Crystal Connection: September 2018


Webinar, Sept 19: Population Health Management for Employers
What does your wellness program look like? Regardless of its complexity, your program should achieve reduced health care costs and improved wellness, organizational culture and morale.

Please join us for a 1-hour, live discussion ( 2 pm ET / 11 am PT) featuring special guest Rick Fox from Zomo Health, a national health and wellness company, and Andrew Savarese from Crystal’s Employee Benefits team.

Together, they will explore wellness goals, the changing model of a holistic wellness approach, compliance, ROI and the future of wellness for employers.

Register now


Year 2 of NY PFL Program: Changes to Contributions, Benefit Percentage and Duration
In the second year of the New York Paid Family Leave (NYPFL) program, which will commence on January 1, 2019, the maximum benefit will be 55% of the employee's average weekly wage, up to 55% of the statewide average weekly wage for up to 10 weeks of leave.

The State Average Weekly Wage (SAWW) used to determine the cap on contributions and benefit levels will increase from $1,305.92 to $1,357.11. Additionally, contributions will be increasing to .153% of weekly earnings, with a maximum annual contribution of $107.97.

Read our Q&A for more about New York’s paid leave program–the most robust program of its kind in the country.

Medicare Part D Creditable Coverage Disclosure Notices: Due by October 14, 2018
Employers with group health plans that provide prescription drug coverage must notify Medicare Part D eligible individuals by October 14 of each year about whether their plan’s drug coverage is at least as good as the Medicare Part D coverage (in other words, whether their prescription drug coverage is “creditable”).

This notice is important because Medicare beneficiaries who are not covered by creditable prescription drug coverage and who choose not to enroll in Medicare Part D before the end of their initial enrollment period will likely pay higher premiums if they enroll in Medicare Part D at a later date. Thus, although there are no specific penalties associated with this notice requirement, failing to provide the notice may trigger adverse employee relations issues. CMS has provided model notices for employers to use.

Medical Loss Ratio Rebate Distribution: Due by September 30
Reminder: If you’ve received a medical loss ratio (MLR) rebate check from your insurance carrier(s), 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.

Insurance carriers had until August 1 to mail rebate checks to their customers based on their MLR ratio (paid claims vs. premiums paid) that did not meet or exceed a specified limit.

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.

New Jersey Paid Sick Leave Act – Effective October 29, 2018
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.

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DOL Compliance Assistance for AHPs
Following recent guidance expanding the availability of Association Health Plans (AHPs), the Department of Labor (DOL) has issued a compliance assistance publication that addresses a number of issues for AHPs, including:

  • Disclosure requirements (SPD/SMM/SBCs)
  • Reporting requirements (5500 and M-1 filings)
  • Benefit claims administration procedures
  • COBRA rules
  • Consumer protections (HIPAA, ACA, Mental Health Parity, and more)
  • Fiduciary rules (requirement to hold plan assets in trust, requirement that plan assets be used only for benefits and to defray reasonable plan administration costs, prohibited transaction rules)

The publication confirms that the DOL may issue a cease and desist order if a MEWA's conduct is fraudulent, creates an immediate danger to public safety or welfare, or is causing or can be reasonably expected to cause significant, imminent, and irreparable public injury. The DOL may also issue a summary seizure order if it appears the MEWA is in a "financially hazardous" condition.

Review our alert on the recent AHP guidance.

More State Legislative Changes
Review summaries of some of the latest developments in state legislature that affect health benefits.

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