Health & Welfare Plans Newsletter

February 3, 2020

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View job as Senior ESOP Retirement Account Administrator Senior ESOP Retirement Account Administrator  View details

Alerus Financial
East Lansing MI / Troy MI / Bedford NH / Albert Lea MN / Arden Hills MN

View job as Employee Benefits Investigator (Senior Advisor for Health Enforcement) Employee Benefits Investigator (Senior Advisor for Health Enforcement)  View details

Employee Benefits Security Administration [EBSA]
Chicago IL / Telecommute

View job as Supervisory Health Insurance Specialist Supervisory Health Insurance Specialist  View details

Centers for Medicare & Medicaid Services [CMS]
Bethesda MD / Telecommute

View job as Actuary Actuary  View details

Pension Benefit Guaranty Corporation [PBGC]
Washington DC / Telecommute

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[Guidance Overview]

The 2021 Proposed Payment Notice: Insurer Provisions

"CMS wants to require each state to annually report on state benefit mandates that exceed the EHB.... CMS proposes a series of changes to MLR standards.... insurers would be required to deduct prescription drug rebates and any other drug-related price concessions from incurred claims under the MLR.... CMS proposes to amend a policy on drug manufacturer coupons and copay assistance that was finalized in the 2020 payment rule but later walked back in guidance from August 2019."

Katie Keith, in Health Affairs

[Guidance Overview]

The 2021 Proposed Payment Notice: Exchange Provisions

"The most significant potential proposed change is related to the automatic reenrollment process.... Under the proposed rule, CMS would reenroll these consumers in the same QHP but without the application of all or some of their APTCs. This means that even if a consumer's income qualified them for a $0 plan, they would be reenrolled in a plan at the full premium (or some premium that is greater than $0)."

Katie Keith, in Health Affairs

[Guidance Overview]

New Jersey Requires Severance and Increased Notice to Employees Terminated in Layoffs

"[E]mployees may only waive their right to severance if approved by the Commissioner of Labor and Workforce Development or a court of competent jurisdiction. Therefore, any claim for severance pay under the statute cannot be released by a traditional employee separation agreement. Employers that request a release of claims in connection with a plant closing or a layoff will have to provide additional consideration for the release beyond the severance and notice required by the Act."

Choate Hall & Stewart LLP

[Guidance Overview]

Editor's Pick The Health Coverage Tax Credit: In Brief (PDF)

11 pages. "To claim the [Health Coverage Tax Credit (HCTC)], eligible taxpayers must have qualified health insurance ... The HCTC is refundable, so eligible taxpayers may receive the full credit amount even if they had little or no federal income tax liability.... [T]axpayers may receive the credit on a monthly basis to coincide with the payment of premiums. The HCTC has a sunset date of January 1, 2021." [Report R44392, updated Jan. 28, 2020)]

Congressional Research Service [CRS]

Volumes of DOL Data Regarding MEWA Investigations Now Available to the Public

"The hundreds of Voluntary Compliance letters and case summaries not only highlight the primary areas of the DOL's focus in MEWA investigations, but also indicate where EBSA may be willing to yield or compromise.... Revenue sharing arrangements and any transactions with related parties are generally red flags for regulatory scrutiny.... MEWAs sponsored by reputable trade and professional organizations have found themselves in receipt of multi-million dollar settlement negotiations with the DOL in relation to inadvertent compliance failures.... MEWA investigations routinely involve multiple plan years (4 to 6 years is common).... [T]he DOL has made clear that an entity sponsoring a MEWA may not profit from its operations."

ERISA Law Practice, LLC

How Telemedicine is Reducing the Cost of Healthcare

"[M]any employers provide encouragement and incentives to avoid the ER, imposing higher co-pays for ER visits than for urgent and primary care. Coupled with employee education about the true costs of these services, this is a useful strategy. But there is another arrow in the benefits quiver that employers can use to combat the costly PCER phenomenon: telemedicine."

OneDigital Health and Benefits

Key Elements of a Good Health Benefit Plan for Small Companies

"The downside to traditional insurance is that group health insurance premiums have increased significantly in recent years. The least expensive policies usually have higher deductibles, which can be difficult for employees to pay. In this environment, many small employers are looking beyond traditional coverage for affordable options, which include: [1] QSEHRAs ... [2] ICHRAs ... [3] Self-funded Health Insurance ... [4] Taxable stipends ... [5] Association Health Plans."

Employee Benefits Report

[Opinion]

Mercer Comments on Proposed Transparency in Coverage Rules

"Mercer suggests the agencies improve the transparency rules in several ways: [1] Limit the required self-service transparency tool to 'shoppable services' and include quality metrics, not just cost information. [2] Reevaluate the set of services specified in the transparency rule after three years to ensure that transparency is working as intended. [3] Reduce the compliance burden by expanding the special rule for insured plans to provide penalty relief for employers and sponsors with self-funded group health plans if they cannot get the required data to satisfy their obligations under the transparency rules."

Mercer

Press Releases

ECFC Names Christa Day as New Executive Director
ECFC [Employers Council on Flexible Compensation]

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020 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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