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ERISA Compliance in Direct Contracting for Healthcare: Challenges for Employers and Providers
October 23, 2018 WEBCAST
Strafford

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October 15 Deadline for Medicare Part D Notice of Creditable Coverage

"[T]here are five instances in which such notice must be provided: [1] Prior to an individual's initial enrollment period for Part D; [2] Prior to the effective date of enrollment in the employer's prescription drug coverage; [3] Upon any change in the plan's creditable status; [4] Prior to the annual election period for Part D (which begins each October 15); and [5] Upon the individual's request.... [E]mployers must electronically file these notices each year [with CMS] through the form supplied on the CMS website." Fraser Trebilcock

What Employers Need to Know About ACA 'Pay or Play' Mandates

Sept. 18 webinar will clear up any confusion about the ACA 'Pay or Play' mandates and help employers to avoid penalties. Discount for BenefitsLink readers .

Determining Whether Prescription Drug Coverage Is Creditable (PDF)

"Employers with insured plans should ask their health insurance carriers if they have made this determination for the insured product. If an employer must make the determination itself, it may be able to use a simplified method, depending on the plan's design. When a plan's design is not eligible for the simplified method, an actuarial determination must be made." Cowden Associates, Inc.

Heading Into Open Enrollment

"New Jersey's out-of-network 'surprise medical bills' act ... What to do about incentive limits for wellness programs subject to the ADA ... ACA employer shared responsibility penalties increase ... DOL issues updated health insurance marketplace coverage notice ... IRS issues FAQ on ACA applicability to association health plans." Drinker Biddle

Medical Providers Test Boundaries of Benefit Assignments

"While the enforceability of anti-assignment clauses in ERISA plans is well-established in every circuit that has considered the issue, the extent of the rights conveyed by an assignment of benefits in the absence of an anti-assignment clause is very much a facts-and-circumstances determination." Thomson Reuters / EBIA

Attention Plan Sponsors of Fully Insured Health Plans: How To Handle MLR Rebates

"[To] the extent a rebate qualifies as a plan asset, ERISA would generally require the amount to be held in trust. Most employers with insured plans do not maintain trusts for their health plans. The DOL has provided relief from the trust requirement for rebates that are used within three months of their receipt. Thus, employers who decide to distribute the rebate to participants should adhere to this three-month time limit." Burnham Benefits

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Maryland Sues to Head Off Texas-Led ACA Challenge

"Maryland is seeking an injunction that would require the government to continue enforcing the ACA. That has the potential of directly contradicting a possible injunction in the Texas case." HealthLeaders Media

2019 Open Enrollment Dates by State

"The national health insurance open enrollment period for major medical (Obamacare) coverage begins on November 1, 2019. But, some states have extended their open enrollment periods to start before, and in some cases, end after the national Obamacare open enrollment period." eHealth

Two New Federal Surveys Show Stable Uninsured Rate

"The uninsured rate amongst people of all ages in 2017 was 8.8 percent (28.5 million people), which is not statistically different from 2016. Although the number of people with health insurance increased by 2.3 million from 2016 to 2017, there was no change in the percentage of people with coverage ... More than half of the population -- 56 percent -- has employer-sponsored coverage[.]" Katie Keith, in Health Affairs

The Flawed Logic of the Cadillac Tax, Explained

"While it is not clear that there is any potential benefit to the US healthcare system of scaling back its tax incentives, the potential harm is significant. Without the tax incentive, for how long could US employers -- many of whom must compete in a global market against companies that bear far less financial responsibility for workers' healthcare -- continue to pay the lions' share of the healthcare costs for 178 million Americans?" Mercer

Stock Compensation Can Add Zing to Your Benefits Package

"Aside from the traditional retirement plan and medical benefit offerings, some employers may find value in offering creative stock bonus and compensation programs like stock options, restricted stock, and other equity-type arrangements.... This article addresses three sources of federal law that must be kept in mind when designing and implementing a stock compensation program -- the Internal Revenue Code, ERISA, and securities laws." Holland & Hart LLP

Press Releases

McKinley Carter Becomes First West Virginia Investment Firm to Earn Fiduciary Excellence Certification CEFEX

Ascensus Appoints New Regional Vice President Ascensus

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