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April 8, 2019 logo logo
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Actuarial Analyst
in Spring TX

Director of Recordkeeping and Administration
Human Interest
in San Francisco CA

Senior ERISA Compliance Counsel
Hall Benefits Law
in Atlanta GA

Retirement Plan Consultant
National Associates, Inc. [Farmers National Banc Corp.]
in Cleveland OH

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[Official Guidance]

Text of CMS Q&As on 2019 Benefit Year Cost-Sharing Reduction (CSR) Reconciliation (PDF)

"In light of the recent U.S. Court of Federal Claims' decisions on cost -sharing reduction (CSR) payments ... will [CMS] permit issuers to submit CSR data for the 2018 benefit year? ... Will CMS allow issuers who were not litigants in these lawsuits or members of the class action to submit CSR data for the 2018 benefit year? ... Where can issuers find more information on how to complete the CSR reconciliation and restatement processes?" [Unnumbered document, Apr. 8, 2019]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


New ERISA Regulations for Disability Claims and Appeals

Sponsored by Lorman and BenefitsLink

Apr. 18 webinar will explain what new practices to follow, how to change past practices to become compliant with the new regulations, and the risks of non-compliance.BenefitsLink discount.

[Guidance Overview]

CMS Finalizes Policies to Bring Innovative Telehealth Benefit to Medicare Advantage

"CMS is finalizing changes that would allow Medicare Advantage beneficiaries to access additional telehealth benefits, starting in plan year 2020. These additional telehealth benefits offer patients the option to receive health care services from places like their homes, rather than requiring them to go to a healthcare facility." [Also available: Fact Sheet for Contract Year 2020 Medicare Advantage and Part D Flexibility Final Rule .]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

New Jersey Requires Transit Benefit Offering

"New Jersey commuters will be able to use pre-tax dollars to pay for transit fees thanks to a bill Gov. Phil Murphy signed into law on March 1.... Great news for individuals as they will receive tax savings from this pre-tax benefit. Not so great news for New Jersey nonprofits due to a law change in the Tax Cuts and Jobs Acts.... New Jersey nonprofits could see a 21% corporate tax rate applied to this fringe benefit offering."
WithumSmith+Brown, PC

[Guidance Overview]

Massachusetts Issues Proposed Regs and Toolkit for Paid Family and Medical Leave Act

"Employers will be automatically enrolled in the state plan unless they apply to DFML for an exemption to provide their paid family and/or medical leave through a private plan. Employers can apply for an exemption from either the medical leave contribution, the family leave contribution, or both beginning on April 29, 2019. Exemption requests must be filed annually."
The Wagner Law Group

[Guidance Overview]

Questions and Answers on the New Massachusetts Paid Family and Medical Leave Law

"On July 1, 2019, the Department is scheduled to issue final regulations, and on the same day, employers must begin to make payroll deductions to fund the state-administered paid leave program. Eligible workers may take paid leave for certain types of leave beginning Jan. 1, 2021."
Holland & Knight


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In Employee Classification Dispute, Tenth Circuit Holds That LTD Plan's Provisions Failed to Confer Discretion

"[T]he Tenth Circuit held that the [long-term disability] policy did not confer discretion on a health insurer to determine whether a claimant was a salesperson or a non-sales employee, a distinction that significantly impacted the amount of LTD benefits the claimant would receive under the policy." [Hodges v. Life Ins. Co. of North America (LINA), No. 18-1279 (10th Cir. Apr. 2, 2019)]
Thomson Reuters Practical Law

Google Mandates Health and Tuition Benefits, Plus Paid Sick Leave, for Contractors

"Google will require that employers of its U.S. vendor and temporary workers provide ... hospitalization, preventative and wellness services, laboratory and emergency services, prescription drugs, mental health services, labor and delivery, newborn and pediatric services, oral and vision care, rehabilitative and habilitative care and counseling. Employers of vendor and temporary workers must also provide: a minimum of eight days sick leave; 12 weeks of parental leave for birth parents, non-birth parents and adoptive parents; and $5,000 per year in tuition reimbursement to be put toward new skills or taking courses."
HR Dive

Family and Medical Leave: Will Your Program Qualify for a Federal Tax Break?

"For wages paid in 2018 and 2019, you may be able to claim a business tax credit for amounts paid to 'qualifying employees' who take family and medical leave. The credit expires after December 31, 2019.... For the employer to claim a credit for 2018, the employee cannot have earned more than $72,000 in 2017. An evaluation of the workforce will need to be performed to determine eligibility."

Calculating Employer Paid Family and Medical Leave Credits

"The IRS has issued additional guidance on the new Employer Paid Family and Medical Leave Credit [Section 45S] ... Employer policies must have been in place no later than December 31, 2017 for 2018 calendar year filers.... Some states have mandated paid leave laws which limit eligibility ... In these states, the credit is equal to the applicable percentage of the amount of wages normally paid to a qualifying employee during any period -- up to 12 weeks -- the employee is on family and medical leave. However, the wages are first reduced by any paid time off or sick time used, then reduced by the amount of wages paid under the state mandated program."
Moss Adams LLP

Insurance Contracts and SBCs Are Not SPDs for Your Health or Other Welfare Benefits Plan

"While an insurance certificate will outline the eligibility rules, benefits, exclusions, and claims procedures, it may or may not meet all of the requirements for [an ERISA-required summary plan description (SPD)]. While SBCs are certainly required, and are helpful documents for employees to understand and compare their coverage options, they do not meet the requirements to serve as an SPD.... Even if a third-party has prepared an SPD, the responsibility for its content and distribution falls solely with the employer in its role as plan administrator."
Dickinson Wright, via Lexology; free registration required

One Size Doesn't Fit All: Benefits Engagement Through Increased Communication (PDF)

"Several factors are prompting employers to move away from the annual one-size-fits-all onslaught of benefits communications in a short timeframe to more of a marketing approach that gets employees' attention and helps them see what's in it for them.... This shift in the role of communication from inform to engage can help change employee attitudes and perceptions about benefits and the organization they work for.... The key is to ensure that employees understand what they have and to think of their programs as a way to support their current and future well-being needs."
Willis Towers Watson, via Workspan Magazine

Benefits in General

[Official Guidance]

Second Quarter Update to Treasury Department 2018-2019 Priority Guidance Plan (PDF)

36 pages. "The 2018-2019 Priority Guidance Plan sets forth guidance priorities for the Department of the Treasury and the [IRS] based on public input, and taking into account the deregulatory policies and reforms described in Section 1 of Executive Order 13789 ... and Executive Order 13771[.]" [Employee benefit items begin on page 15.]
Internal Revenue Service [IRS]

Editor's Pick Engagement Letters for Employee Benefits Attorneys (PDF)

7-page presentation outline, from ABA EBC 2019 Midwinter Meeting."An initial issue ... is whether employee benefit plans are an independent legal person, different than the plan sponsor. On this issue, the law is not only obtuse, but the federal circuits have conflicting lines of authority.... For pension plans, is the plan sponsor or the plan administrator, if different entities, the proper party to act for the plan? ... For fully insured welfare benefit plans, is the insurer also the plan and thus the proper party? For engagement letters, this issue can often be finessed by an arrangement that does not resolve it but makes it not relevant."
Employee Benefits Committee [EBC], American Bar Association

Editor's Pick Benefit Claims: Alternatives to Litigation (PDF)

16 presentation slides, from ABA EBC 2019 Midwinter Meeting. Topics: [1] Pre-suit settlement negotiations; [2] Media coverage; [3] External review; and [4] Request for review strategies.
Employee Benefits Committee [EBC], American Bar Association

Senate Committee Eyes Lack of Guidance on ERISA Cybersecurity

"There is no definitive answer to the question of whether the sponsor of a benefit plan is subject to the fiduciary standards of ERISA with respect to implementing cybersecurity measures to protect participants' financial data ... Acknowledging a complete lack of guidance, on February 12, 2019, the Senior Pensions Counsel for the Senate Committee on Health, Education, Labor, and Pensions sent a letter to [GAO] requesting guidance ... on issues related to cybersecurity and the private retirement system."
Trucker Huss

Press Releases

Most Popular Items in the Previous Issue

CMS Announces HIPAA Compliance Review Program
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2019, 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, 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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