Health & Welfare Plans Newsletter

October 26, 2020

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Webcasts, Conferences

Mental Health Parity and Addiction Equity Act Compliance Assistance Webcast
October 29, 2020 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

COBRA Compliance
November 19, 2020 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

COBRA Compliance
December 17, 2020 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

COBRA Compliance
January 21, 2021 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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[Official Guidance]

Exceptional Usefulness and Quality and Usefulness iconText of DOL Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act (MHPAEA) (PDF)

39 pages; rev. Oct. 2020. "The goal of this self-compliance tool is to help group health plans, plan sponsors, plan administrators, group and individual market health insurance issuers, state regulators, and other parties determine whether a group health plan or health insurance issuer complies with the Mental Health Parity and Addiction Equity Act (MHPAEA) and additional related requirements under [ERISA] that apply to group health plans.... This tool provides a number of examples that demonstrate how the law applies in certain situations and how a plan or issuer might or might not comply with the law.... The fact patterns used as examples are intended to help group health plans and health insurance issuers identify and address important MHPAEA issues." [Also available: Preface to 2020 MHPAEA Self-Compliance Tool, and News Release.] Icon to read more

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Guidance Overview]

Upcoming Deadline iconMassachusetts Paid Family and Medical Leave: Next Steps

"The next quarterly reports and contributions are due by October 31, 2020.... There is no change in contribution rates for 2021.... The Department requests that employers update their leave administrator contact information by October 31, 2020.... Starting December 2, 2020, eligible Massachusetts employees may request leave to bond with a child on or after January 1, 2021." Icon to read more

Mintz

[Guidance Overview]

Upcoming Deadline iconCalifornia Expands Entitlement to Leave for Crime Victims

"On September 28, 2020, Governor Gavin Newsom signed Assembly Bill (AB) 2992, which ... expands existing law providing protected leave for employees who are victims of domestic violence, sexual assault, or stalking, to include leave for victims of other crimes or offenses 'that caused physical injury or that caused mental injury and a threat of physical injury' ... [and] provides protected leave for an employee 'whose immediate family member is deceased as a direct result of a crime' ... The expanded provisions become effective on January 1, 2021." Icon to read more

Ogletree Deakins

[Guidance Overview]

Passive Cafeteria Plan Enrollments with Rolling Elections

"All Section 125 cafeteria plan elections for health and welfare benefits can be handled via a passive enrollment. That includes medical, dental, vision, health FSA, dependent care FSA, and HSA elections. However, most employers offering passive enrollment will limit the rolling election feature to the medical, dental, and/or vision plan benefits. It is uncommon and generally not best practice for an employer to extend rolling elections to the health FSA, dependent care FSA, or HSA." Icon to read more

ABD Insurance & Financial Services

High Risk Issue iconSixth Circuit: Medicare Secondary Payer Act Prohibits Disparate Impact Discrimination

"This decision has the potential to upend any plan provision purporting to exclude dialysis treatments from network coverage and/or capping dialysis benefits at Medicare-based rates of payment.... [M]edical providers with valid assignments of all rights and benefits under ERISA may still be able to remedy plan terms that offend the MSP Act by asserting [1] an ERISA benefits claim and [2] an equitable claim for reformation of the plan to strike the unlawful terms.... The Ninth Circuit is set to opine on nearly identical issues in the coming months[.]" [DaVita, Inc. v. Marietta Mem. Hospital Employee Health Benefit Plan, No. 20-328 (6th Cir. Oct. 14, 2020)] Icon to read more

Arent Fox

District Court Finds DOL's ERISA Plan Ruling to Be Arbitrary and Capricious

"[T]he Limited Partnership, Data Marketing Partnership (DMP), and its general partner, LP Management Services, sought to create a single health plan under ERISA by grouping together thousands of independent and unrelated internet marketers into a single massive employer plan. DMP took the position that these independent marketers were working owners of DMP and eligible to participate in the health plan. The US District Court for the Northern District of Texas overruled an earlier [DOL] opinion in which the DOL found that the group health plan sponsored by DMP was not a single employer welfare plan under ERISA." [Data Marketing Partnership, LP v. DOL, No. 19-0800 (N.D. Tex. Sep. 28, 2020)] Icon to read more

Holland & Hart LLP

New Plan Year, New COBRA Vendor. New Headaches?

"Late offers of COBRA are most likely to arise when the loss of coverage occurs immediately before a new COBRA administrator begins providing services to a plan. Claims-related challenges could arise in any situation where delays in processing elections and payments occur because they were submitted to a previous COBRA administrator. However, there are some best practices that can help employers avoid these types of situations[.]" Icon to read more

HUB International

CMS Report: Plan Year 2020 Qualified Health Plan Choice and Premiums (PDF)

10 pages. "This report presents CMS Qualified Health Plan (QHP) information for states using the HealthCare.gov eligibility and enrollment platform. It includes plan year 2016 (PY16)-PY20 issuer participation, consumer choice, premiums, and cost sharing metrics. The accompanying appendix file [XLSX] contains PY14-PY20 state- and county-level metrics, as well as metrics not included in prior ASPE reports, such as enrollee access by plan type and the percent of plans with separate drug deductibles, that this report does not present. The associated methodology document [PDF] includes data source and metric definitions." Icon to read more

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

CMS Report: Plan Year 2021 Qualified Health Plan Choice and Premiums (PDF)

10 pages. "This report presents CMS Qualified Health Plan (QHP) information for states with Exchanges using the HealthCare.gov eligibility and enrollment platform (HealthCare.gov states). It includes plan year 2017 (PY17)-PY21 issuer participation, consumer choice, premiums, and cost sharing metrics. The accompanying appendix file [XLSX] contains PY14-PY21 state- and county-level values, including some metrics which this report does not present, such as enrollee access by plan type and the percentage of plans with separate drug deductibles. The associated methodology document [PDF] includes data source and metric definitions." Icon to read more

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

Premiums Drop Slightly as 2021 Open Enrollment Period Draws Near

"Overall, premiums are expected to drop by 2 percent for a 27-year old for a silver benchmark marketplace plan sold through HealthCare.gov. This builds on a 4 percent decline for 2020 and a 2 percent decline for 2019. The unsubsidized average benchmark plan premium for a 27-year old will be $369/month for 2021 (compared to $388/month for 2020).... Lower premiums are expected even with the pandemic." Icon to read more

Katie Keith, via Health Affairs Blog

High Risk Issue iconNew Cross-Plan Offsetting Class Action Lawsuit Highlights Exposure to Self-Insured Health Plan Sponsors

"[Plaintiffs claim] that UnitedHealth breached its fiduciary duties under ERISA when it used assets from the plaintiffs' plans to recoup financial losses from other separate plans, effectively using plaintiffs' plan assets for its own benefit.... [T]he plaintiffs assert that, 'By engaging in cross-plan offsetting, United treats the thousands of Plans it administers as one extremely large piggybank, moving more than $1.2 billion among its Plans each year to suit its own interests. Each cross-plan offset violates ERISA, and in most cases, the money ends up in United's own pocket.' " [Scott v. UnitedHealth Group, Inc., No. 20-1570 (D. Minn. complaint filed Jul. 14, 2020)] Icon to read more

Hall Benefits Law, via Lexology; free registration 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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