Defined Benefit Consultant
ERISA Fiduciary Services Inc.
in NY, Telecommute

Retirement Plan Administrator
Premier Plan Consultants
in CA

Client Manager
Financial Services Company - Retirement Plans
in OH

Pension Administrator - Retirement Plans
Steidle Pension Solutions, LLC
in NJ

Experienced Plan Consultant
Randall + Hurley
in MT

Employee Benefits Specialist / Paralegal
McNees Wallace & Nurick LLC
in PA

Compensation Associate
Newport Group
in IA, IL, WI, Telecommute

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Text of DOL Opinion Letter FMLA2018-1-A: No-Fault Attendance Policies and FMLA (PDF)

"This letter responds to your request for an opinion concerning whether an employer's no-fault attendance policy violates the Family and Medical Leave Act (FMLA). The policy effectively freezes, throughout the duration of an employee's FMLA leave, the number of attendance points that the employee accrued prior to taking his or her leave. As explained [in this letter], such a policy does not violate the FMLA, provided it is applied in a nondiscriminatory manner." Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Text of DOL Opinion Letter FMLA2018-2-A: Organ Donation Qualifies as 'Serious Health Condition' under FMLA (PDF)

"An organ donation can qualify as an impairment or physical condition that is a serious health condition under the FMLA when it involves either 'inpatient care' under Section 825.114 or 'continuing treatment' under Section 825.115. Thus, ... an organ donation would qualify as a serious medical condition whenever it results in an overnight stay in a hospital. Of course, that is not the only means for organ donation to involve 'inpatient care' or 'continuing treatment.' Organ-donation surgery, however, commonly requires overnight hospitalization, ... and that alone suffices for the surgery and the post-surgery recovery to qualify as a serious health condition."
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Everyone Wants Telemedicine. So Why Aren't Your Employees Using It?

"[E]mployers with programs in operation in 2016 reported that just 7% of eligible employees, on average, used telemedicine at least once.... [H]igher utilization is associated with lower copays.... Real-life examples from how a peer benefited from the service can help boost awareness and thus utilization ... Look at communication materials that address how the service can be utilized during specific times of the year ... [C]onsider a way to 'reward' members for completing the telemedicine pre-use application form." Mercer

Pre-Existing Conditions Vary Widely Across Metropolitan Areas

"In Florence, South Carolina -- a city that's established itself as a regional center for business, medicine and culture in the state -- at least 1 in 3 residents has a pre-existing condition. Just two hours south in the coastal town of Charleston, about 24% of residents have a pre-existing condition. That picture shows the wide variability of pre-existing conditions and the potential impact that a loss of healthcare protections for people with pre-existing conditions could have on metropolitan regions around the U.S." FierceHealthcare

Alphabet Investment in Oscar Seeks to 'Break the Cost Curve'

"Like the retail giants that decided to expand into the healthcare market, and CVS Health's acquisition of a large insurer, Alphabet is the latest nontraditional healthcare company to find the market potential of healthcare companies irresistible. Despite all the uncertainty about healthcare legislation and costs, the sheer size of the healthcare market is tempting for these big players, and companies like Oscar are courting their deep pockets[.]" HealthLeaders Media

High-Deductible Plans Surge, According to CDC

"Enrollment in HDHPs reached 47 percent of the commercially insured, pre-Medicare population in 2018, representing a 3.3-percentage-point increase from 2017 ... according to a quarterly survey by the Centers for Disease Control and Prevention (CDC).... The findings appeared contrary to a recent survey of large employers, which offer the largest share of HDHPs. [One] annual survey ... found the share of employers expecting to offer only HDHPs in 2019 was 30 percent among the 170 companies surveyed, compared with 39 percent in 2018 -- the first decline in seven years. Similarly, [a second] survey found enrollment in HDHPs dipped to 28 percent of covered workers in 2017 from 29 percent in 2016." HFMA

Senate Considers Bills in Response to Texas Individual Mandate Litigation

"On August 23, 2018, Republican senators [introduced] new legislation that they believe would help blunt the impact of a ruling for the plaintiffs in Texas v. United States . The stated aim of the bill is to 'guarantee' equal access to health care coverage regardless of health status or preexisting conditions. However, in the event that the court agrees with the plaintiffs ... the legislation leaves significant gaps."
Katie Keith, in Health Affairs

IRS Issues Guidance for New UBTI 'Siloing' Rules, But Questions Remain

"[1] Does an organization's ability to appoint a representative to an investor committee or other advisory body with respect to an investment partnership constitute such organization's 'participation' in the management of the partnership for purposes of the Control Test? ... [2] To what extent must an exempt organization seek information on underlying trades or businesses from investment partnerships, and what happens if the exempt organization is unable to obtain sufficient information? ... [3] What does it mean that fringe benefit UBTI inclusions are 'not subject' to section 512(a)(6)? Is such UBTI inclusion a de facto silo, or may unrelated trade or business losses be applied against fringe benefit UBTI?" Quarles & Brady LLP

How to Gain Executive Buy-In for Benefits Technology

"Focus on what matters to each stakeholder and how the new system will help them in their specific role. It's also important to understand what type of push-back you might get, so you can be prepared to respond clearly and effectively. Let's take a look at how benefits technology factors into what matters for each of the key stakeholders you'll likely be trying to convince during the purchasing process[.]" Benefitfocus

Using Terminating Multiemployer Plan's Surplus to Fund Employees' Health Insurance Premiums

A terminating multiemployer welfare fund desires to distribute its surplus (which includes pre-tax employee contributions), by procuring benefits. Based upon a reasonable procedure, the trustees approved allocations for approximately 10 groups of employees, each employed by a different former contributing employer. Private letter rulings, such as PLR 201121028, have approved plan termination distributions to former contributing employers to hold and use allocated shares of the surplus for their employees' benefit. The expectation here is that the employers would then be able to drawn down the allocated surplus to pay the employees' portion of current health insurance coverage. Some of the employers do not want to hold the distribution but have agreed to provide the union with records of the co-pay obligations so these sums could paid along with the employer's share of the premiums. The funds can only be used to pay the employees' insurance premiums. Is anyone aware of any issues with the sponsoring union holding the distributed surplus for the sole benefit of the covered employees and forwarding the employees' share of the premiums to the current insurance carrier? BenefitsLink Message Boards

Press Releases

LIMRA and LOMA To Host Hackathon For Innovative Solutions to Fight Fraud in the Life Insurance and Retirement Industries LIMRA

Saratoga Doctor Sentenced To More Than Five Years In Prison For Health Care Fraud And Providing False Billing Statements To Health Care Benefit Programs U.S. Attorney's Office

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Most Popular Items in the Previous Issue

Employee Benefit Arrangements Potentially Affected by IRS Guidance on Revised UBIT Calculations Eversheds Sutherland

A Formula for Choosing the Right PBM for Your Benefits Corporate Synergies

State(d) Objections to the Association Health Plan Rule HUB International