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Health & Welfare Plans Newsletter December 10, 2019 |
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Webcasts, Conferences Managing Complex Leave Issues: Case Studies
Blueprint for Building an Effective Statewide Healthcare Cost Benchmark
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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[Official Guidance] Text of 2019 IRS Form 1095-B: Health Coverage (PDF) "This Form 1095-B provides information needed to report on your income tax return that the individuals in your tax family (yourself, spouse, and dependents) had qualifying health coverage (referred to as 'minimum essential coverage') for some or all months during the year. Individuals who don't have minimum essential coverage and don't qualify for an exemption from this requirement may be liable for the individual shared responsibility payment." [Also available: 2019 IRS Form 1094-B: Transmittal of Health Coverage Information Returns] Internal Revenue Service [IRS] |
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[Official Guidance] Text of 2019 IRS Form 1095-C: Employer-Provided Health Insurance Offer and Coverage (PDF) "This Form 1095-C includes information about the health insurance coverage offered to you by your employer. Form 1095-C, Part II, includes information about the coverage, if any, your employer offered to you and your spouse and dependent(s). If you purchased health insurance coverage through the Health Insurance Marketplace and wish to claim the premium tax credit, this information will assist you in determining whether you are eligible." [Also available: 2019 IRS Form 1094-C: Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns] Internal Revenue Service [IRS] |
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[Guidance Overview] IRS Publication 5213: Health Insurance Provider Fee Information for 2020 Fee Year (PDF) "The due date for Form 8963, Report of Health Insurance Provider Information, for Fee Year 2020 is April 15, 2020 ... The 'applicable amount' for fee year 2020 is $15,522,820,037 ... [R]egulations provide that if a Form 8963 or corrected Form 8963 is required to be filed electronically, any subsequent Form 8963 filed for the same fee year must also be filed electronically, even if the subsequently filed Form 8963 reports $25 million or less in net premiums written." Internal Revenue Service [IRS] |
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[Guidance Overview] Is Your Company Required to File Forms 1094/1095 in New Jersey? "If reporting is required, the state will permit employers to send the same Forms 1094/1095 that they transmit to the IRS to satisfy the [New Jersey law's] requirements. However, the state encourages companies to send data pertaining only to New Jersey full-year and part-year residents as providing information on non-residents of New Jersey may raise privacy and other issues. Coverage returns must be filed with New Jersey no later than March 31, 2020." Jackson Lewis P.C. |
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2020 Large Employers' Health Care Strategy and Plan Design Survey "Of the initiatives employers were asked about, implementing virtual solutions (51%) and developing a more focused strategy to address high-cost claims (39%) were at the top of the list, followed by expanding centers of excellence to include other conditions (26%) and implementing engagement platforms that aggregate top solutions (26%)." National Business Group on Health [NBGH] |
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Solicitor General Weighs In on ERISA Preemption Battle Over PBM State Statutes "On December 4, 2019, the Solicitor General submitted his brief, which recommends that the Supreme Court accept the ... petition for certiorari, and recommends that the Court overturn the appeals court decision. At issue ... is whether an Arkansas statute that regulates the rates charged by Pharmacy Benefit Managers (PBMs), is preempted by [ERISA].... [T]he Arkansas law required PBMs to reimburse pharmacies for generic drugs at a price at least equal to what the pharmacy had paid for the drug." [Pharmaceutical Care Mgmt. Assoc. v. Rutledge, Nos. 17-1609 and 17-1629 (8th Cir. June 8, 2018; cert. pet. filed Oct. 22, 2018)] National Law Review |
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Supreme Court to Hear ACA Insurers' Case: Why Consumers Should Care "[Why] you should pay attention to the case: [1] The integrity of the federal government is at stake.... [2] Obamacare consumers may benefit if the court sides with the insurers.... [3] The co-ops have been stymied.... [4] The U.S. Chamber of Commerce -- a leading opponent of Obamacare -- is defending the risk-corridor provision.... [5] A ruling could influence another big ACA case." National Public Radio [NPR] |
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Providers Get Win in Surprise Billing Compromise, But They're Not Happy "Major bipartisan healthcare legislation to outlaw surprise medical bills will include an arbitration backstop for out-of-network charges, in a massive win for the provider industry. But hospital and provider groups are already signaling that the concession isn't enough. Insurers are also livid with lawmakers for including the arbitration proposal." FierceHealthcare |
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Huge Financial Stakes for Employers as Congress Looks for Deal on Surprise Medical Bills "Former CBO staff at the Council for Affordable Health Coverage did their own analysis of the cost of arbitration and report that binding arbitration costs an estimated $6.2 billion to taxpayers and $21 billion over 10 years to employers and private payers. The downstream impact would be increases to patients’ health insurance premiums, deductibles, copays, and coinsurance." Mercer |
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Surprise Bills Vary by Diagnosis and Type of Admission "This analysis looks at the prevalence of potential surprise medical bills based on patient diagnosis, emergency visits, and type of inpatient admission.... [The authors] analyzed insurance claims from large employer plans to identify how often inpatient admissions, emergency room visits or outpatient surgeries result in a claim from an out-of-network provider." The Peterson-Kaiser Health System Tracker |
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House Energy & Commerce Committee Hearing on 'Proposals to Achieve Universal Health Care Coverage' December 10 hearing. Page includes video and links to testimony of witnesses: [1] Sara Rosenbaum, J.D., Milken Institute School of Public Health, George Washington University; [2] Peter Morley, patient advocate; [3] Jean Ross, RN, National Nurses United; [4] Douglas Holtz-Eakin, Ph.D., American Action Forum; and [5] Scott W. Atlas, M.D., Hoover Institution, Stanford University. Energy & Commerce Committee, U.S. House of Representatives |
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Congress, White House Reach Tentative Deal Over Paid Parental Leave for Federal Workers "Draft language for a must-pass annual defense policy bill includes a provision that would allow 2.1 million civilians who work for the U.S. government across the country to take paid leave to care for a new baby after birth, adoption or the initiation of foster care ... To get the new benefit, employees must have worked for the government for one calendar year and stay for at least 12 weeks after taking the leave." The Wall Street Journal; subscription may be required |
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Benefits in General |
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All in the Family: Why Controlled Group Rules Matter "The determination as to whether or not two companies are members of the same group touches all areas of executive compensation and employee benefits, and can have a material impact on whether or not you are operating your benefit plans and executive compensation arrangements in accordance with applicable rules." Foley & Lardner LLP |
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Press Releases |
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Westminster Consulting Introduces New Initiative: Human Capital Advisory Services
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Most Popular Items in the Previous Issue |
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Text of 2019 Instructions for IRS Forms 1094-C and 1095-C (PDF)
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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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