Health & Welfare Plans Newsletter

October 11, 2019

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[Guidance Overview]

Must an Employer Allow Leave for Domestic Abuse Affecting an Employee's Family Member?

"Various parts of the U.S. have enacted laws that provide employees leave to address domestic violence, such as to attend court hearings, obtain restraining orders, seek counseling, or avail themselves of other victims' services. Sometimes these laws provide leave for employees who are assisting members of their family or household with abuse-related issues [and] some of the laws extend beyond leaves of absence, requiring that employers provide other types of accommodations to victims of domestic violence.... [S]tate and local laws differ, and there is no federal, one-size-fits-all approach."
Littler

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[Guidance Overview]

Medicare Part D Notices Must Be Provided to Medicare-Enrolled Participants by October 15

"Federal guidelines require that, when this notice is combined with other plan materials, it must be 'conspicuous' and there must be a text box at the top of the materials, in 14-point font, explaining that the Medicare Part D creditable/noncreditable coverage notice is included. Many employers choose to place this notice on the top of an annual notice packet to meet this formatting requirement."
Lockton

[Guidance Overview]

IRS Issues Guidance to Clarify Health Reimbursement Arrangement Rules

"An ICHRA is an HRA integrated with individual health insurance coverage or Medicare. Beginning on January 1, 2020, employers can provide ICHRAs that employees can use to purchase individual health insurance coverage.... The proposed regulations clarify that an offer made by an ALE to a full-time employee to participate in an ICHRA will be treated as an offer of minimum essential coverage (MEC) for purposes of avoiding the penalty under Code Section 4980H(a).... The proposed regulations also explain that an employer can avoid the employer shared responsibility penalty under Code Section 4980H(b) by using ICHRAs that are considered 'affordable' and provide minimum value."
The Wagner Law Group

Municipality's Mandatory Wage and Benefit Ordinance Not Preempted by ERISA

"Voters in Oakland approved an ordinance with a provision that required hotel operators to pay employees a minimum hourly wage of $15 with health benefits, or $20 without health benefits.... The court held that the provision was not preempted by ERISA and dismissed the claim. It found that an ERISA plan was not essential to the provision's operation because a hotel employer could simply pay employees an additional $5 per hour to ensure compliance." [Calif. Hotels and Lodging Ass'n. v. City of Oakland, No. 19-1232 (N.D. Cal. Jun. 26, 2019)]
Thomson Reuters / EBIA

Ninth Circuit Enforces Hawaii Anti-Reimbursement Statutes Against Insured Plan

"While the Ninth Circuit's decision reminds us that fully-insured plans have to comply with state insurance laws, including anti-reimbursement statutes, it should not be forgotten that state insurance laws apply only to fully-insured plans. ERISA's broad preemption provision continues to apply for self-insured plans." [Rudel v. Hawai'i Management Alliance Association, Nos. 17-17395, 17-17460 (9th Cir. Sept. 11, 2019)]
Proskauer Rose LLP

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When Must a Non-Grandfathered Group Health Plan Comply with Changes to the Preventive Services Requirement?

"Since compliance is generally required for plan years beginning one year or later after the recommendation or guideline is issued, there will be an interval of at least a year between the date on which a recommendation or guideline is issued and the date on which your plan must cover the services listed in that recommendation or guideline without cost-sharing. For example, if a recommendation is adopted on July 1, 2019, your calendar-year group health plan would be required to cover those services beginning January 1, 2021."
Thomson Reuters / EBIA

Gauging the Risk and Rewards of a Benefits Captive Plan

"Overcoming the complexity and ensuring you're right for a captive can pay off. One captive for private schools has seen single-digit increases of 6% to 7%, compared to the market trends of 10% to 12%.... The ideal company is between 50 and 200 lives, financially stable with a strategy for health risk management and wellness. The right company is also willing to commit and take a long-term view of a captive -- many arrangements require a three-year commitment."
Watko Benefit Group

Congress 'Very Close' to Passing Paid Family Leave for Federal Employees

"Union officials and members are hopeful a Defense policy bill provision providing 12 weeks of paid leave for the birth or adoption of a child and other medical issues will make it into law."
Government Executive

Certain Types of Parent-Teacher Talks Qualify for FMLA Leave, Says DOL

"While the Opinion Letter was examining a specific set of circumstances -- namely, [Committee on Special Education (CSE)] meetings -- the DOL noted its analysis would apply to 'any meeting held pursuant to the IDEA, and any applicable state or local law, regardless of the term used for such meeting.' It also said a doctor did not need to be present for the meeting to qualify for FMLA leave. If the CSE meeting's purpose is to allow the employee to [1] make medical decisions about a child's serious health condition, [2] discuss the child's progress, or [3] ensure the environment is suitable for his needs, then the FMLA may cover it."
HR Daily Advisor

How Will the Medicare Part D Benefit Change Under Current Law and Leading Proposals?

"[P]olicymakers have expressed concerns about the absence of a hard cap on out-of-pocket spending for Part D enrollees, the significant increase in Medicare spending for enrollees with high drug costs, and the relatively weak financial incentives faced by Part D plan sponsors to control high drug costs.... This brief describes how the Medicare Part D benefit will change in 2020 under current law and proposed changes that would affect what beneficiaries, plans, manufacturers, and Medicare pay for drug costs under Part D in the future."
Henry J. Kaiser Family Foundation

Press Releases

Most Popular Items in the Previous Issue

Medical Stop-Loss Premium Survey (PDF)
AEGIS Risk and International Society of Certified Employee Benefit Specialists [ISCEBS]

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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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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