Health & Welfare Plans Newsletter

June 25, 2018

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[Official Guidance]

Text of CMS HIOS Portal User Manual (PDF)

99 pages. Version 28.00.00, June 2018. "The Health Insurance Oversight System (HIOS) is a federal system of record and provides a centralized, multi-user interface for insurance issuers and state/territory regulators to submit, and CCIIO to store information on individual and small group major medical insurance. Information submitted to HIOS is transferred in accordance with CCIIO regulations to provide data updates to Healthcare.gov." [Also available: Quick Reference Guide .]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

A New Pathway to Healthcare Delivery: Association Health Plans

"At least two states (Massachusetts and New York) are threatening to sue the Trump administration over this new rule.... In several states, group health insurance laws will need to be revised to permit individuals and small groups to participate in AHPs if they are not otherwise members of pre-existing tax-qualified bona fide associations.... [M]any states do not permit the inclusion of sole proprietors and individuals in group insurance arrangements." Winston & Strawn LLP

[Guidance Overview]

DOL Releases Association Health Plan Regulations

"The final rule does not remove the current facts and circumstances-based commonality of interest rules test. Rather, the final rule contains additional ways in which groups may come together ... [T]he commonality of interest test is an 'or' test rather than an 'and' test, meaning that groups or association members are either all in the same trade or business or the members are in the same region." Holland & Knight

[Guidance Overview]

Massachusetts Legislature Passes Bill Providing Paid Family and Medical Leave: What Employers Need To Know

"Beginning July 1, 2019, all Massachusetts employers will contribute to the Family and Employment Security Trust Fund at an initial contribution rate of 0.63% of each employee's wages.... Beginning July 1, 2021 ... workers will be able to take family or medical leave and file claims with the Department for medical or family leave benefits" Seyfarth Shaw LLP

The Latest in Texas v. United States

"A range of stakeholders ... filed briefs. Only one of these briefs ... was filed in support of the lawsuit; all the others highlight the positive impact of the ACA and the harm and chaos that will ensue if the states' legal challenge is successful.... The brief by the legal experts is a worthwhile read on the issue of severability."
Katie Keith, in Health Affairs

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The Economic Cost of Disease

"Originally released in 2015 ... [this] study provided an assessment of the cost of absenteeism, presenteeism, and early withdrawal from the workforce.... This year ... the study has been updated to capture the costs associated with workforce withdrawal for informal caregiving. The findings are alarming, showing a 7.7% loss in GDP in 2015, projected to rise to 8.6% of lost GDP by the year 2030." U.S. Chamber of Commerce

[Opinion]

ERIC Works to Bring Clarity to Mental Health Parity Laws

"ERIC's suggested improvements include: [1] Delaying the applicability date of the new requirements in the MHPAEA Guidance Documents ... [2] Formally adopting new requirements through the standard regulatory process ... with opportunity for public comment ... [3] Focusing enforcement efforts on abusers and providing simplified compliance approaches for the great majority of group health plan sponsors and health insurance issuers ... [4] Issuing non-enforcement guidance for MHPAEA violations based on a good-faith compliance standard." The ERISA Industry Committee [ERIC]

[Opinion]

American Benefits Council Comments to OMB on MHPAEA Draft Model Disclosure Request Form

"While a model form could be helpful, it is important that it not be imposed on plans as a requirement for individuals to request information with respect to NQTLs.... Any model form ... should be targeted to specific NQTLs, rather than framed as a general request for plan information related to MH/SUD benefits, which is how the form is currently drafted." American Benefits Council

[Opinion]

American Benefits Council Comments to EBSA on Proposed FAQs About MH/SUD Parity Implementation and the 21st Century Cures Act

"The Departments should clarify that a plan only violates MHPAEA where it cannot demonstrate that the processes, strategies, evidentiary standards, or other factors considered by the plan in implementing the NQTL are comparable to and applied no more stringently to MH/SUD benefits as compared to M/S benefits." American Benefits Council

Executive Compensationand Nonqualified Plans

Primary Components to an Effective Long Term Incentive Plan (PDF)

"[1] Determine business drivers that trigger awards....[2] Determine what level of executive should be eligible to participate.... [3] Determine Share Rates.... [4] Allocation of Award among Eligible Group.... [5] Award Distribution." Fulcrum Partners LLC

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2018 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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