Effective for disability claims filed after April 1, 2018, employee benefit plans subject to the Employee Retirement Income Security Act (ERISA) must comply with new requirements.

Background
In 2016, the U.S. Department of Labor (DOL) released a final rule to strengthen the claims and appeals requirements for plans that provide disability benefits and are subject to ERISA. According to the DOL, the information it received during the delay period did not justify modifying or rescinding the final rule. Thus, the final rule will take effect without change.

Final Rule Applies to "Disability Benefits"
A benefit is considered a "disability benefit" if the claimant has to be disabled in order to obtain the benefit. It does not matter how the benefit is characterized or whether the plan as a whole is a retirement plan or a welfare plan. If the claims adjudicator must make a determination of disability in order to decide a claim, the claim must be treated as a disability claim for purposes of the DOL's claims procedures.

Specific Changes Made By The Final Rule
Specifically, the final rule requires that plans, plan fiduciaries and insurance providers comply with additional procedural protections when dealing with disability benefit. 
Employer Action Steps
The final rule applies to ERISA plans that include disability benefits. These plans must comply with the new procedural protections, effective for claims that are submitted after April 1, 2018. Entities that administer disability benefit claims, including issuers and third-party administrators, will need to revise their claims procedures to comply with the final rule. This includes sponsors of defined benefit pension plans, 401(k) plans, 403(b) plans covered by ERISA, and top hat plans, in addition to disability benefit plans.

Specific employer action items include the following:

Identify all ERISA covered plans that provide for a disability benefit. This includes most long-term disability plans and some short-term disability plans, as well as retirement plans that provide for a disability benefit;
Review current plan documents and summary plan descriptions, and update claims procedure descriptions to include the additional requirements of the final rule; and
If applicable, review any contractual agreements with third parties responsible for making disability determinations to confirm appropriate processes are in place on their end and they have responsibility for complying with the new requirements.

For additional information, please contact your PNW Insurance Solutions Benefits Consultant or Wendee Allen at 425-314-0988 or wendee@pnwisol.com.

The Internal Revenue Service (IRS) has announced that the 2018 annual limitation on health savings account (HSA) contributions by individuals with family coverage under a high deductible health plan (HDHP) is now $6,850. This limit was previously announced as $6,900, but has been revised downward due to an inflation adjustment provision in the Tax Cuts and Jobs Act. The 2018 annual limitation on HSA contributions by an individual with self-only coverage under a HDHP remains unchanged at $3,450.

Click here to read the IRS announcement and contact us with any questions.

PNW Insurance Solutions

(425) 314-0988

www.pnwisol.com

Hello,

I wanted to share with you a very informative webinar, Sexual Harassment Prevention Guidelines. I have included a copy of the slide presentation and a recording of the webinar below.

Download Webinar Slide Presentation
View the Webinar Recording

This webinar covers important topics, including:

• Recognizing Sexual Harassment
• Establishing a Sexual Harassment Policy
• Investigating Sexual Harassment Claims
• Taking Corrective Actions

I hope you find this webinar helpful.

Best,

Wendee Allen
PNW Insurance Solutions
(425) 314-0988

If you've got teenagers covered on either your individual or small group medical insurance plan, be prepared to pay higher rates for them because insurance companies must comply with new Member-Level Rating (MLR) requirements starting in 2018. This change is to help lessen future increases when a member turns age 21.  

Q: What is Member-Level Rating (MLR)? 
A:  Each member gets an assigned rate and these are then added together to determine the premiums charged to the subscriber and any dependents. 

Q:  What are the new regulations about age and rates? 
A:  The Final Rule directs all health plan issuers of small group and individual plan coverage (on and off the  Exchanges) to revise the member level rating age bands used for individuals 0–20 years of age from using 1 age band to now create 7 age bands. The first age band cover ages 0–14, then single year age bands cover 15, 16, 17, 18, 19, and 20. This change will align with utilization of  services while smoothing rate increases over time. 

Q: How does this impact rates? 
A:  Every year members get 1 year older and in most cases move to a new age band. The introduction of the new age bands changes how rates are calculated for members under 21. By 2019, having more age bands will allow a more gradual  increase as experienced today when turning age 21.  2018 is a transition year where all members age 0 to 20 will experience significant increases. 

Want to learn more about this change and how it will impact you? Call PNW Insurance Solutions at (425) 314-0988 and ask to speak with Wendee Allen
 

King County & Snohomish County Health Insurance Open Enrollment begins in 1 week! Are you ready? Need help? We're not called PNW Insurance Solutions for nothing. Contact us today. 
 

The Trump administration announced yesterday that it will no longer make cost-sharing reduction (CSR) payments to insurance companies under the Affordable Care Act (ACA). According to a statement issued by the U.S. Department of Health and Human Services (HHS), the agency's decision to discontinue these payments immediately follows a legal review by HHS, the Department of Treasury, the Office of Management and Budget, and an opinion from the U.S. Attorney General. 

Background
The ACA requires insurers to offer plans with reduced deductibles, copayments, and other means of cost sharing to eligible individuals who purchase plans through the Health Insurance Marketplace. In turn, insurers receive CSR payments arranged by the Secretary of HHS to cover the costs they incur because of this requirement. Whether CSR payments were properly appropriated by Congress has been the subject of litigation since 2014.
To read the HHS statement, click here. 

Call us today for more information about ACA requirements and changes to the Individual & Family marketplace. We're here to help. PNW Insurance Solutions - (425) 314-0988.  Ask for Wendee Allen

New Executive Order Calls for Expanding Access to Association Health Plans

President Trump has signed an executive order calling upon the U.S. Department of Labor (DOL) to consider, among other things, expanding access to Association Health Plans, which could potentially allow employers to form groups across state lines. Until further guidance is issued or legislation is signed, however, all current ACA requirements remain in effect, including penalties for noncompliance.

Key Highlights

The following are key highlights of the order:

Association Health Plans (AHPs): The executive order directs the DOL to consider adopting a broader interpretation of the Employee Retirement Income Security Act (ERISA), which could potentially allow employers in the same line of business anywhere in the country to join together to offer health insurance coverage to their employees.

Short-Term, Limited Duration Insurance (STLDI): The executive order directs federal agencies to consider ways of expanding coverage through low-cost STLDI, which is not subject to certain ACA rules.

Health Reimbursement Arrangements (HRAs): The executive order directs federal agencies to consider changes to the rules regulating HRAs so that employers can make better use of these arrangements for their employees.

Note: In general, executive orders must be implemented in a manner consistent with applicable law, including the Administrative Procedure Act, which requires extended review of and public comment on any federal rules which may be proposed as a result of an executive order. Going forward, we will promptly report changes made to any ACA requirements.

To access your HR library, please visit www.pnwisol.com/hr360. Call with questions (425) 314-0988.

Too often, mistakes happen during Open Enrollment that can expose an employer to significant penalties. Be sure to avoid these costly mistakes with PNW Insurance Solutions' new Five Most Common Open Enrollment Mistakes guide. Click here to download.

PNW Insurance Solutions was interviewed this week in the Mill Creek and Mukilteo Beacon. In the article, owner Wendee Allen discussed how "one size fits all" health insurance rarely ever meets the needs of employers or their employees. Wendee also outlined how healthier employees leads to increased productivity and profits. Download the article.

For small businesses with less than 5 employees in western Washington state, buying health insurance inside the more stable group insurance marketplace will be a challenge, but one which needs facing for 2018.