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64 Matching News Items

1.  Moving from Theory to Implementation of Healthcare Reform: An Overview for Employers of New Guidance, Strategies and Case Studies (PDF)
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
July 14, 2010
18 pages. Slides from a presentation. Fabulous examples. Excerpt: ACA changes impact notices typically distributed with open enrollment materials. 1. Notice of Special Enrollment Rights. 2. General Notice of Preexisting Condition Exclusion. [An MP3 recording of the presentation is available at http://www.vorys.com/healthcarereform.]'(Maybe say in the excerpt that an MP3 recording is available at http://www.vorys.com/healthcarereform )
2.  Insurance Agents Held to Be Employees for ERISA Purposes
Vorys, Sater, Seymour and Pease LLP, via FORC Link to more items from this source
Dec. 22, 2017
"Agents who are supposedly independent are not like franchisees who must follow all of the franchisor's rules.... Insurance companies may also want to consider: [1] Carving out agents they deem to be independent contractors from ERISA plans; [2] Not referring to agents as employees in training and personnel manuals; [3] Adding a term to agents' agreements expressly stating when the agreement will be renewable; [4] Allowing the agents to control their book of business, or, at the very least, having discretion in selling their agency and in writing business for other insurance carriers."
3.  The Fiduciary Duty to Locate Missing Participants
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Nov. 8, 2017
"The DOL has only published guidance outlining the procedures that a terminating retirement plan should follow to locate missing participants, and that ongoing plans should follow before making automatic rollover distributions to an IRA for participants who are owed small-sums (between $1,000 and $5,000). Despite this lack of guidance, the DOL has been asserting in recent audits that a retirement plan's failure to identify and locate a missing participant is a breach of fiduciary duty ... even when the retirement plan has followed its procedures and has relatively few missing participants."
4.  New York's Paid Family Leave Law Becomes Effective January 2018
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Sept. 15, 2017
"An employer may apply to the chair of the New York State Workers' Compensation Board for approval as a self-insured employer by September 30, 2017. To be approved as a self-insured employer, an employer must: [1] provide PFL benefits at least as favorable as required by the PFLL; [2] demonstrate the ability to make PFL payments; [3] submit certain financial information; [4] file with the chair an agreement to pay disability and PFL benefits; [5] assume all liability for PFL benefits that exceed the funds collected in excess of the maximum contribution amount; [6] post a surety bond; [7] allow the chair to examine its operations and records; and [8] file annual reports."
5.  7,000 Insurance Agents Held to Be Employees for ERISA Purposes
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Sept. 13, 2017
"[T]he Court concluded that the evidence supported both sides but that the amount of control American Family exercised (or could have exercised) tipped the scales in favor of employee status. At the same time, the Court noted that prior case law has been 'nearly unanimous' in finding insurance agents to be independent contractors and that the resolution of damages will be 'unusually complicated.' " [Jammal v. American Family Ins. Group, No. 13-437 (N.D. Ohio Aug. 1, 2017)]
6.  More Uncertainty for Wellness Programs
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Aug. 25, 2017
"The judge in a recent court case ordered the [EEOC] to develop the administrative record supporting rewards of up to 30% of the cost of health coverage for participation in wellness programs. If the EEOC is unable to defend the size of the reward, the EEOC may have to change its wellness program rules.... Now employers are left to wonder what the EEOC will do, when the EEOC will do it, and how to design their wellness programs in the interim.... The IRS and DOL wellness program rules remain in effect. WARNING: The DOL is auditing compliance and will follow up on participant complaints."
7.  Mental Health Parity: Can You Show That Your Health Plan Complies?
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
June 27, 2017
"On June 16, 2017, the [DOL] published a draft of a model form that an employee (or his or her representative) could use to request documentation of compliance with the [MHPAEA]. If an employer receives this type of request (even if not on the DOL's model form), it has just 30 days to respond. If an employer doesn't respond in 30 days, penalties of up to $110 per day may apply."
8.  Court Faults Employer for Failing to Provide Accurate Information Regarding Life Insurance Conversion
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
May 15, 2017
"The judge faulted WellStar for not understanding its life insurance policy and incorrectly assuming that its former employee was still covered.... The court considered the fact that WellStar did not follow its own written procedures in determining it had breached its duty to the plaintiff." [Erwood v. Life Ins. Co. of North America and Wellstar Health System, Inc. Group Life Ins. Program, No. 14-1284 (W.D. Penn. Apr. 13, 2017)]
9.  HHS Releases Final Rule on ACA Marketplace Stabilization
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Apr. 16, 2017
"One of the main provisions of the final rule is the authority for insurers to sell less-generous policies that will feature lower premiums, but higher deductibles. Under this new provision, insurers can now sell policies that are four percentage points below ACA standards, compared with two percentage points under current regulations. Another provision, aimed at creating a more stable pool of enrollees, will reduce the current open enrollment period in half."
10.  Are Individually Designed Retirement Plans an Endangered Species?
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Jan. 3, 2017
"As a result of the IRS' changes to its determination letter program, [plan sponsors should]: [1] Ensure that an annual review is performed for all retirement plans to confirm compliance with the IRS' Required Amendment List and Operational Compliance List. Document the annual review in the plan administrator minutes; amend the plans as required, and conduct operational audits to document your diligence.... [2] Carefully scrutinize all proposed amendments to the plan for potential issues. You will no longer be able to clean up problematic language during the determination letter process.... [3] Consider whether a pre-approved plan can satisfy the plan's design and legal requirements."
11.  21st Century Cures Act Provisions That Relate to Group Health Coverage
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Dec. 16, 2016
"The 21st Century Cures Act tasks the HHS, DOL and Treasury with coming up with additional guidance on compliance with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The guidance is supposed to help health plans, patients and health care providers identify compliant and non-compliant plan designs with a particular focus on determining parity in non-quantitative treatment limitations such as standards for medical necessity, preauthorization, provider reimbursement rates, fail-first therapy and step therapy. The guidance will include 'clarifying information and illustrative examples' of how a health plan should provide individuals and their representatives access to plan information to verify a plan's compliance with the MHPAEA."
12.  More Burdens for Federal Contractors with Mandatory Paid Sick Leave
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Oct. 17, 2016
"If a contractor frontloads the full amount of leave year, it may limit the carryover to the next year to 56 hours. But the contract must still frontload the full amount of leave at the beginning of the accrual year. This means that the employee's leave bank may have more than 56 hours in it each year. Employees are not entitled to be paid for their unused sick leave upon termination or resignation. But unused sick leave must be reinstated if an employee is rehired within 12 months after being separated."
13.  Why Am I Getting This Marketplace Notice?
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
July 21, 2016
"The Marketplace is using employment information provided by the individual. That employment information may be old (resulting in Marketplace Notices for individuals who terminated employment before January 1, 2016) and/or may be addressed to a local workplace (resulting in Marketplace Notices going to locations not prepared to respond to them)."
14.  Summer Interns and the ACA Pay-or-Play Penalties
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
June 27, 2016
"A summer intern is not classified as a Full-time Employee during his or her initial measurement period. Rather, the summer intern is in a 'limited non-assessment period' during which no penalties are assessed. The summer intern never becomes an Full-time Employee if he or she terminates employment at the end of the summer (and before the end of the initial measurement period).... If you are using the monthly measurement method, it is likely that a summer intern may need to be offered coverage under your group health plan if your plan does not impose a waiting period, or if the summer intern's employment extends beyond the plan's waiting period."
15.  Major Changes Proposed for Incentive Compensation at Financial Institutions -- Are Other Types of Employers Next?
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
June 17, 2016
"The proposed regulations would require deferral of a significant portion of incentive compensation after the end of the performance period before the award is 'vested' and would also require the vested amount to be subject to substantial forfeiture and clawback risks.... The concepts in the proposals are likely to be extended to publicly traded employers, tax exempt entities, federal contractors, and other employers either by mandate or as emerging best practices."
16.  EEOC Rules on Wellness Programs
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
May 21, 2016
"Up until now, what constituted compliance with the ADA and GINA was subject to debate. The [EEOC] sought to end that debate with the publication of final wellness program regulations under the ADA and GINA[.]" [Article includes charts comparing ADA and GINA requirements.]
17.  Court Invalidates Pittsburgh Paid Sick Leave Law
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Jan. 14, 2016
"[T]he Court held that the ordinance is invalid because no state statute expressly permitted Pittsburgh to enact it. Employers need not comply with the city's paid sick leave requirements. However, the city may still appeal the decision or lobby the state legislature for statutory authority to enact local paid sick leave laws."
18.  OCR Ends 2015 with Announcement of Additional HIPAA Settlements
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Jan. 4, 2016
"[One] investigation involved a breach of 599 individuals' protected health information (PHI) when an unencrypted laptop was stolen from a workstation.... The significant failures within [a second] compliance program included a lack of administrative, physical, and technical safeguards to protect PHI, a failure to conduct an adequate risk analysis of all applications using ePHI, and impermissible use or disclosure of PHI to outside vendors and within mailings. [A third] investigation involved a breach of approximately 90,000 individuals' ePHI after an employee fell prey to a phishing email and opened an attachment containing malware.... Although the three settlements involved different types of a breach, a common theme ... is that the covered entity failed to perform a comprehensive risk analysis."
19.  Form 1095 Deadlines Extended and Other December Developments Impacting Health Benefits
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Jan. 4, 2016
"Two-year delay of the Cadillac Tax ... Pay or play penalties indexed for 2015 and 2016 ... Pay or play 9.5% affordability percentage indexed for 2015 and 2016 ... Disability benefits = hours of service while employed ... Opt-out payments impact the affordability of coverage (but not yet) ... Employers subject to the Service Contract Act catch an overdue break ... More rules for HRAs."
20.  Minneapolis Proposes Extensive Paid Sick Leave
Vorys, Sater, Seymour and Pease LLP Link to more items from this source
Oct. 25, 2015
"The earned sick time proposal would apply to any employer with at least one employee, unless a collective bargaining agreement is in effect. The proposal would require sick time accrual at a rate of one hour for every 30 hours worked.... A public hearing is currently scheduled for November 4, 2015 to discuss the proposal."
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