Health & Welfare Plans Newsletter

June 27, 2019

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BPAS
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in La Crescenta CA

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Aspire Financial Services LLC
in Tampa FL

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Aspire Financial Services LLC
Telecommute

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Randall + Hurley, Inc.
in MT / WA

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Employee Benefits Security Administration, U.S. Department of Labor
in Washington DC / Telecommute

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[Official Guidance]

Text of CMS FAQs: HIPAA and Health Plans -- Uses and Disclosures for Care Coordination and Continuity of Care

"Does HIPAA permit one health plan to share protected health information (PHI) about individuals in common with a second health plan for care coordination purposes? Yes.... Does the HIPAA Privacy Rule permit a covered entity to use and disclose PHI to inform individuals about other available health plans that it offers, without the individuals' authorization, if the covered entity received the PHI for a different purpose? Yes, in certain circumstances."
U.S. Department of Health and Human Services [HHS]

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[Official Guidance]

Text of CMS Publication: Health Insurance Oversight System -- Rates and Benefits Information System User Manual (PDF)

75 pages. "[T]he Health Insurance Oversight System (HIOS) allows the government to collect data from individual and small group market Issuers. The collected data is aggregated with other data sources and made public on a consumer-facing website. The Rate and Benefits Information System (RBIS) web site gathers detailed plan benefit and eligibility data. This user manual explains the features and other aspects related to the use of the RBIS module." [Version 06.00.00, May 2019]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Departments Issue Final Rules on Health Reimbursement Arrangements

"The final rules largely adopt the proposed rules and reiterate that an Individual Coverage HRA is itself a group health plan subject to ERISA. However, ERISA does not extend to the individual insurance policies purchased with HRA dollars if certain requirements are met and the employer does not select or endorse any particular issuer or insurance coverage.... [T]he Departments did not adopt employer recommendations to establish a safe harbor for private exchange based platforms offering individual insurance coverage purchased with HRA dollars."
Winston & Strawn LLP

[Guidance Overview]

COBRA Continuation Coverage Issues for Employers (PDF)

48 presentation slides. Topics: [1] Qualifying Events: When are employees and dependents eligible for COBRA? [2] Elections and Payment: Timely election and payment for COBRA qualified beneficiaries. [3] Coverage Options: Which plan options are available to COBRA qualified beneficiaries? [4] COBRA Subsidies: Navigating the potential nondiscrimination pitfalls. [5] Special Issues: Mergers and acquisitions, Medicare, and domestic partner rule.
ABD Insurance & Financial Services

Top Compliance Issues for 2020 Health and Fringe Benefit Planning

"Review 2020 coverage and eligibility terms in light of employer shared-responsibility (ESR) strategy, factoring in the 2020 affordability safe harbors and minimum value determinations.... Evaluate each new tech vendor that has access to health and welfare plan data to determine whether HIPAA or other data-protection and privacy laws apply.... Monitor state and local legislation for new and expanded [paid unpaid leave] mandates and programs.... Review whether third-party administrators (TPAs) or issuers are using a practice known as cross-plan offsetting to recoup overpayments to healthcare providers."
Mercer

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Court Applies Nondeferential Review Because Insurer Improperly Delegated Discretion to a Claims Administrator

"If an ERISA plan confers discretion to interpret and implement its terms, its decisions generally will be reviewed under the deferential arbitrary and capricious standard. However, as this case illustrates, if the plan lacks delegation provisions or if the plan's procedures are not followed, it is more likely that the nondeferential standard will apply." [Bruton v. American United Life Ins. Co., No. 16-928 (S.D. Ohio Apr. 25, 2019)]
Thomson Reuters / EBIA

Senate Panel Makes Surprisingly Fast Work of 'Surprise Medical Bills' Package

"Members of the Health, Education, Labor and Pensions (HELP) Committee approved a sweeping measure Wednesday that tackles a range of big-ticket health care concerns. The 196-page bill touches nearly every aspect of the health care industry, from lowering the price of prescription drugs and creating a national database of health care costs, to increasing vaccine rates and preventing youth tobacco use."
Kaiser Health News

Executive Order Directs Agencies to Make Healthcare More Transparent

"As a whole, this Order is different from previous Orders in that it doesn't specifically focus on matters related to the insurance markets. Rather its focus is on the consumer and increasing transparency in the cost of providing healthcare coupled with other consumer-friendly measures."
HUB International

Connecticut Enacts Paid Family and Medical Leave Act

"Changes from current legislation: [1] Reducing leave from 16 unpaid weeks in a 24-month period to 12 paid weeks in a 12-month period. [2] Adding a potential two additional weeks for an incapacitating pregnancy-related condition. [3] Covering employers with one or more employees. [4] Reduces the number of months they must have worked for their employer (immediately preceding their request) from 12 months to 3 months with no minimum requirement for hours worked. [5] Applicable affinity definition has been expanded."
OneDigital Health and Benefits

Drivers of 2020 Health Insurance Premium Changes (PDF)

"Key drivers of 2020 premium changes include: [1] Medical trend, which is the underlying growth in health care costs; [2] Recent and ongoing policy changes regarding the expanded availability of short-term limited duration plans, association health plans, and health reimbursement arrangements, as well as the elimination of the individual mandate penalty; [3] Incorporation of projected risk adjustment data validation audit adjustments into 2020 premiums and any adjustments to assumptions used to build the cost of cost-sharing reduction subsidies into premiums; [4] State actions to implement reinsurance programs, impose individual mandate penalties, or enact rules that would facilitate or prohibit the availability of alternative coverage options; and [5] The reinstatement of the health insurance provider fee."
American Academy of Actuaries

Benefits in General

Beneficiary May Sue Trustees of One ERISA Plan for Fiduciary Breaches Causing Loss of Benefits under Another ERISA Plan

"The trial court explained that Amara extended the surcharge remedy to a breach of trust committed by a fiduciary for any violation of fiduciary duty. Next, the trial court found that nothing in the Welfare Fund Trust Agreement prohibits the imposition of a surcharge on the Welfare Fund's trustees. The trial court noted that the Trust Agreement explicitly authorized the use of trust funds to indemnify its trustees." [DeRogatis v. Bd. of Trustees of the Welfare Fund of the Int'l Union of Operating Engineers Local 15, 15A, 15C & 15D, AFL-CIO, No. 14-8863 (S.D.N.Y. June 13, 2019)]
The Wagner Law Group

Supreme Court Decides Important Agency-Deference Question

"The refined test is as follows: First, a court should not afford deference to an agency's interpretation of its own regulation unless the regulation is 'genuinely ambiguous.' ... Second, even if the regulation is genuinely ambiguous, the agency's interpretation must still be 'reasonable.' ... Third, even if the agency's interpretation of the ambiguous regulation is reasonable, a court 'must make an independent inquiry into whether the character and context of the agency interpretation entitles it to controlling weight.' This, in turn, involves three elements." [Kisor v. Wilkie, No. 18-15 (S. Ct. Jun. 26, 2019)]
Reed Smith

DOL and Treasury Update Guidance Agendas for Employee Benefits

"Of the 44 projects, 17 have been pending for at least five years. One of the three new DOL initiatives -- electronic delivery of required participant notices -- reflects an August 2018 White House directive ... The DOL fiduciary rule remains on the agenda, but the projected date has been further delayed from September 2019 to December 2019[.]"
Eversheds Sutherland

[Opinion]

It's Time for Employee Benefit Technology Partnerships

"Consolidated mobile technologies that pull together disparate carriers, payroll organizations, HRIS (learning, PTO, etc.), telemedicine, 401(k), wellness, cost transparency, FSA and other data, all in one-view with drill-down abilities per category, simplify the experience and increase utilization. Focused and planned push/pull notifications through the app to the employee level that matches an employer's strategic initiatives for the year, not just for HR, but for the whole organization, greatly increases the total ROI of the HR team."
Employee Benefit News

Press Releases

NAPA Launches Campaign to Recognize Top DC Wholesalers
National Association of Plan Advisors [NAPA]

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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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