Health & Welfare Plans Newsletter

October 23, 2019

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[Guidance Overview]

Editor's Pick Gene Testing as an Out-of-Pocket Expense

"[T]he genetic test provided both ancestry-related information and health information. [Private Letter Ruling 201933005 states that] only the health information portion could be reimbursed from the Health FSA.... [T]he taxpayer had to allocate the total cost of the test between the health services and the ancestry services ... [using] 'a reasonable method' to value the health information services."
HUB International

[Sponsored]

Join Us in Clearwater Beach, Florida This January!

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

HBCE has been a leading source for employee health benefits and wellness education for nearly 30 years. Attend this premier conference to learn the best ways to reduce costs while improving employee engagement. Register by December 19, 2019 to save! Learn more


More States Approve 'Pathway 2' Association Health Plans

"New state laws allow small employers to form 'Pathway 2' association health plans (AHPs) in Arizona, Florida and North Carolina. However, all three measures rely on a 2018 AHP rule, which a federal court ruling struck down earlier this year ... Other states are considering whether to enact the similar legislation, although some -- like Virginia -- may reject efforts to allow Pathway 2 AHPs."
Mercer

Employer Plans Aren't Embracing Narrow Networks

"Narrow networks aren't popular in health insurance plans, at least not when employers are covering much of the costs. But what about 'a curated network?' That's the pitch from a relatively new insurance company, which says payers could save 20% on total expenses by using a smaller group of providers and a range of telehealth options."
The Dallas Morning News

Open Enrollment Period Is Coming: New Premium Data From CMS

"Overall, premiums are expected to drop by [4] percent for a 27-year old for a silver benchmark marketplace plan sold through HealthCare.gov. The (unsubsidized) average benchmark plan premium for a 27-year old will be $388/month for 2020.... In six states -- three of which adopted a state-based reinsurance program for 2020 -- silver benchmark premiums will decline by double-digits."
Katie Keith, in Health Affairs

Second Circuit Holds Breach of Contract Claims for Retiree Medical Coverage Not Preempted by ERISA

"The retirees claimed that they were entitled to continued medical coverage based on their employment and separation agreements.... The Court found that [the contractual claims] ... derive from a separate promise to confer a benefit to which the retirees were not otherwise entitled, which is the right to parity with active officers. Because the contractual claims are not grounded upon obligations in the medical plan, they are not preempted by ERISA. " [Abernethy v. EmblemHealth, Inc., No. 19-422 (2d Cir. Oct. 21, 2019)]
Kantor & Kantor

[Sponsored]

2020 Onsite Employee Health Clinics Forum (January 23-24; Phoenix, AZ)

Sponsored by World Conference Forum

The leading forum on building & expanding on-site health clinics -- incorporating strategies that reduce costs, ensure employee satisfaction and positively impact patient behavior. Learn more


Failure to Follow Notification Rule Was Not Fatal to FMLA Claim

"The employee had notified her supervisor, but not HR, of her need to take leave. The court held that an employer may not delay or deny FMLA leave when unusual circumstances justify the employee's failure to comply with the notice requirements." [Moore v. GPS Hospitality Partners IV, LLC, No. 17-500 (S.D. Ala. Jun. 3, 2019)]
Society for Human Resource Management [SHRM]; membership may be required to view article

Benefits in General

ERISA Preemption: Courts of Appeal Continue to Rule as They Await Further Supreme Court Attempts to Define, Once and for All, Its Limiting Principles

"Two Courts of Appeal reach opposite results on ERISA preemption ... These two cases show how the courts continue to grapple with the nearly infinite nuances of ERISA's remarkably broad preemption provision. Given the historic interest of the Supreme Court on ERISA preemption, it is likely only a matter of time until this or a related ERISA preemption question is again before that Court."
Seyfarth Shaw LLP

Selected Discussions
on the BenefitsLink Message Boards

Archaeologists Unearth Unamended 20-Year Old Cafeteria Plan Document

Wheee... just got an e-mail from someone who had adopted a Section 125 plan approximately 20 years ago. Never amended or updated since then. What happens if they don't do anything? I'm not even sure where to start to determine what 'required' changes/amendments etc. would have been missed, and when.
BenefitsLink Message Boards

Paying Ex-Wife for Child's Medical Support Using a Health Savings Account

I have joint custody with my ex-wife of our 13 year-old child. She pays for the child's medical expenses with her husband's FSA. Under my support order, I am required to reimburse her 65%. I reimburse her with my HSA account. My question is whether this is a qualifying expense for my HSA.
BenefitsLink Message Boards

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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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