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Association Health Plans: DOL Final Regulations, Issues and Best Practices for ERISA Counsel
September 12, 2018 WEBCAST
Strafford

What Employers Need to Know About ACA 'Pay or Play' Mandates
September 18, 2018 WEBCAST
Lorman Education Services

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Text of IRS Publication 5308: Automated Enrollment for ACA Providers -- The Externals Guide (PDF)

58 pages. Version 2.0.1, August 2018. "This guide provides instructions on how to enroll and maintain A2A Client Application Systems using the IRS Enterprise Portal (IEP). Its scope is limited to the ACA functionality of the AE Application. However, this guide does not discuss any administrative aspects of the AE Application nor does it discuss how to use the IEP other than the aspects you need to know to access the AE Application." Internal Revenue Service [IRS]

The Short-Term, Limited-Duration Coverage Final Rule: The Background, the Content, and What Could Come Next

"Litigation is likely given the expansion of the rule.... [T]he preamble includes an extended discussion about the tri-agencies' legal authority to issue the rule.... Despite the stated purpose of the rule to distinguish between short-term, limited duration insurance and individual health insurance coverage, the tri-agencies blur these lines.... This new policy is expected to siphon off healthy enrollees from the ACA-compliant marketplace.... Beyond higher premiums in the ACA-compliant market, enrollees will not have the benefit of essential ACA protections.... State policymakers may want to consider a larger role in regulating short-term coverage in the wake of the final rule." Katie Keith, in Health Affairs

Family (Leave) Planning: Essentials on the Recently Passed Massachusetts Paid Family Leave Law

"[T]he Massachusetts version of family and medical leave will affect all employers with an employee in Massachusetts. This new law will permit an employee with a serious health condition to take up to 20 weeks of paid medical leave when the employee is experiencing a serious health condition. Additionally, eligible employees will be able to take 12 weeks of paid family leave ...Leave taken under this Act will run together with, not in addition to, leave taken under either the existing Massachusetts Parental Leave Act or the federal Family and Medical Leave Act." Wilmer Hale

Checklist for Strategic and Compliant Enrollment Communications (PDF)

"The checklist includes recommended content for compliant enrollment communications and required health plan notices that you may wish to provide at enrollment time. In addition, the checklist outlines considerations for successfully communicating the value of (and encouraging enrollment in) your employee benefit plans." EPIC

Worried About Healthcare Affordability for Your Low-Wage Workers?

"Employers in the low-wage group have taken steps to address the issue of healthcare affordability for their workers, while operating within business and budget realities. These employers are more likely than employers in the high-wage group to offer voluntary benefits to fill coverage gaps, such as critical illness or hospital indemnity coverage. They are slightly more likely to provide an onsite medical clinic, which can make accessing primary care more affordable as well as more convenient. They are also more likely to offer health coaching and targeted programs for diabetes management." Mercer

Spending on Prescription Drugs in the U.S.: Where Does All the Money Go?

"[In] 2016, total US expenditures on pharmaceutical drugs, including the gross profits of all the intermediaries, were $480 billion ... Two-thirds of this total ($323 billion) was captured by drug manufacturers in the form of net revenues. The remaining third ($157 billion) was retained as gross profits in the supply chain. Of this share, nearly half was captured by retail and specialty pharmacies ($73 billion), and about 20 percent ($35 billion) by providers, such as hospitals and doctors' offices. PBMs and wholesalers together captured approximately 25 percent ($23 billion and $18 billion, respectively)." Nancy L. Yu, Preston Atteberry and Peter B. Bach, in Health Affairs

HSA Contribution Rules: Counter-Intuitive Coordination with Medicare

"Medicare enrollment of an employee has several consequences -- including some retroactive consequences -- for the employee's right to make contributions to a health savings account (HSA). But many employees are unaware that Medicare coverage of the employee's spouse does not necessarily have any effect on the employee's right to make HSA contributions, or the amount of those contributions." Lockton

Affordable Coverage: July 2018 Short-Term Health Insurance and the ACA (PDF)

"Short-term health insurance premiums are 80 percent less costly, on average, than [ACA]-qualified health plans ... [S]hort-term health insurance plans with $5,000 deductibles, $750,000 of total coverage and coinsurance of 20% or less ... were compared to the lowest-priced ACA plans available, which were typically bronze-level qualified health plans. These policies have an average deductible of $5,953, no limit on annual coverage and coinsurance of 20% or less." eHealth

Second Circuit Requires Reevaluation of ERISA Attorney Fee Judgment

"[T]he Second Circuit first concluded the district court incorrectly determined that the plaintiff had not achieved 'some success' -- a threshold requirement for an ERISA fee award -- because 'some success' was achieved by getting the district court to vacate its earlier decision based on an intervening Second Circuit decision. The underlying issue pertained to the appropriate standard of review where a plan allegedly did not have claims procedures that complied with the DOL regulations." [ Tedesco v. I.B.E.W. Local 1249 Ins. Fund , No. 17-3404 (2d Cir. July 6, 2018)]
Proskauer's ERISA Practice Center

Michigan Catching Up On State Employee Pension and Retiree Health Benefit Debt

"[U]nfunded [pension] liabilities fell by $100 million in 2017 ... because the state outperformed its assumptions, but also because the state changed its assumptions.... [T]he state decided to set money aside to pay for current retiree health benefits costs. Lawmakers have saved $2 billion to pay for these benefits and would need another $7.5 billion to catch up on the rest, if lawmakers choose to prefund the costs instead of reducing the benefits." Mackinac Center for Public Policy

Tax Reform May Heighten Impact of NQDC Plans as a Retirement Benefit for Executives

"[T]he most common reason employers offer a NQDC plan is to 'have a competitive benefits package' (36.3 percent) followed by 'helping eligible employees accumulate assets (23.4 percent).... These benefits are increasingly important as executives find their contributions to qualified plans, such as 401(k)s constrained by contribution limits. Indeed, a 'restoration match' was the most common type of employer contribution, provided by 32 percent of NQDC plans, to fill the gap in employer matching contributions to qualified plans created by tax code limits." Plan Sponsor Council of America [PSCA]

Effect of Medicare Mid-Year Enrollment on HSA Contributions

An individual cannot contribute to an HSA once they are enrolled in Medicare. But if they enroll for Medicare on June 1, could they have contributed to an HSA for the first 5 months of the year in question? If yes, how much could they have contributed? Is the maximum prorated for the 5 month period? BenefitsLink Message Boards

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