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EZ Pension Services
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Holland & Hart LLP
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in NY

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What Works Best in Workplace Health Promotion?
October 23, 2018 WEBCAST
WellRight

Opioid Crisis: Insights and Resources for Employers
November 8, 2018 in OH
Worldwide Employee Benefits Network [WEB] - Northeast Ohio Chapter

Maintaining A Safe And Drug-Free Workplace
November 14, 2018 in TX
Worldwide Employee Benefits Network [WEB] - Houston Chapter

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New Comments and Topics

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Text of HHS Regulatory Agenda, Fall 2018

CMS Proposed Rules include: [1] CY 2020 Notice of Benefit and Payment Parameters; [2] Rescinding the adoption of the standard unique health plan identifier and other entity identifier; [3] Grandfathered health plans in the individual and small group markets; [4] Miscellaneous Medicare Secondary Payer clarifications and updates; [5] Civil money penalties and Medicare Secondary Payer reporting requirements; and [6] Health Reimbursement Arrangements and other account-based group health plans.

CMS Final Rules include: [1] Moral exemptions and accommodations for coverage of certain preventive services under the ACA; [2] Religious exemptions and accommodations for coverage of certain preventive services under the ACA; and [3] Adoption of the methodology for the HHS-operated Permanent Risk Adjustment Program for the 2018 Benefit Year Proposed Rule.
U.S. Department of Health and Human Services [HHS]

Now is a great time to join Worldwide Employee Benefits Network (WEB)

Worldwide Employee Benefits Network represents more than 30 areas of expertise within the Benefits Industry. Join today .

Text of IRS Notice 2018-84: Application of Changes in Personal Exemption Deduction to the Premium Tax Credit and the Individual Shared Responsibility Provision (PDF)

"Because the [Tax Cut and Jobs Act] reduces the exemption amount to zero, taxpayers will no longer claim a personal exemption deduction on their individual income tax returns by listing an individual's name and TIN, multiplying the number of allowed exemptions by the exemption amount, and entering that amount on their tax return. Accordingly, taxpayers may have questions about what it means to claim a personal exemption deduction for purposes of the premium tax credit and the individual shared responsibility provision. Until further guidance is issued, the [rules stated in this Notice] apply for purposes of the regulations under Sections 36B and 5000A and for purposes of Section 1.6011 -8(a)[.]." Internal Revenue Service [IRS]

New Jersey Publishes Model Paid Sick Leave Notice; Effective Date is Near

"New employees [i.e., as of October 29, 2018] must receive this written notice from their employer when they begin employment, and existing employees must receive it by November 29, 2018.... The Notice contains a section for employers to insert the start and end of their respective paid sick leave benefit year.... Employers should also be on the lookout for the Notice in Spanish and any other language that the Commissioner determines is the first language of a significant number of workers in the State." Seyfarth Shaw LLP

District Court: Health Plan Must Explain Reasonable and Customary

"The court found that failing to disclose the methodology used to determine the amount payable for out-of-network claims was a violation of the ERISA claims procedures, even though the participant did not specifically request an explanation, because the use of the negotiated in-network amounts to determine the reasonable and customary amount was an internal criteria that was relied upon in making the decision. Further, although the use of the negotiated rates was not, on its face, arbitrary and capricious, denying benefits on the basis of an undisclosed interpretation of a key term was arbitrary and capricious." [ Zack v. McLaren Health Advantage, Inc. , No. 17-11253 (E.D. Mich. Sept. 20, 2018)]
Kilpatrick Townsend

FMLA Failure-to-Promote Claim Is Viable

"A discriminatory interference claim under the Family and Medical Leave Act (FMLA) can be based on a failure to promote, according to a federal district court in Nevada, but an exercise-of-rights interference claim under the FMLA could not be based on a corrected error in FMLA designation that did not result in a prevention of entitled leave." [ Browett v. City of Reno , No. 16-181 (D. Nev. July 24, 2018)]
Society for Human Resource Management [SHRM]

Maintaining Current Enterprise Wide Security Risk Assessment Critical to Managing HIPAA Security Rule and Other Breach Risks

"HIPAA Entities generally will want to ensure that their new enterprise risk assessment documents their consideration of [1] the newly updated Security Risk Assessment (SRA) Tool ... [2] lessons shared in OCR's $16 million Anthem, Inc. resolution agreement, [3] $5.55 million resolution agreement with Memorial Healthcare System and other OCR HIPAA resolution agreements, [4] civil monetary penalty assessments and other Security Rule guidance, [and] ... [5] other emergent internal and external data suggesting potential susceptibilities of their own systems and data to breach or loss."
Solutions Law Press

HHS Opens Door to Major Health-Care Privacy Changes

"[HHS] will release a request for information in November asking the public whether [HIPAA] is blocking a move toward providing coordinated care for patients and creating a value-based payment system ... New regulations in this area could especially enhance the ability of providers to exchange patient information and improve overall patient care[.]" Bloomberg BNA

Americans Describe the Financial Reality of Being Really Sick

"The whole point of health insurance is protection from financial ruin in case of catastrophic, costly health problems. But a recent survey ... of some of the country's most seriously ill people, found that even with health insurance, more than a third of the respondents had spent all or most of their savings while sick. They are often faced with deductibles and co-payments; treatments their insurance won't cover; and financial challenges -- like lost work -- that health insurance alone can't address." The New York Times; subscription may be required

The Future of Drug Rebates: Are They to Be or Not to Be?

"Several potential replacement models are being discussed that could take the place of rebates. A point-of-sale (POS) rebate model might be easiest to implement and could be an interim policy step.... The loss of rebate revenue could cause plan sponsors to re-evaluate their pricing models, plan designs, and underwriting process. Without a new model to represent the current net-of-rebate cost for all drugs, consumers could see higher out-of-pocket costs, or more limited benefits to keep premiums from rising." Deloitte

Consumer-Facing Medicare Plan Tools Are Inaccessible and Inaccurate

"Few would probably describe shopping for health insurance as 'fun,' but research shows Medicare Plan Finder (MPF), the federal government's website for finding information about plan options, makes this process particularly unbearable.... One of MPF's biggest problems? Information about out-of-pocket costs is difficult to find and understand. On top of that, this information doesn't account for an individual's health conditions, physician visits per year, and other factors that impact costs." FierceHealthcare

Text of DOL Regulatory Agenda, Fall 2018

EBSA Proposed Rules include: [1] Health Reimbursement Arrangements and other account-based group health plans; and [2] Definition of an "Employer" under Section 3(5) of ERISA -- Association Retirement Plans and other Multiple Employer Plans.

EBSA Final Rules : [1] Amendment of abandoned plan program; [2] Electronic filing of apprenticeship & training plan notices, and Top Hat Plan statements; [3] Adoption of amended and restated Voluntary Fiduciary Correction Program; [4] Fiduciary rule and prohibited transaction exemptions; [5] Religious exemptions and accommodations for coverage of certain preventive services under the ACA; and [6] Moral exemptions and accommodations for coverage of certain preventive services under the ACA.
U.S. Department of Labor [DOL]

American Benefits Legacy: The Unique Value of Employer Sponsorship

80 pages. "This report considers the value of employer-sponsored benefits and provides an overview of some of the data and analysis that illustrate the important contribution these benefits make to the economy and security of American workers and their families.... Section I provides a brief summary of the characteristics and development of employer sponsorship of benefits, and presents estimates of what the effect might be on the health benefits coverage and retirement security of workers if employers did not provide these benefits. Section II presents more in-depth analysis of several selected topics germane to understanding how employer-sponsored benefits provide value to workers and the broader economy. Section III highlights innovative programs and behavioral economics strategies implemented by employers in order to help employees achieve health and financial security." American Benefits Council

Disaster Planning for Employee Benefits (PDF)

"Natural disasters such as hurricanes, forest fires, ice storms and volcanic eruptions can result in widespread evacuations, work cessation and other disruptions that can significantly impact employees. For that reason, employers and benefit plans also should spend time considering and planning for disasters in a way that focuses on employees and plan participants. This article offers a look at several key planning areas." benefits magazine, a publication of the International Foundation of Employee Benefit Plans [IFEBP]

Press Releases

DataPath White Paper Analyzes Ways a Partner Marketing Program Can Affect a TPA's Success DataPath, Inc.

Insight Financial Partners, LLC is Certified for Fiduciary Excellence Centre for Fiduciary Excellence [CEFEX]

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Most Popular Items in the Previous Issue

Second Circuit Speaks on When Ministerial Acts Can Breach a Fiduciary Duty Robinson & Cole LLP

HHS Increases Civil Money Penalties for HIPAA Noncompliance Thomson Reuters Practical Law

HIPAA and Accounting Cybersecurity Update Winstead PC