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[Guidance Overview]

Exceptional Usefulness and Quality and Usefulness iconKey Decision Points in ACA Reporting Vendor Setup Questionnaires, Part 4: Miscellaneous Questions

"Minimum Essential Coverage (MEC)? Almost always 'yes' ... Minimum value (MV)? Almost always 'yes'.... Self-insured? 'Yes' if medical plan option is not fully insured.... Aggregated ALE group? 'Yes' if multiple EINs in employer's controlled group.... Qualifying offer method? 'Yes' if using federal poverty line affordability safe harbor.... 98% offer method? Recommend 'no'.... Rule of parity? Recommend 'yes'.... Authoritative transmittal? Almost always 'yes'.... Conditional offer of spousal coverage? Almost always 'no'.... Equivalency hours for salaried employees? Almost always 'yes'." Icon to read more

ABD Insurance & Financial Services

[Guidance Overview]

New York City Council Passes Bill to Align City's Sick Leave Law with New York State's Analog

"The bill would also impose a new requirement on employers to report the amount of paid sick and safe leave accrued and used during each pay period, as well as an employee's total balance of ESSTA leave, on a pay statement or other document provided to the employee each pay period. The bill includes an effective date of September 30, though employers would be permitted to restrict employees from using any additional paid sick and safe leave provided under the law until January 1, 2021." Icon to read more


[Guidance Overview]

Philadelphia Expands Entitlement to Paid Sick Leave for Workers Not Covered by FFCRA

"Effective immediately, the amendment requires employers and other 'hiring entities' to provide two weeks of 'public health emergency leave.' ... 'Covered individuals' who work in the city for at least 40 hours in one year for one or more 'hiring entities' are entitled to the leave." Icon to read more

Ogletree Deakins

[Guidance Overview]

DOL Narrows Health Care Provider Definition Under FFCRA

"The DOL's narrowed definition of an HCP does not include employees who are merely employed by an employer who provides health care services or because the employee provides a service that affects the provision of health care services. Examples of employees who are not considered a HCP and therefore entitled to leave under the FFCRA are IT professionals, building maintenance staff, human resources personnel, cooks, food services workers, records managers, consultants, and billers." Icon to read more

GrayRobinson, P.A.

[Guidance Overview]

New Parity Law in California Expands Coverage Obligations for Mental Health and SUD Treatment

"Among other changes, SB 855: [1] Expands the scope of coverage mandates in the California Mental Health Parity Act; [2] Mandates a new, uniform definition of 'medically necessary treatment of a mental health or substance use disorder'; [3] Prohibits 'discretionary clauses' in health plan contracts; [4] Establishes new obligations for payors to arrange for out-of-network coverage of MH/SUD services; [5] Prohibits plans and insurers from limiting MH/SUD benefits or coverage to short-term or acute treatment; [6] Prohibits plans and insurers from rescinding prior authorization for MH/SUD services after services are rendered; [7] Establishes new internal compliance requirements and disclosure obligations; and [8] Establishes new enforcement authority for the Department of Managed Health Care (DMHC) and the Insurance Commissioner." Icon to read more

Manatt, Phelps & Phillips, LLP

ERISA and COBRA Rules Apply to EAPs and Wellness Programs

"If an employer offers only discount gym memberships and free seminars on exercise and nutrition, the employer's wellness program does not provide medical care or benefits in the event of sickness and is not subject to ERISA.... If an EAP maintained by an employer provides only referral services, then it does not provide health care and is not a health plan for purposes of COBRA. In contrast, if the EAP provides health care, it must provide COBRA continuation coverage to employees and dependents that lose health care coverage under the EAP due to a qualifying event." Icon to read more

Verrill Dana LLP

Employers Remain Committed to Health Benefits, Focused on New Payment Strategies, and Open to Government Reforms

"When asked what threatens the affordability of employer-provided health coverage for employees and their families, respondents stated the following market forces present a significant threat: drug prices (90%), lack of transparency (73%), hospital prices (71%), surprise medical bills (58%), and overuse of low-value services/waste (53%). The top delivery and payment reform strategies employers are currently doing: reducing waste and inappropriate care (61%) and steerage within networks (47%).... The most prevalent medical and pharmacy drug strategy employers are currently doing is medication therapy management (49%)." Icon to read more

National Alliance of Healthcare Purchaser Coalitions

How the Pandemic Is Changing the Benefits Employees Want

"Benefits have increased in importance.... Employees prioritize healthcare.... Workplace safety protocols are expected.... Flexibility matters.... Parents and guardians want childcare help.... Focus on financial wellness." Icon to read more

Fast Company

Top Open Enrollment Trends for 2021

"[1] Modest cost increases ... [2] More virtual care options ... [3] Expanded focus on mental health ... [4] Growth in onsite clinics ... [5] Access to more Centers of Excellence (CoE)." Icon to read more

Business Group on Health

Selected Discussions
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Cash in Lieu of Group Health Plan Subsidy?

"I have a client that contributes up to $500 per month toward the cost of health insurance for each eligible employee. One employee does not enroll in the group health plan because he is covered by his wife's group health plan through her employer. The employer has decided they want to pay this employee the $500 benefit that he is 'missing out on.' The employee and employer insist that this should be considered a non-taxable health insurance reimbursement. From everything I have read, that's wrong, and it's considered cash in lieu and is taxable to the employee on his W-2." Icon to read more

BenefitsLink Message Boards

Can File a Late 1094-C Without a Letter 5699?

"Client discovers that 1094-Cs ('Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns') have not been filed since 2016. They want to come forward and file and pay any penalties, but hopefully negotiate them down if possible. (We estimate that if the IRS actually imposes the full penalty, the number will be in the low 6 figures.) Any thoughts on how to do this? Just file the forms and wait to see what happens? Or try to do some type of 'submission'? Where would one even submit it?" Icon to read more

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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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