Health & Welfare Plans Newsletter

June 5, 2019

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[Official Guidance]

DOL Updates Model SAR for Welfare Plans

The Form for Summary Annual Report Relating to Welfare Plans was updated on May 30, 2019.
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

HIPAA Guidance and Enforcement: A New Alignment?

"[OCR] announced that it has entered into a settlement with a business associate that provides electronic medical records services to health care providers ... Shortly after [announcing] this settlement, HHS published guidance on the broad range of HIPAA violations for which a business associate may be held directly liable.... In tandem, the guidance and settlement serve as strong warnings to business associates that they may be held directly liable for acts or omissions that do not meet HIPAA standards."
Ballard Spahr LLP

Health Care Cost-Mitigation Options for Large Employers

"[1] Value-based care, utilizing alternative payment models ... [2] High-performance but narrower networks ... [3] Direct contracting and reference-based pricing ... [4] Adoption of direct primary care or worksite clinics ... [5] Pharmaceutical procurement strategies ... [6] Defined control of J-coded medications and infusions."
CBIZ

Hiring Interns and Other Seasonal Employees: When Does ACA Require Benefits Be Offered?

"[1] If interns qualify as seasonal or variable-hour employees, clearly define them and state this in their offer letters.... [2] Closely track the work and hours of interns. Remember a long-term substitute should not replace hiring regular employees. [3] Measure your seasonal employees over a defined measurement period to know if they will become benefits-eligible if they remain employed.... [4] If you decide to hire interns after they complete their internship, offer benefits as appropriate[.]"
Tango Health

Witnesses Testify in Review of CVS-Aetna Merger

"The nearly $70 billion transaction closed last fall, but [Judge Richard Leon of the U.S. district court for the District of Columbia] has been thoroughly scrutinizing the DOJ-approved deal.... This isn't a trial; it's merely an opportunity for Leon to gather additional perspective on the acquisition as part of his Tunney Act review process.... The hearings will last up to three days, with three witnesses put forward by amici curiae expected to speak first, followed by three witnesses put forward by CVS and the DOJ."
HealthLeaders Media

Why State Healthcare Individual Mandates are Becoming More Popular

"So far, Massachusetts, New Jersey, the District of Columbia and Vermont have passed individual mandates. Penalties vary and may change yearly, but can be range from a couple hundred dollars to $1500.... Many states that filed an appeal against the ruling that the ACA is unconstitutional are considering adding a healthcare individual mandate. Hawaii, California, Washington, Connecticut, Rhode Island and Minnesota are discussing their own versions of this new law."
Tango Health

Editor's Pick An Outline of the Massachusetts Paid Family and Medical Leave Law (PDF)

"After approval of the claim request for benefits, a seven calendar day waiting period applies to the initial claim for benefits, which counts against the total available period of leave allowable in a calendar year.... Certain types of leave may be taken on an intermittent basis. The quantity of intermittent leave proportionately reduces the employee's available leave allotment and the weekly benefits reduce in direct proportion to the intermittent leave."
OneDigital Health and Benefits

CVS to Turn 1,500 Stores Into HealthHUBs

"After piloting its HealthHUB format in a collection of its Houston stores, CVS Health announced during its investor day Tuesday that it's planning for 1,500 retail locations to follow suit in the next two years.... Its goal is for its locations to serve as 'community-based health hubs' that can answer patients' questions about prescription drugs, insurance coverage and their own health conditions."
FierceHealthcare

[Opinion]

Surprise Billing: No Surprise in View of Network Complexity

"[T]he current debate has largely missed two other important problems related to provider networks: inaccurate provider directories and inadequate provider networks. These problems are inherently complex, harder to turn into news stories, and defy simple solutions. Yet, they also affect a much larger number of Americans' financial and physical well-being than does surprise billing."
Simon F. Haeder, David L. Weimer, and Dana B. Mukamel, in Health Affairs

Benefits in General

[Official Guidance]

ERISA Advisory Council to Meet June 25-27

"[The next meeting of] the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on June 25-27, 2019 ... to hear testimony from invited witnesses and to receive an update from [EBSA].... The Advisory Council will study the following topics: [1] Beyond Plan Audit Compliance: Improving the Financial Statement Audit Process ... and [2] Permissive Transfers of Uncashed Checks from ERISA Plans to State Unclaimed Property Funds[.]"
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

District Court Looks to Where Benefit Plan Was Signed and Negotiated in Deciding to Transfer ERISA Class Action from Washington State to Georgia

"The court found that the plaintiff's choice of forum was of minimal importance because it was a putative class action. Interestingly, the court seemed to give considerable weight to the fact that the plan was negotiated and executed in Georgia, finding this was a 'considerable technical connection' to that forum. The court also found that litigation and travel costs would be reduced by having the case in Georgia rather than Washington." [Mayfield v. ACE American Ins. Co., 18-1695 (W.D. Wash. May 13, 2019)]
Baker & Hostetler, via Lexology; free registration required

Companies Lure Young Workers by Helping with Student Loan Repayments

"When it comes to luring top Millennial talent, companies have a new pitch: offering to pay down a portion of employees' student debt. With student loans outstanding reaching $1.5 trillion this year, employers realize it's a perk that can attract some of the best educated recruits. Among those who have student debt, the average owed was $32,731 ... That's enough that many younger households aren't ... doing things they want, like having kids, buying homes or saving for retirement."
Forbes

Younger Workers Put Student Loan Aid Near Top of Desired Benefits

"Health insurance, paid time off and student loan repayment aid -- in that order -- were the top three benefits identified by recent college graduates and those approaching graduation when asked what benefits they most value from an employer.... [R]espondents with college debt most wanted any new benefit dollars from their employer to go toward helping them repay their loans."
Society for Human Resource Management [SHRM]; membership may be required to view article

Selected Discussions
on the BenefitsLink Message Boards

'Mega Wrap' Documents to Avoid Filing Multiple 5500s

I've seen wrap documents for Section 125 plans that allow you to file just one 5500 for all of the benefits that fall under the 125 plan. I've also seen reference to a "Mega Wrap" document, which incorporates the cafeteria plan and underlying benefits in addition to certain health/welfare benefits that are NOT under the cafeteria plan. Is this a viable technique? Ignoring document issues, for now anyway -- just interested in the 5500 question.
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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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