Health & Welfare Plans Newsletter

October 1, 2019

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[Official Guidance]

Text of CMS Bulletin: Opportunity for States to Participate in a Wellness Program Demonstration Project to Implement Health-Contingent Wellness Programs in the Individual Market (PDF)

"[HHS] is publishing this bulletin to announce an opportunity for States to apply to participate in a wellness program demonstration project. Participating States may implement nondiscriminatory health-contingent wellness programs in the individual market ... This bulletin outlines the participation requirements; the criteria HHS, in consultation with the [DOL] and the [Treasury Department], will use to evaluate applications; instructions on application submissions and appeals; and potential future opportunities for additional States to apply."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Trump Administration Announces Opportunity for States to Participate in Wellness Program Demonstration Project

"Under this demonstration project, participating states ... will be able to develop innovative ideas to improve their residents' health by permitting issuers to offer premium cost savings or other incentives for people if they choose to engage in healthy activities and improve their health outcomes through 'health-contingent' wellness programs. While rewards may be offered to enrollees who meet certain health standards, participating states must ensure that a reasonable alternative is offered to people who cannot achieve the wellness program standard because of a medical condition, including a pre-existing condition."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

California Requires Employers to Give Notice of Certain FSA Withdrawal Deadlines

"The law appears to target FSAs requiring employees who terminate employment or otherwise lose FSA eligibility during the plan year to submit claims before the end of the plan year, say, with in 30 or 90 days of employment termination.... Presumably the largest potential downside will be an employee who later asks for a refund of unspent and forfeited funds if the appropriate notice was not provided. Employers in that situation will be between something of a rock and a hard place."
Lockton

[Guidance Overview]

District of Columbia Commuter Benefits Mandate: New Penalties, Fines

"Penalties and fines for non-compliance with Washington, D.C.’s law requiring D.C. employers to offer commuter benefits to their D.C. employees will take effect beginning on November 14, 2019. The law, which became effective on January 1, 2016, requires employers with at least 20 employees in D.C. to offer commuter benefits to their covered employees."
Jackson Lewis P.C.

[Guidance Overview]

Editor's Pick Agencies Ease ACA Rule on Drug Coupons and Out-of-Pocket Costs

"Despite the enforcement relief, employers using or considering copay accumulator programs need to evaluate several issues with counsel: [1] Risk of private litigation.... [2] [I]ssues under ERISA fiduciary and other rules.... [3] Implications of certain HSA-compatible HDHP designs.... [4] Impact of state laws that prohibit copay accumulators."
Mercer

[Guidance Overview]

DOL Advises: FMLA Leave Should Not Be Delayed, No Exception for Collective Bargaining Agreements

"[Opinion Letter FMLA2019-3-A] ultimately concluded that ... the employer could not delay the designation of FMLA-qualifying leave even if the employer is obligated to provide job protection and other benefits equal to or greater than those required by the FMLA pursuant to a CBA or state civil service rules, and must treat the employee's seniority accrual and status the same on FMLA leave that runs concurrently with CBA-protected accrued paid leave as it would if the employee took only protected accrued paid leave provided for by the CBA."
Epstein Becker Green

[Guidance Overview]

Withholdings to Fund Massachusetts Paid Family and Medical Leave Set to Begin October 1

"After an initial delay, payroll and wage withholdings to fund the Massachusetts paid family and medical leave program are set to begin on October 1.... Employers will contribute to the state created fund through a contribution of .75% of employee wages up to the social security cap, currently set at $132,900 per individual for 2019."
Jackson Lewis P.C.

Updates in Telemedicine and Mental Health Parity

"The mental health parity rules allow for differences in benefits between different tiers of network providers. Thus, it may be reasonable to treat the medical plan's network as one tier of provider and the telemedicine network as a separate tier with a different copay structure. But even then, the copay amounts within the telemedicine program for medical services and for mental health services will likely have to be the same."
Warner Norcross & Judd LLP

[Opinion]

What's the Purpose of Health Insurance?

"[E]mployers have battled to design benefits that make employees happy and politicians have tripped over each other trying to curry favor -- and votes -- by assuring us that, if elected, they will cure all our ills; that everything is someone else's fault and we're blameless. Healthcare system abuses and rising costs are not to be taken lightly, but Americans need to acknowledge that our own lifestyle choices have a tremendous effect on the system and our collective cost burden."
Frenkel Benefits

Benefits in General

[Guidance Overview]

California Legislation Sets New Test for Determining Independent Contractor Status (PDF)

"The consequences of worker reclassification from a benefits perspective are significant and wide-sweeping, as independent contractors who are reclassified as employees may be entitled to retroactive benefits under all benefit plans that they would have been eligible for had they been properly classified as employees originally.... Employers [should] be cautious about simply adding independent contractors to benefit plans rather than determining whether they are, in fact, employees. While this may seem a simple solution to the situation, it could create more problems for the employer."
Boutwell Fay LLP

Selected Discussions
on the BenefitsLink Message Boards

Extensions for Form 5500 Are Being Denied

Has anyone else had their Form 5500 extensions denied? Two clients contacted us this week regarding letters they just received from the IRS saying their extension was denied. One client has two plans; one extension request was approved and the other plan's request was denied. I have never seen this happen before.
BenefitsLink Message Boards

Press Releases

Hansen Takes on New Role as PSCA Executive Director
PSCA [Plan Sponsor Council of America]

Most Popular Items in the Previous Issue

FBI Intelligence Bulletin Outlines Methods Used to Commit Fraud Against HSAs
Employers Council on Flexible Compensation [ECFC]

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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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