Health & Welfare Plans Newsletter

May 15, 2019

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Mental Health Parity Compliance Assistance
May 23, 2019 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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[Guidance Overview]

Section 4980H Penalties Continue to Grow in 2020

"This article explains the Code provision and the math behind the 2020 penalty amounts.... While the 0.7450989 [premium adjustment percentage (PAP)] decrease from the proposed rule to the final rule may not seem like much, it decreased the potential section 4980H(a) penalty by $20 and the potential 4980H(b) penalty by $30. This will be a material change for anyone who is assessed a section 4980H penalty in 2020."
Accord

[Advert.]

New ERISA Regulations for Disability Claims and Appeals

Sponsored by Lorman and BenefitsLink

May 23 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]

Massachusetts Provides PFML Template Notices for Employees, Extends Deadlines, and Requests Guidance from IRS

"[1] The DFML has published template notices to provide to employees and self-employed individuals ... [and] has extended the deadline for employers to provide notice to employees. [2] The publication of the electronic approved plan application is now available through MassTaxConnect ... The deadline to file for a private plan exemption is also now subject to a limited extension. [3] The Commonwealth has requested guidance from the [IRS] regarding the tax treatment of PFML contributions."
Ogletree Deakins

[Guidance Overview]

Dallas Implements Paid Sick Leave Law: What You Need to Know

"Dallas Ordinance No. 31181 requires employers to provide one hour of earned paid sick time to their Dallas employees for every 30 hours of time worked. The ordinance is scheduled to go into effect August 1, 2019 for employers with more than five employees who perform at least 80 hours of work in a year in Dallas (and August 1, 2021 for employers with five or fewer employees)."
McDermott Will & Emery

[Guidance Overview]

A Closer Look at the Medicare Advantage Telehealth Flex Rule

"Medicare has long been an enigma for the telehealth community. With limited coverage options, arcane and complex rules, and the threat of massive fines and penalties for missteps, telehealth providers have understandably avoided involvement in Medicare.... Although these barriers remain for Original Medicare, the [Bipartisan Budget Act of 2018] removed these obstacles for Medicare Advantage plans starting in Plan Year 2020."
Morgan Lewis

Does Your Group Health Plan Need a Check-Up?

"Employers with self-funded GHPs should ask their claims administrators if they are engaging in cross plan offsetting with respect to the employers' GHPs. If so, employers should consider stopping that practice and asking the claims administrators to reprocess prior benefit claims.... Employers should perform a compliance audit of their employer mandate reporting process to ensure that the proper reports with the appropriate codes are being filed with the IRS and provided to employees.... Employers should make sure that their claims administrators are following the ERISA claims rules with respect to any partial or complete denial of a benefit claim."
Wilkins Finston Friedman Law Group LLP

A Look at Variable Premium Medical Care Plans

"From September 2016 to June 2017, the [National Compensation Survey] program collected data on medical care premium factors and number of variations (e.g., salary levels or age brackets) from a survey of 6,700 private industry and 1,400 state and local government establishments in the United States. This article provides a summary of data collection efforts and results for the March 2017 reference period."
U.S. Bureau of Labor Statistics [BLS]

House Committee Drafts Bipartisan Proposal to Address Surprise Out-of-Network Billing

"The Energy and Commerce draft would eliminate surprise out-of-network billing for both emergency and non-emergency services (with the notable exception of ambulance services) and across different sites of care (e.g., hospitals, ambulatory surgery centers (ASCs), freestanding emergency departments). Importantly, the legislation would do so for all commercial insurance plan types, including self-insured health plans that can only be regulated by the federal government."
The Brookings Institution

[Opinion]

Amicus Brief of ACLJ to Fifth Circuit Addressing Constitutionality of ACA After Repeal of Individual Mandate (PDF)

"The individual mandate no longer functions as a tax and cannot be sustained as a constitutional exercise of Congress's power to tax.... A decision from this Court holding the individual mandate unconstitutional is consistent with the Supreme Court's NFIB decision and does not trench upon the Supreme Court's prerogative to overrule its own decisions." [Texas v. Azar, No. 19-10011 (5th Cir. amicus brief filed May 10, 2019)]
American Center for Law and Justice [ACLJ]

Benefits in General

[Official Guidance]

Text of IRS Announcement Providing Filing Extension for Returns Delayed Due to Recent Software Outage

"Taxpayers affected by the CCH outage [on Monday, May 6 and some days thereafter] who do not file an extension and file after the deadline should include the phrase 'Late filed return due to CCH Software Outage' as a statement of reasonable cause. Potential tax returns affected by this include Forms 990, 1120, 1120S and 1065 for some calendar year and fiscal year filers."
Internal Revenue Service [IRS]

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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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