Health & Welfare Plans Newsletter

October 30, 2019

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[Guidance Overview]

New HRA Regulations: More on the Employer Shared Responsibility Mandate

"The key stumbling block to ACA compliance in this area is in determining whether the ICHRA coverage provided is 'affordable' for ACA purposes. This is an extraordinarily complex undertaking. To help solve that problem, therefore, the proposed regulations include several safe harbor methods of compliance, such as a location-based safe harbor, a lookback safe harbor and a general affordability safe harbor."
Proskauer

[Guidance Overview]

California's New FSA Claims Submission Deadline Notice Requirement

"[T]here is speculation ... based on the legislative history whether the notice requirement is actually intended to apply to any claims submission deadline -- regardless of whether it occurs before the end of the plan year.... [T]he bill's author takes this position.... [The authors] reached out to Assemblywoman Gonzalez's office to discuss a number of the bill's unclear provisions."
ABD Insurance & Financial Services

[Guidance Overview]

Notifying California Employees of the Deadline for Using Flexible Spending Account Funds

"In preparing to meet this new requirement, public agencies should know the exact deadlines applicable to their flexible spending accounts in order to provide proper notice to employees. The tricky part in determining the deadline is that the exact deadline depends on the employer's own flexible spending account structure, the employer's Section 125 cafeteria plan document, and various options the employer may have chosen."
Liebert Cassidy Whitmore

Falsified FMLA Forms Torpedo Retaliation Claims

"[A]ccusations of falsified FMLA documents are serious. Here, the County of Maui had Straub dead-to-rights on his wrongful conduct through the testimony of Dr. Nizam and Ms. Straub. Before taking action against an employee based upon falsified FMLA certifications, make sure your evidence is equally strong." [Straub v. County of Maui, No. 17-00516 (D. Hi. Sep. 24, 2019)]
McAfee & Taft

Roundup of Selected State Health Developments, Third Quarter 2019

"Employer reporting for state or local individual health coverage mandates drew regulatory action in Massachusetts, New Jersey, and Washington, DC, during the third quarter of 2019. Other health coverage initiatives receiving attention included San Francisco's updated Health Care Expenditure (HCE), a new Florida association health plan (AHP) law, and Vermont's assessments for 'uncovered' employees.... States remained active in expanding telehealth, revising insurance laws, and enhancing leave rights."
Mercer

[Opinion]

Can States Fill the Gap If the Federal Government Overturns Preexisting Condition Protections?

"[B]efore the ACA, state efforts to require insurers to cover people with preexisting conditions resulted in large premium spikes and, in some cases, caused insurers to exit the market. The ACA's premium subsidies have had a critical stabilizing effect. If those subsidies are invalidated, states will have a hard time restoring them with state dollars."
The Commonwealth Fund

Selected Discussions
on the BenefitsLink Message Boards

Can Fund Be Bound by CBA to Provide Claims Information to Contributing Employer?

"Under a multiemployer health and welfare plan, an employer and a local union enter into a collective bargaining agreement which includes a provision that permits the employer to request detailed claims information (which has been sanitized of HIPAA-protected health information) from the fund. The fund is not a signatory to the collective bargaining agreement but later an individual who is both a local union officer and a union trustee for the fund signs in both capacities assenting to the preceding terms, including the portion of the CBA allowing the employer to request detailed claims information. Does the signature on a letter by an individual who is both a local union officer and a union trustee for the fund in both capacities bind the fund to comply with the employer's request for detailed claims information?"
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Press Releases

Most Popular Items in the Previous Issue

FAQs: Health Insurance Marketplace and the ACA
Henry J. Kaiser Family Foundation

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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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