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Health & Welfare Plans Newsletter September 19, 2019 |
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Webcasts, Conferences Tales from the Crypt: PEOs and Other Outsourcing Options: Risks, Benefits and Other Considerations in Using a Contingent Workforce
Big Shots and Brews: An Evening with Northeast Ohio's Employee Benefits Leaders
Unpacking Policy Options to Promote Prescription Drug Affordability
Health Insurance Financial Reporting Hot Topics
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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[Official Guidance]
Text of CMS Publication: HIOS Portal User Manual (PDF) 106 pages; Aug. 2019. "The Health Insurance Oversight System (HIOS) is a federal system of record and provides a centralized, multi- user interface for insurance issuers and state/territory regulators to submit, and CCIIO to store information on individual an d small group major medical insurance.... These technical instructions explain how the HIOS application works within any compatible Internet browser application [.]"
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[Advert.]
Now is a great time to join Worldwide Employee Benefits Network (WEB)
Worldwide Employee Benefits Network helps me connect with thought leaders in the Benefits Industry. Join WEB today at www.webnetwork.org. |
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"As the court noted, a triggering event such as a termination of employment or reduction of hours must cause a loss of coverage under the plan to be a qualifying event requiring a COBRA election notice.... A complete loss of coverage is not required -- a partial loss of coverage, including a premium increase, is enough to give rise to COBRA rights. Contrasting with the decision in this case, some courts have concluded that the failure to continue payroll deductions may constitute a loss of coverage[.]" [Morehouse v. Steak N Shake, No. 18-4186 (6th Cir. Sep. 13, 2019)]
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"The [DOL] has released a revised and updated model notice that employers can use to inform employees of the potential for state premium assistance subsidies for the purchase of group health coverage.... Because the model notice lists the states that provide premium assistance, the DOL has said that an employer can meet its obligation by simply providing the notice to all employees, regardless of where they live."
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DOL Letter Addresses Status of Employer HSA Contributions Under Consumer Credit Protection Act "[DOL Opinion Letter CCPA2019-1] notes that contributions already in an HSA cannot be garnished by an employer. However, HSA contributions that are still in an employer’s possession (i.e., amounts that have not yet been paid to the HSA) could be included when calculating the CCPA’s limitations if they were earnings under the CCPA’s definition."
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Is There Anything Improper About Taking a Vacation During FMLA Leave? "Two recent court cases illustrate an employer’s dilemma when faced with hearing about an employee who is on FMLA leave and has taken a personal trip during the leave. As with most employment cases, the holdings are very fact specific, however these cases remind us of the importance of a thorough analysis when faced with an increasingly common abuse of policy."
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Congressional Committee Targets Private Equity Firms on Medical Billing Practices "Pointing to an increasing trend of private equity firms acquiring physician staffing companies and private emergency transportation companies contracting with hospitals, a key congressional committee announced a bipartisan investigation this week into the practices of private equity firms related to surprise billing."
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California Department of Managed Health Care Opposes AB 1249 "AB 1249 would authorize the Department to create two five-year pilot programs in which Department-approved providers may undertake risk-bearing arrangements with: [1] A voluntary employees' beneficiary association ('VEBA') with more than 100,000 lives, or [2] A trust fund that is a welfare plan and a multiemployer plan with more than 25,000 lives.... [T]he participating entities would be required to report to the Department data concerning cost savings and clinical patient outcomes compared to a fee-for-service payment model. Proposed arrangements would have to be authorized by May 1, 2020 in order to participate."
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DOL Reports 2018 Mental Health Parity Enforcement Activity "The DOL notes that while its global correction approach has resulted in fewer investigations than in previous years, those investigations have produced more impactful results. Also, because many investigations span more than a year and are reported only in the year in which they are closed, the 2018 report by itself does not provide a complete picture of the DOL's enforcement activity."
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Benefits in General |
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Situs of Benefit Plan's Signing May Be Key in Determining Class Action Forum "The Northern District of Washington ... ruled that the plaintiff's choice was less important because the case was a putative class action, meaning that it has not yet been certified by the court as a class. [The court gave] a fair amount of weight to the fact that the plan was negotiated and executed in Georgia, claiming these actions made for a 'considerable technical connection' to making the forum for the lawsuit Georgia. Further, choosing Georgia reduced litigation and travel costs on both sides." [Mayfield v. ACE American Ins. Co., No. 18-1695 (W.D. Wash. May 13, 2019)]
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Denial of Benefits Can Be an Abuse of Discretion in Discrete Circumstances, 9th Circuit Says "Recently, the Ninth Circuit Court of Appeals ... addressed a plan participant's claims of procedural irregularities and illustrated the difficulty that a plan participant may have in challenging an adverse denial of benefits decision. This decision is important in demonstrating how slight differences in the facts and circumstances of a participant's denial of benefits claim can result in potential liability and costly litigation for plan administrators.' [O'Rourke v. Northern California Electrical Workers Pension Plan, No. 17-17419 (9th Cir. Aug. 16, 2019)]
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Selected Discussions |
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VEBA Being Reorganized as 501(c)(3) Organization A client is interested in having their existing VEBA reorganized as a 501(c)(3) organization. Has anyone ever heard of this being done? Even assuming that the IRS would agree to grant this type of request, what are the pros and cons of going down this route?
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Press Releases |
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United States Ranks 18th for Retiree Wellbeing in 2019 Natixis Global Retirement Index
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HERO Announces Winners of 2019 Health and Well-Being Awards
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Most Popular Items in the Previous Issue |
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DOL Opinion Letter Addresses Wage Garnishment of Employer HSA Contributions
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BenefitsLink.com, Inc.
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Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager
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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