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[Guidance Overview]

Agencies Release FAQs on Updated 2021 Summary of Benefits and Coverage Template

"The Agencies have created a revised template SBC for group health plan sponsors and issuers to use to satisfy the ACA's SBC requirements.... [T]he 2021 versions of the SBC materials have 'minor edits' to correct several documents, including the template."

The Wagner Law Group

[Guidance Overview]

Final IRS Rules Clarify UBTI Issues But Renew Uncertainty on Reallocating VEBA Assets

"[T]he IRS/Treasury published final rules addressing how employers that fund health and welfare benefits through a VEBA must calculate the VEBA's UBTI.... The final rules largely mirror proposed UBTI rules the IRS issued in 2014... Rev. Proc. 2020-3 [is the] annual listing of areas where the IRS will not consider private letter rulings. Unfortunately, the IRS added to that list a ban on PLRs involving whether the 100% excise tax on reversions applies to transfers of assets between VEBAs and/or 'repurposing' assets within a single VEBA."

Groom Law Group

[Guidance Overview]

CMS Proposes Methods to Calculate Civil Monetary Penalties for Group, Non-Group Health Plans

"[CMS] has proposed methods to calculate and impose civil money penalties (CMPs) when a group health plan (GHP) or a non‑group health plan (NGHP) entity fails to comply with Medicare Secondary Payer (MSP) reporting requirements. ... Should a GHP fail to perform the required Section 111 reporting within one year of the coverage effective date, it would be subject to a CMP of $1,000 for each day of noncompliance for each individual whose coverage information should have been reported.... Entities that have performed Section 111 reporting as required, but subsequently provide information that contradicts reported information in response to MSP recovery efforts, would be subject to a CMP based on the number of days that the entity failed to appropriately report updates to beneficiary records.... CMS has proposed an error tolerance that would not exceed a 20% threshold."

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

New Jersey Employers Must Offer Pretax Transit Benefits by March 1

"With limited exceptions, the New Jersey Transit Benefits Law requires employers with at least 20 employees to offer them the opportunity to purchase qualified transportation services with pretax dollars at the maximum levels federal law allows.... When enforcement begins, penalties for noncompliance will range between $100 and $250 for a first violation."


[Guidance Overview]

IRS Tax Tip 2020-21: Taxpayers Must Reconcile Marketplace Advance Payments and File Form 8962

"Failing to file Form 8962, Premium Tax Credit, to reconcile 2019 advance payments of the premium tax credit may affect return processing, and delay the taxpayer's refund. It may also affect their ability to get advance payments of the premium tax credit or cost-sharing reductions. Taxpayers who don't file and reconcile their 2019 advance credit payments may not be eligible for advance payments of the premium tax credit in the future."

Internal Revenue Service [IRS]

2018 Health Care Cost and Utilization Report (PDF)

29 pages. "Between 2014 and 2018, per-person spending grew at an average annual rate of 4.3%, climbing to $5,892.... That rise outpaced growth in per-capita GDP, which increased at an average rate of 3.4% over the same period.... Data from Massachusetts shows that for those with commercial insurance the percentage of gross pharmacy spending accounted for by rebates grew from 6.5% in 2014 to 15.6% in 2018. Applying these figures to our data, we find that spending per person declined from an average annual rate of 4.3% to an average annual rate of 3.8% between 2014 and 2018."

Health Care Cost Institute

How Much Is Too Much: Out-of-Pocket Spending Among Medicare Beneficiaries

"[T]he average person covered under traditional Medicare paid $5,460 out of their own pocket for health care in 2016... [H]alf of all traditional Medicare beneficiaries spent at least 12 percent of their income on health care in 2016, with the financial burden falling disproportionately on lower-income, older, and sicker beneficiaries[.]"


Not Like the Others: House Ways and Means Surprise Bill Legislation

"Starting in 2022, patients who receive care from out-of-network providers either in emergency situations (both doctors and facilities) or when receiving care at an in-network facility [would] have their cost sharing limited to the in-network amount ... Patients will also be protected from balance billing if they receive inaccurate information from their health plan.... The Ways and Means draft is supported by providers but rejected, not just for the payment mechanism but also the requirements around network updating, by health plans."

Healthcare Financial Management Association [HFMA]

Plan to Get More from Your Voluntary Benefits in 2021

"To optimize the value of voluntary benefits within your overall benefits program in 2021, consider these three important strategies: [1] Align solutions to workforce demographics ... [2] Enhance benefit communication and decision support ... [3] Simplify the employee experience."



Medicare in the 2021 Trump Budget

"The budget would establish a new payment system for post-acute care, reduce Medicare coverage of bad debts, limit medical malpractice awards, extend through 2030 the 2 percent Medicare sequestration cut under the 2011 Budget Control Act, and pay for all doctor and other outpatient services at the same rate regardless of where they're provided. Most of these proposals also appeared in last year's budget."

Center on Budget and Policy Priorities

Benefits in General

Emergency-Fund-Focused Employers: Goals, Motivations, and Challenges

"More than 4 in 10 employers that expressed at least some interest in offering financial wellness programs said they offer (28.2 percent) or plan to offer (15.3 percent) an emergency fund/employee hardship assistance as a financial wellness initiative.... Emergency-fund-focused employers were more likely than all employer respondents to favor education-based financial wellbeing or debt assistance benefits to employees over product-based benefits, which might include insurance, retirement plans, or employee assistance programs[.]"

Employee Benefit Research Institute [EBRI]

Press Releases

Upcoming Events About Health & Welfare Plans

Feb. 19
Employee Assistance Programs
Lorman Education Services
Fee is required
Feb. 20
HSA to Z: The Ins and Outs of the Health Savings Account
Feb. 20
Demystifying Pharmacy
Worldwide Employee Benefits Network [WEB] - Atlanta Chapter
Fee is required
Feb. 20
Roundtable Discussion on Innovative Uses of Health Savings Accounts
Worldwide Employee Benefits Network [WEB] - Greater Cincinnati Chapter

Most Popular Items in the Previous Issue

Status of the State Individual Health Insurance Coverage Mandates
International Foundation of Employee Benefit Plans [IFEBP]

Text of CMS Proposed Regs: Medicare Program -- Medicare Secondary Payer and Certain Civil Money Penalties
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS], 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

Article submission: Online form, or email to

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