Health & Welfare Plans Newsletter

December 14, 2020

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[Guidance Overview]

ACA Reporting and COBRA

"Employers with fully insured medical plans must address COBRA in ACA reporting only where the qualifying event is triggered by a reduction in hours. Employers with self-insured medical plans must report COBRA coverage in all situations because of the Section 6055 coverage reporting requirements in Part III of the Form 1095-C." Icon to read more

ABD Insurance & Financial Services

[Guidance Overview]

IRS Issues Final Regs on Parking and Commuting Deductions

"Generally, the final regulations match the proposed regulations allowing taxpayers to calculate the disallowance of deductions for certain qualified transportation fringes using the general rule or three simplified methodologies and explain how to determine parking expenses.... The special rule allocating 5% of certain mixed parking expenses to the parking facility can now be used when calculating the general rule ... The exception under section 274(e)(8) now applies to instances where in a bona fide transaction, the adequate and full consideration for qualified parking is zero." Icon to read more

RSM US

[Guidance Overview]

New York DOL Proposes Regs for New Paid Sick Leave Law

"The proposed regulations specifically state that if an employee works less than 30 hours, the employee accrues sick leave at a proportional rate ... Further, the proposed regulations allow employers to use rounding with respect to the number of hours (or partial hours) that an employee has worked for sick leave accrual purposes.... [T]he proposed regulations prohibit an employer from requesting documentation from an employee's health care provider supporting the employee's need to take sick leave unless the employee has taken leave for more than three consecutive previously scheduled workdays or shifts." Icon to read more

Fox Rothschild LLP

Arkansas PBM Law Upheld By Supreme Court

"Some ways that the Rutledge decision may change the landscape of PBM regulation or PBM-pharmacy relationships include: [1] States may enact similar legislation. Of note, 47 State Attorneys General made a bipartisan effort to support Arkansas in this litigation.... [2] [S]tates and pharmacy lobbyists may more aggressively explore ways they can expand upon [the concepts in the Arkansas statute] and still avoid pre-emption.... [3] The decision may reinvigorate interest in use of any willing provider laws.... [4] PBMs will face an increasingly complex patch-work quilt of state requirements[.]" [Rutledge v. Pharmaceutical Care Mgmt. Assoc., No. 18-540 (S. Ct. Dec. 10, 2020)] Icon to read more

Quarles & Brady LLP

Supreme Court Gives Nod to States Regulating Pharmacy Benefit Managers Reimbursement

"With the Court's unanimous decision ... states received a playbook for how to regulate PBMs and pharmacy reimbursement.... The 8th Circuit, which the Court reversed here, recently held that ERISA preempts a North Dakota law that regulates the fees PBMs and third-party payers charge pharmacies, limits what copayments PBMs or third-party payers may charge, and dictates the quality metrics PBMs and third-party payers may use to evaluate pharmacies. The [Rutledge] ruling ... that ERISA does not preempt a state law regulating the price at which PBMs reimburse pharmacies may set the stage for another reversal of the 8th Circuit." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., No. 18-540 (S. Ct. Dec. 10, 2020)] Icon to read more

BakerHostetler

Physician Was Full-Time Employee Entitled to Long-Term Disability Benefits, Court Finds

"Although the plaintiff's employment contract did not require her to work at least 30 hours a week, the court was persuaded by the plaintiff's representations, which were corroborated by her employer. Because Unum failed to define 'full time' by any means other than linking eligibility for coverage to working at least 30 hours a week, the court easily sided with the plaintiff in construing the ambiguity in the manner that would be generally understood." [Connor v. Unum Life Ins. Co. of Am., No. 19-6552 (N.D. Cal. Nov. 24, 2020) Icon to read more

DeBofsky Sherman Casciari Reynolds P.C.

DOL, HHS Finalize Rule to Give More Flexibility to ACA Grandfathered Plans

"The rule clarifies [that] a grandfathered group health plan that is a high-deductible health plan can increase its 'fixed amount cost-sharing requirements, such as deductibles, to the extent necessary to maintain its status as a [high-deductible health plan] without losing grandfather status' ... In addition, the final rule gives plans an alternative method for measuring any permitted increase in fixed-amount cost-sharing. A plan could lose its grandfathered status if its cost-sharing reaches a certain amount." Icon to read more

FierceHealthcare

Congressional Committee Leaders Announce Agreement on Fix for Surprise Billing

"The bipartisan, bicameral agreement protects patients and establishes a fair payment dispute resolution process including: [1] Holds patients harmless from surprise medical bills ... in both emergency situations and certain non-emergency situations where patients do not have the ability to choose an in-network provider. [2] Prohibits certain out-of-network providers from balance billing patients unless the provider gives the patient notice of their network status and an estimate of charges 72 hours prior to receiving out-of-network services and the patient provides consent to receive out-of-network care. [3] Creates a framework that takes patients out of the middle, and allows health care providers and insurers to resolve payment disputes without involving the patient." Icon to read more

Committee on Ways and Means, U.S. House of Representatives

The Effects of Medicare Buy-In Policies for Older Adults on Health Insurance Coverage and Health Care Spending

"[The authors] estimate the coverage and health care spending implications of a Medicare buy-in policy targeting adults ages 50 to 64, similar to proposed legislation.... The main finding ... is that a Medicare buy-in policy's potential to substantially expand health insurance coverage is limited given the subsidies already provided under the ACA. Buy-in enrollment does not exceed 3 million in any of our scenarios, including ones with lower premiums or much more generous subsidies than the ACA provides." Icon to read more

Urban Institute

[Opinion]

Supreme Court Rejects Challenge to States’ Authority to Regulate Pharmacy Reimbursements

"It is at least possible that Rutledge will undermine the cost-containment pressures that have driven insurers to rely so heavily on PBMs, and so it might even lead to some cognizable increase in insurance premiums. On the other hand, it should come as no surprise that the Supreme Court has no interest in stepping in to protect a market that almost all of the states regard as functioning so poorly as to warrant legislative intervention. If Congress disagrees, it certainly could amend ERISA to compel a different arrangement." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., No. 18-540 (S. Ct. Dec. 10, 2020)] Icon to read more

SCOTUSblog

Benefits in General

[Official Guidance]

IRS Announces Tax Relief for Hurricane Zeta Victims in Alabama

"Individuals and households who reside or have a business in Clarke, Dallas, Marengo, Mobile, Perry, Washington, and Wilcox counties qualify for tax relief.... [C]ertain deadlines falling on or after October 28, 2020, and before March 1, 2021, are postponed through March 1, 2021." Icon to read more

Internal Revenue Service [IRS]

Selected Discussions
on the BenefitsLink Message Boards

► 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.

Dependent Care 55% Average Benefit Test Failing -- Can the 'After-Tax' Reclassified Amount Be Pulled Out of the Plan?

"For those owners who are having some DCA contributions reclassified as after-tax in order to pass the Average Benefits Test, can the employer pull that money out of the funding account and just give it back to the employee? Or, does the employee still need to use those funds for qualified DCA expenses? It sort of makes sense to give those dollars back to the employee since they aren't really getting any pretax benefits from it anymore." Icon to read more

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Press Releases

Most Popular Items in the Previous Issue

Text of HHS Proposed Modifications to the HIPAA Privacy Rule (PDF)
U.S. Department of Health and Human Services [HHS]

Text of Agency Final Regs: Grandfathered Group Health Plans and Grandfathered Group Health Insurance Coverage
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; U.S. Department of Health and Human Services [HHS]; and U.S. Department of the Treasury

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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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