Health & Welfare Plans Newsletter

August 19, 2020

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Newly Posted
Webcasts, Conferences

2020 Benefits Symposium - Addressing Issues in the New Normal
August 25, 2020 WEBCAST
Littler

Benefits Calendar & Compliance Reporting
October 1, 2020 WEBCAST
ECFC [Employers Council on Flexible Compensation]

Group Health Plans: Current Trends and Compliance Planning
October 14, 2020 WEBCAST
Lorman Education Services

Employee Benefit Plans of Tax-Exempt and Governmental Employers 2020 - Part 1
October 15, 2020 WEBCAST
American Law Institute Continuing Legal Education Group [ALI CLE]

Employee Benefit Plans of Tax-Exempt and Governmental Employers 2020 - Part 2
October 22, 2020 WEBCAST
American Law Institute Continuing Legal Education Group [ALI CLE]

Employee Benefit Plans of Tax-Exempt and Governmental Employers 2020 - Part 3
October 29, 2020 WEBCAST
American Law Institute Continuing Legal Education Group [ALI CLE]

►See All 127 Upcoming Webcasts and Conferences

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[Official Guidance]

Text of CMS Summary Report of 2018 Benefit Year Risk Adjustment Data Validation Adjustments to Risk Adjustment Transfers (PDF)

48 pages. "This annual report publishes issuers' HHS-RADV adjustments to risk adjustment transfer results. The 2018 benefit year HHS-RADV results will generally be used to adjust 2019 benefit year plan liability risk scores, resulting in adjustments to 2019 benefit year risk adjustment transfer amounts." [Also available: Appendix A -- Issuer-Specific 2018 HHS-RADV Adjustments to 2019 Risk Adjustment Transfers for Non-Merged Market States (XLSX); Appendix B -- Issuer-Specific 2018 HHS-RADV Adjustments to 2019 Risk Adjustment Transfers for Merged Market States (XLSX); and Appendix C -- HHS-Operated Risk Adjustment Program State-Specific Data for 2019 (XLSX)]

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

[Guidance Overview]

IRS Issues FAQs on Leave-Sharing Plans to Aid Employees Affected by COVID-19

"Employers with existing leave-sharing plans may want to expand or amend their plans to include COVID-19 as a major disaster. Employers may want to review state-specific withholding tax requirements to ensure that leave-sharing plans conform to both IRS guidance and state-specific requirements."

Ogletree Deakins

Court Vacates New Section 1557 Rule That Would Roll Back Antidiscrimination Protections for LGBT Individuals

"Judge Block's ruling is limited to would-be changes to the definition of discrimination 'on the basis of sex,' 'gender identity,' and 'sex stereotyping.' He cites heavily to the Supreme Court's recent decision in Bostock v. Clayton County, Georgia ... As expected, the court criticized OCR for issuing the rule ahead of the Bostock decision and relying on the (ultimately wrong) position advanced by the Department of Justice -- and then publishing the rule even after the Court's decision without doing the 'sensible thing' of pausing and reflecting on the ruling." [Asapansa-Johnson v. Azar, No. 20-2834 (E.D.N.Y. Aug. 17, 2020)]

Katie Keith, in Health Affairs Blog

Court Says Marketplace Insurers Are Entitled to Payments for Reducing Cost-Sharing, But Must Offset Premium Tax Credit Increases

"[T]he Federal Circuit Court of Appeals released [decisions in two cases] brought by insurers claiming damages because the Trump administration stopped making so-called cost-sharing reduction (CSR) payments in the fall of 2017.... In one case, the court decided that the insurers were entitled to reimbursement for the payments and should receive them for 2017. But, because after 2017 states allowed insurers to increase premiums to compensate for the loss of CSR payments, the court held in the other case that for 2018 and later, the court of claims must decide whether the additional premium tax credits (PTC) insurers gained from these increases offset the missing CSR payments." [Sanford Health Plan v. U.S., Nos. 2019-1290 and 19-1302 (Fed. Cir. Aug. 14, 2020); Community Health Choice, Inc. v. U.S., No. 2019-1633 (Fed. Cir. Aug. 14, 2020)]

Timothy S. Jost, for The Commonwealth Fund

Choice, Competition, and Flexibility, Part I: Post-ACA Consumer Challenges

"Current consumer challenges ... The legacy of the ACA: coverage expansion without cost control ... Health plan market dynamics: impact of the ACA ... Progressive responses to rising health care costs: public option to single payer."

Brian J. Miller and Robert E. Moffit, in Health Affairs Blog

Health Coverage Affordability Crisis: 2020 Biennial Survey

"In the first half of 2020, 43.4 percent of U.S. adults ages 19 to 64 were inadequately insured. This is statistically unchanged from the last time we fielded the survey in 2018.... There was no statistically significant change in coverage inadequacy between the months leading up to the pandemic and the months that followed, but this may change as the pandemic continues. Half of adults who spent any time uninsured or who were underinsured reported problems paying medical bills or said they were paying off medical debt over time."

The Commonwealth Fund

Sonoma County Approves COVID-19 Sick Leave Ordinance

"The ordinance applies to employees at about 12,000 businesses in unincorporated Sonoma County, including 275 that have more than 500 employees nationwide ... Under the ordinance, those businesses must provide at least 80 hours of paid sick leave to employees who are sick with COVID-19 or need to care for a child or senior family member because a school or caregiving facility is closed due to coronavirus. A key last minute amendment on Tuesday also guarantees the rights of health care workers to get leave because of those caregiving circumstances."

Patch

Benefits in General

Exceptional Usefulness and Quality iconMaximizing Premium Assistance Tax Credits for Self-Employed Individuals

"[B]ecause of the unique control that self-employed individuals have over the income and expenses of their businesses, they have a unique opportunity to make business decisions that can also help maximize their ability to receive Premium Tax Credits.... [W]hile a Solo 401(k) contribution may decrease income which both improves the PTC and reduces the Federal tax liability, the reduced income may also make the QBI deduction lower. As a result, making contributions to a Traditional IRA account instead of a Solo 401(k) could be even more beneficial, as the result would still reduce MAGI to increase the PTC, but would not reduce the QBI deduction for the self-employed individual."

Nerd's Eye View

Selected Discussions
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► It's easy to sign up and participate in discussions! Post answers, ask questions, create custom feeds and views. Join your peers (and potential referral sources or customers)—there is no charge.

Insurer on My LTD Policy is Unilaterally Extending the Claim Response Deadline by 7 Days

"In my ERISA long-term disability plan, the insurer is adding about 7 days to the documented date the claim was faxed to them, for 'processing time.' Obviously this gives them 52 days to respond rather than 45. Is this legal? The SPD does not seem to address it."

BenefitsLink Message Boards

Press Releases

Most Popular Items in the Previous Issue

A Guide to the New FMLA Forms
Society for Human Resource Management [SHRM]; membership may be required to view article

HHS Blocked from Rolling Back Health Care Protections for Transgender Workers
Society for Human Resource Management [SHRM]; membership may be required to view article

View COVID-19 News and Resources

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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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