Health Care Reform Alert

In light of COVID-19, many schools and businesses are being forced to make changes including closings, layoffs, and remote workforces. The Families First Coronavirus Response Act (FFCRA) was signed into law on March 18, 2020, by President Trump. The FFCRA is the first attempt by the federal government to provide relief to workers and their families facing the economic fall-out of COVID-19. It includes provisions to help employees and their employers, by providing emergency paid sick leave and temporarily expanding the Family and Medical Leave Act (FMLA) to allow paid family leave for working families affected by school closures. All of this can leave employers and their employees uncertain about the future and have them asking about benefit elections changes and how to handle benefits during employee leave or business shutdowns. Emergency Paid Sick Leave The FFCRA creates a new Emergency Paid Sick Leave Act (EPSLA) which, effective April 2nd through the end of 2020, requires employers with less than 500 employers to provide paid sick leave to individuals who cannot work (including remote work) due to isolation/quarantine orders, having symptoms of COVID-19, caring for another person in one of those categories, or caring for a minor child due to school or daycare closures. FMLA Expansion Additionally, the FFCRA provides longer paid leave and extends FMLA protection through December 31, 2020 if an employee needs to care for a child under age 18 if their school or daycare is closed for reasons related to the current public health emergency. Maintaining Employee Benefits for Employees It is important to understand an employer's obligation to maintain benefits during leave. In general, if an employee is on a paid leave of absence, they will retain benefits eligibility as long as they are receiving any regular pay from their employer. On the other hand, if an employee is on an unpaid leave, their benefits eligibility will depend on the type of leave and the employer's leave policy. Please note that at this time, the rules about changing benefit elections on a voluntary basis have not changed. This means that unless they experience a permitted election change event, including a leave of absence, participants typically will not be able to adjust benefit elections under a cafeteria plan, such as their medical or prescription drug, dental or vision coverage, or Health Care FSA elections. Keep in mind, however, that Dependent Care FSA elections are more flexible, and participants can change these elections if they experience a change in daycare providers or the cost of dependent care. For the complete article, please read this week's Compliance Buzz .

Adapted from: Employee Benefit Advisor (July 18, 2018) - Cort Olsen, Associate Editor The number of million-dollar medical claims has nearly doubled, with cancer care remaining the most costly health condition, according to a new Sun Life Financial report. Cancer made up $798.7 million in reimbursements to self-funded employers from 2014 to 2017, followed by metabolic disorder and hemophilia disorder, according to Sun Life’s 2018 High-Cost Claims Report. The report, based on analysis of Sun Life’s database of over 62,000 medical stop-loss claimants, shows that high-cost conditions totaled $6.9 billion in paid charges over the four-year period. The number of patients with million dollar claims rose 87%, to 194 in 2017 from 104 in 2014, with most charges ranging from $1 million to $1.5 million, and totaling over $935 million in charges. The growth in million-dollar claims can be expected to expand further due to new life-saving treatment options coming to market, along with existing treatments getting approved for expanded use. “This means better care and outcomes for patients,” says Dan Fishbein, president of Sun Life Financial, who notes that the trend is an important consideration for employers who self-fund their medical plans. “We partner with our clients to protect them from the financial risks of these high-dollar claims, but also to work with them to identify opportunities for cost savings that may improve patient care as well.” Also see: “ In a broken healthcare system, an adviser offers custom medical plans ” Other analysis from the report showed that rare conditions hit highest dollars. The two highest claims for a patient in a single policy year were for metabolic disorder in 2016, with a total of $6.7 million in treatment costs, followed by hemophilia disorder with a total treatment cost of $5 million in 2017. Million-dollar cases left a big footprint. Patients with claims of more than $1 million represented only 2% of the total number of stop-loss claims from 2014 to 2017, but roughly 20%, or nearly $600 million, of the total $3 billion in stop-loss reimbursement. White Paper How virtual behavioral healthcare breaks down barriers and increases access to quality care Employers that offer convenient ways for their employees to identify and treat mental health issues will see healthier employees, decreases in absenteeism and presenteeism, and lower costs as a result of proactively treating the mental health issues that often occur alongside physical conditions. The impact of injectable drugs peaked in 2017 with four of the five costliest injectable drugs, used to treat cancer or related conditions, accounting for approximately $45 million, or 24% of the total $186.3 million spent that year. Employers had an 85% chance of seeing a high-dollar claim in any given policy, according to the report. Those who self-insure their health plans use a stop-loss coverage to protect themselves from excessive financial losses from high-dollar claims. This article originally appeared in Employee Benefit Adviser. See the full article here: https://www.benefitnews.com/news/million-dollar-medical-claims-increase-by-87

Adapted from: Employee Benefits Corporation (May 10, 2018) - Need to Know Speed Read Fact #1 | 100+ Filing the Form 5500 is a requirement for private employers who fall under the Employee Retirement Income Security Act ( ERISA ), who have unfunded health and welfare benefit plans with 100 or more participants on the first day of the plan year. Fact #2 | Health FSA, HRA Employers who offer Health Care Flexible Spending Accounts ( Health FSA ) under a cafeteria plan, and/or Health Reimbursement Arrangements ( HRA ) in some cases, must file Form 5500. The same rules from Fact #1 apply. It is only required if they have 100+ participants on the first day of the plan year. Health FSAs and HRAs may be filed as standalone Form 5500s, or may be filed as part of a Wrap plan filing (see Fact #3 for more). Schedule A is not required for Health FSA and HRA plans. Fact #3 | Fully-Insured or Self-Funded Insurance Plans One, or many? For each fully-insured or self-funded benefit plan an employer offers, the employer must file a separate Form 5500. Employers can also choose to file just one Form 5500 by using one wrap plan for multiple benefit plans. (A wrap plan document and SPD are required for this type of filing.) Fact #4 | Deadlines Calendar-year plans : The many employers with plans that ended December 31, 2017 should be aware that their Form 5500 deadline is July 31, 2018 . General due date for other plans: The exact Form 5500 filing deadline for any benefit plan is the last day of the seventh month following the last day of the plan year. Fact #5 | Extensions Employers can file for an extension of up to 2 ½ months on or before their Form 5500 deadline, by using IRS Form 5558. Want more facts and information about Form 5500s requirements? Please see the Compliance Buzz article " Form 5500 Filing Tips-Who, When, What, How? ".