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October 22, 2020 logo logo
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[Guidance Overview]

IRS Releases 2020 Forms 1094/1095 and Related Instructions, Including New Rules for ICHRA Reporting

"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." Icon to read more

Thomson Reuters / EBIA

[Guidance Overview]

New York State Publishes Paid Sick Leave Website and FAQs

"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." Icon to read more

Seyfarth Shaw LLP

[Guidance Overview]

What's New in the New York DOL FAQ's Addressing New York State Paid Sick Leave?

"[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." Icon to read more

Nixon Peabody LLP

[Guidance Overview]

New York State Issues First Guidance on Paid Sick Leave Law

"[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?" Icon to read more


Court Allows Expansive Interpretation of ERISA Coverage of Welfare Benefit Plan, Effectively Overruling DOL's Analysis

"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)] Icon to read more

Thomson Reuters / EBIA

Exceptional Usefulness and Quality iconAmericans in 'Persistent Confusion' on Health Insurance

"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, which runs from Nov. 1 to Dec. 15 this year, and almost 44% of Americans did not believe plans sold on covered required benefits like pediatric care." Icon to read more

Health Plan Deductibles Don't Result in Better Choices Around Low-Value Services Once Deductibles Are Met (PDF)

"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." Icon to read more

Employee Benefit Research Institute [EBRI]

Even with ACA's Fate in Flux, Open Enrollment Starts Soon -- Here's What's New

"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." Icon to read more

Kaiser Health News

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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.

[Can You Help?] Subscriber-to-Member Ratio -- How Significant When Negotiating Vendor Contracts?

"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." Icon to read more

BenefitsLink Message Boards

Healthcare FSA Continues for Terminated Employee

"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?" Icon to read more

BenefitsLink Message Boards

COBRA Coverage Required When LTD Plan Is Amended to Eliminate Health Coverage for Persons on LTD?

"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?" Icon to read more

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Text of New York State Paid Sick Leave FAQ (PDF)
New York State Department of Labor

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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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