Health & Welfare Plans Newsletter

August 14, 2019

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DOL's Proposed Changes to FMLA Forms Get Mixed Reviews

"[T]he proposed changes would include: [1] Fewer questions requiring written responses. Instead, the forms would have statements with check boxes. [2] Reorganization of medical certification forms to more quickly determine if an impairment is a serious health condition covered by the FMLA. [3] Clarifications to reduce the demand on health care providers for follow-up information."

Society for Human Resource Management [SHRM]; membership may be required to view article

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Bipartisan Bills Would Simplify ACA Employer-Reporting Requirements

"The bills would create a voluntary, prospective reporting system and include other changes, such as making it easier for employers to send employees electronic coverage statements[.]"

Mercer

HHS Proposal to Roll Back Nondiscrimination Protection Draws 130,000 Comments

"A proposed rule that would remove anti-discrimination protections for patients ... generated more than 130,000 comments -- many of them urging the Trump administration to drop the plan opponents call a rollback of health equity."

FierceHealthcare

ACA's 'Cadillac Tax' May Be Headed for Bipartisan Repeal

"The Cadillac tax is a 40% tax on the most generous employer-provided health insurance plans -- those that cost more than $11,200 per year for an individual policy or $30,150 for family coverage. It was a tax on employers, and was supposed to take effect in 2018 ... [T]he House ... recently voted overwhelmingly -- 419 to 6 -- to repeal that part of the ACA entirely. A Senate companion bill is bipartisan and now has a total of 61 cosponsors -- more than enough to ensure passage."

National Public Radio [NPR]

Enrollment of Large-Company Workers in High-Deductible Plans Reaches Historic High

"The share of covered workers enrolled in high-deductible health plans (HDHPs) at large employers reached 47% in 2019. ... HDHP enrollment increased from 35% of such workers in 2018 and 28% in 2017 ... Nearly 30% of HDHP enrollees had a household income of at least $150,000, compared with 17% in traditional plans. Nearly half of HDHP enrollees (45%) had a college degree (versus 28%) and 27% had a graduate school degree (versus 18%)."

Healthcare Financial Management Association [HFMA]

Ambiguous Wording in Travel Accident Policy Costs Insurer Additional $4 Million

"The insurer could have easily cleared up the ambiguity with more careful drafting that would have unambiguously capped the payout at $1 million. Because the policy left it unclear as to whether the 'subject to' language referred to salary or principal sum, and because a grammatical construction rule known as the last-antecedent canon favored the plaintiff's interpretation, Tyll successfully demonstrated and argued the reasonableness of a reading that permitted the recovery of an additional $4 million." [Tyll v. Stanley Black & Decker Life Ins. Program, No. 17-1574 (D. Conn. Jul. 12, 2019)]

DeBofsky, Sherman & Casciari, P.C.

GAO Report on Medicare Part D: Use of Pharmacy Benefit Managers and Efforts to Manage Drug Expenditures and Utilization

"In 2016, [pharmacy benefit manager] rebates offset Part D spending by 20%, from $145 billion to $116 billion. ... Pharmacy benefit managers' compensation for working with plan sponsors primarily consisted of fees from plan sponsors, rather than being allowed to keep a portion of the rebates they negotiated. Plan sponsors used these managers to provide about three-quarters of Part D prescription drug services." [GAO-19-498: Published Jul. 15, 2019. Released Aug. 13, 2019]

U.S. Government Accountability Office [GAO]

Early 2019 Effectuated Enrollment Snapshot

"As of March 15, 2019, 10.6 million consumers had effectuated coverage through the Exchanges for February 2019, meaning that they selected a plan, paid their first month’s premium, if applicable, and had coverage in February 2019. This number represents approximately 92 percent of consumers who made plan selections during the 2019 Open Enrollment Period (11.4 million). Total effectuated enrollment for February 2019 declined less than one percent from February 2018."

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Trends in Subsidized and Unsubsidized Enrollment, August 12, 2019 (PDF)

"During two successive years of declining enrollment from 2016 to 2018, unsubsidized enrollment declined by 2.5 million people, representing a 40 percent drop nationally.... The most recent year of enrollment data shows average monthly enrollment across the entire individual market decreased by 7 percent nationally between 2017 and 2018 at the same time premiums increased by 26 percent.... The average total monthly premium for Exchange enrollees in February 2019 was $594.17, a decrease of one percent from the February 2018 average premium of $597.20."

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

CMS Issues New Reports on Marketplace Enrollment

"The reports show that marketplace enrollment has remained stable, albeit with a slight decline, on a year-over-year basis. Similar to last year, 10.6 million individuals effectuated their coverage for February 2019. ... [T]he second report documents the decline in individual market enrollment among consumers who are not eligible for advance premium tax credit (APTC). More than 2.5 million of these unsubsidized consumers exited the individual market -- a drop of about 40 percent -- from 2016 to 2018."

Katie Keith, in Health Affairs

Benefits in General

[Guidance Overview]

Does Your Plan Use a Limited Scope Audit for Form 5500 Financial Reporting?

"AICPA will no longer use the term "limited scope audits." Rather, such audits will be referred to as ERISA Section 103(a)(3(C) audits. SAS 136 includes new performance and reporting requirements for these audits, and because of that, the audit will no longer be considered to have a scope limitation."

The Wagner Law Group

How Employers Can Provide Student Loan Repayment Assistance as an Employee Benefit (PDF)

"The Employer Participation in Student Loan Assistance Act (HR 795) was first introduced in the House of Representatives in 2017 ... A similar bill, the Employer Participation in Repayment Act of 2019 (S 460), was introduced in the Senate in 2019 ... These bills aim to make student loan repayment assistance tax-free for employers."

Schulte Roth & Zabel LLP

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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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