Health & Welfare Plans Newsletter

April 22, 2019

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Jobs

Section 125 Administrator
401 Plans
in Simi Valley CA

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Great Lakes Pension Associates, Inc.
in Farmington MI

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Webcasts, Conferences

MEWA Considerations; Association Health Plans
RECORDED
Practising Law Institute

Elevating the Financial Wellness Conversation: The What, So What, and Now What
May 14, 2019 in NY
Worldwide Employee Benefits Network [WEB] - New York Chapter

Employee Benefits Briefing
May 14, 2019 in NY
Nixon Peabody LLP

Group Health Plan Laws: Compliance Alphabet Soup
May 30, 2019 WEBCAST
Lorman Education Services

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Discussions

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[Official Guidance]

Health Insurance Oversight System Plan Finder Module: Issuer User Manual (PDF)

76 pages. "For Release 17.00 the User Manual was updated to include: [1] Updated screen captures of the user interface (UI) and content to reflect the redesign changes implemented. [2] Added the informative text on the Product Information page to inform the users that they can view the full list of selected Product Data information by selecting the "View Data" button. [3] Added stepper process for Download Data Template. [4] Added generate file process for Download Data Template and Excel Extract of Issuer Data." [Version 06.00.00, April 2019]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Advert.]

Now is a great time to join Worldwide Employee Benefits Network (WEB)

Sponsored by WEB - Worldwide Employee Benefits Network

Worldwide Employee Benefits Network provides me a forum for education and information exchange with other Benefits Executives. Join today.


[Guidance Overview]

The 2020 Final Payment Notice, Part 1: Insurer and Exchange Provisions

"The final rule does not ... adopt many significant changes to prescription drug standards, or allow navigators and other assisters to use web broker websites.... [T]he final rule allows insurers to adopt accumulator adjustment programs in limited circumstances and maintains an increase in the 2020 premium adjustment percentage as proposed."
Katie Keith, in Health Affairs

[Guidance Overview]

The 2020 Final Payment Notice, Part 2: Risk Adjustment

"CMS did not make changes to its risk adjustment categories for the 2020 plan year ... CMS will continue to exclude the costs of enrollees whose costs exceed $1 million when calculating enrollee-level plan liability risk scores.... CMS clarified that it can withhold certain evidence and analysis from the public upon a state's request.... CMS approved Alabama's request to reduce risk adjustment transfers in its small group market by 50 percent ... The risk adjustment user fee for 2020 is $2.16 per billable member per year, or $0.18 per member per month. This is slightly higher than the $1.80 per billable member per year fee for 2019[.]"
Katie Keith, in Health Affairs

[Guidance Overview]

D.C. Universal Paid Leave Tax Starts Soon

"If you directly or indirectly employ or exercise control over the terms and conditions of employees working in the District and you are required to pay unemployment insurance on behalf of your employees, then you are a 'covered employer' under the Act, regardless of whether you have a physical location in the District, and regardless of the number of employees you employ in the District. As a covered employer, you will be required on a quarterly basis to file a report and contribute ... an amount equal to 0.62 percent of the gross wages you paid your District employees during the quarter. The tax will be computed on wages paid beginning July 1, 2019."
Mintz

[Guidance Overview]

Massachusetts Releases Paid Family and Medical Leave Employee Template Notices

"The notice provided to 1099-MISC contractors differs slightly from the one provided to employees, such as requiring an explanation of how the worker can obtain coverage as a self-employed individual and the contribution obligations they would assume if they choose to obtain such coverage. Employers may provide the notice to employees and contractors electronically and receive the acknowledgments of receipt electronically as well."
Jackson Lewis P.C.

Women, Uninsured More Likely to Use Strategies to Reduce Prescription Drug Costs

"Nearly 60% of adults were prescribed a medication in the previous 12 months, with the majority of these prescriptions (70%) carrying out-of-pocket costs.... 22.0% of women asked for a lower-cost medication compared with 16.4% of men; 12.7% of women did not take their medication as prescribed compared with 9.7% of men; and 6.6% of women used alternative therapies compared with just 3.9% of men."
American Journal of Managed Care

DOJ Takes Aim at Telemedicine with Indictments in $1.2 Billion Medicare Fraud Scheme

"These prosecutions make clear that telemedicine will continue to be an enforcement focus at a time when telemedicine is expanding ... For proponents of telemedicine, the hope is that misconduct and enforcement efforts like the one recently announced will not deter the growth and expansion of telemedicine which can have tremendous benefits such as expanding access to health care and reducing hospital admissions."
Morris, Manning, & Martin, LLP

For HIPAA and Covered Entities and Business Associates: OCR Discussion of Advanced Persistent Threats and Zero Day Vulnerabilities (PDF)

"An advanced persistent threat (APT) is a long-term cybersecurity attack that continuously attempts to find and exploit vulnerabilities in a target's information systems to steal information or disrupt the target's operations.... One of the most dangerous tools in a hacker's arsenal is the 'zero day' exploit or attack which takes advantage of a previously unknown hardware, firmware, or software vulnerability.... There are many security measures that organizations can proactively implement to help mitigate or prevent the damage that an APT or zero day attack may cause."
U.S. Department of Health and Human Services [HHS]

ERISA Governmental Plan Exemption Not Available to Brooklyn Public Library Disability Plan

"The court concluded that the Library does not perform a governmental function.... The court rejected Skornick's argument that providing free educational benefits to the public is a function performed on behalf of a political subdivision. If this were the case, then large swaths of non-profit organizations could avoid ERISA's reach.... Though the City provides funding to the Library and its employees participant in the New York State Employees' Retirement System, that is not the same as the government having ownership of the Library.... The contract between the Library and the City acknowledged the separate corporate identity and existence of the Library." [Skornick v. Principal Financial Group, No. 18-4324 (S.D.N.Y. Apr. 18, 2019]
Kantor & Kantor

2019 Medicare Trustees Report (PDF)

249 pages. "The estimated depletion date for the [hospital insurance (HI)] trust fund is 2026, the same as in last year's report. As in past years, the Trustees have determined that the fund is not adequately financed over the next 10 years.... In 2018, HI expenditures exceeded income by $1.6 billion. The Trustees project deficits in all future years until the trust fund becomes depleted in 2026.... Growth in HI expenditures has averaged 3.0 percent annually over the last 5 years, compared with non-interest income growth of 4.4 percent. Over the next 5 years, projected annual growth rates for expenditures and non-interest income are 7.0 percent and 5.7 percent, respectively." [Also available: 2019 Expanded and Supplementary Tables and Figures (ZIP).]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Opinion]

The Danger of High-Deductible Health Plans for Chronically Ill People

"[S]erious and life-threatening diseases do not wait for financial concerns. Not dealing with this cyclical issue will continue forcing people with chronic disease to make choices with potentially serious unintended consequences. And unfortunately, as we explain, there are serious flaws in many of the approaches commonly suggested to lessen the burden of HDHPs for those with chronic diseases."
Health Affairs

Benefits in General

Addressing 401(k)s, Health Benefits and Compensation After a Merger or Acquisition

"When the buyer and seller both sponsor a 401(k) plan, a common integration strategy is for the buyer to continue its plan for both its employees and the employees it acquires in the transaction... [T]he parties should enter into a transition services agreement outlining their rights and responsibilities during the transition period.... [T]he buyer should obtain the information necessary to fulfill ACA reporting requirements for the next year as well as the data necessary to transition the seller's former employees onto the buyer's hours tracking system for purposes of ACA's 'pay or play' employer mandate. When the seller sponsors a flexible spending account (FSA), the parties must decide whether the buyer will transmit contributions to the seller's plan for the remainder of the year or transfer the seller's employees (along with their elections and account balances) to the buyer's plan."
Voya

Editor's Pick 2019 American Bar Association Midwinter Meeting Report on Plan Fiduciary Responsibilities (PDF)

54-page report of 2018 plan fiduciary litigation, including [1] applications and limitations of the functional fiduciary standard; [2] Section 404 standards and application; [3] duty to protect against violations by other fiduciaries; [4] prohibited transactions; and [5] statute of limitations.
Employee Benefits Law Committee, American Bar Association

Selected Discussions
on the BenefitsLink Message Boards

Employer Skips Top-Paid Group Election for Its Qualified Retirement Plans; Affects Section 129 DCAP?

In determining HCE status, a particular employer client does NOT make the top-paid group election for its five section 401(a) retirement plans. It's desirable for coverage testing purposes that it not make the election. Does the "consistency" requirement of the top-paid group election rules mean that this employer cannot make the election for any of its non-401(a) plans where HCE status is relevant? In this case it's for a Section 129 plan.
BenefitsLink Message Boards

Press Releases

Most Popular Items in the Previous Issue

How Employers Are Tackling Student Loan Debt (PDF)
Employee Benefit Research Institute [EBRI]

Text of HHS Final Notice of Benefit and Payment Parameters for 2020
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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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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