Health & Welfare Plans Newsletter

July 18, 2019

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[Guidance Overview]

IRS Expands Preventive Care to Include Certain Chronic Conditions

"Notice 2019-45 identifies [additional] conditions whose ongoing treatment may now be considered preventive, and, therefore, may be covered by a health plan without first satisfying an HSA-qualifying deductible.... The treatments listed for [these] conditions include certain inhibitors, therapies, monitors, medications, screenings, tests, and statins, which will be considered preventive expenses for HDHP purposes."
Ascensus

[Guidance Overview]

New HRA Rules: What Employers Need to Know

"[Individual coverage HRAs (ICHRAs)] raise two separate questions about affordability under the ACA: Would these plans be 'affordable' coverage that would disqualify an employee who has been offered the coverage from receiving a premium tax credit? ... Would ICHRA coverage be 'affordable' for purposes of the ACA requirement that employers generally offer affordable coverage to at least 95 percent of their full-time employees, or risk a penalty under Code Section 4980H(b)?"
Ogletree Deakins

[Guidance Overview]

Despite New Effort to Zap the Local Texas Sick Leave Bug, Dallas and San Antonio Take Steps to Enforce Looming Ordinances

"On [July 15], a lawsuit seeking an injunction of the San Antonio Paid Sick Leave Ordinance's August 1, 2019 effective date was filed in a Bexar County District Court.... Despite this lawsuit and the appeal of the Austin ruling pending before the Texas Supreme Court, San Antonio and Dallas enforcement agencies appear ready to proceed with their respective ordinances as of August 1, 2019, as both have released model posters and administrative guidance as recently as this week."
Seyfarth Shaw LLP

Paid Sick Days Back on Track in Pittsburgh

"The Pennsylvania Supreme Court upheld the Pittsburgh Paid Sick Days Act ('PSDA') in a decision today, overturning two lower court decisions that found the Act was invalid as an impermissible business regulation." [Penn. Restaurant and Lodging Assoc. v. City of Pittsburgh, No. 57 WAP 2017 (S. Ct. Penn. Jul. 17, 2019)]
Jackson Lewis P.C.

Cadillac in the Ditch: House Votes to Repeal Obamacare Tax Once Seen as Key to Health Law

"The House voted almost unanimously to repeal the tax, which was intended to prompt employers to rein in such costly plans and force employees to spend more of their own money on their care. It was expected to be a key cost-containment provision in President Barack Obama's signature health law and one of the main ways it was supposed to pay for itself."
The New York Times; subscription may be required

CBO Cost Estimate for H.R. 748, the Middle Class Health Benefits Tax Repeal Act of 2019

"The bill would [e]liminate [the 'Cadillac Tax'] ... Estimated budgetary effects would primarily stem from [1] Foregone high-premium excise tax receipts, [2] Lower revenues from decreases in taxable compensation resulting from some employers and employees no longer shifting to lower-cost plans to avoid paying the tax."
Congressional Budget Office [CBO]

Clinic Employee Eligible for COBRA Despite Termination of Employment for Abandoning Patient

"If a covered employee is terminated for gross misconduct, the employee and any covered dependents lose the right to elect COBRA coverage, and the employer is not required to provide an election notice. But as this case illustrates, determining whether the gross misconduct exception applies is difficult, because the COBRA regulations do not define gross misconduct and courts have not agreed on the standard to apply." [New v. Family Health Care, P.C., No. 17-2379 (D. Md. Jul. 1, 2019)]
Thomson Reuters / EBIA

House Lawmakers Add Arbitration to Surprise Billing Measure

"[The House Energy and Commerce Committee unanimously] passed legislation to address surprise medical bills that includes a last-minute compromise to install an arbitration process, handing healthcare providers a major win.... [The No Surprises Act], which now heads to the full House, bans balance billing and requires insurers to pay the median in-network rate for out-of-network surprise bills."
FierceHealthcare

State Actions to Improve the Affordability of Health Insurance in the Individual Market

"Some states are implementing strategies that lower premiums by building on, and increasing the stability of the individual market.... Other states are ... expanding the availability of lower cost coverage sold outside the marketplaces that does not comply with ACA standards ... This brief examines these different approaches and discusses the implications of state policy choices."
Henry J. Kaiser Family Foundation

Rising Generic Prices Help Drive Up Cost of WHO List of Essential Medicines in US

"Of the 265 essential medicines, 197 (74%) were generic. Medicare Part D spending on those drugs were $87.2 billion, with annual spending increasing from $11.9 billion in 2011 to $25.8 billion in 2015 (116%).... Total annual OOP spending increased from $2 billion to $2.9 billion (47%), and annual per beneficiary OOP spending on these drugs increased from $20.42 to $21.17 (4%)."
American Journal of Managed Care

Benefits in General

NLRB Explains When Granting Benefits to Nonunion Employees and Withholding the Same From Union Workers Can Be Lawful

"[T]he Board held that a company's decision to grant nonunion employees an additional paid day off while requiring union employees to work the same day was lawful under the National Labor Relations Act (NLRA). The analysis offered in the majority's opinion may assist employers in understanding how they can comply with the NLRA when, for legitimate business reasons, they decide to grant a benefit to non-represented employees while withholding the same benefit from employees who are represented by a union." [Merck, Sharp & Dohme Corp., NLRB Nos. 05-CA-168541, 06-CA-163815, and 22-CA-168483 (May 7, 2019)]
Ogletree Deakins

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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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