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Welcome to the Snell & Wilmer Benefits Blog. We will be posting about current employee benefits and executive compensation topics and issues. We invite you to contact the authors with your thoughts or questions.Blog Contributors
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What is the Fate of ACA? No Answers Yet from the Fifth Circuit.
Background
As noted in our previous December 2018 blog post, “Texas Judge Declares the Affordable Care Act Unconstitutional – What’s Next?,” and our October 2019 newsletter, “2019 End of Year Plan Sponsor “To Do” List (Part 1) Health & Welfare,” on December 14, 2018, Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled the whole of ACA to be unconstitutional in Texas v. United States of America, No. 4:18-cv-00167. The plaintiffs (certain Republican-led states and two individuals) alleged, and Judge O’Connor agreed, that the repeal of the individual mandate “renders legally impossible” the Supreme Court’s prior savings construction of ACA and that the individual mandate is not severable from the rest of ACA. Read More ›
Posted in Health & Welfare Plans, Health Care Reform
| Tagged ACA, DOJ, individual mandate, reform, SCOTUS, Supreme Court
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Enjoy the End of the Decade with Some Employee Benefit Plan Checklists
Each year, we publish health and welfare, cost-of-living, qualified retirement plan, and executive compensation plan checklists to help individuals and employers stay apprised of updates to the law of employee benefits. We just published the last of these annual checklists. In case you missed them, the links are below.
Happy Holidays!
2019 End of Year Plan Sponsor “To Do” List (Part 1) Health & Welfare
2019 End of Year Plan Sponsor “To Do” List (Part 2) Annual Cost of Living Adjustments
2019 End of Year Plan Sponsor “To Do” List (Part 3) Qualified Retirement Plans
2019 End of Year Plan Sponsor “To Do” List (Part 4) Executive Compensation
Posted in Employee Benefits, Executive Compensation, Health & Welfare Plans, Health Care Reform, Qualified Retirement Plans
| Tagged checklists, COLA, cost-of-living, ERISA, Executive Compensation, Internal Revenue Code, qualified retirement plan, to do list
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A Post-Thanksgiving Treat: IRS Extends Certain ACA Reporting Deadlines and Transition Relief
The IRS provided welcome news to employers preparing to comply with the Affordable Care Act’s (“ACA”) information reporting requirements in early 2020 for the 2019 calendar year. In particular, Notice 2019-63 (the “Notice”) extends the deadline to furnish Forms 1095-B and 1095-C to employees. The new deadlines are provided, below.
| Original Deadline | Extended Deadline | |
| Form 1095-B (to employees) | January 31, 2020 | March 2, 2020 |
| Form 1095-C (to employees) | January 31, 2020 | March 2, 2020 |
Importantly, the Notice does not extend the deadline for filing Forms with the IRS. Instead, the deadline to file with the IRS remains February 28, 2020 (for paper filings) and March 31, 2020 (for electronic filings). Read More ›
Posted in Health & Welfare Plans, Health Care Reform
| Tagged ACA, deadlines, extension, Form 1095-B, Form 1095-c, good faith, notice 2019-63, reporting
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California Cares . . . About Employees Losing Flexible Spending Account (“FSA”) Funds
California recently approved Assembly Bill 1554, adding a flexible spending account notice requirement to § 2810.7 of the California Labor Code. The new law, which takes effect January 1, 2020, states:
(a) An employer shall notify an employee who participates in a flexible spending account, including, but not limited to, a dependent care flexible spending account, a health flexible spending account, or adoption assistance flexible spending account, of any deadline to withdraw funds before the end of the plan year. Notice shall be by two different forms, one of which may be electronic.
(b) Notices made pursuant to subdivision (a) may include, but are not limited to the following: (1) Electronic mail communication. Read More ›
Posted in Employee Benefits, Health & Welfare Plans, Health Care Reform
| Tagged compliance, flexible spending, FSA, Notice
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Must Drug Manufacturer Coupons Count Toward Annual Maximum Out-Of-Pocket Limits? Stay Tuned …
What is the Annual Maximum Out-Of-Pocket Limit (“MOOP”)?
MOOP is the most a participant must pay for covered services under a group health plan in a plan year. After a participant spends this amount on deductibles, copayments, and coinsurance, the health plan must pay 100% of the costs of covered benefits.
What are Drug Manufacturers’ Coupons (“Coupons”)?
Many drug manufacturers offer coupons to patients to reduce out-of-pocket costs. Drug manufacturers may offer these coupons for various reasons including: (1) to compete with another brand name drug in the same therapeutic class; (2) to compete with a generic equivalent when released; or (3) to assist consumers whose drug costs would otherwise be extremely high due to a rare or costly condition. Read More ›
Posted in Employee Benefits, Health & Welfare Plans, Health Care Reform
| Tagged coupons, HHS, MOOP, NBPP, Notice, out-of-pocket maximum
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Preventive Care Can Now Be Covered for Specified Chronic Conditions Before HDHP Deductible
On July 17, 2019 the IRS released Notice 2019-45 resolving a preventive care problem that has been plaguing many high deductible health plans (“HDHPs.”). The Affordable Care Act’s free preventive care mandate appears to be working. People are catching medical problems sooner. As a result, many employers have embraced the concept of free preventive care and want to go a step further – providing free preventive care for certain chronic conditions, such as asthma, diabetes, and heart disease. However, they have run into a snag. Under IRS guidance, treatment for chronic conditions is not “preventive care” and covering it before the deductible is met jeopardizes the plan’s status as an HDHP. Read More ›
Posted in Employee Benefits, Health & Welfare Plans, Health Care Reform
| Tagged ACA, HDHP, notice 2019-45, preventive care
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Authorized Representatives – Fresh Look at an Old Rule
Earlier this year, the Department of Labor issued an information letter explaining ERISA’s authorized representative requirement. Below are some of the takeaways employers may want to consider.
1. The Authorized Representative Requirement Under ERISA
ERISA’s claims procedure regulations expressly give participants and beneficiaries the right to appoint authorized representatives to act on their behalf in connection with a claim for benefits and an appeal of an adverse benefit determination. Furthermore, when a claimant clearly designates an authorized representative to assist with a claim and/or appeal, the plan should direct the claimant’s information and notifications to the authorized representative to act on behalf of the claimant. Read More ›
Posted in Employee Benefits, Health & Welfare Plans, Health Care Reform
| Tagged appeals, authorized representative, claims, DOL, ERISA, health plan
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Reassigning Section 1557: Trump Administration Proposes Reversal of Transgender Benefits Rule
In 2016, the Department of Health and Human Services (“HHS”) Office of Civil Rights issued final regulations implementing the nondiscrimination provisions of the Affordable Care Act (“Section 1557”), which prohibit the categorical refusal of health coverage to transgender participants and require that individuals be treated consistent with their self-selected gender identity. These regulations drew sustained legal challenges and prompted HHS to withdraw, revise and reissue the Section 1557 regulations (the “Proposed Regulations”).
In short, the Proposed Regulations would repeal large portions of the original nondiscrimination rules and would redefine the scope of various protections under Section 1557. Specifically, the Proposed Regulations negate the provisions of Section 1557 covering nondiscrimination based on sex and gender identity. Read More ›
Posted in Employee Benefits, Health & Welfare Plans, Health Care Reform
| Tagged 1557, ACA, EEOC, HHS, transgender, transgender benefits, Trump
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IRS Letters 226J: Having the Right Section 4980H Records Can Be Worth a Small Fortune
As reported in our 2018 End of Year Plan Sponsor “To Do” List (Part 1) Health & Welfare, the Section 4980H penalties are still in effect and the IRS is enforcing them. Employers continue to receive Letters 226J, which the IRS uses to propose employer shared responsibility payments. During the Letter 226J process, the IRS has been allowing employers to challenge proposed penalties and to correct reporting errors. However, the IRS will not necessarily accept an employer’s word at face value.
Recordkeeping is key
One of the biggest problems employers may face is finding records to prove they satisfied the 95% offer of coverage test (to avoid the subsection (a) penalty) or that they offered a specified employee minimum value affordable coverage (to avoid the subsection (b) penalty). Read More ›
Posted in Employee Benefits, Health & Welfare Plans, Health Care Reform
| Tagged 4980H, ACA, Affordable Care Act, Form 1094-C, Form 1095-c, IRS, letter 226j, recordkeeper, vendor
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HHS to Start Randomly Selecting Health Plans for HIPAA Compliance – Are You Ready?
The CMS Division of National Standards, on behalf of HHS, is launching the Compliance Review Program (the “Program”) to ensure compliance among covered entities with HIPAA Administrative Simplification rules for electronic health care transactions. HHS will randomly select health plans and clearinghouses to assess compliance with: (1) transaction formats; (2) code sets; and (3) unique identifiers. Participants in the Program will also have to attest whether they comply with the operating rules, which are required by the ACA and are defined as “the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications.”
If HHS finds that a health plan or clearinghouse is not compliant, HHS has indicated that it will give the covered entity the opportunity to correct issues and achieve compliance, but may impose penalties on covered entities that do not achieve compliance. Read More ›
Posted in Health & Welfare Plans, Health Care Reform
| Tagged audit, Breach Notification, CMS, HHS, HIPAA, Privacy, Security
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