Retirement Plan Administration Associate
The Segal Group
in NY

Retirement Plan Services Systems Specialist
Dubuque Bank and Trust
in IA

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Text of IRS Release Memo for Tax Year 2018 AIR Business Rules (PDF)

"Tax Year 2018 v1.1 Business Rule package has been posted [on the IRS website]. The Business Rules v1.1 will be valid January 1, 2019. There is no change to the schema."
Internal Revenue Service [IRS]

Proposed U-Turn on Employers Paying for Individual Policies Leaves Questions Unanswered

"[E]mployers should bear in mind that the existing rules (which impose substantial penalties for reimbursing for individual health insurance premiums) still apply.... The rules allow employers to offer the HRA only to specific classes of employees (or a combination of classes) ... Notably absent from the list is salaried versus hourly.... [T]he Departments did remove a key hurdle. The proposed new rules would not make the individual insurance policies part of the ERISA plan." HUB International

Trump Administration Moves to Incentivize Health Reimbursement Arrangements

"This post offers background information on HRAs; summarizes the proposed rule; and discusses the rule's potential implications for employers, employees, and the individual insurance market. Comments on the proposal are due within 60 days." Katie Keith, in Health Affairs

CMS Proposes to Modernize Medicare Advantage, Expand Telehealth Access for Patients

"[T]he proposed changes would remove barriers and allow Medicare Advantage plans to offer 'additional telehealth benefits' not otherwise available in Medicare to enrollees, starting in plan year 2020 as part of the government-funded 'basic benefits.' "
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

New Jersey Publishes Paid Sick Leave FAQs Days Before Law Takes Effect on Oct. 29

"The New Jersey Earned Sick Leave Law goes into effect on October 29, 2018 ... Highlights from [recently-issued] non-binding New Jersey sick leave FAQs [include:] ... [1] Covered employers ... [2] Employee eligibility ... [3] Benefit year ... [4] Use of PTO ... [5] Treatment of full-time and part-time employees ... [6] Proration of paid sick leave ... [7] Year-end carryover ... [8] Reasons for use/covered family members ... [9] Interplay between sick leave and overtime ... [10] Interplay between sick leave and other leave entitlements."
Seyfarth Shaw LLP

Third Circuit Applies Materiality Endorsement Standard in DOL Voluntary Plan Safe Harbor Analysis

"[T]he Third Circuit's analysis here considers factors -- such as representations made by an employer's broker -- to which an employer expecting to rely on the safe harbor may not be paying close attention. Interestingly, the court also indicates that the employer's selection of only one provider of supplemental disability insurance (as opposed to offering individuals a menu of options) worked against the employer under the Third Circuit's 'material involvement' endorsement standard." [ McCann v. Unum Provident , No. 16-2014 (3d Cir. Oct. 5, 2018)]
Thomson Reuters Practical Law

How Important Is Price Variation Between Health Insurers?

"[The authors] measure negotiated prices for hospital-payer pairs in Massachusetts and characterize price variation. Between-payer price variation is similar in magnitude to between-hospital price variation. Administrative-services-only contracts, in which insurers do not bear risk, have higher prices. [They] model negotiation incentives and show that contractual form and demand responsiveness to negotiated prices are important determinants of negotiated prices." National Bureau of Economic Research [NBER]; purchase required for full document

Trump Adds a Global Pricing Plan to Wide Attack on Drug Prices, But Doubts Persist

"The proposal to require drug prices in TV ads could be delayed by litigation and notably, if implemented, does not include any penalties for companies who fail to post their prices. The proposed rebate rule was delivered to [OMB] in July. Matt Brow, president of industry consulting firm Avalere Health, said he expects the administration to publish the rule for comment by year's end. Trump's international pricing plan is not as far along as the rebate proposal." Kaiser Health News

Key Updates and Enhancements to Healthcare.gov for the 2019 Open Enrollment

"Streamlined application visual refresh ... Find local help enhancements ... Improved plan information ... Consumer tools and support: Window shopping ... Consumer call center ... Help on demand ... Financial assistance ... Quality Rating System (QRS) Star Ratings Pilot ... Small Business Health Options Program (SHOP) ... Re-enrollment process ... HealthCare.gov scheduled maintenance windows." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

State Individual Health Insurance Coverage Mandates: Rationales and Design Issues (PDF)

45 pages. "Enacting a state mandate is a straightforward way for states to avert the negative consequences of federal mandate repeal. It also offers states other advantages: it can help discourage the spread of insurance coverage that does not meet designated standards, facilitate state outreach to the uninsured, and serve as a source of revenue to finance other state policies aimed at improving insurance markets." The Brookings Institution

DOL Announces Guidance and Relief for Employee Benefit Plans Impacted by Recent Hurricanes

"The guidance generally applies to employee benefit plans, plan sponsors, employers and employees, and service providers to such employers who were located in a county identified now or in the future for individual assistance by [FEMA] because of Hurricane Florence or Hurricane Michael . [1] Verification procedures for plan loans and distributions ... [2] Participant contributions and loan repayments ... [3] Blackout notices ... [4] ERISA claims compliance guidance ... [5] Filing relief."
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Text of EBSA FAQs for Participants and Beneficiaries Following Hurricanes Florence and Michael (PDF)

22 Q&As covering health and retirement plan benefits, including: [1] I think I may be losing my health coverage as a result of the events of one of the hurricanes. What can I do to obtain other health coverage? ... [2] I lost my spouse in one of the hurricanes. My spouse's employer has agreed to pay the premiums for my health coverage for 12 months. What effect will that have on any future eligibility for continuation health coverage under COBRA? ... [3] My employer did not pay my insurance premium. May I pay the premium to continue my coverage? ... [4] How can I make changes in the way my 401(k) plan account is invested if it was affected by the events of one of the hurricanes? ... [5] Can I get money out of my retirement plan if I need financial assistance to help me at this time? ... [6] All of the records concerning my employment with the retirement plan sponsor and my participation in the retirement plan were destroyed as a result of the events of one of the hurricanes. What do I do? Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Employer Failed to File 1094-C and 1095-C

Just started a new job as an HR generalist and we've discovered that our employer failed to file 1094-C and 1095-C with the IRS. We're a self-insured ALE. The entire department retired this summer, and we don't know what they told the IRS. I heard we got a letter that our extension was denied, but I don't have a copy of the letter. I don't have records of any other correspondence. The employees did receive their forms. I'm not sure where to start with the IRS. BenefitsLink Message Boards

Press Releases

PBGC Announces Leadership Appointments PBGC [Pension Benefit Guaranty Corporation]

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Most Popular Items in the Previous Issue

IRS and DOL Audit Focus Points (PDF) McDermott Will & Emery

A New Direction for Health Reimbursement Arrangements Winston & Strawn LLP

Why Do I Keep Getting Billed for Preventive Health Services? Mercer