Health & Welfare Plans Newsletter

August 28, 2019

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Compliance Manager
BlueStar Retirement Services, Inc
in Ponte Vedra Beach FL

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Planned Retirement Consultants & Administrators, LLC
in Ridgewood NJ / San Diego CA

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Planned Retirement Consultants & Administrators, Inc.
in Ridgewood NJ / San Diego CA

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[Guidance Overview]

2020 Drug Coupon Rule Dropped Due to Implementation Concerns

"Employer plans will still be able to exclude the value of drug manufacturer coupons from annual out-of-pocket maximums, even when no generic equivalent is available, under new guidance from the [DOL, HHS and Department of Treasury]. These exclusions, or copay accumulators, are built into many employer plans."

Ogletree Deakins

HHS Walks Back New Policy on Drug Coupons

"HHS will further clarify this policy in a forthcoming regulation for the 2021 plan year. In the meantime, the Departments will not enforce the new rule (which would have applied to plans beginning in 2020) and will allow states to adopt a similar nonenforcement stance. Thus, unless a state prohibits it, insurers and plans can likely continue to exclude drug manufacturer coupons from an enrollee’s annual limit on out-of-pocket costs."

Katie Keith, in Health Affairs

Agencies Provide Guidance on Coupons and Out-of-Pocket Limits for Nongrandfathered Plans

"[DOL, HHS and IRS] acknowledge the confusion previously generated by HHS in the 2020 Notice and stated that HHS, in consultation with the other Departments, will address this issue in the Notice of Benefit and Payment Parameters that will be issued for 2021.... In the meantime, the Departments will not initiate an enforcement action if a plan sponsor (or insurer) excludes the value of the coupon from the OOP limit, including in situations where there is no medically appropriate generic available."

Segal Consulting

Company's 'Point-Reduction' Program to Erase Absence Points May Violate FMLA

"An employer instituted a no-fault attendance policy which allowed employees' absence points to be reduced for each 30-day period of 'perfect' attendance. An employee sued the company, based on the claim that his intermittent FMLA leave kept him from fully participating in that program.... [The Sixth Circuit] found that [the employee] was prejudiced by the policy because his ability to remain employed hinged on not taking FMLA leave, thereby interfering with those rights." [Dyer v. Ventra Sandusky, No. 18-3802 (6th Cir. Aug. 8, 2019)]

Ogletree Deakins

Court Takes Points Off for Employer's FMLA Violation

"The policy treated paid time off for vacation, bereavement, jury duty, military duty, union leave and holidays as days worked toward the 30-day perfect attendance record and such absences did not stop or reset the 30-day clock. In contrast, the point-reduction schedule did not count FMLA leave and other kinds of unpaid leave (such as disability leave) as days worked, so that FMLA leave was treated as an absence that reset the 30-day perfect attendance clock." [Dyer v. Ventra Sandusky, No. 18-3802, (6th Cir. Aug. 8, 2019)]

Manatt, Phelps & Phillips

Tips for Communicating Benefits Topics to Millennials -- from a Millennial

"Millennials have high expectations when it comes to technology.... You won't get the attention of a millennial with an hour-long mandatory meeting teeming with insurance jargon.... Millennials prefer a more personal means of communication in the workplace.... Offer a benefits package that caters to all life stages.... It's important to highlight how your company's benefits will provide savings and teach employees use their plans effectively. "

OneDigital Health and Benefits

Benefits in General

How the New ERISA Employee Benefit Plan Audit Standards Will Affect Your Plans

"If your organization opts for what is currently called an ERISA limited scope audit ... you will be required to provide certain written representations related to the reliability of the certified investment information.... Plan sponsors must be able to produce a completed (or substantially complete draft) Form 5500 in order for their auditor to identify material inconsistencies and material misstatements of fact, if any, with the audited ERISA plan financial statements prior to dating the auditor's report.... Areas of plan reporting that tend to have a high rate of compliance issues, such as prohibited transactions, will be getting a closer review from your plan auditor."

CBIZ

Press Releases

Most Popular Items in the Previous Issue

Text of Agency FAQs About ACA Implementation, Part 40: Limitations on Cost Sharing Under PPACA (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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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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