Health & Welfare Plans Newsletter

October 21, 2014

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Employee Benefits Jobs

Retirement Plan Administrator
Pinnacle Plan Design, LLC
in AZ

Data Conversion Specialist - Client Integration
Transamerica
in NY

Benefits Consultant, Small Group (2-9)
Northwestern Benefit Corporation of Georgia
in GA

Part Time On Call Retirement Planning Consultant
Transamerica Retirement Solutions
in AR, CA, HI, IL, MI, MO, NJ, NY, TN, TX, UT

Senior Defined Contribution Consultant
Aon
in ANY STATE, CT, GA, IL, NJ, NY, TX

Regional Pension Sales Manager
Nationwide Retirement Services
in VA

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Webcasts and Conferences

Defined Contribution Plan Basics
RECORDED
(ASPPA [American Society of Pension Professionals & Actuaries])

Differences Between Balance-forward and Daily Valuation
RECORDED
(ASPPA [American Society of Pension Professionals & Actuaries])

Restatement 12: Maximizing Forfeiture Flexibility
November 3, 2014 WEBCAST
(SunGard Relius)

The Intelligent Fiduciary: Common Problems You Can Avoid (NY CLE Program)
November 5, 2014 WEBCAST
(Osler, Hoskin & Harcourt LLP)

ASPPA Update: What Do the Midterm Election Results Mean For You?
November 6, 2014 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

ERISA: Who are These Fiduciaries (And What are These Weird Numbers)?
November 6, 2014 WEBCAST
(SunGard Relius)

Health Care Reform for Employers: Now What?
December 3, 2014 in IN
(Lorman Education Services)

Collective Bargaining for Healthcare Organizations in the Age of the ACA
December 18, 2014 WEBCAST
(Cammack Retirement Group)

View All Webcasts and Conferences



[Official Guidance]

CMS Announcement: Availability of the ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form (PDF)
"The Form will be available via www.pay.gov on Friday, October 24, 2014 in time for the 2014 benefit year's annual enrollment count submission deadline of November 15, 2014... [R]einsurance contribution payments are not due on November 15, 2014. HHS will offer contributing entities the option to pay: [1] the entire 2014 benefit year contribution in one payment no later than January 15, 2015, reflecting $63.00 per covered life; or [2] in two separate payments for the 2014 benefit year, with the first remittance due by January 15, 2015 reflecting $52.50 per covered life, and the second remittance due by November 15, 2015, reflecting $10.50 per covered life." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


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401(k) Plan Structure Training for Employers

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Retirement plans can be designed in many different ways—does your plan best meet the needs of your organization? The new e-learning course, 401(k) Plan Structure, examines the many aspects to consider when structuring a 401(k) plan. Enroll Now!



[Official Guidance]

Text of CMS Annual Enrollment and Contributions Submission Form Manual (PDF)
64 pages. "This document will enable a Contributing Entity, or a TPA or ASO contractor on behalf of the Contributing Entity, to complete the required steps for the reinsurance contribution submission process. It provides information about the ACA Transitional Reinsurance Contributions Process including: step-by-step instructions for completing and submitting the 'ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form' and Reinsurance Contributions Supporting Documentation; details on key elements and business concepts; and resources to further assist the Contributing Entity." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)  

[Official Guidance]

Text of CMS Supporting Documentation for Transitional Reinsurance Contributions: Job Aid Manual
14 pages. "A Contributing Entity, or a Third Party Administrator (TPA) or Administrative Services-only (ASO) contractor on behalf of the Contributing Entity, can complete all required steps for the ACA Transitional Reinsurance Contributions Process on the Pay.gov website ... by submitting the 'ACA Transitional Reinsurance Annual Enrollment and Contribution Submission Form' (the Form) ... The Transitional Reinsurance Program also requires a Contributing Entity's Annual Enrollment Count in Supporting Documentation to be submitted with the Form. The Job Aid referenced in this manual is designed to support Reporting Entities in the creation of the Supporting Documentation. The Job Aid is an MS Excel workbook that allows users to enter, validate and convert Contributing Entity information into a Comma Separated Value (CSV) file format. This document will enable a Contributing Entity, or a TPA or ASO contractor on behalf of the Contributing Entity, to use the Job Aid and create the Supporting Documentation required to complete step 3 of the required steps for the reinsurance contributions process[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)  

[Official Guidance]

Text of Health Insurance Marketplace Quality Rating System Measure Technical Specifications (PDF)
181 pages. "This document includes the measure specifications and guidelines for data collection for the 2015 Quality Rating System (QRS) measure set. Qualified Health Plan (QHP) issuers will need to reference this document in order to collect and submit QRS measure data to [CMS] in accordance with the QRS 2015 beta test requirements. The document specifically details the following: [1] QRS measure set.... [2] QRS clinical measure technical specifications .... [3] QRS survey measure technical specifications." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Official Guidance]

Text of 2015 Quality Rating System and Qualified Health Plan Enrollee Experience Survey Technical Guidance (PDF)
51 pages. "This document provides technical guidance regarding the 2015 beta tests of the Quality Rating System (QRS) and Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey). It specifies QRS and QHP Enrollee Survey requirements for Qualified Health Plan (QHP) issuers offering coverage through the Health Insurance Marketplaces ... This document includes the following information: [1] Implementation schedule for the 2015 beta test of the QRS and QHP Enrollee Survey ... [2] Entities that must comply with QRS and QHP Enrollee Survey requirements ... [3] QRS and QHP Enrollee Survey requirements ... [4] QRS scoring specifications and rating methodology ... [5] QRS and QHP Enrollee Survey data preview process ... [6] QHP quality rating information display and marketing use[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


[Advert.]

How To Avoid the Pitfalls of Disability Plan Administration

Sponsored by Lorman and BenefitsLink

October 23 webinar. Many employer plans are as much a source of litigation as they are a source of benefits to the disabled. This live webinar focuses on the basics of administering the plan. BenefitsLink discount.



[Official Guidance]

Text of CMS Draft HIX 820 Companion Guide, Version 2.0, October 6, 2014 (PDF)
64 pages. "This companion guide to the ASC X12 005010X306 Health Insurance Exchange Related Payments Implementation Guide (HIX 820) clarifies and specifies data content for payment related information transmitted electronically from [CMS] as a part of implementation of Health Insurance Marketplaces ... created as a part of the [ACA]. This companion guide is not intended to be used separately; it is based on, and must be used in conjunction with, HIX 820." [Also available: HIX 820 X306 Exchange Payment Type Codes.] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

Overview of 2015 QRS Requirements for QHP Issuers (PDF)
"QHP issuers offering family and/or adult-only health insurance coverage of any category through the Marketplaces ... must comply with QRS requirements, if they offered coverage during the previous benefit year and meet minimum enrollment criteria.... QHP issuers are required to collect and submit third-party validated QRS measure data that will be used by CMS to calculate QHP scores and ratings." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

CMS Presentation: FF-SHOP Updates and Live Q&A, October 14, 2014 (PDF)
127 presentation slides. Topics include: [1] Frequently Asked Questions; [2] Increment 2 Testing Overview: Account Creation, Initial Scenario, Change Primary Business Address and Change State, and Employee Flow; [3] Question and Answer Session; and [4] Resources. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

November 1 Deadline for Many Health Plans to Get Health Plan ID from CMS
"A self-insured health plan must answer two questions to determine whether it must obtain a HPID. [1] Does it meet the definition of health plan under 45 CFR 160.103? A health plan is an individual or group plan that provides or pays the cost of medical care ... [2] If it meets the definition of a health plan, is it a controlling health plan (CHP)? A CHP is a health plan that controls its own business activities, actions, or policies, or is controlled by an entity that is not a health plan. A health plan is also a CHP if it has one or more sub health plans that it controls by directing the SHP's business activities, actions, or policies." (Solutions Law Press)  

[Guidance Overview]

New York State Department of Health Releases Long-Awaited Proposed Regs Authorizing Formation of ACOs (PDF)
"The Commissioner of the New York State Department of Health will issue Certificates of Authority (COA) to entities that satisfy the regulatory criteria for ACOs. Among the ACO criteria are the existence of stated mechanisms for governance, accountability, and the distribution of funds. An ACO must have a plan for coordination of care to assure that all medically necessary health care services are available to and used by the patient, including evidence-based treatment initiatives and strategies for patient engagement. The regulations specify standards for the ACO's quality management improvement program, including a process for peer review." (Epstein Becker Green)  

House Approves Health Care Bills Before November Elections
"During a brief September legislative session, the House of Representatives approved a bill defining a full-time employee under the Patient Protection and Affordable Care Act (PPACA) using a 40-hour-per-week standard. Another House bill would allow insurers to sell certain health plans that fail to meet PPACA requirements. Although Senate action is not expected, these provisions could reappear on the legislative agenda in 2015." (Towers Watson)  

ACA's Small-Business Exchanges to See Major Changes in the Coming Months
"One year in, the new small-business insurance marketplaces born out of the new federal health-care law have fallen short of their promise in nearly every state, both in terms of functionality and enrollment. However, many are scheduled to see some important updates heading into year two -- ones that health officials say should make them much more useful and appealing to small employers and their workers." (The Washington Post; subscription may be required)  

Essential Health Benefits: 50-State Variations on a Theme
"The interim policy that defined EHBs by benchmark plans resulted in benefit packages that varied considerably across states. On one hand, chiropractic care was most frequently included (45 states). On the other hand, acupuncture was rarely included (5 states).... 19 states included infertility treatments, 26 states covered autism spectrum disorder, and 31 states covered treatments for TMJ.... For obesity, 23 states included bariatric surgery, but only 12 of them cover nutrition counseling and just three of them cover weight loss programs." (Robert Wood Johnson Foundation)  

D.C. City Council Removes Final Obstacle to Enforcement of Sick and Safe Leave Amendments
"Changes to the Sick and Safe Leave Act (SSLA) include removing a requirement that employees work for one year prior to accruing SSLA leave. Instead, the Act provides that leave starts to accrue on the date of hire and can be used after 90 days. Employees now are eligible to accrue and use leave whether or not they have worked 1,000 hours in the prior 12 months. The amendments also extend the law to cover tipped restaurant employees -- a sea change for the hospitality industry." (Jackson Lewis P.C.)  

GAO Report on Federal Paid Administrative Leave: Additional Guidance Needed to Improve OPM Data
"GAO was asked to examine the use of paid administrative leave [within federal agencies]. This report [1] describes paid administrative leave policies at selected federal agencies; [2] reviews practices in recording and reporting paid administrative leave and describes the number of federal employees granted such leave, and the amount and associated salary costs of such leave; and [3] describes categories for which large amounts of paid administrative leave have been charged by individual employees at selected federal agencies." (U.S. Government Accountability Office [GAO])  

Are Your Benefit Plans Ready for Ebola?
"Will Ebola treatment costs be covered by commercial carriers? Maybe.... [M]ost plans include an exclusion of coverage for employees who are traveling abroad on short-term assignment.... Critical illness policies need to have an infectious disease rider included (not standard), and currently, no policies specifically cover Ebola." (William Gallagher Associates)  

Health Reform Reduces the Deficit, Contrary to Senate GOP Analysis
"The decline in projected Medicare spending means that health reform provisions that cut Medicare costs directly will save less than previously thought. (A provision that reduces Medicare costs by a certain percentage will save fewer dollars if that percentage cut is applied to a smaller base of costs.) But the Senate Republican analysis lowers CBO's estimate of health reform's Medicare savings to reflect that effect alone, as though not one dollar of the savings from the slowdown in health costs were due to health reform's focus on reducing cost growth in the U.S. health care system." (Center on Budget and Policy Priorities)  

Australia Will Raise $5 Billion by Privatizing Its Biggest Health Insurer
"[T]he sale would remove the current conflict where the government is both the regulator of the private health insurance market and owner of the largest market participant. Medibank provides cover to 3.8 million people.... Australia has been shrinking the role of government in health care. Although a national single-payer scheme was established in 1975, the federal government re-introduced private choice within a few years." (National Center for Policy Analysis Health Policy Blog)  

Benefits in General; Executive Compensation

2015 Marketplace Forecast for North American Insurance Buyers
"In the Employee Benefits space, Willis predicts rate increases holding at 5-6% for organizations with self-insured plans and 9.5-10.5% for insured plans. Possible cost savings from marketplace options such as public and private exchanges are balanced for the moment by the steadily rising cost of treating widespread chronic disease conditions, increased costs and prevalence of specialty drugs and expenses associated with health care reform." (Willis)  

Absent Initial Showing That It Is a Fiduciary, Employer Is Immune from Breach of Fiduciary Liability Claim Under ERISA
"[T]he Fourth Circuit rejected fiduciary breach and equitable estoppel claims, determining that an employer's failure to alert an employee that he was no longer covered under a life insurance plan and the continued acceptance of premium payments constituted administrative, not fiduciary, functions[.]" [Moon v. BWX Technologies, Inc., No. 13-1888 (4th Cir. July 2, 2014)] (Wilson Elser)  

FASB Puts Stock-Based Compensation on Its Agenda
"[FASB] will address technical issues involving stock compensation such as accounting for income taxes on vesting or settlement of awards, and the related presentation of excess tax benefits on the statement of cash flows. The FASB's tentative positions, if finalized, could significantly ease some of the complex accounting requirements for companies that pay stock-based compensation ... A separate but related project that FASB added to its agenda will address potential improvements to accounting for share-based payments to non-employees operating as contractors." (Society for Human Resource Management [SHRM])  

M&A Snapshot: Retention Awards at Acquired Companies (PDF)
"[The authors] looked at U.S.-based public companies involved in 181 acquisitions with a transaction value greater than $1 billion between the beginning of 2010 and the end of March 2014.... [The] review identified 69 companies (39% of all acquired companies during this period) that offered some form of retention award to employees and/or executives prior to the close of the deal.... While primarily made in cash, award designs vary from broad-based programs to single awards made to one or more executives heavily involved in the transaction or key to the success of the business. Many companies used a maximum bonus pool from which to make grants, while other awards were determined on an individual basis." (Towers Watson)  

ISS's New Approach to Equity is Better and Worse
"[W]hat was once a beautifully simple and critically flawed up or down vote is now a beautifully complex and differently flawed scorecard ... Overall, the better aspect is that the approach is less didactic than it has recently been. This means a bit more wiggle room to shape your company's approach to suit your objectives. Frustratingly, the things that make this better also make it worse." (Performensation)  

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