Health & Welfare Plans Newsletter

July 17, 2019

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Retirement Account Administrator
Alerus Financial
in Arden Hills MN / Albert Lea MN / East Lansing MI / Troy MI / Bedford NH

Senior Retirement Plan Administrator
Professional Capital Services, LLC
in Philadelphia PA / Telecommute

Benefits Analyst
University of Maryland Medical System
in Baltimore MD

Defined Contribution Administrator
Pension Investors Corp.
in Hollywood FL / Telecommute

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[Official Guidance]

Text of IRS Notice 2019-45: Additional Preventive Care Benefits Permitted to Be Provided by a High Deductible Health Plan Under Section 223 (PDF)

"This notice expands the list of preventive care benefits permitted to be provided by a high deductible health plan (HDHP) under section 223(c)(2) of the Internal Revenue Code without a deductible, or with a deductible below the applicable minimum deductible (self-only or family) for an HDHP.... The Treasury Department and the IRS, in consultation with HHS, have determined that certain medical care services received and items purchased, including prescription drugs, for certain chronic conditions should be classified as preventive care for someone with that chronic condition. These medical services and items are limited to the specific medical care services or items listed in the [Appendix in this Notice] for the chronic conditions specified in the Appendix."
Internal Revenue Service [IRS]

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Health Reimbursement Arrangement Plans Update

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July 23 webinar will review the benefits of establishing an individual coverage HRA or an excepted benefit HRA and provide you with what you need to know to establish one or both of them. BenefitsLink discount.


[Official Guidance]

Text of CMS 2019 Benefit Year Risk Adjustment Updated HHS-Developed Risk Adjustment Model Algorithm 'Do It Yourself' Software Instructions (PDF)

25 pages. "The 2019 benefit year risk adjustment model was recalibrated using blended coefficients from the 2016 enrollee-level External Data Gathering Environment (EDGE) data and 2014 and 2015 MarketScan data." [Also available: Technical Details (XLSX) and 2019 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of CMS Enrollment Manual for Federally-Facilitated Exchange and Federally-Facilitated Small Business Health Options Program (PDF)

186 pages, July 10, 2019. "All enrollments made on or after July 10, 2019 should be processed in accordance with the operational requirements set forth in this document.... This manual provides operational policy and guidance on key topics related to eligibility and enrollment within the FFEs and FF-SHOPs, as well as within the SBEs-FP, which use the federal platform for eligibility and enrollment."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

HHS Proposal Drastically Revises ACA Section 1557 Nondiscrimination Regs

"The revision to the Proposed Rule's scope would appear to give most insurance issuers and TPAs more flexibility in certain plan designs. Nonetheless, issuers and TPAs should exercise caution ... [T]he Proposed Rule's preamble does not include language in the current rule's preamble that would have protected TPAs' activities in certain instances."
Groom Law Group

[Guidance Overview]

Latest Developments and Deadlines Regarding the New Massachusetts PFML Law

"Certain categories of employment are excluded from PFML ... Employers may require employees to use intermittent PFML in increments.... Employers may pay different contribution rates for different groups of employees ... Employers may apply for a private plan exemption only once per quarter ... Penalty for failure to maintain an approved private plan."
Holland & Knight

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[Guidance Overview]

Nevada Mandates Paid Leave for Workers to Use for Any Reason

"Nevada employers with 50 or more employees in the state will be required to provide employees with at least 0.01923 hours of paid leave for each hour worked in a 'benefit year,' which employees may use for any reason.... [An] employee who works 40 hours a week will earn approximately 40 hours of paid leave a year.... [T]he Law will become effective on January 1, 2020."
Epstein Becker Green

Fifth Circuit Hears Oral Arguments in Appeal of District Court Ruling on Affordable Care Act

"The state intervenors and the House argued that the individual mandate ... simply presented individuals with a 'lawful choice,' made unenforceable by the TCJA since there was now no legal consequence for not buying insurance. In other words, the state intervenors argued, 'shall' does not really mean shall; rather, the individual mandate is now voluntary.... [T]he state intervenors and House [argued] that, by eliminating the penalty but not the rest of the ACA, Congress had expressly deemed the mandate severable." [Texas v. Azar, No. 19-10011 (5th Cir. oral arg. Jul. 9, 2019; audio recording)]
Faegre Baker Daniels

State Attorneys General Secure $10 Million Settlement in Multistate HIPAA Data Breach Lawsuit

"A Washington-based health insurer (Premera Blue Cross) and 30 state attorneys general have reached a $10 million settlement in an investigation resulting from a data breach involving the protected health information (PHI) of more than 10 million individuals.... The settlement requires the insurer to: [1] Pay $10 million to the states ($5.4 million will be paid to Washington State and $4.6 million will be divided among the remaining 29 states). [2] Complete a lengthy list of compliance steps to protect PHI in its possession."
Thomson Reuters Practical Law

Health Insurance Index Report for the 2019 Open Enrollment Period (PDF)

20 presentation slides. "Average premiums for two-person families broke $1,000 per month for the first time in 2019. Total combined annual premiums plus deductible for a four-person family now tops $25,000.... The average individual deductible decreased 6% for 2019. The average family deductible decreased 8% for 2019.... HMO plans continue to dominate the market, representing 56% of all plan selections, the same as in 2018."
eHealth

Press Releases

Most Popular Items in the Previous Issue

A Deep Dive Into Student Loan Repayment Assistance Benefits
International Foundation of Employee Benefit Plans [IFEBP]

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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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