Health & Welfare Plans Newsletter

April 2, 2019

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[Official Guidance]

Text of DOL Q&As About Federal District Court Ruling on Final Rule on Association Health Plans (PDF)

"Plans and health insurance issuers must keep their promises in accordance with the policies and pay valid claims. Your AHP may change its structure or operations going forward.... [DOL disagrees] with the District Court's ruling and [is] considering all available options in consultation with the Department of Justice.... The District Court's decision does not diminish state oversight of AHPs under state insurance laws and regulations."
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Advert.]

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[Guidance Overview]

FMLA Can and Should Run Concurrently with Paid Leave

"One common situation involving FMLA designation arises when an employee, seeking to defer FMLA usage while using other forms of leave, refuses to provide the FMLA medical certification form. May the employer -- or must the employer -- designate the leave as FMLA-qualifying without the medical certification? Although the Opinion Letter does not address this situation directly, the answer would appear to be yes, provided the employer otherwise has enough information to determine that the leave is being taken for an FMLA-qualifying reason."
Ballard Spahr LLP

New Jersey Updates, Expands Family and Disability Benefits

"New Jersey has updated and aligned four state leave laws to work together more seamlessly, extended its paid family leave benefit to 12 weeks in a 12-month period and increased wage replacement amounts in the state's paid leave programs.... Two of the amended laws ... provide employees with job protections during unpaid leave. The other two ... establish programs that provide partial wage replacement for family and medical leave. Leave under the laws typically runs concurrently and may run concurrently with leave under the federal [FMLA] when eligibility conditions are met."
Mercer

How to Address ACA Reporting Mistakes or Failures (PDF)

"ALEs should have furnished 2018 individual statements to full-time employees by March 4, 2019. ALEs also should have filed either paper reports with the IRS by February 28, 2019 ... or electronic reports by March 31 ... If an ALE has missed one of these deadlines, it should file within 30 days or by August 1, 2019, to significantly reduce its IRS penalty exposure."
EPIC

District Court Trumps DOL Association Health Plan Rule (PDF)

"[T]he court ruled that DOL unreasonably 'relaxed' two of the three criteria, the 'purpose' test and the 'commonality of interest' test, which were historically used to restrict when an association could establish a bona fide association for purposes of sponsoring a single large group health plan.... [S]tates have been reviewing those laws that restrict the definition of association plans to conform their state laws with DOL's Final Rule. The district court decision likely will disrupt that process." [State of New York v. U.S. Department of Labor, No. 18-1747 (D.D.C. Mar. 28, 2019)]
Holifleld, Janich & Ferrera

[Advert.]

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

Sponsored by Lorman and BenefitsLink

Apr. 11 webinar. Review design and taxation of incentives, laws that prohibit discrimination based on health factors, and exceptions for certain wellness and supplemental plans. BenefitsLink discount.


Federal District Court Vacates Key Provisions of DOL's Association Health Plan Rule

"The Court noted that the AHP Final Rule includes a severability provision, and remanded to the DOL to consider how the severability provision affects the remaining parts of the AHP Final Rule.... Generally, when a case is remanded to an agency, the agency cannot appeal, because the decision is not final.... [The authors] expect that the DOL is considering all of the available options and assume they will seek an appeal due to the uncertainty created by the decision and the limited substantive discretion they have if they were to accept the remand." [State of New York v. U.S. Department of Labor, No. 18-1747 (D.D.C. Mar. 28, 2019)]
Groom Law Group

San Francisco's Annual Health Care Expenditure Report Due April 30

"Employers with San Francisco employees must submit annual Health Care Security Ordinance (HCSO) reports for 2018 by April 30, 2019. The report includes a section on compliance with the city's Fair Chance Ordinance (FCO). Penalties for failure to file can reach up to $500 per quarter."
Mercer

Employers Overwhelmingly Support Pre-Existing Condition Coverage Requirements

"A survey of 600 employers of various sizes ... found that 95 percent were in favor of Congressional action to preserve protections for existing conditions in the case of an ACA repeal or negation.... Expansion of subsidies to help purchase ACA exchange plans, for example, was only supported by 45 percent of respondents. Increasing funding for health exchange enrollment was even less popular, with only 30 percent of survey respondents in favor of the proposal."
MedCity News

Gallup Survey Finds Americans Borrowed $88 Billion to Pay Healthcare Costs

"Americans borrowed an estimated $88 billion to pay for health care last year and one in four people skipped care because of costs ... The nationwide survey of 3,537 adults also found that lower-income adults were more likely to skip care or fear bankruptcy over spiraling medical costs. But even affluent households have deferred care over concerns about finances."
USA TODAY

Hospital Associations Urge Court of Appeals to Reverse Ruling Invalidating Entire ACA

"An AHA-led coalition of major hospital groups filed a joint amicus brief urging an appeals court to overturn a lower court ruling invalidating the ACA. The hospital groups contend that the lower court's ruling has no basis in the law, subverts the intent of Congress, and would greatly harm healthcare access and delivery. A separate amicus brief filed jointly by 24 state hospital associations reiterated the providers concerns and urged the court to reverse the ruling."
HealthLeaders Media

[Opinion]

Addressing Surprise Medical Bills Without Raising the Cost of Health Care

"As consumers, people tend to focus on out-of-pocket liability, and individual cases of egregious surprise billing have a shock-value that grabs attention. However, it is also important to keep a close eye on the less salient payments that insurers make to physicians because these are passed on through the prices of premiums."
RAND Corporation

[Opinion]

Testimony of American Benefits Council at House HELP Subcommittee Hearing on 'Examining Surprise Billing: Protecting Patients from Financial Pain'

11 pages. "While a number of states have sought to address this problem through regulation of health insurance sold in the state, over 60 percent of employer-sponsored coverage is offered to employees through self-funded group health plans. ERISA exempts self-insured plans from state insurance regulations ... Accordingly, the problem of surprise billing cannot be left to the states to solve. Adequately addressing this problem in a way that limits the financial burden on all consumers necessitates a federal solution."
American Benefits Council

Press Releases

ACOPA Responds to American Academy of Actuaries Unilateral Actions
ASPPA College of Pension Actuaries [ACOPA]

Most Popular Items in the Previous Issue

Ethics for Employee Benefits Lawyers (PDF)
Employee Benefits Committee [EBC], American Bar Association

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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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