Tag Archives: Regs and guidance

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Agencies release final rule on short-rerm, limited duration health insurance
The Department of Labor’s (DOL) Employee Benefits Security Administration (EBSA), the Department of Treasury, and the Department of Health and Human Services (HHS) issued a final rule amending the definition of short-term, limited-duration health insurance that individuals may purchase. The final rule permits insurers to sell policies that cover periods longer than the three-month maximum permitted under the Patient Protection and Affordable Care Act (ACA), allowing for an initial period of 364 days and for renewals of up to 36 months.

To read the entire final rule, click here.

Medicare Part D premiums continue to decline in 2019
The Centers for Medicare & Medicaid Services (CMS) announced that the average basic premium for a 2019 Medicare Part D prescription drug plan is projected to decline for the second year in a row. Earlier this year, CMS announced several changes in the Part D program aimed at further empowering Part D plans to drive a hard bargain with drug manufacturers and lower the cost of prescription drugs. CMS has been working to ensure that Medicare Part D plans can leverage all of the tools that are available to commercial plans in negotiations.

To learn more, click here.

CBO publishes report on the cost related to employer mandate repeal and Cadillac tax delay
The Congressional Budget Office (CBO) released estimates related to the cost of the “Employer Relief Act” (H.R.4616), which would suspend the collection of penalties on large employers that decline to offer qualifying health insurance coverage for plan years 2015-2018 and delay implementation of the excise (“Cadillac”) tax on high-premium insurance plans by one year. The report assessed the costs based on the legislative text approved by the House Ways and Means Committee on July 11.

To learn more, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

IRS releases Draft 2018 IRS Form 1095-C and Form 1094-C
The Internal Revenue Service (IRS) has released Draft 2018 IRS Form 1095-C: Employer-Provided Health Insurance Offer and Coverage and Draft 2018 Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns. The instructions have not been released that contain the due dates of the forms.

GAO-defined “employer” under Section 3(5) of ERISA
The Government Accountability Office (GAO) reviewed the new rule from the Employee Benefits Security Administration of the U.S. Department of Labor (DOL) on the definition of “employer” under section 3(5) of ERISA—Association Health Plans. The GAO found that (1) the final rule (a) establishes under Title I of ERISA additional criteria under ERISA section 3(5) for determining when employers may join together in a group or association of employers that will be treated as the “employer” sponsor of a single multiemployer “employee welfare benefit plan” and “group health plan,” as those terms are defined in Title I of ERISA; (b) states that, by establishing a more flexible commonality of interest test for the employer members than DOL had adopted in sub-regulatory interpretive rulings under ERISA section 3(5) and otherwise removing undue restrictions on the establishment and maintenance of Association Health Plans (AHPs) under ERISA, the regulation facilitates the adoption and administration of AHPs and expands access to affordable health coverage, especially for employees of small employers and certain self-employed individuals; and (c) sets out the criteria that would permit, solely for purposes of Title I of ERISA, certain working owners of an incorporated or unincorporated trade or business, including partners in a partnership, without any common-law employees, to qualify as employers for purposes of participating in a bona fide group or association of employers sponsoring an AHP and also to be treated as employees with respect to a trade, business, or partnership for purposes of being covered by the AHP; and (2) DOL complied with the applicable requirements in promulgating the rule.

For more information, click here.

Considerations for product governance risk management

A key focus of the insurance regulatory authorities around the world has been the protection of policyholder interest. This has resulted in more emphasis on product governance and product life-cycle management. The insurance directive launched under the European Union insurance law has issued guidelines for insurers to embed product oversight and governance into their risk management frameworks.

A robust product governance process can help reduce mis-selling and complaints, and increase policyholder confidence in the market. It can also ensure internal and regulatory compliance for the products offered by the insurer.

The core components of a robust product governance process are:

• Product governance policy
• Product development
• Pricing and value
• Distribution and sales
• Legal, compliance and risk management
• Ongoing assessment of the product

To read more about building a strong product governance policy, read Neha Taneja’s article here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

2018 Social Security and Medicare Trustees Reports released
The Social Security and Medicare Boards of Trustees issued their annual financial review of the programs. The projections indicate that income is sufficient to pay full scheduled benefits until 2026 for Medicare’s Hospital Insurance program, until 2032 for Social Security’s Disability Insurance program, and until 2034 for Social Security’s Old Age and Survivors Insurance program. The Supplementary Medical Insurance (SMI) Trust Fund remains adequately financed throughout the projection period, but only because SMI has unlimited access to general revenues.

For more information, click here.

The CMS RDS Center changes its location for retiree and cost report files
The Retiree Drug Subsidy (RDS) Center of the Centers for Medicare and Medicaid Services (CMS) is changing the location where retiree and cost report files are sent via Connect:Direct. By the end of 2018, all files that are currently sent to the RDS Center via Connect:Direct must be sent to the new location. This change only impacts vendors that submit data to the RDS Center via Connect:Direct and does not affect vendors that submit data using the RDS secure website.

For more information, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

IRS inflation adjusted amounts for HSAs in 2019
The Internal Revenue Service (IRS) released Revenue Procedure 2018-30, which provides the inflation-adjusted amounts for health savings accounts (HSAs) for calendar year 2019. The updated limits specify the maximum annual contributions to HSAs that may be tax-deductible, as well as the minimum deductibles and the maximum out-of-pocket expenses allowed under qualifying high-deductible health plans (HDHPs).

For more information, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Small employers receive relief for small business healthcare tax credit
The Internal Revenue Service (IRS) issued guidance that provides relief for certain small employers that wish to claim the “Small Business Health Care Tax Credit” for 2017 and later years.

The tax credit can benefit certain small employers that provide health coverage to their employees. Generally, small employers must provide employees with a qualified health plan from a Small Business Health Options Program (SHOP) marketplace to qualify for the credit. Small employers may only claim the credit for two consecutive years.

Notice 2018-27 gives guidance about calculating the credit under these circumstances. The notice does not affect previous transition relief for the credit that was separately provided for 2014, 2015, and 2016.

For information on whether a county had or has coverage available through a SHOP marketplace, click here.

Relief granted for taxpayers affected by reduction of maximum deductible health savings account contributions
The IRS announced relief for taxpayers with family coverage under a high-deductible health plan (HDHP) who contribute to a health savings account (HSA). For 2018, taxpayers with family coverage under an HDHP may treat $6,900 as the maximum deductible HSA contribution.

To learn more, click here.

FAQ: Prescription drug pricing and policy
A published Congressional Research Service (CRS) report addresses frequently asked questions (FAQs) about government and private-sector policies that affect drug prices and availability. Among the prescription drug topics covered are federally funded research and development, regulation of direct-to-consumer advertising, legal restrictions on re-importation, and federal price negotiation. The report provides a broad overview of the issues as well as references to more in-depth CRS products.

To download the report, click here.