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Pinnacle Plan Design, LLC
Tucson AZ / Telecommute

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Saint Louis MO / Edwardsville IL / Henderson KY

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[Official Guidance]

Text of 2019 Instructions for IRS Form 1095-A: Health Insurance Marketplace Statement (PDF)

"Form 1095-A is used to report certain information to the IRS about individuals who enroll in a qualified health plan through the Health Insurance Marketplace. Form 1095-A also is furnished to individuals to allow them to take the premium tax credit, to reconcile the credit on their returns with advance payments of the premium tax credit (advance credit payments), and to file an accurate tax return." [Also released: 2019 Form 1095-A]
Internal Revenue Service [IRS]

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[Guidance Overview]

Individual Coverage HRAs: Practicalities and Potential Pitfalls for Employers

"The chief advantage of offering an ICHRA as opposed to traditional employer-sponsored group health plan coverage is that it transfers much of the financial risk from the employer to the individual marketplace, thus allowing for more predictable costs for the employer from year to year ... Offering an ICHRA will also result in employers giving up nearly all control regarding the kinds of health benefits they offer to their employees."
Trucker Huss

[Guidance Overview]

HHS Proposes New Wellness Demonstration Projects

"To date, wellness programs have been limited to employers, but the [ACA] included a demonstration project to allow HHS and states to experiment with extending wellness programs to the individual market. States that are approved for a demonstration project could allow issuers in their individual market to vary the cost of coverage by as much as 30 percent because of, say, high blood pressure or high cholesterol. This could allow backdoor health status underwriting, which the ACA set out to prohibit."
Katie Keith, in Health Affairs

[Guidance Overview]

Massachusetts Employers Need to Gear Up for Health Plan Reporting

"Massachusetts requires residents to maintain MCC, and employers that provide qualifying health coverage to state residents must report certain data to the state and distribute employee notices. Employers offering health insurance to Massachusetts residents will want to confirm that the insurer will handle MCC reporting. Employers sponsoring self-insured plans for Massachusetts residents will want to verify that their third-party administrators (TPAs) will file the reports and may soon be asked to complete MCC attestation forms."

Ninth Circuit Enforces Hawaii Anti-Reimbursement Statutes Against Employer's Insured Plan

"[T]he Court ruled that the Hawaii statutes were saved from preemption because they were directed toward entities engaged in insurance and substantially affected the risk pooling arrangement between the insurer and the insured. In other words, the Hawaii statutes regulate the extent to which insurers may limit coverage and recover certain types of reimbursement and thus impact the eventual net value of any payment made to a plan member and create more risk for insurers.' [Rudel v. Hawai'i Management Alliance Association, No. 17-17395 (9th Cir. Sept. 11, 2019)]

Employees Dread Open Enrollment, Would Rather Talk About Their Weight Than Benefits

"[O]ne in five workers spend only a few minutes reviewing benefits offered by their employer before making a decision. The survey also revealed women are more likely to bring up their mental health with friends (26 percent) than discuss their finances (18 percent) or their employee benefits (20 percent)."
Wolters Kluwer; free registration required

Medicare Part D Notice Due October 14

"Employers must send employer-sponsored, health plan Medicare-eligible members a Medicare Part D Notice (Notice) notifying them whether their prescription drug (Rx) benefits qualify for coverage. The Notice is due before October 14, 2019. There have been no changes in the Model Part D Coverage Notice since last year -- thus you can use your 2018 Notice (although you will need to update your 2018 notice with corresponding 2019 dates)."

Benefits in General

Some Independent Contractors in California Will Become Employees

"The new law will reduce worker misclassification, 'which erodes basic worker protections like the minimum wage, paid sick days and health insurance benefits,' the governor said in his signing message.... The legislation codifies and expands the use of criteria established in the 2018 Dynamex [decision which] created a presumption that a worker who performs services for a hirer is an employee for wage and benefit claims under wage orders issued by the Industrial Commission."

Selected Discussions
on the BenefitsLink Message Boards

MEWAs and 'Statutory Employees' of Life Insurance Companies

The Code has a concept of a "statutory employee," which makes an otherwise non-common law employee an employee for employment tax (but not for income tax) purposes. These employees receive a W-2 with Box 13 checked. A common type of statutory employees are full-time life insurance salespersons. The Code also provides that a full-time life insurance salesperson is treated as an "employee" for purposes of participating in a qualified retirement plan and for Code Sections 104, 105, 106, 125, and certain other sections (which generally provide that an employer can provide welfare benefits on a tax-favored basis). ERISA generally subjects welfare plans that cover employees of two or more unrelated employers to state insurance law (among other things) because the plan is a MEWA. If an entity provides benefits to independent contractors, for example, it risks creating a MEWA. Question: Can a life insurance company offer welfare benefits to its full-time life insurance salespersons (i.e., ones who are statutory employees) without creating a MEWA?
BenefitsLink Message Boards

Form 1094-C Correction

Has anyone dealt with filing corrections for entities that filed Form 1095-Cs under the wrong entity? For example, entities A and B are part of the same controlled group. B pays this group of employees (and provides their Form W-2s), but their Form 1095-Cs were filed under entity A. This means that entity B has filed Form W-2s but no corresponding 1094-Cs or 1095-Cs, which is likely to trigger a letter from the IRS. 
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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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