligibility for continuation health coverage under COBRA? ... [3] My employer did not pay my insurance premium. May I pay the premium to continue my coverage? ... [4] How can I make changes in the way my 401(k) plan account is invested if it was affected by a Covered Disaster? ... [5] Can I get money out of my retirement plan if I need financial assistance now? ... [6] All of the records concerning my employment with the retirement plan sponsor and my participation in the retirement plan were destroyed as a result of a Covered Disaster. What do I do?
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Selected Discussions
on the BenefitsLink Message Boards

State and Local Regs/Compliance Calendar Available for H&W Plans?

What is the best source for state and local compliance calendar for health & welfare plans? Has anyone seed a comprehensive calendar that includes multiple state/localities?
BenefitsLink Message Boards

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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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