Health & Welfare Plans Newsletter

July 26, 2018

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[Guidance Overview]

Massachusetts Paid Family and Medical Leave on Tap

"Beginning in 2021, Massachusetts workers will be entitled to up to 12 weeks of paid family leave and up to 20 weeks of paid medical leave for their own serious medical condition in a benefit year, with a combined maximum of 26 weeks in any year. Benefits will be funded through a payroll tax that will start in 2019.... Massachusetts' paid family and medical leave law will apply to employers with at least one employee working in the state.... Employers may apply for approval to opt out of the state program if they provide benefits that either match or exceed those provided under the new law." Conduent

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House Adopts Bills Enhancing HSAs, FSAs, and HRAs

"Individuals would now be able to purchase over-the-counter (OTC) medications with an HSA, FSA, or HRA without being required to obtain a prescription for eligibility purposes ... Certain sports and fitness expenses -- including gym memberships and the cost to participate in certain physical exercise programs -- would be treated as qualified medical expenses up to a limit of $500 a year for an individual and $1,000 a year for a joint return ... HSA contribution would be raised to $6,650 for individuals and $13,300 for families ... Individuals would no longer be barred from contributing to an HSA if his/her spouse is enrolled in a medical FSA ... Spouses over the age of 55 would be able to make 'catch-up' contributions to the same HSA." Connect Your Care

For Large Employers, the Opioid Epidemic Can Stretch Far Beyond Medical Claims

"Employers are spending nearly nine times more to treat opioid addiction and overdoses (prescription and illicit drug use) than they did 12 years ago -- from $300 million in 2004 to $2.6 billion in 2016 ... Many health plans and PBMs have a stake in improving care outcomes, and they have key assets -- especially data -- -that could be used for diagnosis and treatment. Strategies that some health plans and PBMs are already using include: [1] Pharmacy lock-in programs ... [2] Utilization management tools ... [3] Medication-assisted treatment (MAT) ... An ecosystem approach is still needed." Deloitte

Honeywell Cleared of Liability for Retiree Lifetime Health Care

"The retirees weren't vested with lifetime health-care coverage because the collective bargaining agreements and the plan documents at issue didn't include a promise to continue providing such coverage, [according to a federal judge in Michigan]. The ruling means that Honeywell isn't required to provide health-care coverage or make any minimum premium contributions related to the plan starting Aug. 1." [ International Union, United Automobile, Aerospace, and Agricultural Implement Workers of America (UAW) v. Honeywell Int'l Inc. , No. 11-14036 (E.D. Mich. July 25, 2018)]
Bloomberg BNA

CMS Jusitifies Risk Adjustment Formula for 2017; Collections and Payments Will Resume

"The regulation does not make substantive changes from previous risk adjustment regulations and, instead, provides a more thorough explanation of CMS' assumptions in developing its risk adjustment methodology. With this new rule, CMS will ... begin collecting and paying out about $10.4 billion in risk adjustment transfers for 2017. Insurers will receive invoices in mid-September with payments made in October." Katie Keith, in Health Affairs

HHS Expected to Allow States to Waive Obamacare Provisions

"States may receive more flexibility to make changes to their Obamacare markets under rules likely to be issued soon by the Trump administration ... Many states have complained that rules issued during the Obama administration implementing Section 1332 are too rigid and prevent them from making changes needed to allow for more affordable coverage.... The administration is likely to issue a final rule soon that would allow short-term limited duration plans to cover enrollees for up to a year, rather than just three months under a regulation issued by the Obama administration in 2016." Bloomberg BNA

IRO Barred from Litigating URAC's Revocation of External Review Accreditation

"The ACA's final regulations require external review to be conducted by an accredited [independent review organization (IRO)], and agreements between plans and IROs must satisfy certain content requirements. As a result, it may be advisable for a services agreement between the plan and its IRO to address what happens if an accredited IRO has its accreditation revoked (for example, requiring the IRO to notify the plan of any revocation of its accreditation within a set time period)." [ BHM Healthcare Solutions, Inc. v. URAC, Inc. , No. 18-1119 (D.D.C. July 20, 2018)]
Thomson Reuters Practical Law

[Opinion]

Addressing the Drug Cost Problem is a Thorny Issue

"Although ... a move away from rebates as a key form of cost control is warranted, ... both private and public sector entities' budgets are partially constructed by the rebate stream.... [A] phased approach, over three or more years, would allow for a more thoughtful and organized transition to a post-rebate world. Other entities, such as PhRMA, the trade group for pharmaceutical manufacturers, agree." Mercer

Benefits in General

Ninth Circuit: Collective Claims Made on Behalf of ERISA Plans Survive Motion to Compel Arbitration

"[T]he plaintiffs' ERISA claims alleged 'fiduciary misconduct as to the Plans in their entireties,' not merely 'mismanagement of individual accounts,' and were brought 'to benefit their respective Plans across the board, not just to benefit their own accounts.' Consequently, the claims were not captured within the scope of the employees' arbitration agreements, and were not subject to arbitration." [ Munro v. Univ. of Southern Calif. , No. 17-55550 (9th Cir. July 24, 2018)]
McGuireWoods

Ninth Circuit Holds That Arbitration Agreement Does Not Extend to ERISA Fiduciary Breach Claims

"The court rejected USC's argument that because the case involved a defined contribution plan with individual accounts, the relief could individually benefit the plaintiffs, and, therefore, their arbitration agreements covered the claims.... [T]he court refused to reach the employees' argument that ERISA breach of fiduciary duty claims are inarbitrable as a matter of law[.]" [ Munro v. Univ. of Southern Calif. , No. 17-55550 (9th Cir. July 24, 2018)]
Greensfelder

Social Security Administration to Notify Employers of Name/SSN Errors

"Starting in August 2018, the Social Security Administration (SSA) will begin mailing 'Educational Correspondence' to employers that submit Forms W-2 containing employee names and Social Security numbers (SSNs) that do not match SSA's records." ADP

Executive Compensationand Nonqualified Plans

[Guidance Overview]

Tax Reporting for Nonqualified Deferred Compensation Plans

"The reporting of nonqualified deferred compensation plans is complex and depends on several factors, including contributions, vesting and payments, as well as the different rules that apply for income tax and employment taxes (FICA/FUTA).... [This article provides two] charts to assist employers and payroll vendors in properly following the IRS rules for the reporting of these payments.... [1] Defined contribution-type nonqualified plans (like an excess 401(k) plan); [2] Defined-benefit-type nonqualified plans (like a SERP)." Stevens & Lee

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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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