Health & Welfare Plans Newsletter

September 11, 2019

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Deputy Regional Manager for Investigations

Office for Civil Rights, U.S. Department of Health and Human Services
Chicago IL

Senior Consultant

Multnomah Group, Inc.
Portland OR / CA / CO / WA / Telecommute

Regional Sales Vice President, Outside Retirement Sales Consultant

RetireWell Administrators, Inc.
Marlton NJ / Telecommute

NQ Client Services Manager

Newport Group
Lake Mary FL / Dallas TX

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[Official Guidance]

Text of DOL Opinion Letter FMLA2019-3-A: Whether Employer May Delay Designating Paid Leave as FMLA If Delay Complies with Collective Bargaining Agreement (PDF)

"Once your employer has enough information to determine that an employee's leave request qualifies as FMLA leave, your employer must designate the leave as FMLA leave. As noted in [DOL Opinion Letter FMLA2019-1-A], once an eligible employee communicates a need to take leave for an FMLA-qualifying reason, an employer may not delay designating such leave as FMLA leave, and neither the employee nor the employer may decline FMLA protection for that leave."

Wage and Hour Division [WHD], U.S. Department of Labor [DOL]

[Advert.]

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[Official Guidance]

Text of DOL Opinion Letter CCPA2019-1: Whether Employers' Contributions to Employees' HSAs Constitute Earnings for Wage Garnishment Purposes Under the Consumer Credit Protection Act (PDF)

"When a HSA contribution is still in the employer's possession and is about to be paid to the account, it could be subject to the [Consumer Credit Protection Act (CCPA)] limits on garnishment.... Generally, as long as an employer does not determine its HSA contributions on the basis of the amount or value of individual employees' services and does not give employees an option of receiving cash in lieu of an employer's contribution, the employer's contributions to an HSA are not earnings under the CCPA and are not subject to the CCPA's garnishment limitations."

Wage and Hour Division [WHD], U.S. Department of Labor [DOL]

When Ambiguity in Plan Language Cost an Employer $4 Million

"An employer learned the full cost of ambiguity when a Connecticut federal district court agreed with an employee’s widow that the word 'maximum' was ambiguous in the company’s life insurance plan, thus making the widow entitled to an additional $4 million in benefits. This decision serves as a warning for employers sponsoring insured benefits." [Tyll v. Stanley Black & Decker Life Ins. Program, No. 17-1574 (D. Conn. Jul. 12, 2019)]

McDermott Will & Emery

Recent Increase in IRS Enforcement of ACA Reporting Penalties

"Although the IRS has regularly enforced failure-to-file penalties since the law's enactment, employers subject to the ACA and related information reporting requirements have just recently begun receiving notices of late filing penalties for the 2017 reports submitted. Employers should be aware that the IRS is signaling stepped-up enforcement of ACA compliance for 2017 and subsequent tax years."

Hanson Bridgett LLP

ACA Round-Up: Health Insurance Tax, Mental Health Parity, and Special Enrollment Periods

"As we await the 2020 open enrollment period (which starts in November) and major rules like the notice of benefit and payment parameters for 2021 (which is expected this fall), federal agencies continue to release new guidance and analysis. Federal regulators have recently released an estimate of the health insurance tax plan for year 2020, frequently asked questions on mental health parity, and special enrollment periods for those affected by Hurricane Dorian."

Katie Keith, in Health Affairs

2019 Medical Loss Ratio Rebates

"Using data reported by insurers to CMS, [KFF estimates] insurers will be issuing a total of at least $1.3 billion across all markets -- exceeding the previous record high of $1.1 billion in 2012 (based on 2011 experience). The amount varies by market, with insurers reporting at least $743 million in the individual market, $250 million in the small group market, and $284 million in the large group market."

Henry J. Kaiser Family Foundation

Obamacare Caused Premiums to Spike; Here's How States Are Lowering Them Again

"Premiums for benchmark plans in 2019 are lower in six of the seven states that have ... waivers in place. The median premium decrease in those six states was 10.72%. Premiums rose by a median of 6.32% in 31 of the 44 states and the District of Columbia that did not obtain waivers. The median premium decrease in the 13 non-waiver states in which they declined was 5.67%, much lower than the median decrease in the six waiver states whose premiums fell in 2019."

The Heritage Foundation

Navigating the Payer-Provider Relationship

"[1] Keep communications with payers clear, open, and transparent to maintain a long-lasting relationship. [2] Develop a structured process for monitoring payer changes to avoid reimbursement surprises post-claim. [3] When needed, officially object to payer changes that are relevant to your business, while still understanding that changes are often necessary. [4] Maintain good relationships to enable innovative partnerships."

HealthLeaders Media

Investors' Deep-Pocket Push to Defend Surprise Medical Bills

"Often led by doctors with the veneer of noble concern for patients, physician-staffing firms -- third-party companies that employ doctors and assign them out to health care facilities -- have opposed efforts to limit the practice known as balance billing.... But as lobbyists purporting to represent doctors and hospitals fight the proposals, it has become increasingly clear that the force behind the multimillion-dollar crusade is not only medical professionals, but also investors in private equity and venture capital firms."

Kaiser Health News

CVS Wants to Create a Netflix-Like Healthcare Experience

"CVS Health wants to connect the physical and digital experience to expand consumers' access to care ... Those experiences could be a virtual doctor visit, using an AI-powered chatbot or sending health data to a physician through a connected device ... The company is investing heavily in its technology infrastructure and wants to leverage the differentiated capabilities of both companies, and its combined size, to move forward with innovation[.]"

FierceHealthcare

[Opinion]

Groupon for Healthcare Services May Fill a Void for Consumer-Focused Pricing

"The use of Groupon and other pricing tools is symptomatic of a healthcare market where patients desperately want a deal, according to a [recent article]. What’s driving consumers to use such pricing tools for healthcare services is the high cost of care (and high cost sharing for those who are insured) coupled with the lack of price transparency that enables patients to shop for scheduled elective services."

Healthcare Financial Management Association [HFMA]

Benefits in General

NLRB Affirms Right to Unilaterally Implement Changes to Benefit Plans Based on Waiver

"[T]he NLRB found that E.I. DuPont De Nemours did not violate the NLRA by unilaterally implementing changes to its company-wide retiree medical and dental plans based on the unions’ waiver of the right to bargain over such changes." [Du Pont De Nemours and Company, Nos. 05-CA-090984, 09-CA-091793, and 26-CA-092629 (NLRB Sep. 4, 2019)]

Proskauer Rose LLP

Financial Wellness Statistics: Reasons to Adopt a Program

"Here's exactly how these programs help ... [1] ~3% reduction in employee wage garnishing ...[2] 1% lower employee turnover ...[3] 24.6% reduction in absenteeism ...[4] Lower healthcare costs -- $271.50 saved per employee per year ...[5] 13% increase in employees on track to retire on time ...[6] 25.6% increase in HSA and FSA contributions."

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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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