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A Better Partnership


Jan 2017
January 04, 2017

Health & Welfare Plans: Your First "To-Do" List for 2017

As 2016 came to a close, there was a flurry of activity by both Congress and the federal agencies affecting health and welfare plans. Here are some issues that you should keep in mind as we start 2017:
  • Privacy Notice for Wellness Program. Under new EEOC regulations, wellness programs that use health risk assessments and/or medical exams and tests (such as blood screenings) must begin distributing a notice to plan participants that explains how the plan safeguards and limits disclosure of the medical information it collects. The notice is required for plan years that begin on or after January 1, 2017, and should be distributed before the wellness program begins collecting information for the new year.
  • 1095-C Forms Due to Employees by March 2, 2017. For employers who averaged 50 or more full-time equivalent employees during 2016, the IRS has extended the deadline for distributing the 1095-C form to full-time employees from January 31, 2017, until March 2, 2017. But the deadline for filing the 1094-C form with the IRS remains February 28, 2017, if filing by paper, and March 31, 2017, if filing electronically.
  • New Disability Claims Procedures.The Department of Labor (DOL) has revised claims and appeals procedures for disability benefit programs, putting in more participant protections similar to those that apply to medical claims. If you are involved in claims appeals, you’ll want to revise your claim appeal procedures to incorporate these changes. You’ll also want to take some time during 2017 to review and possibly update plan documents and summary plan descriptions to bring them up to date for when the new rules are effective.
  • HIPAA Special Enrollment Rights.The federal agencies confirmed that if employees and their dependents lose eligibility in individual market coverage (including Exchange coverage), they are entitled to HIPAA special enrollment in an employer-sponsored group health plan for which they are otherwise eligible and had previously declined to enroll. You’ll want to take some time to review plan documents and summary plan descriptions regarding HIPAA special enrollment rights. If your plan’s language is not clear on the issue, consider updating plan documents and summary plan descriptions to clarify that employees and their dependents have a special enrollment right if they lose eligibility in individual market coverage.
  • Coverage for Preventive Services. The Health Resources and Services Administration (HRSA) has updated its guidelines of women’s preventive services, and under the ACA, non-grandfathered plans must incorporate these changes into their plans for plan years beginning on or after December 17, 2017. During 2017, you’ll want to discuss with your TPAs and insurers their plans for incorporating these new requirements, and also look at your plan and summary plan description documents to see if they need to be updated.
  • Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs). The 21st Century Cures Act allows employers who average fewer than 50 full-time equivalent employees (determined under the ACA’s employer responsibility rules) to have Health Reimbursement Arrangements that can reimburse premiums for individual insurance policies up to $4,950 for individual coverage and $10,000 for families. Small employers looking to implement a QSEHRA will want to put in place a plan document that complies with the technical requirements under the law.
If you need any assistance with these issues, or any other health and welfare plan issues, please contact Norbert F. Kugele ( or 616.752.2186), Stephanie Grant ( or 248.784.5068), Kent Sparks ( or 616.752.2295) or any other member of Warner’s Employee Benefits Practice Group.

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