Health & Welfare Plans Newsletter

April 26, 2019

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Dallas Passes City Ordinance Mandating Paid Sick Leave

"The ordinance ... could eventually require all Dallas private employers to provide paid sick leave to any employee who performs at least 80 hours of work for pay within the City of Dallas in a year for an employer. The number of yearly paid sick leave hours and the effective date depends on the size of the employer."
FordHarrison

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District Court Finds Undocumented Immigrant Status Insufficient Basis to Rescind Coverage on Material Misrepresentation Grounds

"A federal trial court has ordered a self-insured health plan to pay more than $760,000 in benefits to a hospital that provided care to a plan participant before his death. During treatment for a severe illness, it was discovered that the participant was an undocumented immigrant and had enrolled in the plan using a false name and Social Security number.... The court concluded that the participant was an eligible employee because he worked, and was paid for, 30 or more hours per week.... [N]othing in the plan language excluded employees who were not authorized to work." [Avera McKennan v. Meadowvale Dairy Employee Benefit Plan, No. 18-4010 (N.D. Iowa Apr. 12, 2019)]
Thomson Reuters / EBIA

Is Your Wellness Program Built for Success?

"Behavior design science tells us that a flexible, personalized approach addressing individual interests, readiness to change, preparation to meet obstacles, and learning preferences (e.g., telephonic coaching, online coaching, chat with coach, and mobile apps) is key to supporting successful behavior change.... Cultural support -- including visible support from leaders, front-line managers and grass roots wellness champions -- has also been shown to be a key best practice for successful wellness initiatives."
Mercer

HHS Restrains Regulatory Changes in 2020 Benefit and Payment Parameters Notice

"These regulations cover less ground than those for prior years, but insurers and advisors must nonetheless become familiar with the changes, which have been released later than usual. Proposed changes that were not adopted (e.g., those involving generic drugs) may reappear in future rulemaking after HHS considers the comments it received."
Thomson Reuters / EBIA

Litigation, Legislation Leave AHP Guidance in Flux

"The court found that DOL had unreasonably expanded ERISA's definition of 'employer.' ... Notably, the court preserved the nondiscrimination requirements that apply to Pathway 2 AHPs. While the requirements place restrictions on different premium rates based on health status, the court said, they don't limit which associations qualify as employers and therefore weren't central to the case.... AHPs developed under prior guidance -- primarily DOL advisory opinions and earlier court rulings -- aren't affected by the court's decision and can proceed unchanged."
Mercer

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Ohio Attorney General Calls for Legislation to Address State's Arrangements with PBMs

"Attorney General Yost's four-step plan includes requests for legislation that will require: [1] All of the state's various PBM contracts be aggregated under one single contract and therefore administered through one point of contact; [2] The Ohio Auditor of State have unlimited access to review all PBM drug contracts, purchases and payments; [3] All PBMs working with state plans act as fiduciaries (requiring them to act in the best interest of the plans' participants,); and [4] Any non-disclosure agreements, or gag orders aimed at concealing the costs of prescription drugs, be prohibited."
Calfee, Halter & Griswold LLP

Student Loan Debt Is Weighing Heavily on Employees -- and Employers

"[T]he most common way that employers engaging with employees on student loan debt say they are offering financial wellness solutions is via pilot programs (38 percent). And the most common challenge such employers face is complexity of the programs (48 percent) and challenges in making the business case to upper management (45 percent)."
Paul Fronstin, EBRI [Employee Benefits Research Institute]

Benefits in General

[Guidance Overview]

Editor's Pick Unrelated Business Income Tax Filings for 2018 Complicated by Tax Cuts and Jobs Act of 2017

"TCJA 2017 added section 512(a)(6) to the Code to provide that tax-exempt organizations that carry on more than a single unrelated trade or business must first determine UBTI separately for each unrelated trade or business.... Since the UBTI rules allow an exempt organization to offset gross income with deductible expenses that are directly related to producing such income, the identification of expenses associated with different trades or businesses will now have heightened significance because such expenses cannot be offset against income from other trades or businesses."
Buck

Proposed Overtime Rule May Affect Employee Benefit Plans

"If retirement plan sponsors pay more overtime to more employees, both [DB] and [DC] plans that recognize overtime in their definition of earnings may see increased costs ... [A] plan's NHCE accrual rates and deferral/contribution percentages may fall if the plan excludes overtime from the pay used to determine benefits but includes overtime in the pay used for nondiscrimination testing.... Employers should check to see if eligibility for any health or fringe benefits (such as adoption or education assistance, employee discount programs, or group term life insurance) is conditioned on an employee's exempt or nonexempt status."
Mercer

Editor's Pick Department of Labor EBSA Enforcement Results and Priorities

"The 2018 statistics reveal that EBSA continues to focus on its national priorities and major cases in which it can accomplish the biggest impact and recovery. Left unsaid by EBSA is our experience that EBSA is demanding higher amounts in order to settle audit findings.... While EBSA's published statistics focus on how many cases it closed and resolved, Euclid's internal monitoring of EBSA enforcement of multi-employer plans has found that the agency initiated more audits in 2018 than 2017.... While the focus on missing participants is more well known, EBSA has increased its investigative focus on health plans, including ACA and mental health compliance."
Euclid Specialty Managers

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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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