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CMS Issues New 2019 Guidance Documents for Insurers

"The guidance discussed [in this article] ranges from an enrollment manual for the federal marketplaces to new materials on eligibility redeterminations, student health plans, translation requirements for direct enrollment, and discontinuation notices. CCIIO is likely to continue issuing similar guidance as the 2019 open enrollment period -- which begins on November 1, 2018 -- approaches." Katie Keith, in Health Affairs

New ERISA Regulations for Disability Claims and Appeals

August 13 webinar will explain what new practices to follow, how to change past practices to become compliant with the new regulations, and the risks of non-compliance. Discount for BenefitsLink readers .

HHS Issues Regs to Resume Collections and Payments Under the Risk Adjustment Program

"Only the risk adjustment methodology for 2014-2018 is at issue under the New Mexico ruling. These regulations address the risk adjustment methodology for 2017; HHS has indicated that it expects to issue separate regulations specifying the methodology for 2018. For 2019, HHS has already finalized recalibrated parameters for the risk adjustment methodology[.]"
Thomson Reuters / EBIA

Coverage of Wilderness Treatment Program at Issue in Mental Health Parity Dispute

"The court concluded that: [1] The plan's exclusion unambiguously applied to services provided at the outdoor youth treatment program. [2] The complaint sufficiently alleged that the exclusion violated the MHPAEA. [3] The exclusion did not violate the ACA." [ Vorpahl v. Harvard Pilgrim Health Ins. Co. , No. 17-10844 (D. Mass. July 20, 2018)]
Thomson Reuters Practical Law

The Feasibility of Implementing Different Benefits for Different Categories of Employees

"[O]ne option employers are using is to create entirely separate cafeteria plans for separate categories of employees and associates, or separate business units.... [L]evels of benefits can diverge across the plans ... and face less risk under the IRC. However, this option requires creation of separate plans and plan documents, with separate reporting and disclosure obligations. This can also require additional operational and administrative functions to maintain the separation of multiple plans." FutureEmployer, by Seyfarth Shaw

DOL's Association Health Plan Rule Faces Legal Challenge from 12 States

"Expanding the definition of employer is inconsistent with the ACA and federal benefits law, which violates ... the Administrative Procedures Act, the lawsuit alleges. The rule 'conflicts with the clear statutory structure that Congress adopted in the ACA' by pulling those currently protected by the ACA's minimum health benefit requirements in the small and individual health insurance marketplaces into the large group market, which doesn't have the same protections, the attorneys general wrote." Bloomberg BNA

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How to Engage Your Millennial Employees in Health Benefits

"Help them understand their health benefits ... Avoid 'one size fits all' benefit plans ... Offer high-end plans ... Include dental, vision, and prescription drug coverage ... Offer tax-advantaged benefit accounts ... Make it fun ... Focus on 'total well-being' ... Provide simple technology integration." DataPath

HSA Bills Increasing Contributions and Expanding Access Pass House

"On [July 25], the House passed ... H.R. 6199 : Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018, [and] H.R. 6311 : Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018 ... Both bills still need to pass the Senate, where 60 votes are required to overcome the filibuster and reach the President's desk for signature.... Senate passage is far from certain."
ABD Insurance & Financial Services

Three Things You Need to Know About Congress' Effort to Expand HSAs

"[1] Many of the proposed changes affect how and when a person can contribute to an HSA and how the funds can be used and rolled over.... [2] One HSA expansion provision is not so straightforward -- allowing HDHPs to cover up to $250 (self-only) and $500 (family) annually for non-preventive services that currently may not be covered pre-deductible ... [3] How late is 'too late' to make changes for January 1?" Mercer

Are Employers Really Overindulging on Health Insurance?

"The problem with cost-shifting as a means of staying below the tax threshold is that while some employees can afford to pay more out of pocket for health care, many simply can't. Employers are looking for ways to help lower-paid employees manage health care costs, but it's not an easy problem to solve." Mercer

Another District Court Denies Arbitration of ERISA Claims

"On the same day the Ninth Circuit denied arbitration in Munro v. University of Southern California , a district [court] also denied a motion to compel arbitration of a former employee's ERISA breach of fiduciary duty and prohibited transaction claims ... The court found that the plaintiff's claim was not subject to arbitration because the plaintiff did not agree to arbitrate and because her claim fell outside of the scope of the arbitration provision." [ Brown v. Wilmington Trust, N.A. , No. 17-250 (S.D. Ohio July 23, 2018)]
Greensfelder

Ninth Circuit Addresses Whether to Enforce an Agreement to Arbitrate ERISA Claims

"The Ninth Circuit analogized the plaintiffs in this case to plaintiffs in a qui tam action brought on behalf of the U.S. Government under the False Claims Act.... The Court stated that individual agreements to arbitrate do not extend to qui tam actions because those are brought on behalf of the government by the plaintiffs. Similarly, the Court said, an ERISA Section 502(a)(2) breach of fiduciary duty claim is brought on behalf of an ERISA plan by its participants." [ Munro v. Univ. of Southern Calif. , No. 17-55550 (9th Cir. July 24, 2018)]
Seyfarth Shaw LLP

Pension/OPEB 2018 Assumption and Disclosure Study, with Analysis of New Accounting Standards Updates (PDF)

29 pages. "The 2017 median discount rate for pension plans in the study decreased 48 basis points since 2016 and more than two and half percentage points since 2007 ... Median plan funding levels increased from 2016, with pension plan assets equal to approximately 86% of the projected benefit obligation (PBO) in 2017 compared to 82% in 2016.... The 2017 median discount rate for OPEB plans in the study decreased 42 basis points since 2016 and more than two and a half percentage points since 200 ... The percentage of funded OPEB plans in the study has remained nearly unchanged since 2007 with 52% of plans being funded in 2017 compared with 49% in 2016 and 52% in 2007." PwC

IRS Identifies Basic Security Safeguards to Enhance Cybersecurity

"The IRS highlights these protections: [1] Anti-virus software.... [2] Firewalls.... [3] Two-factor authentication.... [4] Backup software/services.... [5] Drive encryption.... [6] Data security plan." Thomson Reuters / EBIA

Adjust a Tipped Employee's Wages in Order to Make Pre-Tax Sec. 125 Contributions?

Employer has a policy whereby tipped employees pay health insurance premiums by check (because income fluctuates and they may or may not have enough to deduct from one pay period to the next). Employer has a Section 125 plan. Can a tipped employee's wages and tax withholding be adjusted so that the impact on the employee is the same as if the premium were deducted from pay pre-tax? The answer is a clear "No", right? I don't think it's a 125 issue as much as a tax withholding/reporting issue. It seems to me that the employer must accurately report all wages paid and the premium amount is wages paid, even if the employee writes a check back to the employer for premiums. BenefitsLink Message Boards

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