Spencer’s Benefits NetNews – September 7, 2018

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Featured This Week

New Reports

  • Analysis: Questions to ask before contracting with a health plan, 8/18 (313.2.-1)

    (Read Intelliconnect) »

  • Analysis: Contracting with a PBM, 8/18 (325.6.-5)

    (Read Intelliconnect) »

  • Analysis: Self-funding, 8/18 (331.1.-1)

    (Read Intelliconnect) »

  • Analysis: Definitions used in HIPAA regulations, 8/18 (502.-61)

    (Read Intelliconnect) »

  • News

    Plan administrators are proper parties for mental health services discrimination claims

    A recipient of mental health services whose health plan reduced the amount of reimbursement for out-of-network psychologists and social work services was allowed to sue the plan administrator for alleged ERISA violations, but her claims were dismissed as to the non-administrator entities, a federal district court has ruled. In a recovery of benefits claim under 29 U.S.C. Sec. l 132(a)(l)(B), only the plan and the administrators and trustees of the plan in their capacity as such may be held liable. As to her claims under the Federal Parity Act, the financial restrictions for mental health services were found to have violated the Act.

            (Read Intelliconnect) »

    New opinion letters address FLSA and FMLA issues, from organ donation to volunteer status

    The Labor Department’s Wage and Hour Division (WHD) has issued six new opinion letters August 28 addressing various compliance issues under the FLSA and the FMLA. The department says that the release of those letters “demonstrates its continued commitment to providing meaningful compliance assistance to help employees understand their rights and ensure that employers have the information they need to comply with federal labor laws.”

            (Read Intelliconnect) »

    IRS extends temporary nondiscrimination relief for closed DB plans through 2019

    The IRS has extended for an additional year the temporary relief provided in IRS Notice 2014-5 for certain closed defined benefit (DB) pension plans (i.e., plans that are closed to new entrants as of a specified date, but continue to provide ongoing accruals for existing participants). Thus, the temporary relief is available for plan years beginning before 2020, if the conditions of Notice 2014-5 are satisfied.

            (Read Intelliconnect) »

    Senators introduce bill to retain prohibition on preexisting condition exclusions

    Senators Thom Tillis (R-NC), Lamar Alexander (R-TN), Chuck Grassley (R-IA), Dean Heller (R-NV), Bill Cassidy, M.D. (R-LA), Lisa Murkowski (R-AK), Joni Ernst (R-IA), Lindsey Graham (R-SC), John Barrasso (R-WY), and Roger Wicker (R-MS) have introduced the Ensuring Coverage for Patients with Pre-Existing Conditions Act, which would amend HIPAA to guarantee the availability of health insurance coverage in the individual or group market. The legislation prohibits discrimination against beneficiaries based on health status, including the prohibition against increased premiums for beneficiaries due to preexisting conditions.

            (Read Intelliconnect) »

    Tips for preparing employees for upcoming open enrollment include using mix of communication methods

    The Summer season is coming to end, which means open enrollment is looming. Productive employees who are engaged with their careers may not have the time to focus on their benefit offerings or may be overwhelmed with amount of choices that are available to them, especially during open enrollment season. Clarity Benefit Solutions says brokers must make it their mission to properly educate employees about their benefit packages, so they can make an informed decision.

            (Read Intelliconnect) »

    ‘Applicable large employer’ status does not change with enrollment in an AHP

    On August 20, 2018, the IRS updated its “Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act,” with a new question on association health plans (AHPs). New Q&A18 confirms that applicable large employer (ALE) status does not change with enrollment in an AHP.

            (Read Intelliconnect) »