Headlines about "Health plan admin - misc"

Gathered from the web by the editors at BenefitsLink.com.
Ninth Circuit: 'Reopening' a Claim, After the Statute of Limitations Has Run, Does Not Waive That Defense
"If the statute of limitations has already run, does the claim administrator 'waive' the statute of limitations defense by agreeing to reopen a claim? NO.... Even when MetLife 'reopened' the claim in 2009, five years after claim denial, the 2004 statute of limitations defense applied, barring the 2011 lawsuit. This also is a good case to review because it discusses how an appeal denial letter should be written, when considering the statute of limitations defense." [Gordon v. Deloitte & Touche, LLP Long Term Disability Plan, No. 12-55114 (9th Cir. Apr. 11, 2014)] (Lane Powell PC)

Tax Preparers' New Role: Health Coverage Advisers
"Tax preparers like Jackson Hewitt and H&R Block say they have helped tens of thousands of people apply for tax credits to help defray the cost of private insurance bought through the exchanges. In addition, the big tax service companies and makers of tax preparation software like Intuit's TurboTax are calculating potential penalties for those who do not have insurance." (The New York Times; subscription may be required)

Odd-Hour Workers Face Loss of Employer Health Plans
"Thousands of these so-called variable-hour employees -- many of whom work on college campuses that don't operate during summer months -- could lose their benefits as employers use new formulas to classify workers as full time or part time. The distinction determines which employees are entitled to company-sponsored health coverage.... About 68% of U.S. employers have variable-hour workers ... with most of them in the hospitality, retail and education industries." (The Wall Street Journal; subscription may be required)

Patients Often Win If They Appeal a Denied Health Claim
"A 2011 GAO report sampling data from a handful of states before the health law took effect found that patients were successful 39 to 59 percent of the time when they appealed directly to the insurer. When appealing to a third party (such as the state insurance commissioner), patients also were often successful in getting the service in question -- winning as many as 54 percent of such decisions in Maryland[.]" (Kaiser Health News)

Health Care Reform Spurs Move to Defined Contribution Model
"Employers say the top two reasons for contemplating a switch to DC benefit models are to lower health care costs and to offer their employees more choice in the allocation of their benefit dollars (59% and 40%, respectively). Employees report they would allot 75% of their benefit dollars to health, dental, and vision coverage, leaving 25% for other coverages such as voluntary life, disability, accident, and critical illness insurance. Even with this allocation by employees, 42% of brokers feel the shift to DC plans will lead to an uptick in sales for voluntary products." (Prudential)

Ninth Circuit Finds Reconsideration of Benefit Denial Does Not Extend Statute of Limitations (PDF)
Summary provided by the Court: "[U]nder federal law, the plaintiff's claim accrued no later than the date her administrative appeal right expired, and the ERISA plan insurer's reconsideration of her claim did not revive the statute of limitation. The panel held that the ERISA plan was not estopped from asserting a statute of limitation defense based on the insurer's representation that the plaintiff could bring an ERISA action. Turning to California law for guidance, the panel held that the plan did not waive its statute of limitation defense based on the insurer's representation. Dissenting, Judge Reinhardt wrote that the plan waived its right to invoke the statute of limitation by inviting the plaintiff to reopen her case, submit new documents, and appeal if dissatisfied." [Gordon v. Deloitte & Touche, LLP Long Term Disability Plan, No. 12-55114 (9th Cir. Apr. 11, 2014)] (U.S. Court of Appeals for the Ninth Circuit)

[Official Guidance] Key Priorities for Compliance Reviews of Issuers and Plans on Federally-facilitated Marketplaces for the 2014 Benefit Year (PDF)
"CMS will perform compliance reviews of issuers offering Qualified Health Plans (QHPs) in the Federally-facilitated Marketplaces (FFM). For purposes of this document, QHPs include stand-alone dental plans, unless otherwise indicated.... CMS will review data at both the issuer and the QHP level. Policies, procedures and any other applicable documentation may be requested, as part of the compliance review process, to show compliance with issuer standards. As additional final regulations and operational guidance are published, those standards may be included as part of the compliance reviews ... [T]his list should not be construed as a comprehensive listing of all standards applicable to QHP issuers in the FFMs, nor a limitation on CMS' authority or ability to review compliance with standards not appearing on this list." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)

Top 10 Ways Companies Cut Healthcare Costs
"The most implemented strategies of top performers last year: Procured a pharmacy benefit manager in an attempt to tamp down pharmaceutical costs; Provided employees with healthcare cost transparency ... Contributed funds to employees' health savings accounts ... The most popular strategies for 2014: Make plan design changes after analyzing how they'll impact other parts of employee compensation -- like retirement contributions and salary ... Increase employee contributions in tiers with dependent coverage at a higher rate than individual coverage ... Adopt payment methods that hold healthcare providers more accountable for the quality and cost of care; Offer telemedicine programs[.]" (HR Benefits Alert)

District Court Holds ERISA Plans Can't Recoup Overpayments from Healthcare Providers without Following Procedural Steps
"[A] federal district court in Illinois recently held that health plans may not simply unilaterally recover overpaid funds from health care providers, but rather must provide the appeal and other procedural protections required under the [ERISA] ... While it has long been the rule that ERISA's appeal and other procedural rights must be allowed when ERISA plans issue 'adverse benefit determinations' on claims submitted for reimbursement, it has not always been clear that these same procedures are required with respect to recoupment decisions." [Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, No. 09 C 5619 (N.D. Ill. Mar. 28, 2014)] (Arent Fox)

CMS Identifies Key Priorities for 2014 Compliance Reviews of Qualified Health Plans in the Federally Facilitated Marketplace
"These key priority areas include, among others: [1] ongoing compliance with issuer participation standards, [2] not employing marketing practice or benefit designs that will have the effect of discouraging enrollment of those with significant health needs, [3] executing appropriate delegation agreements with delegated and downstream entities, [4] ensuring compliance of appointed agents/brokers, [5] making sure that the provider network is sufficient so that services are accessible without unreasonable delay, and [6] ensuring that the qualified health plan (QHP) makes health plan applications and notices accessible to individuals in accordance with the Americans with Disabilities Act and for individuals with limited English proficiency." [Source document: Key Priorities for FFM Compliance Reviews for the 2014 Benefit Year.] (Epstein Becker Green)

[Official Guidance] Text of IRS PLR 201415011: VEBA Can Extend Benefits to Domestic Partners of Participants (PDF)
"Trust represents that the total amount Trust will expend to provide impermissible benefits to domestic partners who are not dependents ... would not exceed three percent (3%) [in any year of the Trust's operation] ... therefore, Trust's Section 501(c)(9) tax-exempt status will not be jeopardized.... [T]he HRA coverage provided to a domestic partner who is a dependent of a Participant within the meaning of Section 152 (or child as defined in Section 152(f)(1)) is not includible in the Participant's gross income.... The fair market value of the coverage provided by Plan to a non-dependent domestic partner of a Participant ... is includible in the gross income of the Participant under Section 61, and is wages for FICA, FUTA, and income tax withholding purposes. The amount of employee FICA attributable to the coverage that is paid by Plan on a Participant's behalf that is not withheld from the Participant's wages is also includible in the Participant's income, and is wages for employment tax purposes.... Trust is the employer under Section3401(d)(1) for purposes of the employment taxes on the amount of wages that result from the HRA coverage provided to a Participant's non-dependent domestic partner. Thus, Trust is required to withhold income tax and the employee portion of the FICA tax on such wages. Trust must also pay the employer portion of the FICA tax and the FUTA tax.... Trust may treat the coverage as provided on an annual basis for purposes of employment tax withholding." [Dated January 13, 2014; released April 11, 2014.] (Internal Revenue Service [IRS])

Should We Have Expected This Week's Big Surprise on Employer Health Insurance?
"There's one Obamacare number that stands out above the rest this week -- 8.2 million. That's how many people have taken up employer-sponsored insurance since September, and most of them were previously uninsured ... The [RAND] survey ... attributes the drop in the uninsured rate over the past six months mostly to gains in employer coverage. For all the predictions of employers dumping coverage for health insurance exchanges, this was a pretty surprising finding. Obamacare was actually driving millions of uninsured Americans to sign up for employer insurance." (The Washington Post; subscription may be required)

Off-Exchange Options Flew Under Enrollment Radar
"While only about 25% of those between the ages of 18 and 34 signed up for coverage on public exchanges ... about 40% of that same age group bought off-exchange plans in the fourth quarter through the online comparison-shopping site eHealth.... WellPoint ... recently reported that about 20% of the roughly one million customers it expected to enroll new plans nationwide would be off the exchanges. The number was even higher for Highmark, which noted that approximately 30% of 133,000 members who enrolled as of the middle of last month chose coverage outside the exchanges." (Employee Benefit Adviser)

Causal Analyses in ERISA and the Affordable Care Act
"This commentary piece offers some observations on the causal analyses under ERISA section 510 and ACA section 1558. Part I discusses the relationship between a but-for analysis and a mixed-motives analysis. Part II observes that the recent U.S. Supreme Court case University of Texas Southwestern Medical Center v. Nassar may change the causal analysis for ERISA section 510 claims. Part III introduces the causal analysis applicable to ACA section 1558 claims and compares that to the traditional mixed-motives analysis." (JURIST)

[Guidance Overview] New Employee Notification Requirement for Certain Michigan Employers that Sponsor Fully Insured Health Plans
"A new Michigan law regarding abortion coverage requires certain employers to provide employees with a new notice. The new law is the Abortion Insurance Opt-Out Act ... Fully insured plans issued or renewed on or after March 13, 2014 may not provide coverage of 'elective abortions.' Rather, an optional rider must be purchased to provide coverage for these abortions. For employer-sponsored fully insured plans that include this optional rider, employers must provide employees with notice of that coverage." (Miller Johnson)

Five Employer Characteristics for Private Exchange Implementation
"The clearest distinction in a private exchange is the ability to offer a myriad of plans and networks as well as ancillary products.... Private exchanges can offer a unique consumer experience, initially during enrollment and then ultimately in supporting employees and their families to manage their health and healthcare needs.... Early experience is showing that consumers that are given a pool of money will tend to spend the money more prudently consistent with their needs and values." (Healthcare Trends Institute)

[Guidance Overview] ACA Employer Reporting Requirements Finalized
"The final rules retain the rule in the proposed rules directing reporting entities to provide taxpayer identification numbers (TINs) for all covered individuals and to provide a date of birth only if a TIN is not available after the reporting entity makes reasonable efforts to obtain it. The final rules consider it reasonable to solicit a TIN three times." (Seyfarth Shaw LLP)

Comments on Provider Nondiscrimination Requirements requested by IRS, EBSA and CMS
"Section 2706 of the Public Health Service Act ... provides that a group health plan shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable state law.... [M]any group health plans have ignored this requirement, feeling that it was really an issue for their third party administrators who are responsible for maintaining the networks and handling provider issues. However, in a curious turn of events, the Agencies are now asking for public comments on this issue." (Kilpatrick Townsend)

Coverage Expansion in the States: Challenge and Opportunity
"[T]he percentage of uninsured non-elderly adults declined from 17.9 percent in September 2013 to 15.2 percent in March 2014. This translates to 5.4 million people who now have health insurance who previously did not, and these figures largely don't capture the surge in enrollment that occurred at the end of March. These numbers, coupled with the reported 7.1 million enrollment in the federal insurance Marketplace, signal strongly that many Americans have gained coverage." (Robert Wood Johnson Foundation)

[Guidance Overview] Transitional Reinsurance Program Modified
"Plan sponsors can determine the financial impact from the Transitional Reinsurance fees for the 2014, 2015, and 2016 benefit years. Administrators can review their methodology for counting covered lives to determine the fees. Plans that are both self-administered and self-insured can evaluate if they are exempted from the 2015 and 2016 fees." (Cheiron)

[Guidance Overview] Final 2015 Letter to Issuers in the Federally-Facilitated Marketplace: Access and Non-Discrimination Considerations
"The final letter indicates that CMS will conduct reasonable access reviews, but depending on whether actual network membership does or does not have to be submitted, it is not clear how these reviews will proceed or the standards that the agency will use.... CMS clarifies in the final letter that the agency will limit its oversight to cost sharing design aspects of qualified health plans sold in the exchange Marketplace and will not consider limitations and exclusions, discriminatory benefit definitions, or discriminatory definitions of key over-arching terminology such as the plan's medical necessity definition[.]" (Health Reform GPS)

Spring Cleaning Series: Self-Auditing by Employee Benefit Plans
"A self-audit should, at a minimum, focus on issues of particular importance to the IRS and DOL. While the actual retirement or health plan documents and records are very important, the IRS and DOL are also expanding their retirement plan focus to the people behind the plans by looking closely at internal controls in plan operations (on the IRS side) and fiduciary training (on the DOL side). The IRS and DOL will generally pursue a more thorough audit or examination of plans with weak or unclear internal control and fiduciary structures." (Quarles & Brady LLP)

GFOA Publishes Best Practice on Developing a Process for Complying with the ACA
"In the [Best Practice (BP)], the [Government Finance Officers Association (GFOA)] offers guidance for state and local governments that sponsor group health plans with regard to implementing a process for monitoring federal health care requirements under the [ACA]. The BP encourages plan sponsors to establish a monitoring process that, on at least a quarterly basis, will: [1] ensure compliance with the ACA; [2] implement appropriate and cost-effective benefit options for employees and retired members; and [3] avoid financial penalties for non-compliance." (Gabriel, Roeder, Smith & Company)

[Guidance Overview] You Can Do With a Carryover What You Can't Do with the Grace Period: Have an HSA
"[A] general purpose carryover makes the individual HSA-ineligible. This applies even after the entire $500 (or other amount) carried over is spent.... But then the [Chief Counsel Memorandum 201413005] goes on to say that an individual who elects a limited purpose, HSA-compatible FSA (i.e. one that reimburses only for dental, vision, preventive care, or post-deductible expenses, or some subset of those) can carryover the $500 from a general purpose FSA into the limited purpose FSA.... A plan can also automatically provide this result, without the requirement for a participant election. The CCA also says the participant can elect to waive the carryover entirely." (Benefits Bryan Cave)

Nevada Offers Rare Bet: Year-Round Sales of Health Plans
"Insurers that sell individual plans have to offer insurance to all comers during an annual open enrollment period, which this year ended for most people on March 31. However, the health law allows insurers to sell individual plans off the exchange outside the regular open enrollment if they wish to do so, as long as they don't discriminate against people who are sick. Health policy experts say they don't expect insurers to take advantage of the extra selling opportunity often.... Still, at least one state is embracing the prospect." (Kaiser Health News)

The ACA: Some Unpleasant Welfare Arithmetic
"Under the [ACA], between six and eleven million workers would increase their disposable income by cutting their weekly work hours. About half of them would primarily do so by making themselves eligible for the ACA's federal assistance with health insurance premiums and out-of-pocket health costs, despite the fact that subsidized workers are not able to pay health premiums with pre-tax dollars. The remainder would do so primarily by relieving their employers from penalties, or the threat of penalties, pursuant to the ACA's employer mandate." (National Bureau of Economic Research [NBER])

[Guidance Overview] IRS Clears Up Murky FSA Carryover Rule: What You Need to Tell Employees
"The IRS' advice to individuals wishing to participate in an HSA: Do not carryover any FSA funds into the next plan year -- or make sure carryover funds are deposited in an HSA-compatible FSA. Additional guidance for employers: If your cafeteria plan offers both a general-purpose health FSA and an HSA-compatible FSA, you may automatically place any FSA carryover funds of HDHP enrollees into the HSA-compatible FSA for the following year." (HR Benefits Alert)

House Approves 40-Hour Definition of Full-Time Employee
"The House has approved legislation to define a full-time employee under the [ACA] as an employee who works, on average, 40 hours per week. The Save American Workers Act (H.R. 2575 ) was approved by a vote of 248-179. Senate action on the bill is unclear, and the White House has issued a veto warning." (Towers Watson)

[Guidance Overview] How Will The ACA Impact Your Service Contract Act Compliance?
"Government contractors who use a cash-in-lieu approach for their [Service Contract Act (SCA)] employees may find it costs more than they expect to satisfy the ACA's 'affordability' requirement since the cash-in-lieu payments do not count as employer-provided health coverage under the ACA. Although the cash-in-lieu payments satisfy the employer's fringe benefit obligations under the SCA, no similar credit is given to the employer for such payments under the ACA. Moreover, whatever portion of a cash-in-lieu payment is applied to pay the premium cost for employer-provided group health coverage will count as an employee cost, not employer cost. As a result, government contractors could face significantly increased costs unless they reconsider the popular cash-in-lieu approach to fringe benefits." (McKenna Long & Aldridge LLP)

Text of Amicus Brief by Defense Research Institute in Support of Overturning Disgorgement of Profit Award in Rochow v. LINA (PDF)
"Awarding recovery for disgorgement of profits under ERISA's catchall provision in a run-of-the-mill benefits case is inconsistent with ERISA... ERISA's benefits claim process was expressly designed to address all aspects of benefits determinations and does not contemplate collateral remedies.... The catchall provision does not provide a remedy for delays caused by an erroneous benefits denial.... Disgorgement of profits under the catchall provision would generate gratuitous litigation by encouraging participants to re-characterize ordinary claims for benefits as fiduciary breaches." [Rochow v. LINA, No. 12-2074 (6th Cir. Dec. 6, 2013); judgment vacated and rehearing granted Feb. 9, 2014] (Defense Research Institute [DRI])

Even the Healthy Locked Out of 2014 Policies Now
"With limited exceptions, insurance companies have stopped selling until next year the sorts of individual plans that used to be available year-round. That locks out many of the young and healthy as well as the sick and injured, even those who can afford to buy without government subsidies.... The next wide-open chance to sign up comes in November, when enrollment for 2015 begins in the government-run insurance marketplaces created by the health care law. Companies are following that schedule even for the plans they sell outside the federal and state exchanges." (Associated Press)

Young Workers Not Flocking to Employer-Sponsored Health Plans
"Young workers in the U.S. signed up for employer-sponsored health plans at a lower rate than last year, a surprising result that helped keep overall workplace enrollment rates flat.... Take-up rates among workers under 30 fell 1.4 percentage points from 2013 to [2014] Over the past five years, that rate has declined by 7.6 percentage points to 62.1% of those eligible." (The Wall Street Journal; subscription may be required)

Employees' Class Action Challenges Wellness Incentive Under State Wage Hour Law
"A pharmacy chain is being sued over its requirement that employees undergo a 'wellness exam' or pay a $600 surcharge on their health plan contribution. The lawsuit, filed in California state court as a class action, characterizes the surcharge as an illegal 'wage deduction,' and contends that employees who did take the exam should have been compensated for the time and expense of doing so." [Watterson v. Garfield Beach CVS, LLC, No. RG14717292 (Cal. Super. Ct., filed March 13, 2014) (Thompson SmartHR Manager)

[Official Guidance] Text of IRS Notice 2014-24: Health Insurance Providers Fee; Procedural and Administrative Guidance (PDF)
"This notice provides a temporary safe harbor for covered entities that report direct premiums written for expatriate plans on a Supplemental Health Care Exhibit (SHCE). A covered entity may apply this temporary safe harbor for purposes of reporting direct premiums written on Form 8963, Report of Health Insurance Provider Information, which is used to calculate the fee imposed by Section 9010 of the [ACA].... [T]his notice provides a temporary safe harbor for 2014 and 2015 for a covered entity that reports direct premiums written for expatriate plans on its SHCE that include coverage of at least one non-United States health risk." (Internal Revenue Service [IRS])

Why It's Not Too Late for Your Employees to Get on the Exchange: Special Enrollment Periods
"[S]pecial enrollment rights in the Exchanges look a lot like the special enrollment rights provided in HIPAA for employer sponsored plans.... [F]or employers, determining whether or not to continue a plan in its current form, to terminate coverage or to change eligibility for coverage should not assume that employees who lose coverage would be barred from the exchanges for the remainder of 2014." (Fox Rothschild LLP)

[Guidance Overview] IRS Final Rule on ACA Play or Pay Mandate Allows Employers to Finalize Compliance Preparations
"[E]mployers are not eligible for any partial credit in determining the amount of the penalty assessed. In other words, an employer that offers coverage to 69% of its full-time employees in 2015 or 94% in 2016 will pay the same penalty that it would pay if it did not offer any coverage at all. This means no employer can afford to inadvertently fail the coverage threshold, so careful attention must be paid to the final regulation's definition of full-time employee and the detailed rules imposed for measuring hours of service[.]" (Vedder Price)

[Guidance Overview] New ACA Information Reporting Starts for Employers in 2015
"All employers that offer self-insured health plans must report on every individual covered under the plan. Large employers that are subject to the play or pay requirement must report to the IRS each year on every individual who was a full-time employee for one month or more during the year.... Employers need to work quickly because it will be challenging to build systems that can capture all the data required starting January 1, 2015." (Jones Day)

Companies That Reduce Employee Hours to Avoid ACA Fines Might Face ERISA Litigation
"As much as possible, the monitoring of external communications and avoidance of comments on employment policy is extremely important to combat public misperception ... [B]usiness reasons for any changes in employment policy that could be misconstrued as an attempt to avoid ACA penalties should be explained via consistent company messages." (Wolters Kluwer Law & Business)

Seventeen States, Washington, D.C. Will Run SHOP Marketplaces
"States have sought to improve the availability of small-group coverage by implementing standard participation requirements and offering competitive choices of insurers and plans. They also have aimed to improve the shopping experience by providing online access to personalized assistance." (Wolters Kluwer Law & Business)

Why Some Don't Pay Their Obamacare Premium: It's Not What You Think
"Researchers at the U.C. Berkeley Labor Center released estimates Wednesday showing that about 20 percent of Covered California enrollees are expected to leave the program because they found a job that offers health insurance. Another 20 percent will see their incomes fall and become eligible for Medi-Cal, the state's insurance program for people who are low income. In addition to the 40 percent of enrollees who move to Medi-Cal or job-based insurance, between 2 and 8 percent of those who sign up for Covered California are estimated to become uninsured, the analysis noted." (Kaiser Health News)

Trucker Huss Benefits Report, March 2014 (PDF)
Article titles include: [1] Final 90-Day Health Plan Waiting Period Rules Issued; [2] United States Supreme Court Decision in Quality Stores Case; and [3] IRS Issues Final Regulations Implementing the ACA's Information Reporting Requirements under Code Sections 6055 and 6056. (Trucker Huss)

[Guidance Overview] IRS Final Regs Impose Complex Reporting Requirements on Self-Funded Plans and Insurers Starting in 2016 (PDF)
"Beginning in 2016 (for information on 2015), insurers and self-funded plans will be required to report information about health coverage provided during the prior year to all enrollees, including Taxpayer Identification Numbers of all covered individuals and the specific dates that such individuals had such health coverage, as required by Code section 6055. In addition, employers with 50 or more full-time equivalent employees will be required to report information about health coverage offered during the prior year to full-time employees, including information about the lowest cost option offered and whether the minimum value requirements were satisfied, as required by Code section 6056.... [The authors] address key questions related to the reporting, and summarize the information provided in a chart ... What transition relief is available for 2015? ... Who must file these forms? ... What form is used to report this information? ... How are these forms filed? ... When are these forms due? ... What information must be disclosed? ... What reporting penalty may apply?" (Groom Law Group)

[Guidance Overview] How to Calculate Employer Health Care Responsibilities
"Two part-time workers combined can equal a full-time employee....No part-time coverage required.... Measurement period.... How to calculate.... Seasonal worker exclusion... Smallest businesses exempt... Two penalties.... Threshold is 70% for 2015." (Journal of Accountancy)

NLRB Classification of Athletes as Employees Highlights a Health Care Reform Land Mine
"Let's consider a hypothetical: on January 1, 2016, the IRS reclassifies enough students and independent contractors as 'full-time employees' so as to cause the University to miss the 95% mark, and at least one employee used a premium credit to purchase coverage on an exchange. It appears that after paying all the health care plan costs, the University could also be liable for a penalty in the neighborhood of $20 million, per year.... Given the high stakes involved with a failure to satisfy the 95% test, employers need to consider their margin for error, and give serious consideration to the circumstances involving anyone who is performing services but is not being treated as an employee." (Porter Wright Morris & Arthur LLP)

Use of HIPAA-Protected Personal Health Information by Employer Investigating FMLA Issue for Litigation Not Barred in Eleventh Circuit
"[T]he 11th Circuit determined that while HIPAA prohibits the use and disclosure of personal health information in employment-related decisions, it does not bar a defendant in litigation from using the plaintiff's personal health information to defend against that lawsuit. Thus, at least in the 11th Circuit, 'fruit of the poisonous tree' can be used by employers to defend their employment decisions made based on fruit from their HIPAA-covered plans.... [T]he Court seems to gloss over the distinction made in the HIPAA regulations between functioning as a covered entity-health plan and functioning as an employer. The employee was suing the employer in this case, not the plan, and the employer, functioning as an employer, simply should not have had access to this information." [Bailey v. City of Daytona Beach Shores, No. 13-11127 (M.D. Fla. Mar. 20, 2014)] (Jackson Lewis, via National Law Review)

IRS e-File Form Submission Process for ACA Providers (PDF)
27 presentation slides. Excerpt: "The following ACA related forms can be submitted electronically: [1] Form 8947: Report of Branded Prescription Drug Information is scheduled to be ready for electronic filing in the fall of 2014. [2] Form 8963: Report of Health Insurance Provider Information. [3] Form 8453-R: Declaration and Signature for Electronic Filing of Forms 8947 and 8963.... ACA information reports can be transmitted electronically via the ACA Form Acceptance (AFA) site on irs.gov." [The slides include detailed instructions for accessing and submitting forms electronically.] (Internal Revenue Service [IRS])

How to Create a Benefits Plan That Appeals to the Young and Cool
"Millennials care about their benefits.... Millennials want to choose what type of coverage they get.... Millennials have competing benefit offers; they need to be courted.... Millennials want real-time, instant information ... But they also crave face-to-face mentorship.... Insurance Cards will no longer do the trick." (Forbes)

[Official Guidance] Text of CMS Guidance on ACA Premium Credits and Enrollment Periods for Victims of Domestic Abuse (PDF)
"The Department of the Treasury recently clarified that a married individual who is living apart from his or her spouse at the time of filing an income tax return for 2014, and is unable to file a joint return as a result of domestic abuse, will be permitted to claim a premium tax credit while filing a tax return with a filing status of married filing separately.... This guidance provides two options for Marketplaces to ensure that this rule can be immediately implemented for the purpose of determining eligibility for advance payments of the premium tax credit (APTC) and cost-sharing reductions (CSR).... This special enrollment period will be available through May 30, 2014 during which an eligible individual who is married and a victim of domestic abuse may apply for and enroll in coverage for the individual and his or her dependents through the Federally-Facilitated Marketplace." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)

[Official Guidance] Text of CMS Shared Responsibility Provision Question and Answer on Coverage Gap for Individuals Determined to Be Eligible for Medicaid or CHIP (PDF)
"[A]n individual who applies for coverage on or before March 31, 2014 and is found eligible for Medicaid based on that application will have Medicaid on or before March 31, [2014] Under these circumstances, even if such an individual did not have coverage before March 31st, he or she will qualify for a short coverage gap exemption for the period of time before his or her Medicaid coverage was not yet effective, back to January 1, 2014.... The IRS and Treasury Department intend to publish guidance allowing an individual to claim a hardship exemption from the individual shared responsibility payment for the months in 2014 prior to the effective date of the individual's CHIP coverage if the individual submits a coverage application prior to the close of the open enrollment period and is found eligible for CHIP." [Dated March 31, 2014.] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)

Text of Amicus Brief by Employer Organizations in Support of Employer on Appeal to Sixth Circuit of Rochow v. LINA (PDF)
"The decision, if affirmed, would significantly increase the risk, cost, and uncertainty associated with offering ERISA-governed employee benefits, including a dramatic increase in the expense and burden of resolving benefits cases. These effects will have negative repercussions for the availability and affordability of valuable employee benefits on which millions of American workers and their families depend.... [T]he district court fashioned a purportedly 'appropriate equitable' remedy under Section 502(a)(3) that is contrary to the carefully balanced scheme and purposes of ERISA, and inappropriately punitive in nature. As such, the decision should be reversed." (American Council of Life Insurers, American Benefits Council, Chamber of Commerce of the United States of America, and America's Health Insurance Plans [AHIP])

[Guidance Overview] 'Shared Responsibility' Final Regs and 2015 Transition Guidance
"Now that the parameters of the pay-or-play mandate appear to be set, employers should decide exactly how they will comply. Time is running short -- applicable large employers that wish to use the look-back measurement method and a 90-day administrative period should begin tracking hours of service by April 2 if they have calendar year plans, and all employers must count full-time employees and FTEs during a period of at least six consecutive months in 2014." (King & Spalding)

April and May 2014 Filing and Notice Deadlines for Qualified Retirement and Health & Welfare Plans
"[This] filing and notice deadline table provides key filing and notice deadlines common to calendar year plans for the next two months. Please note that the deadlines will be different if your plan year is not the calendar year. Please also note that the table does not include all applicable filing and notice deadlines, just the most common ones." (King & Spalding)

[Guidance Overview] Is Your Health Plan Premium Affordable Under the ACA?
"A large employer subject to the employer mandate in 2015 (i.e., an employer that employed at least 100 full-time employees and/or full-time equivalent employees during 2014) that intends to minimize exposure to ACA penalties should review the safe harbors and determine which safe harbor, or combination of safe harbors, works best for its full-time workforce.... Form W-2 Wages Safe Harbor.... Rate of Pay Safe Harbor.... Federal Poverty Line Safe Harbor." (Bond, Schoeneck & King)

[Guidance Overview] 90-Day Maximum Health Plan Waiting Period: Final Regs Give Some Relief
"[E]mployers may wait until the end of an 'orientation period' to begin counting the 90 days, and proposed rules issued in tandem with the final regulations tell us that such an orientation period can last no more than one calendar month (less one day). This may allow employers to re-instate past practices of enrolling new hires on the first of the month after 90 days of service, rather than enrolling employees mid-month or shortening the waiting period to 60 days in order to allow first-of-month enrollments and still comply with the 90-day maximum." (Frost Brown Todd)

[Guidance Overview] To Be, or Not to Be (Compatible with an HSA When Enrolled in a Health FSA) -- That Is the Question
"For those employers who have already struggled with the questions presented by having both a high-deductible health plan (HDHP) with an HSA and a health FSA with a carryover feature, the guidance [of IRS Chief Counsel Memo No. 201413005] is welcome.... Even if the employee (or spouse) does not make an election for the health FSA in Year 2, anticipating the need to make HSA contributions, if the health FSA has money leftover from Year 1 the employee may be ineligible to contribute to the HSA for all of Year 2." (Hill, Chesson & Woody)

[Guidance Overview] CMS Clarifies Availability of Retroactive Premium Tax Credits and Special Enrollment Periods, and Provides Guidance on Direct Enrollment in SHOPs
"[P]rior transition relief was provided for employers unable to obtain timely FF-SHOP eligibility determinations. Now, this guidance allows state-based SHOPs to mirror the FF-SHOP relief (with CMS approval), giving otherwise eligible small employers the opportunity to claim a tax credit for 2014 even if their state-based SHOP does not have a fully functional enrollment portal." (Thomson Reuters / EBIA)

[Official Guidance] Text of IRS Notice 2014-24: Health Insurance Providers Fee; Procedural and Administrative Guidance (PDF)
"This notice provides a temporary safe harbor for covered entities that report direct premiums written for expatriate plans on a Supplemental Health Care Exhibit (SHCE). A covered entity may apply this temporary safe harbor for purposes of reporting direct premiums written on Form 8963, Report of Health Insurance Provider Information, which is used to calculate the fee imposed by section 9010 of the Affordable Care Act." (Internal Revenue Service [IRS])

Three Steps to Drive Clear, Cost-Saving Benefits Communication Campaigns with Measurable Outcome (PDF)
"Benefits account for almost 30% of total compensation spending. An effective communication program helps your company make the most of its investment... Companies that are highly effective at communication are 1.7 times as likely to outperform their peers.... 61% of employees are likely to accept a job with lower pay but better benefits.... A company is four times more likely to lose talented workers in the next year if employees are not satisfied with wellness promotion." (Benz Communications)

Broker Strategies for Maintaining E&O Coverage in 2014
"Brokers' interest in private exchanges will continue as long as they have the tools, size and capabilities to deliver the full range of benefits and services clients want. However, agents need to remember that business expansion will usually mean an expansion in errors and omissions (E&O) coverage as well. Benefit brokers need to carefully consider that the definition of services in their E&O policy matches the full scope of the services they offer so there is no gap in coverage should a claim be brought against them." (Healthcare Trends Institute)

[Official Guidance] Text of CMS Revised Bulletin #3 on HHS-Granted Special Enrollment Periods for Federally-Facilitated Marketplace and State Partnership Marketplace Issuers (PDF)
"[T]his bulletin clarifies the: [1] Type of [Special Enrollment Periods (SEPs)] to which Bulletin #3 applies; [2] Coverage effective dates for HHS-granted SEPs; [3] Process for terminating former coverage when the consumer has selected a new qualified health plan (QHP) through an SEP; [4] Treatment of advance payments of the premium tax credit and cost-sharing reductions (APTC/CSR) in retroactive coverage scenarios in the FFM; and, [5] Applicability to stand-alone dental plans." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)

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