Health & Welfare Plans Newsletter

October 18, 2019

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Woodcliff Lake NJ

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[Guidance Overview]

New San Antonio Ordinance Headlines Heatwave of Texas PSL Developments

"On October 3, 2019, the San Antonio City Council adopted an amended PSL ordinance, now known as the Sick and Safe Leave Ordinance (SSLO). Despite a number of key differences between the SSLO and San Antonio's original paid sick leave ordinance, the new mandate similarly faces an uphill battle with ongoing local and statewide efforts to zap the Texas PSL bug. For the time being, the SSLO goes into effect on December 1, 2019 for all San Antonio employers."
Seyfarth Shaw LLP

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Editor's Pick 2019 End of Year Plan Sponsor 'To Do' List, Part 1: Health and Welfare Plans

"The repeal of the individual mandate had little impact on employer group health plans, although it spawned a significant case challenging the lawfulness of ACA.... As we await a ruling, ACA is still the law of the land and employers must continue to comply."
Snell & Wilmer

U.S. District Court Rules in Favor of Airline Flight Crew Employees on Paid Sick Leave Challenge

"On October 11, 2019, a federal judge ... ruled that Washington state's paid sick leave law does not violate the Constitution or federal preemption law, thereby guaranteeing sick leave benefits for airline flight crew employees based in Washington.... This is one of several recent lawsuits filed by airlines seeking an exemption from state and local sick leave laws. Two other suits challenging sick leave laws are currently pending in Massachusetts and New York. Presently, eleven states, the District of Columbia, and 22 localities have enacted paid sick leave laws." [Air Transport Assoc. of America v. Washington Dept. of Labor & Indus., No. 18-5092 (W.D. Wa. Oct. 11, 2019)]
FordHarrison

Employee Who Sang in Rock Band During FMLA Leave Can't Advance Retaliation Claim

"According to the court ... the evidence indicates that his employers 'honestly believed -- rightly or wrongly -- that an individual who was capable of screaming rock lyrics into a microphone in a bar until the small hours of the morning was capable of coming to work that day or the day before.' Thus, even if the employee could establish the prima facie case, he could not establish that the reason given for his termination was pretextual."  [Beishl v. County of Bucks, No. 18-2835 (E.D. Pa. Sep. 17, 2019)]
Wolters Kluwer; free registration required

'Open' Might Not Mean Open: How FMLA May Affect a Position's Availability

"An employer may run afoul of the FMLA by preemptively terminating an employee on FMLA leave even though it has a reasonable belief the employee will not return from leave. Circumstances could change during the protected FMLA period, and an employee could unexpectedly return to work. Filling that job as another employee’s ADA accommodation could cause trouble. The employer must know the employee is not returning or face potential liability." [Maxwell v. Washington County, No. 18-154 (N.D. Miss. Oct. 1, 1029)]
Bradley

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Participant Could Sue LTD Insurer Before Exhausting Administrative Remedies, District Court Says

"The U.S. District Court for the District of Arizona has ruled ... that a long-term disability plan participant need not exhaust an insurer's administrative remedies before suing in federal court, unless the insurance contract and other relevant communications specifically require such exhaustion." [Greiff v. Life Ins. Co. of North America, No. 18-496 (D. Ariz. Jul. 5, 2019)]
The Wagner Law Group

Higher Employer-Sponsored Healthcare Premiums Occur in Companies with a Predominantly Female Workforce

"[In] companies [with 50 or more employees] where women accounted for 75% or more of the workforce, ESI premiums averaged $7233 for single coverage, as opposed to $6400 in companies where women account for 25% of the workforce."
American Journal of Managed Care

GM Won't Raise Health Care Costs for UAW Members -- Employee Share Remains at 3%

"Most employer health plans are getting more expensive and less comprehensive. The UAW is ensuring GM's benefits stay comprehensive for workers -- a move that competing automakers Ford and Fiat Chrysler likely will adopt in their negotiations ... GM [had] wanted unionized workers to pay for 15% of their health care costs through premiums and deductibles, up from 3%, and it wanted to allow its pharmacy benefit manager, CVS Health, to exclude certain medications from its approved list of drugs."
Axios

Household Healthcare Spending Has Become Less Regressive

"[In 2005,] households in the bottom 20 percent of income paid 26.8 percent of their income, with the percentage declining for the top 1 percent of income to 13.8 percent.... [In] 2016, the incidence of health spending was similar across incomes, with the bottom 20 percent paying 22.6 percent of their income, compared to 21.4 percent for the top 1 percent[.]"
Health Affairs

Senator Predicts Congress Will Act on Surprise Billing Before End of Year

"Sen. Bill Cassidy, M.D. [R-LA] who has thrown his support behind one solution to the surprise billing problem, predicted Congress will pass legislation by year's end.... Congress is now debating two possible solutions. Both would make patients who receive such bills 'held harmless' so they only have to pay their portion of the bill they would have paid if everything was in-network. The debate is over how the out-of-network physicians will be paid."
FierceHealthcare

Physicians to Congress: Don't Let Surprise Billing Fix Hand Power to Insurers

"More than 100 physician organizations ... [urged Congress in an October 16 letter] not to turn more power over to health insurers.... Any law passed by Congress should hold patients harmless for any excessive costs but not hand over more market power to insurers, the groups said, advocating for an independent dispute resolution process rather than letting insurers establish a benchmark median rate for all out-of-network charges."
FierceHealthcare

Getzen Model of Long-Run Medical Cost Trends Update for Years 2020 to 2029+ (PDF)

11 pages. "The small increase in inflation and decline in technology factor offset each other, leaving the estimated nominal medical cost trend increases for 2029 and beyond at 5.2%, the same as in last year's update.... In addition to shifting local market conditions, actuaries should also consider additional national forces such as the continued cost shifting that has routinely caused private health insurance premiums to rise 1%-2% faster than average medical costs, a surge in pharmaceutical pricing and of course the impact of contemplated changes in state and federal legislation."
Society of Actuaries

[Opinion]

Air Ambulance Fees: Surprise Billing Policy and the Airline Deregulation Act

"It is critical to understand how air ambulances have become so lucrative, for their success reveals the core of the policy challenges that underlie other surprise bills. The air ambulance business model does not rely on a new technology or providing a valuable service; instead, it rests upon a carefully devised legal strategy that exploits the basic charge model in health care and then hides behind a legal loophole to prevent state policy makers from policing the industry."
Health Affairs

Benefits in General

[Official Guidance]

Text of Draft Instructions for 2020 IRS Forms 1099-R and 5498: Distributions from Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, Etc., and IRA Contribution Information (PDF)

26 pages. "File Form 1099-R ... for each person to whom you have made a designated distribution or are treated as having made a distribution of $10 or more from profit-sharing or retirement plans, any individual retirement arrangements (IRAs), annuities, pensions, insurance contracts, survivor income benefit plans, permanent and total disability payments under life insurance contracts, charitable gift annuities, etc. Also, report on Form 1099-R death benefit payments made by employers that are not made as part of a pension, profit-sharing, or retirement plan."
Internal Revenue Service [IRS]

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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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