Health & Welfare Plans Newsletter

November 4, 2019

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[Official Guidance]

Text of IRS Publication 5165 for Processing Year 2020: Guide for Electronically Filing ACA Information Returns for Software Developers and Transmitters (PDF)

71 pages; Oct. 2019. "[This publication] outlines the communication procedures, transmission formats, business rules and validation procedures for information returns transmitted electronically through the AIR System.... Software Developers, Transmitters, and Issuers should use the guidelines provided in this publication along with the Extensible Markup Language (XML) Schemas published on IRS.gov ... when the following information returns are transmitted electronically ... Form 1094-B, Transmittal of Health Coverage Information Returns; Form 1095-B, Health Coverage; Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns; Form 1095-C, Employer-Provided Health Insurance Offer and Coverage."
Internal Revenue Service [IRS]

[Guidance Overview]

New Federal Rule Could Impact Small Businesses Looking to Purchase Health Insurance for 2020

"Changes in 2020 include: User fee rate reduction ... New premium measures ...  Hardship flexibility ... More enrollment options ... Advanced payments."
National Association for the Self-Employed [NASE]

[Guidance Overview]

Extreme Couponing: How Manufacturer Coupons Impact Health Plans

"[C]onflicting rules could be read to require a plan administrator to credit coupons for brand-name drugs without a therapeutically equivalent generic drug available as required by HHS while simultaneously requiring a plan administrator not to credit coupons for brand-name drugs without a therapeutically equivalent generic available as required by the IRS.... [Recent] FAQs provide that the Departments intend to undertake rulemaking regarding the Notice and its possible implications for 2021. In the interim, the Departments will not initiate any enforcement action[.]"
Thompson Hine, via Lexology; free registration required

Study Shows Cost Shift Between Government and Private Payers

"Overall, employers were found to have paid 241% for inpatient costs and 293% for outpatient hospital services as compared with the reimbursement of the same providers by Medicare. These services account for about 44% of total spend for privately-insured medical care."
Frenkel Benefits

Senate Fails to Invalidate Section 1332 Guidance

"On October 30, 2019, the U.S. Senate failed to advance a resolution to invalidate the Trump administration's guidance on state innovation waivers under Section 1332 of the [ACA]. The guidance encourages states to more broadly reshape their state insurance markets and relaxes prior interpretations of Section 1332's 'guardrails.' It invites, among other options, the possibility for states to direct federal subsidies towards non-ACA plans."
Katie Keith, in Health Affairs

Supreme Court Will Hear Risk Corridors Case in December

"The Court’s decision will have a one-time effect on the bottom line of many insurers. But how the Court resolves this backward-looking dispute about a now-expired program will not meaningfully change how the Affordable Care Act or health insurance markets operate in the future." [Moda Health Plan v. U.S., Nos. 2017-1994, 2017-1224, 2017-2154, 2017-2395 (Fed. Cir. Nov. 6, 2018; cert. pet. granted Jun. 24, 2019)]
The Brookings Institution

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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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