Employee Benefits Associate
Morgan Lewis & Bockius LLP
in DC

Defined Contribution Pension Administrator
Pension Investors Corporation of Orlando, Inc.
in FL

Pension Administrator
Retirement Programming Ltd.
in NY

ESOP Administrator
Blue Ridge ESOP Associates
in VA, Telecommute

401(k) Account Manager
ABG Retirement Plan Services
Telecommute

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Nondiscrimination Testing for Health Plans: Code Section 105(h) and Post-ACA Design Alternatives
December 5, 2018 WEBCAST
Lorman Education Services

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Text of CMS and Treasury Department Guidance: State Relief and Empowerment Waivers

34 pages. "This updated guidance provides supplementary information about the requirements that must be met for the approval of a State Innovation Waiver, the Secretaries' application review procedures, the calculation of pass-through funding, certain analytical requirements, and operational considerations.... Changes include increasing flexibility with respect to the manner in which a section 1332 state plan may meet section 1332 standards in order to be eligible to be approved by the Secretaries, clarifying the adjustments the Secretaries may make to maintain federal deficit neutrality, and allowing for states to use existing legislative authority to authorize section 1332 waivers in certain scenarios....

"The Secretaries will consider favorably section 1332 waiver applications that advance some or all of these five principles ... [1] Provide increased access to affordable private market coverage.... [2] Encourage sustainable spending growth.... [3] Foster state innovation.... [4] Support and empower those in need. Americans should have access to affordable, high value health insurance.... [5] Promote consumer-driven healthcare.... Consistent with [these] principles ... the Secretaries intend to provide states with maximum flexibility within the law to innovate, empower consumers, and expand higher value and more affordable coverage options." Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services [HHS]; U.S. Department of the Treasury

Register Today for HBCE and Save!

As employers today continue to struggle to reduce health care costs while trying to improve employee engagement, identifying a clear path to what works can feel seemingly impossible. The Health Benefits Conference & Expo (HBCE) is here to help!

Administration Announces State Relief and Empowerment Waivers

"The new flexibilities available to states include ... [1] Allows states to provide consumers with plan options that best meet their needs, while, at the same time, ensuring people, including those with pre-existing conditions, retain access to the same level of coverage available today without the waiver; [2] Continues to require that a comparable number of people have coverage, but expands the definition of coverage to include more types of coverage, such as short-term plans; [3] Provides greater flexibility for states to consider improvements in comprehensiveness and affordability for state residents as a whole versus the prior focus on specific populations; [4] Supports increased variation and flexibility for states that may want to leverage components of the Federal Exchange platform to implement new models; and [5] Provides flexibility for states to meet the state legislative authority requirement. The guidance clarifies that in certain circumstances, existing state legislation that provides statutory authority to enforce ACA provisions and the state plan, combined with a duly-enacted state regulation or executive order, may satisfy the requirement that the state enact a law." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

New California Law Aims to Increase PBM Disclosure and Transparency

"Under Assembly Bill (AB) 315 , signed into law by Governor Jerry Brown late in September of 2018, employers should have access to more information from PBMs regarding drug costs and economic ties between PBMs and both pharmacies and pharmaceutical manufacturers. Employers may be able to use this information to negotiate better prices with PBMs or to otherwise control plan costs.... Employers will be able to request the information from PBMs quarterly."
Ogletree Deakins

IRS Clarifies Role of Gross-Ups When Taxes Are Assessed on an Earlier Year's Fringe Benefits

"[ Program Managers Technical Advice (PMTA) 2018?015 ] reminds readers that the employer is legally responsible for withholding both the employer's and employee's portions of FICA tax and [federal income tax withholding (FITW)]. If the employer fails to withhold, does not withhold the correct amount, or withholds and does not remit the taxes to the IRS, the employer is liable for the payment of the FITW and FICA."
Ogletree Deakins

CMS Proposes Rule to Require Drug Pricing Transparency

"The Proposal states that even though the List Price is typically not the price paid, it is a basic piece of factual information that the consumer should know in order to have at least one metric for comparison shopping.... The Proposal states that the List Price is simply a required disclosure of factual information in a commercial speech setting, thus requiring a lower level of First Amendment scrutiny.... The Proposal assumes that enforcement will come from private actions for false or misleading advertising under the federal Lanham Act." Dorsey

Handling HIPAA Breaches: Investigating, Mitigating and Reporting

"[1] Stop the breach.... [2] Contact the privacy officer.... [3] Respond promptly.... [4] Investigate appropriately.... [5] Mitigate the effects of the breach.... [6] Correct the breach.... [7] Impose sanctions.... [8] Determine if the breach must be reported to the individual and HHS.... [9] If required, report the breach to the individual and HHS." Holland & Hart LLP

Why FSAs are Worth It -- Even for Low Income Earners

"There is a myth that individuals in lower income brackets can't afford to have anything else deducted from their paychecks and therefore they forgo having a Flexible Spending Account (FSA).... As an account holder, an FSA helps you pay for things you likely already have to pay for, but now you get to do it tax free. There are hundreds of eligible expenses for tax-free purchase with your health care FSA funds, including prescriptions, doctor's office copays, health insurance deductibles, and coinsurance." Connect Your Care

Cost-Sharing Reduction Payments Must Be Made, Despite Congress's Refusal to Appropriate Funds

"[T]he court rejected the government's summary judgment arguments that compensation is contingent on appropriations, and instead looked to the plain language of Section 1402, which provides that the government 'shall pay' an insurer for their portion of unpaid premiums. Relying on a separate Federal Circuit decision ... the court held the 'shall pay' language creates an obligation and right independent of Congressional funding appropriations. Sanford was awarded $360,254 and costs." [ Sanford Health Plan v. U.S. , No. 18-136C (Fed. Cl. Oct. 11, 2018)]
Wolters Kluwer; free registration required

Departments Expand Definition of Short-Term, Limited-Duration Health Insurance

"The new rule, set to take effect this month, allows insurers to offer these policies with medical underwriting and the exclusion of pre-existing medical conditions. While the rule may weaken the ACA-compliant individual health insurance market risk pool, it is not expected to affect employer-sponsored coverage." Buck

Text of IRS Disaster Relief Announcement WI-2018-07, for Victims of Severe Storms in Wisconsin

"Victims of severe storms, tornadoes, straight-line winds, flooding, and landslides that took place beginning on Aug. 17, 2018 in Wisconsin may qualify for tax relief ... Individuals who reside or have a business in Crawford, Dane, Juneau, La Crosse, Monroe, Richland, Sauk, and Vernon counties may qualify ... [C]ertain deadlines falling on or after Aug. 17, 2018 and before Dec. 17, 2018, are granted additional time to file through Dec. 17, 2018. This includes taxpayers who had a valid extension to file their 2017 return due to run out on Oct. 15, 2018." Internal Revenue Service [IRS]

Imputing Income for Discriminatory Premiums Under 105(h)

Say an employer has a self-insured group health plan. The same plan coverage, waiting period, benefits, etc. are offered to all employees. If HCIs paid, say, 10% of the cost of coverage and non-HCIs paid 50%, we would violate 105(h). If the premium payments by employees remained the same (10% and 50%), but the employer imputed taxable income to the HCIs equal to 40% of the premium, does this solve the 105(h) problem? I know the typical solution in post-termination or COBRA subsidization is to make the premium payment or subsidy taxable. Does this same solution carry over directly to the continuing employment scenario? Alternatively, the HCIs' base salary could be increased, but the employer wants to avoid having to increase base salaries for optics and other reasons. BenefitsLink Message Boards

Reporting Forgiven Arrears Balances as Imputed Income

If an employer uses the arrears method for collecting an employee's obligations for H&W benefits while they are on unpaid LOA and the employer elects to forgive the balance in lieu of collecting the balance, is there any way to do that and avoid the imputing of income to the employee? If the employee owes a balance and rather than collecting the balance the employer would like to forgive the amount, do we need to include the forgiven amount as imputed income on the employee's W-2? BenefitsLink Message Boards

Press Releases

American Retirement Association General Counsel Craig Hoffman to Join Trucker Huss Trucker Huss

Experienced Trial and Appeals Litigators to Tackle High-Stakes ERISA and ESOP Matters for McDermott Clients McDermott Will & Emery LLP

ASPPA Welcomes James Nolan as 50th President ASPPA [American Society of Pension Professionals & Actuaries]

ASPPA Honors Mark Iwry, Others with 2018 Industry Awards ASPPA [American Society of Pension Professionals & Actuaries]

Federal Court Orders Illinois Pension Plan to Restore $419,758 Following DOL Investigation Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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Most Popular Items in the Previous Issue

Wellness Promotion/Prevention: Overcoming Legal and Compliance Hurdles (PDF) Alston & Bird

New Federal Laws Ban Gag Clauses in Pharmacy Contracts McDermott Will & Emery

HHS Announces Annual Adjustments to Civil Monetary Penalties, with Implications for Employer-Sponsored Health Plans Thomson Reuters / EBIA