Health & Welfare Plans Newsletter

August 21, 2019

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Jobs

Defined Benefit Analyst
OneAmerica
in Indianapolis IN

Defined Benefit Actuarial Analyst
TRA, Inc.
Telecommute

Compliance Analyst
TRA, Inc.
Telecommute

Distributions Analyst
Loren D. Stark Company
in Houston TX

Defined Contributions Consultant
Loren D. Stark Company
in Houston TX / Telecommute

Retirement Plan Sales Territory Manager
Loren D. Stark Company
in Irving TX

Retirement Account Analyst
Alerus Financial
in Bedford NH

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Webcasts, Conferences

2019 ERISA Disability Case Law Update
August 22, 2019 WEBCAST
ProLawCLE

Health Reimbursement Arrangements Compliance Assistance
September 12, 2019 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Elevating Financial Wellness in the Workplace
September 19, 2019 in IL
Worldwide Employee Benefits Network [WEB] - Chicagoland Chapter

►See 160 Upcoming Webcasts and Conferences

►See 1546 Recorded Webcasts


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[Guidance Overview]

DOL Opines That Parent's Attendance at IEP Conference Warrants FMLA Leave

"The FMLA allows eligible employees to use protected leave to 'care for' a family member with a serious health condition.... Courts have not always agreed on how to apply these rules....  Generally, attending care meetings with health care personnel has been found to qualify ... In the opinion letter, the WHD found that attendance at the IEP meetings qualified as 'care for a family member' because part of the purpose of these meetings was to make arrangements for changes in care."

Jackson Lewis P.C.

[Guidance Overview]

Massachusetts Paid Family and Medical Leave: The Final Regulations and Related Tax Considerations

"[T]he final regulations adopted the definition of 'employment' as used in the Massachusetts unemployment laws. As a result, 24 categories of employees are now exempt from the Massachusetts Paid Family and Medical Leave (MPFML).... Given the level of state-mandated benefits under MPFML, Massachusetts employers will not be eligible for the 45S credit once benefit payments become mandatory beginning on January 1, 2020."

Morgan Lewis

Ten Years of Health and Well-Being at Work (PDF)

21 pages. "Almost nine in 10 employers plan to address mental health stigma and have concerns with employee access to behavioral health services.... Over three-quarters feel it is very important to offer programs specific to the health needs of women.... More employers are extending programs to family members and retirees.... Four condition categories -- oncology, musculoskeletal, cardiology and kidney -- account for $455 billion in health care spending.... [N]early nine out of 10 employers are concerned about costs related to these conditions.... Centers of Excellence strategy implementation continues to increase."

Optum

Can Plan Administrators Get Into Trouble by Deciding a Disability Claim Too Quickly?

"[N]othing in the Policy required Defendant to decide within 14 days…. Therefore, Defendant’s argument that it had to deny Plaintiff’s claim at the conclusion of a 14-day investigation even while it was waiting on medical records is unpersuasive.... Defendant should have -- at a minimum--waited a few more days to gather medical records before denying Plaintiff’s initial claim." [Speca v. Aetna Life Ins. Co., No. 18-835 (D. Nev. Aug. 8, 2019)]

Lane Powell PC

How to Get Around ERISA Anti-Assignment Provisions

"There are three possible ways for providers to avoid application of the anti-assignment provisions in plan documents. One way is for providers to act as the patient's 'authorized representative.' ... A second way to avoid application of anti-assignment provisions in ERISA plans is to have the patient sign a limited power of attorney, allowing the hospital to pursue the patient's rights in the name of the patient. ... A third way to avoid application of an anti-assignment clause in an ERISA plan is when the plan waives the anti-assignment provision by paying the provider directly. "

King & Spalding, via JDSupra

An Update on Health Reform Lawsuits

"While Congress and many Americans are taking an August break, lawsuits about the [ACA] grind on in the federal courts. [This article reviews] the current status of the major cases, including those challenging the validity of the ACA and related regulations and those challenging Trump administration initiatives that undermine the ACA."

Timothy Jost, for The Commonwealth Fund

SAMHSA's Annual Mental Health, Substance Use Data Provide Roadmap for Future Action

"Among the findings of the 2018 [National Survey on Drug Use and Health sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) are]: [1] The number of individuals reporting pain reliever misuse decreased from 2017 by 11 percent ... [2] Heroin-related opioid use disorder decreased significantly among young adults 18-25 years of age. [3] Additionally, young adults have shown improvement with respect to other drug misuse ...  [4] Use of illicit substances by pregnant women decreased significantly from 2017; this trend also extended to their use of tobacco and alcohol. [5] Marijuana use, in general, appears to be an issue of note."

U.S. Department of Health and Human Services [HHS]

Benefits in General

Fee Shifting in ERISA Cases: Considerations in Mediation

"There are important reasons for defendants to be wary that they may have to pay plaintiff's legal fees.  There also are ways that a defendant may -- and may not -- successfully challenge plaintiff's claims for legal fees.... [T]he principal amount at issue is not the only potential loss that is at stake ... It's not hard for plaintiffs to have 'success on the merits' in order to get their fees paid.... Defendants have most success challenging hours billed and certain costs."

Bob Blum Mediation

Selected Discussions
on the BenefitsLink Message Boards

How to Properly Address a Response to IRS Employee Shan Montoya (Form 1095-C, etc.)?

Anyone who has worked with Applicable Large Employers who have failed to properly file their Forms 1095-C, etc. with the IRS has seen letters from the IRS signed by Shan Montoya, Operation Manager. My question is simple: Does anyone know whether this person prefers to be addressed as "Mr. Montoya", "Ms. Montoya", or something else?

BenefitsLink Message Boards

Press Releases

Key PBGC Leadership Appointments
PBGC [Pension Benefit Guaranty Corporation]

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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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