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December 3, 2019 logo logo
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[Guidance Overview]

Proposed Transparency in Health Coverage Rule: Potential Implications for Self-Insured Health Plans

"The Cost Sharing Disclosure would mandate that Plans ... provide Participants with a clear estimate of their cost-sharing liability for covered items or services.... [T]he public disclosure of provider rate data may allow self-insured plans to compare their network rates to those offered to similarly situated plans in the same network and across competing network providers.... Note that the proposed rule would allow Plans to delegate responsibility and liability for Cost Sharing Disclosures to third parties, such as the Plan's TPA or ASO provider. While Plans may also delegate responsibility for Rate Disclosures to a third party, the Plan would still be responsible for any liability associated with non-compliance. "

Eversheds Sutherland


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[Guidance Overview]

Another Year, Another ACA Reporting Extension

"New this year, the IRS is giving coverage providers (like insurance carriers) a limited pass on providing the 1095-B statements to individuals (filing with the IRS is still required).... To qualify for the relief, the coverage provider has to post a notice on its website that the form is available on request. It also has to provide the form within 30 days of a request. Notably, this relief does not apply to self-funded employers who report coverage taken by full-time employees on Part III of the Form 1095-C."

HUB International

[Guidance Overview]

IRS Releases Annual Transition Relief Notice for ACA Reporting with a New Twist

"Notice 2019-63 provided new transition relief for entities supplying the Form 1095-B to individuals and, in certain very limited circumstances, for self-insured employers providing the Form 1095-C to individuals.... [T]he IRS will not assess a penalty under IRC section 6722 against an entity for not furnishing a Form 1095-B to an individual so long as ... two conditions are satisfied ... [T]he transition relief provision was not extended to IRC section 6056 reporting (i.e., the Form 1095-C)."


[Guidance Overview]

IRS Extends ACA Reporting Deadline and Issues Transition Relief

"Those that do not file by the new deadlines have a more uphill battle to avoid penalties under Code Sections 6721 and 6722. In that case, the IRS would apply a reasonable cause analysis when determining the penalty amount for a late filer.... [T]his analysis will take into account such things as whether reasonable efforts were made to prepare for filing ... and the extent to which the filer is taking steps to ensure that it can comply with the reporting requirements for 2019."


[Guidance Overview]

IRS Plays Not-So-Secret Santa, Offers Delay for Supplying 1095-Cs to Employees

"The delay is automatic and does not depend on the employer or insurer asking for an extension. The delay does not apply to the deadlines to file ACA reporting forms with the IRS.... As additional good news, the IRS said it will continue to apply to 2019 filings the same 'good faith' approach to employer ACA filings that applied to filings for the 2015 through 2018 calendar years. "


[Guidance Overview]

The Massachusetts Paid Family Leave Self-Funded Private Plan Exemption: What We Know Now

"In order to establish a private plan, an employer must apply annually to the Massachusetts Department of Paid Family and Medical Leave (the 'Department') for an exemption. An application must be submitted to the Department in advance of the quarter for which the employer is seeking exemption, although for the quarter covering October 1 - December 31, 2019 only, employers have until December 20, 2019 to apply.... Although somewhat opaque at first, the self-funded private plan application process has solidified over the past weeks[.]"


Editor's Pick Transamerica Annual U.S. Employer Health Care Survey: Employer-Based Health Coverage Strong, With Affordability Concerns

119 presentation slides. "More companies report providing benefits to part-time employees than ever before.... A majority of companies that provide healthcare benefits (55%) offer at least three health plans, most commonly a PPO and increasingly an HMO.... More than three in four employers (76%) made no changes to healthcare benefits in the past 12 months.... Three in five (62%) employers expect positive changes to health benefits in the next 1-2 years."

Transamerica Center for Health Studies

Pathways to Affordable Health Coverage for Low-Income Workers

"[A]llowing workers to choose subsidized Marketplace coverage over their employer's plan would make an estimated 2.7 million more people (9 percent of the uninsured population) eligible for affordable coverage. This option would promote equity among working families by giving low-income employees access to the premium and cost-sharing assistance available to people without offers of employer coverage."

Health Affairs

Benefits in General

Beware of the 'Overshare': Construe Requests for ERISA Plan Documents Narrowly!

"Administrators of ERISA plans frequently receive requests from participants, beneficiaries, and their representatives for plan-related documents. A recent decision from the Court of Appeals for the Fifth Circuit supports providing only those documents that fall under a narrow reading of ERISA Section 104(b)(4). Over-production could serve to facilitate litigation." [Theriot v. Building Trades United Pension Trust Fund, No. 18-10250 (E.D. La. Nov. 4, 2019)]


DOL Inspector General Semiannual Report to Congress (PDF)

104 pages. "Legislative changes to [ERISA] and criminal penalties for ERISA violations would enhance the protection of assets in pension plans. To this end, the OIG recommends the following legislative actions: [1] Repeal ERISA's limited-scope audit exemption.... [2] Expand the authority of [EBSA] to correct substandard benefit plan audits and ensure that auditors with poor records do not perform additional plan audits.... [3] Require direct reporting of ERISA violations to DOL.... [4] Strengthen criminal penalties in Title 18 of the U.S. Code."

Office of Inspector General, U.S. Department of Labor [DOL]

MassMutual Workplace Financial Wellness Study (PDF)

16 data-rich presentation slides. "Eight in ten plan sponsors believe their employees are struggling financially, and often in ways that are not addressed by their current benefits offering.... Plan sponsors are aware of such challenges because they hear their employees talking about them, they see lower retirement plan participation than they would like to see, their employees are taking on second jobs, or taking loans from their retirement plans. Nearly six in ten plan sponsors believe their employees are looking to them, their employer, for support."


Selected Discussions
on the BenefitsLink Message Boards

Cafeteria Plans 'Restart' Every Year?

"I was doing a little digging on a cafeteria plan issue and I came upon this paragraph: 'While cafeteria plans have much in common with their qualified retirement plan counterparts...there are significant differences. For example, failure to correct an administrative error in a qualified retirement plan could result in taxation of all future (otherwise deferred) benefits as well as a loss of exemption for trust earnings.... Cafeteria plans, on the other hand, by their very nature restart each year i.e., an administrative error should not affect prospective exclusions once correction is made.' This is kind of a head-scratcher from my qualified plan perspective, where an error is an error until it's fixed. Does anyone have a cite for this restarting notion?"

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Most Popular Items in the Previous Issue

The Value of an HSA as a Tool for Retirement Savings
Chelko Center for Benefits Management, Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
(407) 644-4146

Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2019, 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, 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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