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Text of Agency Proposed Regs: Health Reimbursement Arrangements and Other Account-Based Group Health Plans

209 pages. "[T]hese proposed rules allow integrating HRAs with individual health insurance coverage, if certain conditions are met. The proposed rules also set forth conditions under which certain HRAs would be recognized as limited excepted benefits....

• "[The] Department of the Treasury and the [IRS] propose rules regarding premium tax credit (PTC) eligibility for individuals offered coverage under an HRA integrated with individual health insurance coverage....
• "[The DOL] proposes a clarification to provide plan sponsors with assurance that the individual health insurance coverage the premiums of which are reimbursed by an HRA or a qualified small employer health reimbursement arrangement (QSEHRA) does not become part of an ERISA plan, provided certain conditions are met....
• "[HHS] proposes rules that would provide a special enrollment period in the individual market for individuals who gain access to an HRA integrated with individual health insurance coverage or who are provided a QSEHRA.

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Agencies Announce Proposal to Expand Access to Quality, Affordable Health Coverage

"Because medical expense reimbursements from HRAs are tax-preferred, HRAs -- that workers and their families use to purchase coverage of their choosing -- provide the same tax advantage enjoyed by traditional employer-sponsored coverage. The proposed regulation would not alter the tax treatment of traditional employer-sponsored coverage. It would merely create a new tax-preferred option for employers of any size to use when funding employee health coverage. While the employer would fund the cost of individual health insurance coverage, the employee would own the coverage, allowing the employee to keep the coverage even if he or she left the employer and was no longer covered by the HRA. In the near term, the proposed regulation, if finalized, would provide opportunities to employers, especially small and mid-size employers who have struggled to offer coverage, to fund the cost of individual health insurance coverage on a tax-preferred basis." Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Administration Provides New Health Options for Small-Business Employees

"Americans should have more options than one plan their employer selects for them. And they should be able to maintain their insurance when they change employers or exit the job market to raise a family or care for a sick loved one. That's why the administration is proposing a regulation that would create a new way for employers to provide health coverage for employees. This proposal would give millions of workers and their families more control over their health care. It also holds the promise of more-efficient health-care spending, expanded business growth, and higher wages." Alexander Acosta, Steven Mnuchin and Alex Azar, via The Wall Street Journal; subscription may be required

Trump Administration Loosens Restrictions on Health Reimbursement Arrangements

"While the new proposed rule does not eliminate the employer mandate penalty, it would allow HRAs used to pay for individual insurance premiums on the exchange or off the exchanges to satisfy the employer mandate, depending on whether the HRA is affordable. That would depend in part on the amount the employer contributes to the HRA." Modern Healthcare Online; free registration required

Trump Administration Expands Health Reimbursement Arrangements for Marketplace Coverage

"Under the new rule, HRA money would remain exempt from federal and payroll income taxes for employers and employees. Additionally, employers with traditional coverage would be permitted to reserve $1,800 for supplemental benefits like vision, dental and short-term health plans." FierceHealthcare

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ACA Regulations Watch: What to Expect This Fall

"[F]our rules [are] under review at OMB, and four rules [are] not yet at OMB but are expected this fall.... [On] October 11, HHS submitted two new final rules on the ACA's contraceptive requirements.... One notable absence on the current OMB review list is the Notice of Benefit and Payment Parameters rule for 2020....HHS expects to release additional regulations this fall." Katie Keith, in Health Affairs

Ninth Circuit: ERISA Does Not Preempt State's Unfair Trade Practices and Mental Health Parity Laws

"[T]he Ninth Circuit Court of Appeals ruled that a state's unfair trade practices and mental health parity laws will not be preempted by ERISA unless certain requirements are met.... The court ... stated that any duty for the insurer to refrain from unfairly harming its competitors arises under state law, not under the terms of an ERISA plan. This claim would exist regardless of whether any ERISA plans were involved, because the insurer has an independent duty to refrain from engaging in unfair and deceptive business practices." [ Hansen v. Group Health Plan Cooperative , No. 16-35684 (9th Cir. Sept. 4, 2018)]
The Wagner Law Group

Mandatory Employee Notice Issued for New Jersey Earned Sick Leave Law: October 29 Deadline

"By October 29, 2018, employers will be required to 'conspicuously post the notification in a place or places accessible to all employees in each of the employer's workplaces.' The notice must be posted in the language that is the 'first language of a majority of the employer's workforce,' and the Department is expected shortly to issue versions of the notice in ten languages other than English."
Proskauer

Westchester County, New York, Mandates Employee Sick Leave

"Westchester County has just enacted an Earned Sick Leave Law which will soon require Westchester employers to provide sick leave to its employers. All Westchester employees -- both full-time and part-time -- who work more than 80 hours per year are eligible to earn sick time. The law, which was passed on October 1, will take effect 180 days from its adoption: March 30, 2019." Fisher Phillips

Will You Be the Last Kid on the Block to Add Paid Parental Leave?

"In 2018, 41% of survey respondents offer paid parental leave to their employees, up from only 25% of respondents to [the] 2015 survey.... The median amount of leave offered to birth parents is six weeks, compared to four weeks for non-birth parents. The length of leave offered is unchanged from the 2015 survey." Mercer

Judge Denies Request to Reconsider Risk Adjustment Ruling

"In denying the federal government's request, Judge Browning maintained his conclusion that part of HHS' risk adjustment formula from 2014 to 2018 was arbitrary and capricious. Although HHS has taken steps to address this flaw for 2017 and 2018, it has not done so for 2014 to 2016[.]" [ New Mexico Health Conn. v. HHS , No. 16-878 (D. N.Mex. Oct. 19, 2018)]
Katie Keith, in Health Affairs

CMS Reports Data Breach in ACA Agent and Broker Portal

"CMS officials have reported a data breach in the portal for the part of the marketplace exchange used by agents and brokers who help consumers sign up for health insurance. The activity affected about 75,000 individual files, and the portal has been disabled as officials investigate what happened." American Journal of Managed Care

NLRB Approves Unilateral Benefits Changes Consistent with Past Practice

"Because the changes did not materially vary in kind or degree from prior changes, the employer was merely maintaining the status quo expressed in its past practice when the collective bargaining agreement was in effect. Accordingly, [the NLRB found that] the employer did not violate the Act by implementing changes without providing the union with advance notice and the opportunity for bargaining."
Polsinelli PC

Winning the Self-Reported Diagnosis Limitation in Disability Claims

"[A new case] highlights that the limitation still applies even when there might be some weak evidence in the medical records verifying the diagnosis. That's because the diagnosis rested 'primarily' on self-reported symptoms." [ Floerke v. SSM Health Care Plan and Unum Life Ins. Co. , No. 17-567 (W.D. Wisc. Oct. 17, 2018)]
Lane Powell PC

Press Releases

DOL Obtains Consent Order and Judgment to Distribute Assets to Participants in Chicago Hospital Retirement Plan Employee Benefits Security Administration [EBSA], U.S. Department of Labor

OneDigital Health and Benefits Acquires Assurance Benefits Group, LLC OneDigital Health and Benefits

Custodia Financial Announces Expansion of Retirement Loan Eraser Program to Prevent a Broader Range of 401(k) Loan Defaults and Address Retirement Plan Leakage Custodia Financial

Willis Towers Watson Joins Forces with Tandem HR Solutions to Drive Real-Time Employee Performance Management Willis Towers Watson

Corporate Synergies Names Greg Blemlek Vice President and Senior Benefits Consultant in Greater Philadelphia Corporate Synergies

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Most Popular Items in the Previous Issue

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

Handling HIPAA Breaches: Investigating, Mitigating and Reporting Holland & Hart LLP

Why FSAs are Worth It -- Even for Low Income Earners Connect Your Care