Health & Welfare Plans Newsletter

July 9, 2019

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[Guidance Overview]

Final HRA Regs Offer New Option to Fund Student Employee Health Coverage

"[C]olleges and universities now have a new option available to subsidize the cost of student health insurance coverage for student employees. The individual coverage HRA can be designed to reimburse the premiums for the individual coverage only, or it can be designed to also reimburse qualified medical expenses."
Ice Miller LLP

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[Guidance Overview]

A High-Level Look at Compliance with the Mental Health Parity and Addiction Equity Act

"The purpose of this article is to provide a high-level MHPAEA compliance guide for employers who sponsor self-funded health plans.... Overview of Requirements ... Self-Compliance Tool ... Two-Step Test for Financial Requirements and Quantitative Treatment Limitations.... Four-Step Test for Nonquantitative Treatment Limitations."
Foley & Lardner LLP

[Guidance Overview]

Editor's Pick Non-Federal Governmental Plans and MHPAEA (PDF)

45 presentation slides. "The purpose of this presentation is to: [1] provide an overview of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA); [2] discuss how MHPAEA applies to Non-Fed Plans; [3] provide information related to MHPAEA enforcement; and [4] introduce MHPAEA resources and compliance tools."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Coming August 1: Dallas and San Antonio Implement Paid Sick Leave Ordinances

"The Dallas and San Antonio ordinances are quite similar.... Employers must permit eligible employees to accrue paid sick leave at a rate of one hour per every thirty hours worked. Eligible employees are any employees who have performed at least eighty hours of work for pay in a year for an employer within Dallas or San Antonio, including work performed through a temporary or employment agency. Employers with sixteen or more employees may cap the accrual of paid sick leave at sixty-four hours per year."
Jackson Walker

[Guidance Overview]

New Final Rules Permit Individual Coverage Health Reimbursement Arrangements

"In designing an ICHRA, employers can select which types of medical expenses are or are not reimbursable. When designing ICHRAs, employers can elect to limit reimbursements to individual insurance premiums only, or alternatively, could allow for the reimbursement of individual insurance premiums as well as out-of-pocket costs, such as copayments, deductibles or coinsurance. If an employer chooses the latter, however, it will have to satisfy additional requirements in order to comply with nondiscrimination requirements of the Internal Revenue Code[.]"
Holland & Knight

Editor's Pick Employer's Guide to QMCSOs

36 pages. "This guide to Qualified Medical Child Support Orders (QMCSOs) was created to provide a basic, but practical, summary of the major QMCSO rules as of May 1, 2019. It provides information on: [1] QMCSO administrative requirements; [2] QMCSO enrollment, disenrollment, and employee contribution requirements; [3] Summary applicable requirements other than QMCSO rules; [4] Sample procedures and documents ... [5] consulting issues such as carrier rules or employer administrative concerns."
Arthur J. Gallagher & Co.

District Court Vacates HHS Rule That Would Require Drug Price Disclosure in TV Ads

"The plaintiffs in the case included three large drugmakers: Merck & Co., Eli Lilly and Co., Amgen Inc., as well as the Association of National Advertisers, Inc, challenging the [HHS] requirement that drugmakers post the list prices of prescription drugs equal to or greater than $35 for a month's supply.... The decision came one day before the rule ... was set to go into effect." [Merck v. HHS, No. 19-1738 (D.D.C. Jul. 8, 2019)]
HealthLeaders Media

UnitedHealth Group, Inc. Petitions Supreme Court to Allow Cross-Plan Offsetting

"If the Supreme Court were to allow [UnitedHealth] and, in turn, other TPAs, to continue their practice of cross-plan offsetting, ... ERISA Plan members may be the most at risk for the continuation of the practice." [Peterson v. UnitedHealth Group Inc., No. 17-1744 (8th Cir. Jan. 15, 2019; cert. pet. filed May 30, 2019)]
Sheppard Mullin

Supreme Court Seeks Solicitor General's Input on ERISA Preemption of State Regulation of Pharmacy Benefit Managers

"The [Arkansas] statute created an appeals process through which pharmacies could challenge the reimbursement rates offered by PBMs.... The law applied to both ERISA and non-ERISA health plans.... The Circuits are split on whether ERISA preempts all regulation of PBMs, or whether ERISA preempts no regulations of PBMs. " [Pharmaceutical Care Mgmt. Assoc. v. Rutledge, Nos. 17-1609 and 17-1629 (8th Cir. June 8, 2018; cert. pet. filed Oct. 22, 2018)]
Seyfarth Shaw LLP

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Eighth Circuit Addresses Amara's Limits in Health Plan Reimbursement Dispute

"Joining other circuit courts, the Eighth Circuit has held that a health plan's SPD was the plan's written instrument for ERISA purposes because it was the only document providing benefits ... As a result, a reimbursement provision in the SPD was enforceable against a plan participant who received benefits under the plan after an accident and later secured a settlement from a third party." [MBI Energy Services v. Hoch, No. 18-1539 (8th Cir. Jul. 3, 2019)]
Thomson Reuters Practical Law

Oral Arguments and Legal Drama in the Texas v. United States ACA Case

"The oral arguments ... will not be broadcast but will be posted on the Fifth Circuit website ... It is highly unlikely that a ruling would be imminent.... [T]he Fifth Circuit has several options." [Texas v. Azar, No. 19-10011 (5th Cir. oral arg. sched. Jul. 9, 2019)]
Association of Health Care Journalists

Wellness Champions Make Powerful Allies

"Wellness champions communicate wellness programs by word of mouth and spark wellness conversations among employees that may otherwise not take place, creating a certain openness around these topics. They can also create support for employees who aren't feeling ready to join the culture of wellness."
Frenkel Benefits

California Individual Mandate Signed into Law

"The legislation will allow up to 850,000 residents to receive financial assistance in paying their premiums, along with state-funded programs to advertise and help residents navigate the marketplace. Californians who do not have insurance coverage will owe a penalty equal to 2.5% of salary or $695 per adult and $347.50 per child, or up to $2,085 per family, whichever is greater."
Tango Health

[Opinion]

Striking Down ACA Would Weaken Medicare

"[T]he ACA altered Medicare's annual payment updates to hospitals, skilled nursing facilities, and certain other health care providers, as well as payments to Medicare Advantage health plans. If the district court's decision stands, it's unclear whether [CMS] could continue paying providers and plans or would first have to establish new regulations resetting all of these payment rates."
Paul N. Van de Water, for Center on Budget and Policy Priorities

Benefits in General

Every Generation Agrees: Humans -- Not the Internet -- Are Top Source for Open Enrollment Information About Benefits

"[J]ust 11% of employees name the Internet as the place they turn to learn about benefits at enrollment season each year. That number falls to just 10% of Millennials and 7% of Generation Z workers."
Colonial Life

Benefit and Compensation Issues in Employment and Separation Agreements

"[1] Salary continuation and Code Section 409A ... [2] Release timing and Code Section 409A ... [3] Changes to employment agreements and Code Section 409A ... [4] Compensation and constructive receipt Issues ... [5] Taxability of non-cash benefits ... [6] Drafting COBRA language ... [7] Paying for COBRA coverage ... [8] Employment through bonus payment date ... [9] 401(k) deferrals and severance pay ... [10] Equity awards."
Miles & Stockbridge

Press Releases

PSCA Kicks Off 401(k)/403(b) Day Prep With New Campaign
PSCA [Plan Sponsor Council of America]

Most Popular Items in the Previous Issue

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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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