Health & Welfare Plans Newsletter

November 22, 2019

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Employers Are Affected by Latest Healthcare Transparency Rules

"For the self-insured employer, supporting and rolling out this level of transparency will be costly, with investments in new technology and communication plans to effectively launch the initiative with employees ... [T]he employer cost savings will be greatest prior to employees meeting their deductible or out of pocket spending. Once those milestones are reached, there is little incentive for employees to continue researching and shopping for care."

Tango Health

Group Benefits Testing Overview: There's Still Time for 2019

"If the test is done during the year and the failure is caught early enough, an employer can quickly make changes; communicate those changes to affected highly compensated employees and owners ... If the test is done retrospectively, you may need to re-characterize the 'discriminatory benefits' as taxable benefits or the plan risks losing its tax-favored status, and all plan participants lose the income tax exclusion."

Findley

How Common Is Out-of-Network Billing?

"In 2017, nationally: 16.5% of visits with emergency room services had an out-of-network claim from an emergency medicine specialist. 12.9% of visits with lab/pathology services had an out-of-network claim from a pathologist. 8.3% of visits with anesthesiology services had an out-of-network claim from an anesthesiologist.... Variation across states differs by type of service. Pathology and emergency services had the largest variation. Cardiovascular and surgery services had the the smallest variation."

Health Care Cost Institute

Signs Your Health Plan's Administrative Platform is Becoming Obsolete

"Plans that opt to patch together several point solutions -- for claims processing, risk adjustment, medical management and more -- take on the challenge of keeping all the pieces working in unison to support efficient plan operations and top-quality member care.... [H]ow do you know whether your platform is suited to support today's challenges, whether it's on the road to becoming obsolete or -- even worse -- already there? "

Evolent Health

Case Studies of Employer Healthcare Cost Control

"Employers across the country have increased their premiums to a point where finding a difference between a traditional PPO and a high deductible health plan (HDHP) is getting more and more difficult. So how do you manage those costs while still offering plans your employees will love?"

Benefitfocus

DOL Speeds Up Plans to Seek Comments on Improving the FMLA

"Earlier this year, the DOL estimated it would request information on this topic in April 2020. But in this fall's regulatory agenda ... the DOL said it may seek comments on improving the FMLA as soon as this month."

Society for Human Resource Management [SHRM]; membership may be required to view article

Comparison of CBO-Scored Surprise Billing Legislation

"In 2019, the Congressional Budget Office has released scores on four separate policy proposals related to surprise billing. An 'unofficial' score on a fifth proposal was leaked to press in September. This factsheet describes each of the proposals and its CBO score. The takeaway is that proposals that rely more heavily on arbitration to determine out-of-network provider payments save less, and relying on arbitration based on providers' billed charges actually increases costs for the government and consumers alike."

Families USA

[Opinion]

Some Reminders on How HIPAA Works

"[W]hat we have today is a set of privacy and security rules that work really well where they apply -- but that don't apply at all in an increasing range of situations where health information is collected, created and analyzed, including wearables, mobile applications, community and patient support groups, personal health records and a broad array of 'consumer directed' health care activities."

Wilmer Hale

Benefits in General

[Official Guidance]

Draft of IRS Publication 15-A: Employer's Supplemental Tax Guide, for Use in 2020 (PDF)

28 pages. Topics include: [1] Who are employees? [2] Employee or independent contractor? [3] Employees of exempt organizations. [4] Religious exemptions and special rules for ministers. [5] Wages and other compensation. [6] Sick pay reporting. [7] Pensions and annuities.

Internal Revenue Service [IRS]

[Official Guidance]

DOL Regulatory Agenda, Fall 2019

Prerule Stage (EBSA): "Open MEPs" and Other Issues Under Section 3(5) of ERISA.

Proposed Rules (EBSA):

  • Fiduciary Rule and Prohibited Transaction Exemptions
  • Grandfathered Group Health Plans and Grandfathered Group Health Insurance Coverage
  • Default Electronic Disclosures by Employee Pension Benefit Plans Under ERISA
  • Transparency in Coverage

Final Rules (EBSA): Adoption of Amended and Restated Voluntary Fiduciary Correction Program.

Prerule Stage (WHD): Request for Information: The Family and Medical Leave Act of 1993.

U.S. Department of Labor [DOL]

[Official Guidance]

IRS Regulatory Agenda, Fall 2019

Proposed Rules:

  • Further Guidance on the Application of Section 409A to Nonqualified Deferred Compensation Plans
  • Determination of Governmental Plan Status
  • Deferred Compensation Plans of State and Local Governments and Tax-Exempt Entities
  • Additional Rules Regarding Pension Plan Funding and Benefit Restrictions
  • Application of Section 409A to Nonqualified Deferred Compensation Plans
  • Collectively Bargained Welfare Benefit Funds
  • Guidance on Rules Applicable to IRAs Under Sections 408 and 408A
  • Spousal IRAs, SEPs and IRA Technical Changes
  • Reporting and Notice Requirements for Deferred Vested Benefits Under Section 6057
  • Requirements for Employee Stock Ownership Plans
  • Excise Tax on High Cost Employer-Sponsored Health Coverage
  • Minimum Vesting Standards
  • Rules Relating to Employer-Provided Meals and Employer-Operated Eating Facilities
  • Application of Nondiscrimination Requirements, Backloading Limitations, Certain Plan Termination Rules, Benefit Limitations, and Top Heavy Rules to Statutory Hybrid Plans
  • MEPs and the Unified Plan Rule
  • Section 4960 Excise Tax on Tax-Exempt Organization Compensation
  • Use of Actuarial Tables in Valuing Annuities, Interests for Life or Terms of Years, and Remainder or Reversionary Interests
  • Regulations Under Section 401(a)(9) Updating Life Expectancy and Distribution Period Tables for Purposes of the Required Minimum Distribution Rules
  • Health Reimbursement Arrangements and Other Account-Based Group Health Plans
  • Voluntary Employees' Beneficiary Association (VEBA) Regulations

Final Rules:

  • Reporting and Notice Requirements for Deferred Vested Benefits Under Section 6057
  • Regulations Explaining How to Compute Unrelated Business Taxable Income (UBTI) of Voluntary Employees' Beneficiary Associations (VEBAs)
  • Application of Normal Retirement Age Regulations to Governmental Plans
  • Health Insurance Providers Fee
  • Additional Rules Regarding Information Reporting of Minimum Essential Coverage
  • Withholding on Certain Retirement Plan Distributions Under Section 3405(a) and (b)

Internal Revenue Service [IRS]

Earnings and Employment Data for Workers Covered Under Social Security and Medicare, by State and County, 2017 (PDF)

461 pages. "In 2017, 173.0 million workers had earnings taxable under the Social Security program.... Social Security taxable earnings totaled $6.998 trillion ... In 2017, 177.0 million workers had earnings taxable under the Medicare program.... Medicare taxable earnings totaled $8.654 trillion. Medicare taxes totaled about $251 billion."

U.S. Social Security Administration [SSA]

Are You Periodically Benchmarking Your Group Benefits Plan?

"For those employers looking to target a more specific comparison, consider using e-surveys of key employers within your region or industry. This gets very specific and takes a bit longer. To garner cooperation/participation, your company would need to play a key role in reaching out to those targeted employers to encourage their participation, and in exchange, they would receive the results on a de-identified basis."

Findley

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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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