Health & Welfare Plans Newsletter

October 9, 2019

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New Jersey State Individual Mandate: Employer Obligations and Filing Process

"New Jersey is requiring Applicable Large Employers to use IRS forms 1094-C and 1095-C (1095-B, and 1094-B if fully-insured) to communicate health insurance information to the state.... The instructions note that out-of-state employers that withhold and remit New Jersey Gross Income Tax for New Jersey residents have the same filing requirements as businesses located in New Jersey.... Employers will have to submit their state-level ACA reporting information by March 31, 2020[.]"
Tango Health

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Number of U.S. Organizations Offering Mental Health Coverage on the Rise

"Since 2014, there's been a 26% increase in organizations offering mental health coverage, with nearly 90% of organizations offering this benefit in 2019. This year, 21% of organizations reported it as one of their most costly conditions -- a 50% increase from 2014."
International Foundation of Employee Benefit Plans [IFEBP]

CMS Releases 2018 Medical Loss Ratio Data

"On October 4, CMS released new MLR data for the 2018 reporting year.... Overall, insurers owe rebates of more than $1.37 billion to nearly 9 million consumers. This represents an average of $154 in rebates per person. The rebates are most significant in the individual market, where insurers owe $769 million to an estimated 3.7 million consumers."
Katie Keith, in Health Affairs

How to Ensure That Tuition Reimbursement Doesn't Break the Bank

"[1] Consider a fixed annual dollar amount for reimbursement.... [2] Ensure that workers are attending classes that will directly improve their performance! ... [3] Use length-of-service requirements to determine eligibility ... [4] Make sure you are dedicating your dollars to high-performing employees by requiring the fulfillment of employee performance standards before course approval.... [5] Limit reimbursement to courses that lead to a degree ... [6] Use academic requirements for tuition reimbursement benefits.... [7] Implement payback provisions for workers who leave before their reimbursement requirements have been met."
International Foundation of Employee Benefit Plans [IFEBP]

Benefits in General

Attorney Fees Under ERISA Section 502(g)(1): An Exception to the American Rule

"ERISA Section 502(g)(1) vests courts with discretion to award attorney fees and costs in an action brought by a plan participant, beneficiary or fiduciary. This article examines the standards courts apply when assessing motions for these discretionary awards."
Law.com; free registration required

North Carolina Court Awards $41,000-Plus Penalty for Failure to Produce Documents Requested by Plan Participants

"The requested documents were ... produced in discovery some 748 days after the initial 30-day period had expired! ... The Court noted that the plaintiffs were substantially prejudiced by defendants' conduct because they were 'left in the dark' about the correct appeal process, and also noted that the 'failure to provide the requested documents frustrated plaintiffs' ability to litigate' their dispute due to the lack of essential facts contained in the requested documents." [Kinsinger v. SmartCore, LLC, No. 17-643 (W.D.N.C. Aug. 27, 2019)]
Jackson Lewis P.C.

Benefits Young Job Seekers Look for Today

"[1] Health insurance ... [2] Paid time off ... [3] Student loan forgiveness ... [4] Remote work ... [5] 401(k) matches ... [6] Tuition reimbursement ... [7] Pensions ... [8] Paid parental leave,"
Voya

Selected Discussions
on the BenefitsLink Message Boards

MLR Rebate on Marketplace Subsidized Policy

Taxpayer purchased 2018 health insurance policy from ACA Marketplace costing $1,000/month but qualified for advance payment of Premium Tax Credits of $600/month, which reduced his actual net premium to only $400/month. Insurance company failed to meet Medical Loss Ratio and sent Taxpayer an MLR rebate of $1,800 (15% of total gross premiums of $12,000). Doesn't seem right that the Taxpayer received 100% of the MLR rebate while he only paid 40% of the premiums. Anybody have an opinion on how this will shake out from a tax/PTC perspective?
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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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