Health & Welfare Plans Newsletter

November 21, 2019

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[Guidance Overview]

CMS Issues Controversial Health Care Pricing and Insurance Coverage Transparency Rules

"[T]hese new regulations come with potentially new antitrust risks.... If the rules survive legal challenges, their impact on health care costs remains to be seen.... [T]he Massachusetts Office of the Attorney General recently reported that Massachusetts's online cost estimators intended to increase transparency 'have had a limited impact on patient selection of high-value health care options.' "

Pepper Hamilton LLP

[Guidance Overview]

Paid Family and Medical Leave Is Coming to Connecticut

"[On] January 1, 2022, the then-current Connecticut FMLA will be more closely aligned with the federal FMLA  ... [1] What are the reasons an employee will be able to take paid leave? ... [2] How much pay will an employee on leave receive? ... [3] Who will pay for the leave? ... [4] Can an employer opt out of the requirements of the act? ... [5] Can an employee be required to use paid leave concurrently? ... [6] What are the employer's requirements to provide notice to employees regarding the Connecticut FMLA? ... [7] Is there a private right of action?"

Epstein Becker Green

[Guidance Overview]

CMS Finalizes Hospital Price Transparency Rule and Proposes New Transparency Requirements for Health Plans

"CMS is proposing to require most group health plans, including self-insured plans, and health insurance issuers to disclose price and cost-sharing information to participants. The proposals would require plan participants to be able to access real-time, personalized cost-sharing information, including an estimate of their cost-sharing liability for all covered health care items and services through an online tool or paper format.... CMS has also proposed to allow health plans that share with consumers savings that result from consumers shopping for lower-cost services to take credit for such 'shared savings' payments in issuers' medical loss ratio (MLR) calculations. "

K&L Gates

[Guidance Overview]

Medicare Secondary Payer Reporting Required for Prescription Drug Coverage Beginning in 2020

"Beginning next year, group health plans (GHPs), including Medicare Secondary Payers, are required to follow the 'Substance Use - Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities' (SUPPORT Act) rules on reporting on prescription drugs and coverage. Current group health plan (GHP) reporting requirements are focused on exchanging drug coverage information in order to coordinate benefits under Medicare Part D."

Hall Benefits Law

D.C. Circuit Judges Hear Oral Arguments in Association Health Plans Case

"Based on the arguments and the questions asked by the judges, it seems the decision may leave the most important issues in the case undecided. That is, how will AHPs that include small groups or individuals be regulated under the [ACA] -- should they be governed under the lenient rules that apply to large-group plans or under the more protective rules that apply to individuals and small groups? In addition, how will growth in AHPs affect premiums for small groups and individuals not covered by AHPs?" [State of New York v. U.S. Dept. of Labor, No. 18-1747 (D.D.C. Mar. 28, 2019; notice of appeal filed by DOL Apr. 26, 2019; oral arg. Nov. 14, 2019; audio recording)]

Timothy Jost, via The Commonwealth Fund

Trends in Employer Health Care Coverage, 2008-2018

"Average annual growth in the combined cost of employees’ contributions to premiums and deductibles outpaced growth in U.S. median income between 2008 and 2018 in every state. Middle-income workers spent an average 6.8 percent of income on employer premium contributions in 2018; per-person deductibles across single and family plans amounted to 4.7 percent of median income."

The Commonwealth Fund

IRS Releases Draft 2019 Forms 1094 and 1095 and Related Instructions

"Few changes are proposed for 2019. Both sets of instructions have deleted statements that the IRS needs coverage information to determine whether individuals are liable for an individual shared responsibility penalty.... The Plan Start Month box will still be optional on Form 1095-C for 2019, and the multiemployer plan interim guidance will still apply -- but the IRS continues to warn that these provisions may change in the future."

Thomson Reuters / EBIA

Benefits in General

[Guidance Overview]

The Future of Retirement Plan Disclosures?

"Currently, plan sponsors can rely on a 2002 safe harbor for electronic delivery of documents and other information required under ERISA. However, the 2002 safe harbor is limited ... [P]lan sponsors may not rely on the proposed rule. Therefore, no changes should be made to current distribution procedures based on the new electronic disclosure rules at this time. [T]he proposed rule only applies to retirement plans -- so welfare plan disclosures (such as COBRA notices) would remain subject to the 2002 safe harbor."

Drinker Biddle

Planning for 2020: Year-End Deadlines and Considerations for Employee Retirement, Health and Welfare Plans

"As the end of the year approaches, employers should be aware of important year-end deadlines and considerations related to their retirement and health and welfare plans. [The authors] have compiled a list of these deadlines and provide guidance on how to comply with recent plan changes."

Husch Blackwell

Health and Pension Benefits for United Mine Workers of America Retirees: Recent Legislation

"Eligible UMWA members receive postretirement health and pension benefits from one of three multiemployer health benefit plans and one multiemployer pension plan. ...  Legislation in the 116th Congress would expand the eligibility for retiree health plans to receive federal transfers and authorize federal transfers to the UWMA pension plan."

Congressional Research Service [CRS]

Press Releases

DOL Obtains Consent Order and Judgment to Restore Assets to Participants in Ohio Employee Benefit Plans
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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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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