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Untangling the FMLA and ADA Overlap Puzzle to Avoid Employment Litigation
August 30, 2018 WEBCAST
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Text of IRS Q&As on Employer Shared Responsibility Provisions Under the ACA

New Q&A 18 added Aug. 20, 2018: "Do the employer shared responsibility provisions apply if an employer that is not otherwise an ALE offers coverage through an Association Health Plan (AHP)? No. Whether an employer member of an association that offers coverage through an AHP is an ALE that is subject to the employer shared responsibility provisions depends on the number of full-time employees (and full-time equivalent employees) the member employer employed in the prior calendar year and is unrelated to whether the employer offers coverage through an AHP. An employer that is not an ALE under the employer shared responsibility provisions does not become an ALE due to participation in an AHP, and an employer that is an ALE under the employer shared responsibility provisions continues to be an ALE subject to the employer shared responsibility provisions regardless of its participation in an AHP." Internal Revenue Service [IRS]

Text of DOL 'ERISA Compliance Assistance' on Association Health Plans (PDF)

Unnumbered and undated overview of ERISA aspects of association health plans including the recently issued regulations; seems to provide no new information but includes useful hypertext links. "What is an Association Health Plan (AHP)? ... What ERISA provisions apply to AHPs? ... Are exemptions available for an AHP from any of ERISA's prohibited transaction provisions? ... Does the [DOL] have any voluntary correction programs for employers or associations who make mistakes in operating an AHP ... Does ERISA contain any special MEWA enforcement provisions that apply to AHPs? ... Do the States have any authority over AHPs ... When can AHPs be established under the new rule?" [Published online Aug. 17, 2018] Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Self-Funded ERISA Health Plans and New Jersey's 'Surprise' Out-of-Network Medical Bill Law

"[P]lan sponsors will want to weigh the administrative burdens of complying with the Surprise Medical Bill Law's protections and disclosure requirements against the protective advantages offered to its covered participants.... Most notably, Electing Plans will be sparing participants from being balance billed for 'inadvertent [out of network] services' and services provided on an 'emergency or urgent basis' in excess of the deductible, copayment, or coinsurance amount, and will potentially be shifting the dispute resolution process to the Electing Plan and provider without participant involvement." Epstein Becker Green

San Antonio Mandates Paid Leave for Private Sector Employees

"The ordinance requires employers to provide paid leave to be used for specified reasons for employees' and their family members' health-related issues.... The law takes effect on August 1, 2019, for employers with more than five employees. For employers with five or fewer employees, the law becomes effective on August 1, 2021.... All employers doing business in the city of San Antonio must provide the specified paid leave.... Employers must grant employees one hour of earned paid sick leave for every 30 hours worked in the city of San Antonio." Ogletree Deakins

Nine Innovative Benefits and Reminders to Support the Working Parent

"[1] Flexibility ... [2] Convenience ... [3] Child care benefits ... [4] Flex and dependent care assistance programs ... [5] Real maternity and paternity leave ... [6] Employee Assistance Program (EAP) services ... [7] Family friendly discounts ... [8] Telemedicine ... [9] Insurance carrier value-adds." OneDigital Health and Benefits

It's Not Just the Uninsured -- It's Also the Cost of Health Care

"Now that the [ACA] has expanded health coverage, the percentage of the non-elderly population that is uninsured is now just under 11%, the lowest level ever recorded.... Another 15.5% who have insurance either skipped or delayed care because of the cost or reported that they or someone in their family faced problems paying their bills in 2017. That brings the total percentage of non-elderly people with insurance and affordability problems to 26.2%. More striking: nearly half of all people in fair or poor health -- 46.4% -- are uninsured or have affordability problems despite having coverage." Drew Altman, Kaiser Family Foundation, via Axios

CMS Awards $8.6 Million in Funding to States to Help Stabilize Markets

"States can use the funds for activities such as: [1] Conducting economic analyses and market scans of the State's health insurance market to improve and expand the number of affordable healthcare coverage options under new flexibilities offered to states by CMS guidance and regulations; and [2] Examining plan policies, procedures and claims related data related to access to mental health and substance use disorder treatment services, including opioid treatment services." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Ninth Circuit Withdraws Altera Decision, Leaving the Tax Court Decision in Force for Now

"[T]he Tax Court [had] invalidated [Treas. Reg. 1.482-7A(d)(2)] which provides that in the context of qualified cost-sharing agreements the cost of employee stock compensation must be treated as a per se expense allocated between related parties.... On July 24, 2018, the Ninth Circuit by a vote of 2-1 reversed the Tax Court's [decision] ... Prior to the release of the opinion, one of the two judges who voted to reverse the Tax Court died.... The decision to withdraw the case ... was done by the Court and appears to be an admission by the Court that they made a mistake in allowing Judge Reinhardt's vote to be cast after he passed." [ Altera Corp. v. Comm'r , Nos. 16-70496, 16-70497 (9th Cir. Aug. 7, 2018)]
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Text of IRS PLR 201833014: Amendment of Welfare Benefit Trust to Provide Benefits for Active as Well as Retired Employees Does Not Cause Disallowance of Deduction for Prior Contributions (PDF) Internal Revenue Service [IRS]

Benefits Considerations for Seasonal Employees Transitioning to Ongoing Positions Morgan Lewis

Why Investigating a Health Plan's Grandfathered Status Matters to Providers Bloomberg Law

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