Health & Welfare Plans Newsletter

November 26, 2014

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Employee Benefits Jobs

Compliance Analyst
The Newport Group
in FL, NC

Sr. Advisor, Retirement Plan Services
First National Bank
in NE

Vested Interest Relationship Manager
PNC
in OH

Loan and Distribution Associate
WLR & Associates, Inc.
in NC

Employer Compliance Analyst
Southern California Pipe Trades Administrative Corporation
in CA

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Webcasts and Conferences

SHOP Marketplace Series
December 2, 2014 WEBCAST
(Centers for Medicare & Medicaid Services [CMS])

Winter 2014 Seminar on Demand
December 9, 2014 in CA
(Western Pension & Benefits Council - San Diego Chapter)

SHOP Marketplace Series
December 9, 2014 WEBCAST
(Centers for Medicare & Medicaid Services [CMS])

View All Webcasts and Conferences



[Guidance Overview]

New ACA Guidance Permits Employer-Initiated Measurement Period Changes
"IRS Notice 2014-49 introduces a proposed method for applying the look-back measurement period in two scenarios. The first one involves a transfer of employment within the same applicable large employer (ALE) between two positions with different look-back measurement periods. In the second scenario, the employer changes the applicable look-back measurement period for an entire employee classification group. The final regulations previously released ... did not clarify how to apply the look-back measurement period methodology in either of these two cases." (Ogletree Deakins)  


[Advert.]

Forum on Rewarding Healthy Behaviors – Feb 4-5 2015 – Las Vegas

Sponsored by World Congress

Learn from Employee Health leaders how innovative workplace wellness strategies, preventive health management initiatives and evidence-based success impact workforce productivity, improve overall employee wellness and increase ROI.



CDHPs Enroll Nearly a Quarter of Covered Employees
"Enrollment in consumer-directed health plans (CDHPs) spiked from 18 percent to 23 percent of all covered employees in plan year 2014 ... Meanwhile, enrollment in health maintenance organizations (HMOs) fell to just 16 percent, the lowest level of enrollment seen since ... 1993. Enrollment in traditional plans -- including preferred-provider organizations (PPOs), point of service (POS) plans, and indemnity plans, combined -- fell from 64 percent to 61 percent." (Society for Human Resource Management [SHRM])  

Administration Warns Employers: Don't Dump Sick Workers From Plans
"As employers try to minimize expenses under the health law, the Obama administration has warned them against paying high-cost workers to leave the company medical plan and buy coverage elsewhere.... Because most large employers are self-insured, moving even one high-cost worker out of the company plan could save a company hundreds of thousands of dollars a year. That's far more than the $10,000 or so it might give an employee to pay for an exchange plan's premiums." (Kaiser Health News)  

Health Plans Excluding More Drugs as Costs Rise
"Express Scripts will exclude 66 brand-name drugs from its main formulary, or list of drugs that it covers, in 2015. This marks an increase from 48 in 2014. Likewise, CVS will exclude 95 drugs, up from about 70 in 2014. Benefits firms push back against high-priced drugs when less expensive clinical equivalents are available ... [In 2014, Express Scripts] decided to stop covering Advair, which can cost more than $370 per month, after determining that less expensive competing drugs treat asthma just as well. Advair maker GlaxoSmithKline offered a lower price, though, and now the drug is back on Express Scripts' main formulary in 2015." (FierceHealthPayer)  

Proposed ACA Changes Could Offer Navigators Unfair Advantage Over Brokers
"Key among the controversial proposals is the requirement that all exchanges, qualified health plan insurers, and Web-based brokers and agents provide telephonic interpreter services in at least 150 languages. That requirement does not extend to navigators and assisters, although HHS is asking for public comment on whether it should.... The proposed rule also clarifies that all non-navigator assisters are required to maintain a physical presence in their service areas, but can provide assistance by telephone, Internet, or by other remote means." (Insurance Broadcasting)  


[Advert.]

Discover the different types of health exchanges and how they work

Sponsored by Lorman and BenefitsLink

December 10 webinar. Exchanges are a primary mechanism to help individuals and employers make better healthcare decisions and control costs. Take a deep dive into the different types of exchanges, how they work and who can enroll. BenefitsLink discount.



NAIC Releases Draft Model Law Addressing Managed Care, Provider Network Adequacy
"The draft model law ... includes several new criteria to be examined in determining the sufficiency of a provider network, including geographic population dispersion and new health care delivery system options such as telehealth and telemedicine. Provider directories are also addressed ... with a new requirement that online provider directories be available and updated at least monthly. Print copies of provider directories must be available upon request, as well as accessible versions of the directories for individuals with disabilities or limited English language proficiency." (Epstein Becker Green)  

Insurers' Listings of In-Network Doctors Often Out of Date
"Many insurers are offering smaller networks of doctors in their Medicare Advantage and commercial health plans this year. But those networks may be even narrower than they seem, physicians and regulators say, because the lists often include names and addresses that are erroneous or out-of-date. In some cases, the doctors shown as participating in plans have moved, retired or died, surveys show. Others are listed under the wrong specialty, work in hospitals full-time and don't see outpatients, or don't accept the plan being offered." (The Wall Street Journal; subscription may be required)  

Standards for Health Insurance Provider Networks: Examples from the States
"This brief profiles laws, regulations, and guidance in place in states around the country. Rather than offering a 50-state survey of standards, the brief instead highlights good examples of network adequacy protections. These protections can serve as models for other states or for the federal government as they take steps to ensure that all health plan provider networks deliver meaningful access to care." (Families USA)  

Health Insurance Coverage and Health Care Access and Affordability in Massachusetts: Holding Steady in 2013
"The 2013 [Massachusetts Health Reform Survey] provides a new baseline for assessing the impacts of the state's efforts to improve the affordability of care and reduce health care spending because it coincides with the first full year under the provisions of Chapter 224 of 2012 and precedes the roll-out of major changes under the [ACA] that began in January 2014. Findings show that while Massachusetts has maintained high levels of health insurance coverage and health care use, the cost of care continues to remain a significant burden, especially for low- and middle-income individuals and families." (Urban Institute)  

[Opinion]

Health Spending: Temporary Downturn or New Normal?
"Purchasers (governments and employers) and their third-party payers have hit the limits of what they are willing and able to spend on health care.... [M]ost patients are not able to pay the substantial increases (50 to 100 percent) in their out-of-pocket costs under the [ACA's] mandated insurance plans.... Traditional providers no longer control the medical marketplace.... The new clinical paradigms -- precision medicine and disease management -- are already reducing the demand for inpatient-focused acute care." (Jeffrey C. Bauer, for HFMA)  

Benefits in General; Executive Compensation

[Guidance Overview]

FASB Drops Extraordinary Item Reporting: Section 162(m) Impact
"Some performance-based compensation awards that are exempt from the Section 162(m) $1 million deduction limitation are calculated by excluding items of gain, loss or expense that are within the FASB definition of 'extraordinary events.' ... In October, FASB agreed to drop the segregation, separate reporting and strict definition of extraordinary items. Accordingly, except as provided through the effective date provision, companies will no longer need to segregate on the income statement those items that are currently defined as extraordinary." (Thompson Hine)  

GOP Leaders Urge SEC to Ditch Pay-Ratio Rule
"[In a letter to SEC Chair Mary Jo White], House Financial Services Committee Chairman Jeb Hensarling, Texas Republican, joined by fellow Republicans Reps. Scott Garrett and Bill Huizenga, disputed that the 'absence of a median pay ratio disclosure was a proximate cause of the financial crisis' and warned that the proposed rule would be unduly costly and detract from more important SEC priorities." (CFO)  

Compliance and Communication Needed In Compensation Disclosure
"[In] 2015 29 percent of companies surveyed plan to add a description of their engagement actions, over 35 percent of companies surveyed plan to do a better job of explaining how they arrived at their pay decisions by including some kind of alternative to the summary compensation table and 38 percent of companies surveyed plan to add graphical descriptions to enhance the understanding of their disclosures." (Bloomberg BNA)  

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