Health & Welfare Plans Newsletter

June 7, 2019

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Jobs

Recent Graduate - Employee Benefits Investigator
Employee Benefits Security Administration, U.S. Department of Labor
in Silver Spring MD / Philadelphia PA / Telecommute

RPS Administration Manager
DB&T
in Dubuque IA

Compliance Consultant
DB&T
in Dubuque IA / Telecommute

RPS Implementation Consultant
DB&T
in Dubuque IA / Telecommute

Retirement Plan Actuary
Benefit Consultants Group
in Cherry Hill NJ

TPA Operations Team
Premier Metro Atlanta TPA Firm
in Atlanta GA

Senior Benefits Advisor
Employee Benefits Security Administration, U.S. Department of Labor
in San Francisco CA / Telecommute

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[Guidance Overview]

Editor's Pick Recommended Practices for Employer-Provided Meals and Snacks in Light of Recent IRS Guidance

"The IRS continues to aggressively audit how free meals and snacks offered to employees in many workplaces are treated for federal tax purposes.... Technical Advice Memorandum 201903017 ... is essentially the first guidance on employer-provided meals and snacks that the IRS has published in nearly two decades.... Employers with free or subsidized food and snack programs should consider implementing various design, operational, and recordkeeping policies and practices that align with current IRS views, as set out in the TAM[.]"
Morgan Lewis

[Advert.]

Association Health Plans, Time to See Them From a Whole New View Point

Sponsored by Lorman and BenefitsLink

June 11 webinar will reintroduce you to Association Health Plans (AHPs) and Multiple Employer Welfare Arrangements (MEWAs) and help you weigh the pros and cons of these programs. BenefitsLink discount.


[Guidance Overview]

How to Comply with Upcoming Deadlines for Massachusetts Paid Family and Medical Leave Law (PDF)

"This [article] focuses on the upcoming deadlines and ... steps that employers should consider to meet the compliance requirements: [1] Post conspicuous notice of the PFML law in the workplace. [2] Provide individualized notice to employees and covered contractors and obtain written acknowledgement by June 30, 2019. [3] Begin payroll deductions by July 1, 2019, and remit contributions each quarter. [4] File for a private plan exemption by September 20, 2019, if desired."
Latham & Watkins

[Guidance Overview]

Paid Sick Leave in San Antonio and Dallas: Answers to Employer Questions

"What are an employer's obligations under the new paid sick leave ordinances? ... Are there any major differences between the Dallas ordinance and the San Antonio ordinance? ... Do the ordinances require paid sick leave for part-time employees? ... If a company is not located in the city of San Antonio or the city of Dallas, but some of its employees work in either or both cities, does the company need to comply with the ordinances?.... What type of notice must employees give when using paid sick leave? ... Is there a grace period for compliance?"
Ogletree Deakins

Court Upholds Denial of Benefits for Mental Health Residential Treatment Based on Lack of Medical Necessity

"Although not addressed in this opinion, medical management standards that limit or exclude mental health benefits based on lack of medical necessity are considered nonquantitative treatment limitations under the federal mental health parity rules. This means that a plan must generally administer such limitations for mental health benefits the same way they are administered for medical/surgical benefits." [O.D. v. Jones Lang LaSalle Medical PPO Plus Plan, No. 17-13060 (11th Cir. May 15, 2019)]
Thomson Reuters / EBIA

Legal Promise of Equal Mental Health Treatment Often Falls Short

"Many patients ... struggle to get insurance coverage for their mental health treatment, even though two federal laws were designed to bring parity between mental and physical health care coverage. Recent studies and a legal case suggest serious disparities remain.... Insurers can no longer write policies that charge higher copays and deductibles for mental health care, nor can they set annual or lifetime limits on how much they will pay for it. But patient advocates say insurance companies still interpret mental health claims more stringently."
Kaiser Health News

Recent Trends in Stop Loss Claims

"The largest single Sun Life claim was $7.5 million and the largest injectable drug claim was $1.8 million. Injectable drugs account for 9.2% of the total cost of large cost claims. Cancer claims continue to dominate with almost 27% of claims paid. In 2018, 85% of policies have had some reimbursement, with 51.9% of employers submitting at least one cancer claim."
Frenkel Benefits

Social Security Error Jeopardizes Medicare Coverage for 250,000 Seniors

"Because of what the Social Security Administration calls 'a processing error' that occurred in January, it did not deduct premiums from some seniors' Social Security checks and it didn't pay the insurance plans ... The problem applies to private drug policies and Medicare Advantage plans that provide both medical and drug coverage and substitute for traditional government-run Medicare. Some people will discover they must find the money to pay the plans. Others could get cancellation notices. Medicare officials say approximately 250,000 people are affected."
Kaiser Health News

[Opinion]

American Benefits Council Letter to Senate HELP Committee on Lower Health Care Cost Act (PDF)

"[T]he Council supports the use of the benchmark payment methodology ... [T]he use of the in-network guarantee could materially disrupt the ability of plans and issuers to negotiate with potential network providers ... The Council believes that the use of a mandatory [independent dispute resolution] process would continue to impose on plans and issuers -- as well as providers -- significant administrative inefficiencies, unnecessary costs, and unpredictable outcomes."
American Benefits Council

Benefits in General

EBSA Provides Revised Model Summary Annual Report Forms

"These revised versions made minor changes to prior model SAR language; for example, the address where plan participants can request a full copy of a Form 5500 has changed."
CBIZ

Selected Discussions
on the BenefitsLink Message Boards

Honor a Consent Order Despite Having No QMCSO?

An employee is being required by a court to cover his two dependent children on our health plan. We haven't received a QMCSO from the state. The employee provided a signed Consent Order from the court that details the requirement to add the 2 children. He and his attorney think the Civil Action Order sent by the court to the child support agency probably didn't include a provision to add the children and only addressed the removal of his child support payment, and that's why a QMCSO hasn't been sent by the state. The coverage effective date was April 1, 2019 according to the Consent Order. Thoughts on next steps? Use the Consent Order, or tell the employee he needs to get a QMCSO generated and sent? Our SPD doesn't appear to say that the Consent Order would qualify.
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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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