Health & Welfare Plans Newsletter

February 26, 2020

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[Guidance Overview]

Editor's Pick ACA Reporting Requirements: Last-Minute Compliance Tips for Paper (Feb. 28) and Electronic Filers

"[T]he IRS has extended the [ACA] deadline for health plan sponsors to furnish individuals IRS Forms 1095-B and 1095-C until March 2, 2020. However, it did not extend the due date for filing the 2019 Forms 1094-B, 1095-B, 1094-C, or 1095-C with the IRS. Those Forms are due February 28, 2020, for paper filers, and March 31, 2020, for electronic filers. Following a few simple rules will make this process much smoother for both employers and employees."

Dickinson Wright

[Guidance Overview]

Editor's Pick IRS Concludes There Is No Statute of Limitations on ACA 'Pay or Play' Taxes: Steps Employers Should Take Now

"Considering the IRS has an evergreen option to assess ESRP, employers should consider taking the following action to limit liability: [1] Keep the following records indefinitely: Records of how full-time status is determined.... Records of waiting periods.... Records of offers of coverage.... [2] Ensure that the Forms 1094-C and 1095-C are filed with the IRS timely.... [3] Ensure that Form 1095-C is furnished to employees timely."

Dickinson Wright

[Guidance Overview]

New California Laws Affect Health Insurance, Family Leave, Other HR Policies

"The California Department of Managed Health Care (DMHC) has posted a letter summarizing 2019 health insurance laws on balance billing, telehealth, fertility preservation and other coverage issues.... [O]ther new California laws tighten the rules for classifying workers as independent contractors, expand family leave, broaden eligibility for domestic partner registration and impose an individual health coverage mandate."

Mercer

Surprise Medical Bill Legislation: The Devil Is in the Details

"More than 20 states have passed some form of legislation protecting patients against surprise balance billing, and there are currently three proposals being considered by Congress. Generally, the state laws and federal bills all prohibit balance billing of patients in certain situations. They differ, however, in two major respects: what situations are covered and how payment disputes between the provider and the insurer are resolved."

Pepper Hamilton LLP

Prescription Drug Importation Gets Renewed Attention

"A Safe Importation Action Plan, released by HHS and FDA, outlined two pathways for allowing importation of certain prescription drugs ... Will either pathway to importation result in real cost savings? ... Will the cost of getting FDA approvals for importation, through either of the new pathways, diminish any cost savings achieved through importation? ... Is there any assurance that the medications will be sold in the US at lower prices?"

Mercer

Amazon Rolls Out Amazon Care Telehealth to Seattle-Based Employees

"The launch of Amazon's telehealth service to its Seattle-based employees is the next domino to fall in preparation for a potential public rollout. Amazon has made a series of plays since unveiling Amazon Care back in September 2019 that suggest it's building out the virtual care service, which could be poised for a public launch."

Business Insider

Telehealth and Telemedicine: Frequently Asked Questions (PDF)

15 pages. "This report provides responses to frequently asked questions about telehealth and telemedicine, serving as a quick reference with easy access to information. Where applicable, the report provides the legislative background pertaining to the question." [Report R46239, Feb. 25, 2020]

Congressional Research Service [CRS]

Health Plan Fiduciaries Should Be Mindful of DOL Enforcement Activities

"The DOL alleged that the plan fiduciaries generally failed to properly select and supervise plan service providers, which resulted in excess fees being charged to the plan. The court agreed with the DOL's premise that welfare plan fiduciaries generally had the same duty to select and monitor the performance (and fees) of plan service providers as the fiduciaries of defined contribution retirement plans." [Acosta v. Chimes District of Columbia, Inc., No. 15-3315 (D. Md. Feb. 26, 2019)]

Benefits Law Group of Chicago

Sick Sibling, Healthy Kids Don't Trigger FMLA Leave

"[The plaintiff] did not allege that either of the minor children -- who would be considered his daughter and son under in loco parentis -- was experiencing a 'serious health condition' that required his care, the court said. Instead, [his] sister had the serious health condition.... With care for siblings not covered under the FMLA and the children themselves healthy, the plaintiff failed to establish that he qualified for leave under the FMLA[.]" [Brede v. Apple Computer Inc., No. 19-2130 (N.D. Ohio Jan. 23, 2020)]

Manatt, Phelps & Phillips, LLP

Offering Conservative Care Benefits Can Attract and Retain the Workforce of the Future

"Across the U.S., back pain accounts for more than 264 million lost workdays in a year. Lost work days come with a cost of more than $50 billion in health care expenses, a number that rises to $100 billion when lost wages and decreased productivity are added to the mix.... Conservative care is non-surgical care that carries less risk, lower costs and avoids addictive medicines and risky side effects."

Minneapolis/St. Paul Business Journal

Benefits in General

Supreme Court Updates for 2020: Employee Benefit Cases

"On remand, the Court asked the Second Circuit to consider whether to allow new arguments made by the IBM plan fiduciaries and federal agencies regarding the duty to act on inside information when managing the assets of an employee stock ownership plan (ESOP).... [T]he Supreme Court recently decided to grant review of ... the Eighth Circuit's 2018 decision ... [to determine] whether ERISA preempts state law attempts to regulate pharmacy benefit managers (PBMs)." [Retirement Plans Committee of IBM v. Jander, No. 18-1165 (S. Ct. Jan. 14, 2020); Rutledge v. Pharmaceutical Care Mgmt. Assoc., Nos. 17-1609 and 17-1629 (8th Cir. June 8, 2018; cert. pet. granted Jan. 13, 2020)]

Verrill Dana LLP

Selected Discussions
on the BenefitsLink Message Boards

Does a Self-Funded Health Plan Have to Rebate Premiums That Produce a Surplus?

"Is a self-insured health plan that charges premiums that produce a surplus, i.e., the total amount collected exceeds the claims paid/incurred, required to rebate some portion back to the employee?"

BenefitsLink Message Boards

Press Releases

Upcoming Events About Health & Welfare Plans

Feb. 27
Alabama
Regional Benefits Forum
Southeast Benefits Education Network [SBEN]
Fee is required
Mar. 4
Texas
IRA and HSA Seminar
Ascensus
Fee is required
Mar. 4
District of Columbia
Healthcare Coverage and Costs: Assessing Medicare-Based Approaches
National Academy of Social Insurance [NASI]
Fee is required
Mar. 4
Ohio
What To Do When Culture Sucks
Worldwide Employee Benefits Network [WEB] - Greater Cincinnati Chapter
Fee is required

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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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