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May 22, 2019 logo logo
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Alerus Financial
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Sunwest Pensions
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Manager, COB / COBRA
1199SEIU Benefit and Pension Funds
in New York NY

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Webcasts, Conferences

Mandated Sick Pay: Options and Requirements
June 20, 2019 WEBCAST

SALGBA Regional Conference
August 26, 2019 in NC
State and Local Government Benefits Association [SALGBA]

►See 147 Upcoming Webcasts and Conferences

►See 1537 Recorded Webcasts


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[Official Guidance]

Text of CMS Q&As for Part D Sponsors: Additional Guidance Regarding Part D Bids (PDF)

Unnumbered memorandum dated May 20, 2019. "On April 5, 2019 [CMS] announced that if there is a change in the [Anti-Kickback Statute] rules effective in 2020, CMS will conduct a voluntary two-year demonstration that would test an efficient transition for beneficiaries and plans to such a change in the Part D program.... If CMS proceeds with the demonstration after publication of a final AKS rule, CMS will provide instructions on when and how a Part D plan sponsor will notify CMS that they wish to participate in the demonstration. The decision to participate will need to be made at the plan benefit package (PBP) level."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


Group Health Plan Laws: Compliance Alphabet Soup

Sponsored by Lorman and BenefitsLink

May 30 webinar will explain and walk through the many different legal requirements that can apply to a group health plan. BenefitsLink discount.

[Guidance Overview]

Editor's Pick Discovering and Interpreting ACA Reporting Errors

"Before rushing off to fix an apparent error, first be sure you actually have one.... The error may be in the underlying data sent to the payroll/reporting vendor or an error in their system. In other cases, it may not be a true error, but may be a difference of interpretation in how the IRS codes should be applied on the forms.... Depending on the error, you may want to review forms filed in earlier and/or later years to see if there are similar errors in those forms."
HUB International

[Guidance Overview]

Editor's Pick Massachusetts Paid Family and Medical Leave Law: The Employer 'Private Plan' Exemption

"The benefits offered to employees by the approved plan must be greater than or equal to the benefits provided by MAPFML.... Self-insured plans must be bonded.... Fully-insured plans must be covered by policy issued by a Massachusetts licensed insurance company.... There are penalties for noncompliance.... Employer must maintain an 'adequate security deposit'.... Plan changes must be reported.... It doesn't get an employer out of everything.... Major plan updates are required.... The application process is tedious and an exemption must be renewed annually.... here are many questions about Q1 2019.... Is an exempt plan subject to ERISA? ... It may not save money.... Alternative Approaches."

Fact Check: Did the ACA Create Preexisting Condition Protections for People in Employer Plans?

"Protections for preexisting conditions for most people with job-based insurance predated the ACA by more than a decade.... [T]he principal purpose of [HIPAA] was to put an end to what was known as 'job lock.' That happened when people with preexisting health conditions were afraid to leave one job with insurance for another job with insurance because the new insurance would not cover their condition, or would impose long waiting periods.... Most of the states had already attempted to address the job-lock problem by the mid-1990s, but states could not reach the majority of the population with health insurance because they were covered by [ERISA]."
Kaiser Health News

Out-of-Network Provider's Claim Against Health Insurer Avoids ERISA Preemption

"A provider that is not seeking benefits based upon an assignment of a patient's claims under ERISA but instead is pursuing state law claims based solely on agreements and representations made directly by the insurer to the provider may survive attempts to remove the case on grounds of ERISA complete preemption." [California Spine and Neurosurgery Institute v. Boston Scientific Corp., No. 18-7610 (N.D. Cal. May 3, 2019)]
Seyfarth Shaw LLP


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Editor's Pick Breaking Down the Bipartisan Senate Group's New Proposal to Address Surprise Billing

"[A] bipartisan group of senators [has] released new legislation to address surprise medical bills ... by prohibiting balance billing for categories of services where surprise bills commonly arise and prescribing an initial payment from insurers tied to median in-network rates, with the option for providers or insurers to initiate an arbitration process to challenge this rate. By tying automatic payment to the insurer's median in-network rate ... the [STOP Surprise Medical Bills Act] could reduce health care costs as well, although the existence of arbitration as a backstop makes that uncertain."
Health Affairs

House Ways and Means Committee Hearing: Protecting Patients from Surprise Medical Bills

May 21 hearing. Testimony from: [1] The Honorable Katie Porter (D-CA); [2] The Honorable Cathy McMorris Rogers (R-WA); [3] James Patrick Gelfand, ERISA Industry Committee (ERIC); [4] Tom Nickels, American Hospital Association (AHA); [5] Jeanette Thornton, America's Health Insurance Plans (AHIP); [6] Dr. Bobby Mukkamala, American Medical Association (AMA).
Committee on Ways and Means, U.S. House of Representatives

Oklahoma Governor Signs Law Regulating PBMs

"Oklahoma Gov. Kevin Stitt ... signed into law HB 2632, which protects patient access to pharmacy services by establishing network adequacy and 'any willing pharmacy' requirements, minimizes pharmacy benefit manager conflicts of interest by prohibiting higher reimbursement rates for PBM-owned pharmacies, and limits PBM abuses by prohibiting retroactive claim adjustments and denials."
National Community Pharmacists Association [NCPA]

Employer Contributions to HSAs Jump in 2018

"Health savings accounts received record-breaking contributions in 2018 with accountholders and employers pouring $33.7 billion into HSAs, up 22% from 2017. Employer contributions grew to their highest level, totaling over $8 billion in 2018."

U.S. District Court Highlights Job Reinstatement Obligations After FMLA Leave

"This decision highlights the importance of considering reinstatement obligations even after FMLA leave has expired and the perils of not reinstating an employee returning from FMLA leave to a position with similar responsibilities. The decision also emphasizes the importance of scrutinizing the elimination of a position when the employee who generally fills that position is on FMLA leave to ensure the elimination of that position is not merely a pretext for retaliation." [Ottley-Cousin v. MMC Holdings, Inc., No. 16-577 (E.D. N.Y. May 6, 2019)]
Ogletree Deakins

CBO Testimony to House Budget Committee on Key Design Components and Considerations for Establishing a Single-Payer Health Care System

"CBO conveyed two main points in its testimony: First, moving to a single-payer system would be a major undertaking. It would involve significant changes for all participants--individuals, providers, insurers, employers, and manufacturers of drugs and medical devices. Because health care spending currently accounts for about one-sixth of the nation's economic activity, those changes could significantly affect the overall U.S. economy. And the transition toward a single-payer system could be complicated, challenging, and potentially disruptive. Second, to establish a single-payer system, lawmakers would need to make many decisions and would face complex trade-offs."
Congressional Budget Office [CBO]

Benefits in General

[Official Guidance]

Text of IRS Regulatory Agenda, Spring 2019

Benefits-related items include: Determination of Line of Business for Purposes of No-Additional-Cost Service and Qualified Employee Discount Fringe Benefits; Further Guidance on the Application of Section 409A to Nonqualified Deferred Compensation Plans; Deferred Compensation Plans of State and Local Governments and Tax-Exempt Entities; Additional Rules Regarding Pension Plan Funding and Benefit Restrictions; Collectively Bargained Welfare Benefit Funds; Guidance on Rules Applicable to IRAs Under Sections 408 and 408A; Spousal IRAs, SEPs and IRA Technical Changes; Requirements for Employee Stock Ownership Plans; Minimum Vesting Standards; Stage Withholding on Certain Retirement Plan Distributions Under Section 3405(a) and (b); Definition of Church Plan; Application of Various Provisions of Section 2711 of the Public Health Service Act, the [ACA], and the Internal Revenue Code to Health Reimbursement Arrangements; Voluntary Employees' Beneficiary Association (VEBA) Regulations ; Notice to Participants of Consequences of Failing to Defer Receipt of Qualified Retirement Plan Distributions; Expansions of Applicable Election Period and Period for Notices.
Internal Revenue Service [IRS]

[Official Guidance]

DOL Regulatory Agenda, Spring 2019

Proposed Rules (EBSA): [1] Fiduciary Rule and Prohibited Transaction Exemptions, [2] Grandfathered Group Health Plans and Grandfathered Group Health Insurance Coverage, [3] Improving Effectiveness of and Reducing the Cost of Furnishing Required Notices and Disclosures. Final Rules (EBSA): [1] Amendment of Abandoned Plan Program 1210-AB47, [2] Electronic Filing of Apprenticeship & Training Plan Notices, and Top Hat Plan Statements, [3] Adoption of Amended and Restated Voluntary Fiduciary Correction Program, [4] Health Reimbursement Arrangements and Other Account-Based Group Health Plans, [5] Definition of an 'Employer' Under Section 3(5) of ERISA -- Association Retirement Plans and Other Multiple Employer Plans.
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

More Than Half of Small Businesses Plan to Offer New Benefits in 2019

"More than half of small businesses (56 percent) plan to offer new benefits to their employees in 2019, according to recent research from small business consultant Clutch. Small businesses offering new benefits are most likely to offer paid time off (19 percent), health benefits (15 percent), and retirement benefits (11 percent)."
Wolters Kluwer; free registration required

Independent Contractor or Employee? DOL, NLRB Weigh Online Marketplaces

"In the burgeoning gig economy, some businesses may need to assess whether a particular worker is an employee or an independent contractor to determine ... whether certain workers are employees eligible for ERISA-covered benefit plans or [are] independent contractors excluded from those plans.... [DOL Opinion Letter FLSA2019-6] and [an April 16, 2019] NLRB memorandum may provide a guide ... However, given the potential for litigation, the varying tests applied by other federal agencies and courts, and the divergent standards under some state laws, employers should work with legal counsel to make these determinations."

Earnings and Employment Data for Workers Covered Under Social Security and Medicare, by State and County, 2016

"The data show, by sex and age, the number of wage and salary workers and self-employed persons, the amount of their taxable earnings, and the amount they paid in Social Security and Medicare contributions."
U.S. Social Security Administration [SSA]

Selected Discussions
on the BenefitsLink Message Boards

Nebraska Divorce Decree -- Healthcare Coverage Exception and ERISA Preemption

We have a client with a self-funded health plan. Ex-spouse of employee in Nebraska claims he should still be covered for 6 months (until divorce decree is final for purposes of health plan per Nebraska statute). [1] Because the plan is self-funded would ERISA preemption apply? [2] Would the answer be different if the plan was insured?
BenefitsLink Message Boards

Press Releases

Most Popular Items in the Previous Issue

A Medicare Primer (PDF)
Congressional Research Service [CRS]

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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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