Health & Welfare Plans Newsletter

December 15, 2020

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[Guidance Overview]

Exceptional Usefulness and Quality and Usefulness iconWhen COBRA Meets COVID-19: Concerns for Plan Administrators and TPAs (PDF)

"What should plans do about qualified beneficiaries who have not yet elected COBRA or paid premium ... What about qualified beneficiaries who experienced a qualifying event shortly before the National Emergency began on March 1, 2020, but who had not elected and/or paid for COBRA coverage as of March 1, 2020? ... What if a qualified beneficiary waits until after the Outbreak Period to elect COBRA or pay premiums that otherwise would have come due during the Outbreak Period, but cannot afford the large premium payment due to ensure retroactive coverage for the entire period? What if they pay only part of it? ... When the Outbreak Period ends, should plans send out COBRA notices to everyone who had a qualifying event shortly before or following March 1, 2020, and who has not already elected COBRA? ... What if the President decides in the future that only certain parts of the country are experiencing an emergency due to the pandemic?" Icon to read more

Robinson & Cole LLP, via ERISA Report

[Guidance Overview]

Final Rule on Grandfathered Health Plans Will Allow Higher Employee Cost-Sharing

"Although the changes are relatively minor, the new rule will enable grandfathered group plans to impose higher cost-sharing requirements without losing grandfathered status." Icon to read more

Katie Keith, in Health Affairs Blog

[Guidance Overview]

Transparency in Healthcare Coverage: Understanding the Final Rule

24 presentation slides. Topics: [1] Applicability and timing; [2] Internet-based, self-service cost-sharing tool; [3] Machine-readable files -- public disclosure pricing data; [4] Special rule to prevent unnecessary duplication, privacy and security, enforcement, and good faith safe harbors; and [5] Implications for plan sponsors. Icon to read more

Groom Law Group, via American Benefits Council

[Guidance Overview]

Navigating Difficult FMLA and ADA Issues in the Middle of a Pandemic (PDF)

50 presentation slides. Topics: [1] Does a positive COVID-19 test = FMLA leave? [2] Generalized fear = FMLA leave? [3] Underlying health conditions during pandemic: do they trigger FMLA leave? What are the ADA Implications? [4] "Caring for" a high-risk family member = FMLA leave? [6] Is physical presence at work critical anymore? Handling work-from-home requests during the pandemic. Icon to read more

FMLA Insights

[Guidance Overview]

Pittsburgh Expands COVID-19 Paid Sick Time

"Pittsburgh's Temporary COVID-19 Emergency Paid Sick Leave Ordinance ... [gives] certain workers in the city up to an additional 80 hours of paid sick time.... The Ordinance remains in effect until one week after the official termination of the public health emergency declared by either the Commonwealth or the City of Pittsburgh (Pennsylvania recently extended its emergency proclamation through February 22, 2021)." Icon to read more

Fisher Phillips

[Guidance Overview]

Upcoming Deadline iconNew York State and New York City Safe and Sick Leave Requirements Beginning Jan. 1, 2021

"While the provisions of these laws are similar, they are not identical. One notable difference is that the NYC Paid Safe and Sick Leave Law requires employers to provide employees with a Notice of Employee Rights and maintain a policy meeting specific requirements. NYC employers with 100 or more employees and employers of domestic workers are required to provide an updated Notice by Jan. 1, 2021." Icon to read more

Lockton

[Guidance Overview]

Upcoming Deadline iconMaking Sense of Colorado’s New Paid Sick Leave Rulemaking

"On November 10, 2020, the CDLE published its final Wage Protection Rules, implementing the Colorado Wage Act as amended by the HFWA. While the Wage Protection Rules answer some coverage questions regarding the looming paid sick leave requirements of the HFWA, they conspicuously leave some unanswered, and in a few respects actually create more confusion." Icon to read more

Ogletree Deakins

Supreme Court Finds ERISA Does Not Preempt State Prescription Drug Pricing Law

"Act 900 in Arkansas regulates the price paid by PBMs for the cost of drugs purchased at retail pharmacies through mechanisms designed to ensure that the pharmacy would at least recover the cost that it is able to negotiate with a typical wholesaler selling the drug.... The Supreme Court ruled that Act 900 ... does not 'immediately and exclusively' affect ERISA plans but is a form of cost regulation that will not so acutely affect the benefits and operation of employee benefit plans as to warrant preemption." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., No. 18-540 (S. Ct. Dec. 10, 2020)] Icon to read more

Ballard Spahr LLP

Supreme Court Rules That ERISA Does Not Preempt State Law Regulating PBM Reimbursements

"Concluding that '[Arkansas Act 900] is merely a form of cost regulation[,]' the Court found that forcing PBMs to pay higher costs for some drugs, and passing those costs along to plans, did not interfere with a central matter of plan administration [nor] with national uniformity. The Court rejected the argument that Act 900 affects plan design by mandating a particular pricing methodology for pharmacy benefits, finding 'that argument is just a long way of saying that Act 900 regulates reimbursement rates.' " [Rutledge v. Pharmaceutical Care Mgmt. Assoc., No. 18-540 (S. Ct. Dec. 10, 2020)] Icon to read more

Robinson & Cole LLP

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Failed DCAP 55% Test at Year-End -- Does W-2 Box 10 Need to Be Modified?

"We tested our cafeteria plan late in the year and found that it has failed the DCAP 55% test. We have just one pay period left in the year, and we're working with our payroll vendor (ADP WFN) to create an imputed income code to include the amounts that caused the plan to fail in HCEs' gross income. Does Box 10 of the employee's W-2 need to be modified as well? We've been scrambling to find assistance with how to make the corrections, but we haven't found any guidance on how this would actually appear for employees on their W-2s." Icon to read more

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Most Popular Items in the Previous Issue

ACA Reporting and COBRA
ABD Insurance & Financial Services

Congressional Committee Leaders Announce Agreement on Fix for Surprise Billing
Committee on Ways and Means, U.S. House of Representatives

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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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