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[Official Guidance]

Text of IRS Proposed Regs: Application of the Employer Shared Responsibility Provisions and Certain Nondiscrimination Rules to HRAs and Other Account-Based Group Health Plans Integrated with Individual Health Insurance Coverage or Medicare

70 pages. "This document sets forth proposed regulations to clarify the application of the employer shared responsibility provisions and certain nondiscrimination rules under the Internal Revenue Code to health reimbursement arrangements (HRAs) and other account-based group health plans integrated with individual health insurance coverage or Medicare (individual coverage HRAs), and to provide certain safe harbors with respect to the application of those provisions to individual coverage HRAs. The proposed regulations are intended to facilitate the adoption of individual coverage HRAs by employers, and taxpayers generally are permitted to rely on the proposed regulations. The proposed regulations would affect employers, employees and their family members, and plan sponsors"
Internal Revenue Service [IRS]

[Guidance Overview]

Federal Agencies Issue Guidance and Report on Enforcement of Mental Health Parity and Addiction Equity Act (PDF)

"The FAQ guidance and other materials issued by the Departments signal an ongoing commitment to vigorously enforce the requirements of MHPAEA. The FAQs provide insight into how the Departments compare [non-quantitative treatment limits (NQTLs)] applied to [mental health/substance use disorder (MH/SUD)] benefits with comparable limits on medical benefits."
Segal Consulting

[Guidance Overview]

Preparing for Duluth, Minnesota's Sick and Safe Time Ordinance, Effective January 1, 2020

"Duluth's Ordinance differs from both Minneapolis and St. Paul's ordinances, complicating the web of local laws employers must track and follow and setting a potential trap for employers. The City of Duluth's Ordinance applies to employers with at least five employees, regardless of whether those employees work in Duluth. Employees of covered employers are entitled to sick and safe time if they spend more than 50 percent of their working time in the City of Duluth's geographical limits."
Jackson Lewis P.C.

[Guidance Overview]

Editor's Pick How Health Reimbursement Agreements (HRAs) Help Employers Expand Coverage Options for Their Employees

"[CMS has] designed a downloadable tool [XLSM file] to help employers decide whether to offer an individual coverage HRA.... The tool provides specific rate information for the least expensive plan in a certain category (the 'lowest cost silver plan') based on an eligible employee's age and geography. Employers can use this tool in deciding the funding level for an individual coverage HRA.... [L]arge employers ... can use this tool to determine whether their offer of coverage through an individual coverage HRA would be considered affordable based on standards established in the new HRA rules."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

California District Court Deems Independent Review Organization Functional Health Plan ERISA Fiduciary

"The plan ... had a clause that guaranteed coverage for medically necessary treatment, but nowhere in the plan did it define 'medical necessity.' Due to this vagueness, the court concluded that [independent medical review (IMR) organization] had discretion in reaching its determination of medical necessity of treatment for the plaintiff's daughter. This discretionary authority established them as a functional fiduciary.' [Josef K. v. California Physicians' Service, No. 18-6385 (N.D. Cal. June 3, 2019)]
Hall Benefits Law

Are the DOL's Proposed New FMLA Forms Just Another Version of Hamburger Helper?

"What's GOOD about the forms? [1] Font size is larger ... [2] There definitely are more boxes for ease of use, and streamlining can be good.... [3] [T]he new forms appear to do a better job at requiring that the physician provide substantive information about future treatment ... What are the CHALLENGES with the forms? ... [1] If the physician simply checks a box associated with one of the serious health conditions presented, it is possible that the actual medical facts supporting the need for leave are never addressed in the form.... [2] At times, the medical certification form can be a bit confusing."
FMLA Insights

Why Businesses Should Understand Voluntary Benefits in the Workplace

"[C]ritical to the success of any voluntary program is not only bringing a good set of quality products from a reputable and financially strong provider to the workplace, but also complementing them with employee education, easily accessible enrollment tools, and resources and guidance to help employees decide which benefits are right for them."

Incentivizing Corporate Wellness

"A holistic wellness program that examines a number of areas helps to address the root cause of health problems rather than just the symptoms. For example, many employers may offer stress management programs leading to less workplace friction, but in the long-term additionally reduce hypertension and heart disease. A holistic and comprehensive program with an eye to the long game helps your staff address improved performance and overall wellbeing."
United Benefit Advisors

Editor's Pick Texas v. U.S.: Some Possible Consequences of the ACA Constitutionality Challenge Pending in the Fifth Circuit

"A decision in ... the case challenging the constitutionality of the [ACA] is expected at any time. [The authors] have outlined a short summary of the litigation, sketched out a possible timeline and offered [their] thoughts on a handful of frequently asked questions."
Groom Law Group

Benefits in General

Senate Confirms Eugene Scalia as Labor Secretary

"The Senate on [September 26] confirmed Eugene Scalia to succeed Alex Acosta, the labor secretary who resigned in July ... Scalia is a partner at the Washington law firm Gibson Dunn, where he has represented companies such as Walmart, Ford and UPS in workers rights claims. He is also the son of the late Supreme Court justice Antonin Scalia."
The Washington Post; subscription may be required

2019 Employer Approaches to Financial Wellbeing Solutions

"More than half [of surveyed employers] reported currently offering financial wellness initiatives to employees (51 percent). Another 20 percent were actively implementing and 29 percent were interested in implementing such initiatives.... There was little consensus on what financial wellbeing looks like.... A third (34 percent) of employers reported either currently offering student loan debt assistance (11 percent) or planning to offer (24 percent) such initiatives."
Employee Benefit Research Institute [EBRI]

Employment of People Ages 55 to 79

"After declining for decades, the share of people in the United States ages 55 to 79 who were employed began to increase in the mid-1990s: In 1995, 33 percent of people in that age range worked, but by 2018, 44 percent did.... The changes in employment of people ages 55 to 79 -- the period during which many people stop working -- were related to changes in their demographic characteristics and the jobs they held, as well as to changes in Social Security."
Congressional Budget Office [CBO]

Press Releases

Most Popular Items in the Previous Issue

2019 Employer Health Benefits Survey
Henry J. Kaiser Family Foundation, Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
(407) 644-4146

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, 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, 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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