Health & Welfare Plans Newsletter

July 29, 2019

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Jobs

Defined Benefit Plan Administrator
Northeast Professional Planning Group, Inc
in Red Bank NJ / Tarrytown NY

Retirement Plan Consultant
Ubiquity Retirement and Savings
in San Francisco CA / AZ / CO / DC / FL / IL / KY / MA / NC / NJ / NV / NY / OR / SC / TX / Telecommute

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

Retirement Plan Administrator
APC
in Plainview NY / Telecommute

Retirement Plan Consultant
First American Bank
in Elk Grove Village IL

Defined Benefit Operations Specialist
Transamerica
in MA

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[Guidance Overview]

Key Highlights of Final HRA Regs

"Under the new regulations (which go beyond the 'QSEHRAs' that were provided for under the 21st Century Cures Act for small employers), an employer, regardless of size, can now help employees pay for individual health insurance coverage that the employee obtains either through an [ACA]-compliant State Exchange or outside the Exchange.... [An] 'Excepted Benefit HRA' ... may be an option for an employer that wishes to make a higher contribution than can otherwise be made on behalf of an employee under a health flexible spending account, and it allows for the rollover of unused funds from year to year."
Trucker Huss

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What Rises to the Level of Gross Misconduct Under COBRA?

"A Maryland district court recently ruled that the behavior resulting in an employee's termination did not rise to the level of gross misconduct, and therefore the employer was responsible for offering COBRA coverage after the employee's termination.... [A]lthough the conduct was obviously substandard, the court concluded that one isolated incident of negligence that did not cause harm to the patient did not rise to the level of gross misconduct." [New v. Family Health Care P.C., No. 17-2379 (D. Md. Jul. 1, 2019)]
Graydon

Prescription Drug Rebates, Explained

"This animation explains how rebates for prescription drugs work and why they matter in the debate about lowering drug costs. The video breaks down how prescription drug rebates are determined, who benefits from them, how they affect spending by insurers and consumers and the role of pharmacy benefit managers in the process."
Kaiser Family Foundation

A Small Group of Patients Facing High Drug Costs Drive Health Care Spending

"Among people who get their coverage from a large employer, just 1.3% of employees were responsible for almost 20% of overall health spending, averaging a whopping $88,000 per year.... 'Persistently high spenders' are people who have accumulated big health care bills for at least 3 consecutive years. They often have HIV, MS, cystic fibrosis, rheumatoid arthritis, diabetes, cancer and other serious conditions requiring frequent and often costly care. Drugs are lifesavers for these patients, but also big offenders when it comes to costs."
Drew Altman, via Axios

[Opinion]

ERIC Letter to IRS Requesting Explanation of IRS Review of Household Income to Determine ESRP Liability, and Suspension of All Further ESRP Assessments and Collection Activities

"[ERIC] member companies believe that they are being assessed for every full-time employee who received a subsidy, even though some of those individuals could not have been eligible for a subsidy under Code Section 36B. Based on these initial lists received for the 2015 and 2016 tax years, our member companies suspect that nobody -- not the Exchanges, the Service, HHS, or any other government entity -- is actually reviewing tax records submitted by individual taxpayers and large employers to confirm that employers are being assessed an ESRP penalty only for full-time employees who did not receive an offer of affordable coverage based on household income."
The ERISA Industry Committee [ERIC]

Benefits in General

Fifth Circuit Finds Limitations Period for Miscalculation Claim Began to Accrue Upon Notice of Benefit Calculation

"[T]he best practice is to evaluate the insurance company's calculation of the monthly benefit at the outset ... [C]laims administrators ... would best protect their interests if they clearly and simply lay out the benefit calculation and all factors they considered at the time they approve a claim for benefits. They should also give appeal rights with these written determinations." [Faciane v. Sun Life Assurance Co. of Canada, No. 18-30918 (5th Cir. Jul. 25, 2019)]
Kantor & Kantor

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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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