Senior Retirement Plan Administrator Well Established TPA CT / MA / ME / NH / RI
	Enrolled Actuary San Diego Pension Consultants San Diego CA / Telecommute

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Voluntary Fiduciary Correction Program
January 16, 2020 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Administering Benefit Claims: Avoiding Mishaps and Litigation, Compliance Challenges for ERISA Counsel
February 5, 2020 WEBCAST
Strafford

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[Guidance Overview]

Proposed Rule Would Require Transparency of Cost-Sharing and Pricing Information

"[N]on-grandfathered group health plans and health insurers would have to provide upon request to a participant or beneficiary, or their authorized representative, certain information that would enable them to better understand their health care costs before obtaining treatment. The information would be similar to what is provided in an Explanation of Benefits (EOB) form, but would be provided before services are rendered instead of after."

Segal Consulting

[Sponsored]

Now is a great time to join Worldwide Employee Benefits Network (WEB)

Worldwide Employee Benefits Network represents more than 30 areas of expertise within the Benefits Industry. Join today. 

Fifth Circuit Weighs In on ACA; Remands Severability Question to District Court for Closer Examination

"The Fifth Circuit determines that given the complexity of the severability doctrine and the unique challenges presented by the extensive, complex and frequently-amended ACA, the District Court fell short of the standard needed for determining whether the entire ACA was inseverable from the Individual Mandate.... [T]he Fifth Circuit instructs the District Court to do the necessary legwork of parsing through the 900 pages of the post-2017 ACA explaining how each particular provision is inseverably linked to the Individual Mandate." [Texas v. U.S., No. 19-10011 (5th Cir. Dec. 18, 2019)]

Accord

Continued Uncertainty as Fifth Circuit Strikes Individual Mandate, Remands on Rest of ACA

"The Democratic attorneys general ... have already indicated that they will appeal the decision to the Supreme Court.... If the Supreme Court agrees to hear the appeal, the timing of the Fifth Circuit's decision in mid-December makes it less likely that the case will be heard during the Court's current term (which would result in a decision in summer 2020). However, the Court ... could allow for expedited briefing to allow the case to be considered this term. The Justices may want to hear the case this term in light of the significant uncertainty created by the litigation. If the Court declines to hear the appeal, the case will continue before Judge O'Connor who must undertake a provision-by-provision severability analysis." [Texas v. U.S., No. 19-10011 (5th Cir. Dec. 18, 2019)]

Katie Keith, in Health Affairs

Fifth Circuit Affirms Unconstitutionality of ACA's Individual Mandate, But Orders Do-Over of District Court's Severability Analysis

"The Fifth Circuit acknowledged the difficulty of applying the severability doctrine -- particularly as to a complicated, lengthy, and subsequently amended statute such as the ACA. That said, the Fifth Circuit also faulted the district court's December 2018 ruling for not explaining with sufficient precision how portions of the post-TCJA version of the ACA would 'rise or fall' based on the individual mandate's constitutionality." [Texas v. U.S., No. 19-10011 (5th Cir. Dec. 18, 2019)]

Thomson Reuters Practical Law

ACA 1095 Penalties Are Real

"While no one can predict how long the [ACA] will be in place, 1095 reporting for the 2019 calendar year is still required, and IRS enforcement is on the rise.... The deadline to file with the IRS is March 31, 2020, for electronic filing, February 28, 2020, for paper filing. Electronic filing is required if your company is filing 250 or more forms."

ERISAfire

[Sponsored]

COBRA: Simple Concept - Complicated Rules

Jan. 16 webinar. COBRA requirements for employers, including plans subject to COBRA, special COBRA rules for Health FSAs, when COBRA must be offered and for how long, and required notices. BenefitsLink discount. 

DOJ Omnicare/CVS Suit Highlights Potential Pharmacy Benefit Claims Abuse Exposure for Health Plans

"The charges made in the complaint filed against Omnicare highlight an area of claims payment eligibility not regularly verified ... when administering pharmacy benefit claims -- the existence of a current valid prescription to support the dispensation of the billed prescription medication."

Solutions Law Press

Congress Strikes Taxes That Helped Pay for the ACA

"The big end-of-year spending and tax bill Congress plans to approve this week will eliminate three big taxes -- the health insurance tax, the 2.3 percent excise tax on medical devices, and the so-called Cadillac tax on certain high-value employer plans.... (An extra 0.9 percent Medicare tax on income above a certain threshold is still in effect.)"

Association of Health Care Journalists

[Opinion]

ECFC Thanks Congress, Administration for Repeal of the Cadillac Tax

"Repeal of the Cadillac Tax continues to be one of our highest legislative priorities ... [ECFC wants] to thank Congress and the Administration for recognizing the deleterious effect that the Cadillac Tax would have on employer sponsorship of health care plans, especially consumer-directed health plans, and for repealing the tax."

Employers Council on Flexible Compensation [ECFC]

Congress Set to Repeal 40 Percent Excise Tax on High-Cost Health Plans, Pass SECURE Act

"[T]he excise tax on high-cost health plans, which was scheduled to go into effect January 1, 2022, would never take effect.... The bill would also [1] [R]eauthorize funding for the Patient-Centered Outcomes Research Institute (PCORI) for another 10 years ... [2] Provide relief from the nondiscrimination rules for closed defined benefit plans ... [3] Increase the age for the required beginning date for mandatory distributions from age 70-1/2 to age 72 ... [3] Require individual account plans to include lifetime income disclosures in their annual periodic benefit statements[.]"

Sibson Consulting

Self-Funded Benefits Plan Approval Request Under Service Contract Act ('SCA')?

"I've been having trouble finding information about self-funded health benefits plan approval requests under the Service Contract Act. The regulation is only three short sentences, and doesn't give much to go by. 29 CFR § 4.171(b)(2) says: 'A contractor may request approval by the Administrator of an unfunded self-insured plan in order to allow credit for payments under the plan to meet the fringe benefit requirements of the Act. In considering whether such a plan is bona fide, the Administrator will consider such factors as whether it could be reasonably anticipated to provide the prescribed benefits, whether it represents a legally enforceable commitment to provide such benefits, whether it is carried out under a financially responsible program, and whether the plan has been communicated to the employees in writing. The Administrator in his/her discretion may direct that assets be set aside and preserved in an escrow account or that other protections be afforded to meet the plan's future obligation.'"

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Most Popular Items in the Previous Issue

Fifth Circuit Opinion: ACA Individual Mandate Is Unconstitutional; Remanding to District Court as to Severability (PDF)
U.S. Court of Appeals for the Fifth Circuit

Cadillac, Other ACA Taxes Repealed in Spending Bill
Mercer

Last Minute Funding Action by Congress Sets the Stage for Major Savings and Health Changes
Ascensus