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Health & Welfare Plans Newsletter July 25, 2019 |
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Webcasts, Conferences COBRA Basics Part 2: Qualified Beneficiaries for COBRA Purposes
COBRA Basics Part 3: Identifying Qualifying Events for COBRA Purposes
HERO Forum19
Association Health Plans: Recent Developments, Key Issues, and Best Practices for ERISA Counsel
ERISA Basics National Institute
ERISA Litigation
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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[Guidance Overview]
Westchester County Passes Earned Sick and Safe Time Leave Laws "Westchester County, a Northern suburb of New York City [which is] home to IBM and a number of other large employers, has joined the growing list of jurisdictions guaranteeing the vast majority of employees paid sick and safe time leave. Initially, the Earned Sick Leave Law provides up to 40 hours of sick leave to eligible employees."
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[Guidance Overview]
San Antonio Delays Paid Sick Leave Ordinance; Dallas Ordinance Begins August 1 "On Wednesday, July 24, 2019, approximately one week before San Antonio's paid sick leave ordinance was scheduled to go into effect for most employers, a Texas state court stayed implementation of the city's paid sick leave ordinance until at least December 1, 2019. In the meantime, the Dallas paid sick leave ordinance remains scheduled to go into effect on August 1, 2019 for most employers."
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Eighth Circuit Case Highlights Importance of Digging into Third Party Administrator Procedures "Some TPAs ... have ceased the practice [of cross-plan offsetting] altogether, at least with respect to non-network providers. Others, responding only to the Eighth Circuit's narrow ruling, have taken the position that the practice is still permissible as long as it's specifically authorized by the plan.... [P]lan sponsors looking to minimize risk should opt out or otherwise end the practice of cross-plan offsetting. Even if the plan has already been given the opportunity to opt out, and the window has passed, nothing prevents a plan sponsor from revisiting the issue with the Plan's TPA." [Peterson v. UnitedHealth Group Inc., No. 17-1744 (8th Cir. Jan. 15, 2019; cert. pet. filed May 30, 2019)]
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"[W]hen an administrator knows that an employee wishes to maintain participation in a plan, it acts in a fiduciary capacity when it conveys, or fails to convey, material information to a plan participant about the retention of eligibility for the benefits.... With respect to the VP's advice to Dawson-Murdock to not appeal her denial of benefits to Unum, the Fourth Circuit found that this action of conveying information about plan benefits to a beneficiary in order to assist plan-related decisions, is a fiduciary activity under ERISA." [Dawson-Murdock v. National Counseling Group, Inc., No. 18-1989 (4th Cir. Jul. 24, 2019)]
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ACA Affordability Percentage Goes Down for 2020 "Employers now have the tools to evaluate the affordability of their plans for 2020. Unfortunately, for some employers, a reduction in the affordability percentage will mean that they will have to reduce what employees pay for employee only coverage, if they want their plans to be affordable in 2020."
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2019 Milliman Medical Index (PDF) 12 pages. "[C]osts grew by only 2.9% from 2017 to 2018, and then by a moderately higher 3.8% from 2018 to 2019.... [D]rug costs ... increased by approximately 4.5% from 2017 to 2018, and then by only 2.1% from 2018 to 2019.... From 2018 to 2019, ... employer versus employee contribution rates have grown at similar rates, 3.6% versus 4.0%, respectively."
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Senate Postpones Vote on Health Bill "The Senate will wait until after the August recess to vote on a health care bill that would require health benefits brokers to disclose their commissions ... The Lower Health Care Costs Act ... takes aim at a number of issues, including surprise medical bills, high drug prices and public health problems. Buried in the bill is a requirement that health benefits brokers reveal fees and other enticements they receive from the insurance industry."
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California Re-Enacts Individual Mandate and Adopts Other Health Insurance-Related Changes "As of January 1, 2020, every resident of California will be required to be enrolled in minimum essential coverage (MEC) or pay a penalty.... [S]elf-funded employers will now be required to report to California as well as the federal government. For insured employers, carriers will be providing the information on covered employees to the state of California."
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"Even though you may have solid health insurance for your family, the policy's provisions may not meet the requirements set by the college your child attends. That means you may be forced to buy an entirely new policy the college sells or sponsors. At some colleges, the cost of the policy is over $5,000 for the 2019-2020 academic year[.]"
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[Opinion]
Revisiting the IRS's Eligible Medical and Dental Expenses "[T]he definitions of eligible expenses outlined in Publication 502 are unclear, inconsistent, and do not reflect national public health priorities.... [T]he current document should be revisited to more clearly and consistently define eligible medical expenses; include more eligible expenses related to disease prevention; incentivize healthy eating and exercise behaviors to combat public health issues such as obesity and diabetes; and be religiously neutral."
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Selected Discussions |
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Are Multiple Employer Plans Available for Cafeteria (Section 125) Programs? Can you have Multiple Employer Plans in the Section 125 plan arena, similar to qualified retirement plans? In other words, could an association (of some sort) sponsor its own plan, and have unrelated (and by that, I mean not part of a controlled group or affiliated service group) member businesses adopt the plan as Participating Employers, and have all testing, administration, 5500's if required, etc. done separately for each business, but it's not a "MEWA" (where contributions, etc. would be pooled)?
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Insured Health Coverage for Different Classes of Employees A small company that currently doesn't offer any group health plan acquires the assets of another small company, along with 3 employees from that company. Those 3 employees had group health coverage and the acquiring company is continuing that benefit for them. Does the company have to offer group health coverage to its other employees? Can the company create different classes of employees and offer some classes but not others? Can the company have different employee contributory rates towards premiums (to be done through a 125 plan)? The company has fewer than 50 employees, and all the employees are NHCEs. The owner would not be included in the health plan.
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Press Releases |
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ASC Trust is Certified to Industry Best Practices
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Most Popular Items in the Previous Issue |
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Potential Changes to Annual Plan Audits for Large Employers Spark Concerns
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