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Health & Welfare Plans Newsletter October 22, 2020 |
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Newly Posted NYS Paid Sick Leave Law and Other Pandemic Leave Laws
Integrated Healthcare Delivery - Using Coordinated Care and Data Analytics to Reduce the Cost of Healthcare
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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[Guidance Overview]
"ALEs should note the new requirement to report the start month of the plan year on Form 1095-C and read the instructions carefully since there are some nuances. ALEs that offered ICHRAs in 2020 will have to collect and report information the IRS needs to evaluate ICHRA affordability. Notably, the instructions indicate that an ALE must report the age of any employee receiving an ICHRA offer, while other ICHRA information is required only for full-time employees receiving an offer of affordable ICHRA coverage." Thomson Reuters / EBIA |
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[Guidance Overview]
"Multiple weeks after the New York State Paid Sick Leave (NYPSL) law's September 30, 2020 effective date, the State has published a NYPSL website and set of frequently asked questions (FAQs). While the administrative guidance ... addresses certain ambiguities in the NYPSL law, other questions and gray areas remain." Seyfarth Shaw LLP |
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[Guidance Overview]
"[The FAQs] make clear that an employee may use paid sick leave for routine healthcare appointments, such as for routine visits to the doctor, dentist, or eye doctor, as these are considered preventive medical care. This means an employee may use paid sick leave to take their child to an annual check-up or to cover time missed from work for their own routine eye exam.... [T]he FAQs confirm that while employees must be allowed to carry over unused sick leave into the following calendar year, employers are not required to allow employees to use more sick leave than the annual accrual limits stated in the statute." Nixon Peabody LLP |
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[Guidance Overview]
"[The FAQ] does not provide employers clear and definitive guidance with respect to a number of critical questions ... [1] To ascertain the amount of leave required to be provided, are employers required to count their employees nationwide, or just those within New York State? ... [2] Must an employer allow carryover of unused, accrued sick leave if the employer frontloads the total required amount of sick leave ... at the start of each calendar year? ... [3] Can an employer place a maximum cap ... on the amount of sick leave that must be carried over from one calendar year to the next calendar year?" Littler |
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"At issue was whether the individual limited partners were 'working owners' or 'bona fide partners' for purposes of ERISA provisions allowing those categories of non-employees to participate in ERISA plans alongside employees.... According to the DOL, permitting the software to capture data while they used their personal electronic devices did not constitute 'work' by the individual partners.... The court, however, concluded that the partners were actively engaged in the partnership's business by providing personal services consisting of contributing their data and collectively deciding what to do with it.... [T]he court enjoined the DOL, preventing it from refusing to acknowledge the ERISA status of the plan." [Data Marketing Partnership, LP v. DOL, No. 19-0800 (N.D. Tex. Sep. 28, 2020)] Thomson Reuters / EBIA |
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"According to [a recent] survey ... a majority of Americans (62.8%) do not realize [ACA] plans cover those with pre-existing conditions ... Nearly nine out of ten Americans (87%) could not identify the correct timing of open enrollment for Healthcare.gov, which runs from Nov. 1 to Dec. 15 this year, and almost 44% of Americans did not believe plans sold on Healthcare.gov covered required benefits like pediatric care." InsuranceNewsNet.com |
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"Individuals reaching their deductible were 83 percent more likely than those not reaching their deductible to have received imaging for an uncomplicated headache within the first 120 days of diagnosis.... There was a 126 percent increase in use of colorectal cancer screenings once individuals reach their deductible among individuals under age 50 ... In addition to more nuanced plan designs that effectively discourage low value care, these findings underscore the need to implement provider-facing initiatives to reduce-low value care -- and ensure that policies are aligned with consumer cost-sharing to achieve low-value care avoidance." Employee Benefit Research Institute [EBRI] |
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"Although final rates have yet to be analyzed in all states, those who study the market say the premium increases they have seen to date will be in the low single digits -- and decreases are not uncommon." Kaiser Health News |
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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. |
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"This probably sounds elementary, but what is the significance of subscriber to member ratio when negotiating contracts with vendors. Is a higher ratio (3.5) better than a lower (2.0) or is it the other way around? I would think lower is better, if my understanding is correct." BenefitsLink Message Boards |
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"We have several employees who terminated this year (7/31/2020) and as part of a severance agreement their H&W benefits were continued including health FSA. One of the employees' severance benefits continue into 2021. We offer changes at open enrollment. Should we offer him the opportunity to do health FSA for 2021? Does anyone see an issue for post-July 2020 healthcare FSA deductions being allowed?" BenefitsLink Message Boards |
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"We have a couple former employees who are in our medical plan because they left on Long Term Disability -- our medical plan says former employees on LTD remain eligible. The medical plan is being amended to no longer cover employees on LTD. Normally, this wouldn't trigger COBRA, but, since we never offered COBRA when these employees initially left employment, do we need to offer them COBRA now?" BenefitsLink Message Boards |
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Press Releases |
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Sankaty Light Benefits Launches Unique Health Insurance Plan
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WiPN Announces Retirement Plan Industry Study of Gender Workplace Issues
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Empower Retirement Achieves $110 Billion in New Retirement Plan Sales
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Most Popular Items in the Previous Issue |
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Text of New York State Paid Sick Leave FAQ (PDF)
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ERISA/Cybersecurity Considerations in the COVID Age
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David Rhett Baker, J.D., Editor and Publisher
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