Crystal Connection: June/July 2018


PCORI Fees: Due by July 31
The annual fee to fund the Patient-Centered Outcomes Research Institute (PCORI) is due this July.

For self-funded plans, the self-insured employer/plan sponsor is responsible for submitting the fee and accompanying paperwork to the IRS. Employers subject to the fee must submit it by July 31 of the year following the last day of the plan year.

For the coming year, self-insured health plan sponsors should use Form 720 for the second calendar quarter to report and pay the PCORI fee by July 31, 2018.

Fully-insured plan sponsors do not need to file. There are special rules for Special Arrangements such as HSA or HRA accounts.

Medical Loss Ratio Rebate Distribution: Due by September 30
It’s that time of year when insurance carriers pay a rebate to their customers based on their Medical Loss Ratio (paid claims vs. premiums paid) that do not meet or exceed a specified limit. Carriers should mail all their checks no later than August 1.

If you receive an MLR rebate, you have three months from the date you received the check (and no later than September 30) to resolve how you will allocate the funds most effectively.

If you’ve received a rebate check and you aren’t sure how to spend it, read our tip sheet, How Employers Should Handle MLR Rebates.

Recent Laws in New Jersey
On May 2, 2018, New Jersey’s Paid Sick Leave Act (Act) was signed into law. The Act will require virtually all employers to provide paid sick leave to employees, effective October 29, 2018.

An employer with a paid leave policy (including, for example, vacation, paid time off and sick leave) that is at least as favorable to employees as the Act’s requirements is not required to provide employees with additional paid sick leave. The employer’s policy must provide at least the same amount of paid leave and permit employees to use paid leave for the same purposes as required under the Act. Additional details can be found here.

On June 1, New Jersey Governor Phil Murphy signed into law the Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “Act”), which requires providers to disclose more information regarding their out-of-network status to patients. Additionally, the Act changes how certain out-of-network services are billed, including changes to “surprise billing” during emergencies and an arbitration process to resolve billing disputes between a provider and a plan.

Self-insured health plans subject to ERISA that cover individuals who receive healthcare services in New Jersey must decide before the end of August whether it will elect to be subject to the Act. If a self-insured health plan elects to be subject to the Act, its members will be protected by the changes to “surprise billing” during emergencies and the plan will be able to settle certain billing disputes with providers through the Act’s arbitration process. Please note that if a self-insured health plan elects to be subject to the Act, it may need to revise its plan documents to reflect how certain out-of-network services will now be billed.

Additional details on the Act can be found here.

Recent Laws in Massachusetts
On June 28, 2018, Massachusetts enacted a mandatory statewide paid family and medical leave program. Beginning in 2021, eligible employees may take protected paid leave for certain family and medical reasons. The leave program will be financed through employer and employer contributions.

Effective July 1, 2019, employers must comply with a new workplace poster requirement and new hire notice and begin remitting contributions for the paid family and medical leave program. Employers should keep track of developments related to the new paid family and medical leave program, including publication of model workplace posters and employee notices. Proposed regulations are to be published for public comment by March 31, 2019.

We will continue to track and inform of developments with the new program. Updates are posted on our website. Additional details can be found here.

On April 1, 2018, the Pregnant Workers Fairness Act (PWFA) went into effect. The law requires Massachusetts employers that have six or more employees to provide reasonable accommodation for their employees’ pregnancies or pregnancy-related conditions upon request, unless it would cause undue hardship. The law also prohibits these employers from discriminating against employees and applicants based on pregnancy or related conditions. Additional details can be found here.

More State Legislative Changes
San Francisco issued final rules implementing the city’s paid sick leave ordinance. The rules took effect on June 7, 2018. Employees earn 1 hour of paid sick leave for every 30 hours worked. Employers with 10 or more employees may cap an employee's sick time balance at 72 hours. Employers with fewer than 10 employees may cap an employee's sick time balance at 40 hours.

For California statewide, the Healthy Workplaces, Healthy Families Act (HWHFA) was amended to make providers of in-home supportive services eligible to receive paid sick and safe time.

Employers must allow employees to accrue and use up to 40 hours of paid sick leave per year to care for themselves or their family members for reasons related to domestic or sexual violence, public health, or school-related events or meetings for their children.

Rhode Island issued regulations implementing the paid sick and safe leave provisions that take effect July 1, 2018.

Read about these and other recent changes to state health benefit mandates and leave laws affecting California, Colorado, Florida, Kansas, Maryland, Minnesota, Mississippi, New Jersey, New York, Rhode Island, South Dakota, and Virginia.

Marketplace Trends
It’s no secret that the costs of medical and pharmaceutical care are so inflated, they are untenable expenses for many Americans, causing them to delay or altogether avoid receiving the medical care they need to prevent or manage illness. In 2018, we will see increased efforts to create price transparency and fairness to lower costs for consumers.

Thought Leadership
It’s a common scenario: Your company has a major deal in the works, and you want to get your executives out to meet the client ASAP. If your firm doesn’t own its own aircraft, you have essentially two options: fly commercial or charter a jet. If your company charters third-party-owned aircraft, there are unique potential exposures to account for. Read the full article, “Chartering an Aircraft? Here is Your Insurance Checklist.”

It’s an honor for sure, and an opportunity to serve a community you care about. You’ve been invited to join the board of a school, tenant association, museum, religious institution or other nonprofit. But before you accept, you need to think a bit about your potential liability. Read “What to Know Before Serving on a Nonprofit Board.”

Check out more thought-provoking commentary at

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