For many US employers, the annual window during whichemployees may change their choice of employer-sponsored health benefits -- openenrollment -- is quickly approaching.

With this in mind, plan sponsors should take note of 4 keyissues:

1. The growing popularity of Health Savings Accounts (HSAs)with both employees and employers

Available to participants in conjunction with high-deductiblehealth plans, HSAs are tax-exempt accounts for the specificpurpose of funding qualified medical expenses.

Since HSAs were established in 2003, their popularity inconnection with employer-sponsored plans has grown rapidly. Inlarge part, this is due to the current trend of escalating medicalcosts –- current estimates of retiree medical expenses suggest atleast $275,000 for a couple retiring at 65 –- a trend that does notshow signs of changing course.

The value of retiree medical benefits and vehicles for reducingthe impact of those costs is at an all-time high. HSAs address thisconcern and provide a valuable employee retention incentive due tothe preferential tax treatment for both current and future medicalexpenses.

The key attribute about HSAs is that they offer employees thepotential for triple tax savings. This can serve as an incentivefor employees who hesitate to elect this relatively newconsumer-driven model of health insurance coverage.

When offered through their employer, employees may make pre-taxsalary deferral contributions to their HSA; accumulate tax-freeearnings on those contributions; and take advantage of tax-freedistributions to pay for qualified medical expenses.

Further, HSAs allow employers to contribute to their employees’HSAs, thus avoiding payroll taxes such as Social Security andMedicare, Federal Unemployment Tax and Federal InsuranceContributions Act (FICA).

Finally, once an HSA account owner reaches age 65, distributionsfrom their HSA may be taken for non-medical expenses and taxed asordinary income without being subject to a tax penalty, similar todistributions from a traditional IRA.

2. The fate of the Affordable Care Act

As most sponsors of group health plans know, the Affordable Care Act (ACA) faces an uncertainfuture.

In this regard, employers should keep in mind that Congress’sactions are not likely to directly impact employers’ 2018 plan yearor the plan design choices that employers have made.

For this reason, employers that continue to operate as if theACA will remain in effect in 2018 will best-positioned to deal withwhat comes next.

The summary of benefits and coverage (SBC) is an example of arequirement introduced by the ACA. The SBC summarizes group healthplan coverage for employees, describing important plan featuressuch as deductibles, co-pays, co-insurance and coveredservices.

SBCs are intended to permit employees to understand and makeinformed choices about available coverage options.

While the insurer or other third party typically provides theSBC to an employer for distribution with open enrollment materials,employers are ultimately responsible for the SBC’s content anddistribution. Failing to provide SBCs to employees participantscarries a steep penalty.

For the first time since 2012 (when employers were firstrequired to provide the SBC), the content and format requirementsfor SBCs have been revised, effective for open enrollment occurringon or after April 1, 2017. For calendar year plans, the upcoming2018 open enrollment is the first for which the new SBCrequirements are in effect.

3. Regulation of wellness programs

Employer-sponsored wellness programs areregulated by an assortment of Federal agencies, which can makethese popular programs challenging to run.

Applicable regulations include those under the Affordable CareAct; the Health Insurance Portability and Accountability Act(HIPAA); the Americans with Disabilities Act (ADA) and the GeneticInformation Nondiscrimination Act (GINA).

Ongoing lawsuits challenging the validity of these regulationsadd another layer of difficulty to employers’ compliance efforts.Recent court cases, however, should signify to employers thatregulations are here to stay, at least for now.

4. Mental health benefits

As open enrollment approaches, employers sponsoring group healthplans should work with their service providers to review plandesigns and to ensure that the benefits they offer to theiremployees and their disclosures satisfy the Mental Health Parityand Addiction Equity Act.

Based on data reported by the Departments of Health and HumanServices, Labor, and Treasury, enforcement efforts regarding theserules have increased in recent years.

Additionally, the Department of Labor (DOL) is in the process ofworking out the nuts and bolts of required disclosures, recentlyreleasing a draft model form disclosure to assist plan participantsin requesting information from their health plans and the insurersabout their mental health coverage. DOL is seeking public commentsprior to finalizing the draft model form.

Finally, in addition to increased enforcement activity,litigation by private parties regarding mental health benefits hasgone up.

As we enter the fall, employers considering how to reflect theseissues and changes in their benefits programs for 2018 shouldconsult with counsel regarding their suitability as well as thefiner points of implementation.

Allison Wielobob is counsel with the Employee Benefitspractice group at Eversheds Sutherland LLP in WashingtonD.C.