Health & Welfare Plans Newsletter

December 10, 2020

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View job as Defined Benefits Combo Cash Balance Consultant for Loren D. Stark Company (LDSCO)
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Empower Retirement
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Webcasts, Conferences

New York Paid Sick Leave Law: What Employers Need to Know
December 15, 2020 WEBCAST
Fisher Phillips

Ethical Considerations for Employee Benefits Lawyers: Pandemic Edition
December 17, 2020 WEBCAST
American Bar Association Joint Committee on Employee Benefits [JCEB]

Employee Assistance Plans - Helping Your Employees Navigate Through Uncertain Times
January 7, 2021 WEBCAST
Worldwide Employee Benefits Network [WEB] - Baltimore Chapter

Understanding Connecticut Paid Family & Medical Leave
January 14, 2021 WEBCAST
Disability Management Employer Coalition [DMEC]

New Price Transparency Rules for Health Plans: Key Issues for Plan Sponsors, Service Providers, and Insurers
February 3, 2021 WEBCAST
Strafford

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[Official Guidance]

Text of IRS Final Regs: Qualified Transportation Fringe, Transportation and Commuting Expenses Under Section 274 (PDF)

70 pages. "This document contains final regulations to ... address the elimination of the deduction under section 274 for expenses related to certain transportation and commuting benefits provided by employers to their employees. The final regulations provide guidance to determine the amount of such expenses that is nondeductible and apply certain exceptions under section 274(e) that may allow such expenses to be deductible." Icon to read more

Internal Revenue Service [IRS]

[Guidance Overview]

Summary of Provisions of HHS’ Proposed 2022 Notice of Benefit and Payment Parameters and Other Key Regs (PDF)

"The notice includes important proposed rules and parameters for the operation of the individual and small group health insurance markets in 2022 and beyond.... [1] Direct-enrollment flexibilities ... [2] Risk adjustment ... [3] User fees ... [4] PBM reporting ... [5] MLR changes ... [6] 1332 waiver regulation ... [7] Actuarial Value Calculator." Icon to read more

Wakely Consulting Group

[Guidance Overview]

COVID-19 Leave Arrives in Pittsburgh

"The law applies to employees who are [1] working for that employer within Pittsburgh after the effective date of this ordinance, [2] normally work for that employer within the City of Pittsburgh but are currently teleworking from any other location as a result of COVID-19, or [3] work for that employer from multiple locations or from mobile locations, provided that 51% or more of such employee's time is spent within the City of Pittsburgh. An employee may take up to 80 hours of leave, and this time is in addition to time under the PSDA." Icon to read more

Jackson Lewis P.C.

[Guidance Overview]

IRS FAQ Offers Relief from 80/50 Rule for Vanpools Affected by COVID-19

"The new FAQ posted on the IRS website announces that, for 2020, the 80/50 rule will be considered satisfied for a vehicle if, at the beginning of the 2020 calendar year, the employer reasonably expected the vehicle's use would satisfy the 80/50 rule but the rule was not actually satisfied 'due to the COVID-19 emergency.' For this purpose, the emergency is deemed to have begun on the date of the President's emergency declaration, which was March 13, 2020." Icon to read more

Thomson Reuters / EBIA

Text of Supreme Court Opinion: ERISA Does Not Preempt Arkansas Statute Regulating PBMs (PDF)

19 pages. "Arkansas' Act 900 regulates the price at which pharmacy benefit managers reimburse pharmacies for the cost of drugs covered by prescription-drug plans.... The Court holds that the Act has neither an impermissible connection with nor reference to ERISA and is therefore not pre-empted.... [N]ot every state law that affects an ERISA plan or causes some disuniformity in plan administration has an impermissible connection with an ERISA plan. That is especially so if a law merely affects costs.... ERISA does not pre-empt state rate regulations that merely increase costs or alter incentives for ERISA plans without forcing plans to adopt any particular scheme of substantive coverage.... Like the New York surcharge law in Travelers, Act 900 is merely a form of cost regulation.... Indeed, Act 900 is less intrusive than the law at issue in Travelers, which created a compelling incentive for plans to buy insurance from the Blues instead of other insurers. Act 900, by contrast, applies equally to all PBMs and pharmacies in Arkansas. As a result, Act 900 does not have an impermissible connection with an ERISA plan." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., Nos. 17-1609 and 17-1629 (8th Cir. Jun. 8, 2018; S. Ct. No. 18-540, oral arg. Oct. 6, 2020)] Icon to read more

Supreme Court of the United States

Year-End COVID-19 Considerations for Health and Welfare Plans

"Employers should consider end-of-the-year plan amendments to document mid-year changes resulting from the pandemic and related government action. Employers should evaluate whether they have appropriately notified employees of changes in benefits, particularly those that have resulted in changes to any Summary of Benefits and Coverage. Employers should evaluate plan administration in the face of extended plan deadlines." Icon to read more

Ballard Spahr LLP

Proposed 2022 Benefit and Payment Parameters Include Increased Cost-Sharing Limits, New Rules for COBRA-Related Exchange Special Enrollments and MLR Rebates

"HHS has released proposed regulations with the 2022 benefit and payment parameters and insurance market and Exchange-related proposed rules. Although largely aimed at insurers and Exchange regulators, some provisions may be of interest to employers and their advisors.... [1] Annual cost-sharing limits.... [2] COBRA and exchange special enrollment.... [3] MLR reporting and rebates ... [including] Prescription drug concessions.... [and] Rebate prepayment." Icon to read more

Thomson Reuters / EBIA

New Transparency Rules Mean Health Plans, PBMs Must Disclose Their Accumulators, Maximizer Programs

"Plan members use coupons to cover their copays and out-of-pocket costs. The savings may be a huge relief, but members haven't always realized that because their health plan or its PBM was using an accumulator, the value of the coupon not counting toward the deductible. The shock comes when the value of the coupon runs out.... [T]he new transparency rules for health plans issued by CMS in October include a provision that, effectively, requires health plans and PBMs to disclose to their beneficiaries that they are using accumulators or maximizers." Icon to read more

Managed Healthcare

Drug Middlemen Shift Arguments to Escape Liability, State Laws

"The recent wins make it harder for states to rein in prescription drug costs and bring more transparency to the price-setting process. They've also weakened the protections ERISA put in place to prevent beneficiaries from having to pay inflated drug prices." Icon to read more

Bloomberg Law

Connecticut Launches Bundled Payment Program for State Employees in Effort to Reduce Healthcare Costs

"The new program, along with other efforts related to the state health plan, is proposed to save $185 million through FY21, according to the article. Some state governments, like Connecticut, have high enough volumes that COVID-19 may accelerate their adoption of value-based payment models, according to Chad Mulvany." Icon to read more

Healthcare Financial Management Association [HFMA]

[Opinion]

American Hospital Association Comments on Commercial Health Plan Abuses

"Certain health plan practices threaten patient access to care and drive excessive administrative costs and burden in the health care system. While these concerns pre-date COVID-19, the current public health emergency both highlights and demands immediate action to protect patients and providers. Regulators should increase their oversight of health plans and implement a comprehensive simplification agenda, beginning with streamlining prior authorization requirements and processes, as well as monitoring for abusive payment delays and denials. These efforts will go a long way to addressing unnecessary costs in the system and allow for a more rational, navigable health system for patients." Icon to
read more

Physicians for a National Health Program [PNHP]

Benefits in General

Legal Considerations When an Employee Dies

"When an employee dies -- regardless of the cause -- employers often want to immediately help the employee's family financially in their time of grief, but a number of administrative, legal, and tax-related issues must be considered before an employer pays final compensation and benefits to the beneficiaries or estate of the deceased employee." Icon to read more

Pillsbury Winthrop Shaw Pittman LLP

Press Releases

AWS Announces Amazon HealthLake
AWS [Amazon Web Services, Inc.]

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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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