Health & Welfare Plans Newsletter

May 28, 2015

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Employee Benefits Jobs

401(k)/Pension Administrator
Alliance Pension Consultants, LLC
in IL

Defined Benefit Administrator
Guardian Life
in MA

Investment Advisor - Retirement Plan Services
The PrivateBank
in IL

403(b) Plan Administrator
Carroll Consultants, Ltd.
in PA

Sr. Relationship Manager
John Hancock
in CA

Trust Accounting/5500 Specialist
Sentinel Benefits & Financial Group
in MA

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Webcasts and Conferences

Certificate in Global Benefits Management
June 8, 2015 in IL
(International Foundation of Employee Benefit Plans [IFEBP])

Accounting and Auditing Institute for Employee Benefit Plans
June 15, 2015 in CA
(International Foundation of Employee Benefit Plans [IFEBP])

Latest in Compensation and Benefits Accounting - Emerging Topics in Stock-based Compensation
June 18, 2015 WEBCAST
(PricewaterhouseCoopers LLP)

Form 5500 Update
June 24, 2015 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

Employer Shared Responsibility and Information Reporting
June 24, 2015 WEBCAST
(IRS [Internal Revenue Service])

What Plan Sponsors Should Think About Now
June 30, 2015 in GA
(JMM CPA)

Collaborative Care Summit/ACO West
August 20, 2015 in CA
(Opal Events)

View All Webcasts and Conferences



[Official Guidance]

Text of CCIIO Technical Guidance 2015-0001: Medical Loss Ratio (MLR) Reporting and Rebate Requirements (PDF)
3 pages. "The purpose of this bulletin is to provide guidance regarding: the limited circumstances in which a health insurance issuer may, for MLR reporting purposes, exclude agent and broker fees or commissions from earned premium ... and to whom a health insurance issuer must provide MLR rebates ... when a portion or all of the premium is paid with advance payments of the premium tax credit." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


[Advert.]

Private & Public Exchange Summit, July 15-16

Sponsored by World Congress

Join Payer and Exchange executives in July for the 6th Annual Private and Public Exchange Summit. The Summit will explore approaches for health plans and exchanges to improve market share, encourage engagement, and reduce the cost trend.



[Guidance Overview]

Potential Employer Penalties Under the ACA (PDF)
"Historically enforcement of the filing requirement and collection of the excise tax has been light, but the IRS is now indicating that it expects employers to report failures and pay fines as applicable.... It is not entirely clear from the IRS instructions whether the form must be filed even if no tax is due because the failure was due to reasonable cause and corrected promptly. It is also unclear how to determine if a failure is due to reasonable cause.... The penalty for filing Form 8928 late is 5% of the unpaid excise tax for each month the form is late, up to a maximum of 25%. A separate penalty calculation applies for late payment of the excise tax." (Cowden Associates, Inc.)  

[Guidance Overview]

Confusion at the Intersection of Employers, Union-Affiliated Coverage and ACA Tax Reporting
"[T]he employer does not report on the fund's coverage actually supplied to its bargaining unit employees. But the employer does need to prove its compliance with the ACA's employer mandate with respect to its full-time bargaining unit employees. Happily, in most cases the employer will be able to take credit for the Taft-Hartley fund's offer of coverage, as long as the employer is making contributions to the fund on behalf of the employee, and the fund offers at least minimum value coverage to the employee and at least minimum essential coverage (MEC) to the employee's children." (Lockton)  

[Guidance Overview]

Compliance Issues for Wellness Plans (PDF)
8 pages. "This [article] covers ... [1] State of the nation for employer-sponsored wellness plans; [2] Health Insurance Portability and Accountability Act's (HIPAA's) non-discrimination rules; [3] Americans with Disabilities Act (ADA); [4] Genetic Information Non-Discrimination Act (GINA); and [5] State law concerns." (Marsh & McLennan Agency LLC)  

[Guidance Overview]

FAQs 'Clarifying' Preventive Care Services in Fact Break Some New Ground (PDF)
"The new FAQs create some confusion about whether, and in what circumstances, group health plans and health insurance issuers may continue to use their definition of medical necessity. Historically, group health plans and health insurance issuers, and not attending providers, have defined medical necessity. The new FAQs can arguably be seen as part of a recent trend in the Departments' guidance to defer to providers, rather than to plans and issuers, in determining medical necessity." (Groom Law Group)  


[Advert.]

Are you prepared for an audit?

Sponsored by ERISA Diagnostics

DOL audits are on the rise -- no business is immune. Are your plan documents up to date? Have you filed your Form 5500? Plan compliance is all about the process of managing risk, and it begins by asking a few questions. Let's start the conversation.



[Guidance Overview]

Clarifying Misunderstood Terms: Seasonal Workers and Seasonal Employees
"A seasonal worker is an employee who performs labor or services on a seasonal basis.... A seasonal employee is ... 'an employee who is hired into a position for which the customary annual employment is six months or less.' ... The seasonal employee is unique compared to part-time, variable hour, and full-time employees ... because it does not factor in an employee's hours of service.... [S]easonal workers are only relevant for determining if an employer is an [Applicable Large Employer (ALE)]. Seasonal employees are only relevant when determining if a new employee can be placed into an initial measurement period." (Health Care Attorneys P.C.)  

[Guidance Overview]

CMS Webinar: ACA Financial Appeals, May 27 and 29, 2015 (PDF)
30 presentation slides. "Purpose: To describe the administrative appeals procedures set forth in 45 CFR 156.1220 related to the Risk Adjustment (RA) and Reinsurance (RI) programs." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

CMS Webinar: Resolving Common Reinsurance Discrepancies, May 26, 2015 (PDF)
25 presentation slides. "[T]his training will help issuers answer the following questions and concerns when investigating [reinsurance (RI)] discrepancies: [1] Sometimes, the RIDE report's individual claim amount doesn't match my values; [2] How to identify which claims were included for RI; [3] Why was a claim excluded from RI? [4] Why is a claim orphaned?" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

CMS Webinar: FF-SHOP Logo Submission and Enrollment Data Reconciliation, May 26, 2015 (PDF)
77 presentation slides. Topics include: [1] Individual market testing for 820 transactions; [2] Submission specifications; [3] Enrollment data reconciliation concepts; [4] High-level reconciliation approach; [5] MFT requirements; [6] Key data elements; [7] Inbound file requirements -- structure, validation and content; [8] Outbound file -- structure, record level dispositions, and field level dispositions; [9] Follow up & dispute resolution; and [10] Example scenarios. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

Characteristics of the Population With Consumer-Driven and High-Deductible Health Plans, 2005-2014
"CDHP enrollees were less likely than those with traditional coverage to be between the ages of 21 and 34 in 2014, and more likely to be ages 45-54. CDHP enrollees were more likely than traditional-plan enrollees to be in households with $150,000 or more in income in every year except 2006, 2009 and 2010. They were also more likely to be in households with $100,000-$149,999 in income in most years. They were roughly twice as likely as individuals with traditional coverage to have college or postgraduate educations in nearly all years of the survey." (Employee Benefit Research Institute [EBRI])  

A Farewell to Yard-Man
"First, the Court restated some of the more employer-friendly language from its previous case.... Next, the Court set out a series of principles of contract interpretation that should be applied to plan interpretation, all of which generally tend to weigh against a finding of lifetime 'vesting' of retiree health benefits... Employers also will be heartened by the Court's rejection of the Sixth Circuit's holding that retiree health benefits are a form of deferred compensation." [M&G Polymers USA, LLC v. Tackett, No. 13-1010 (U.S. Jan. 26, 2015)] (Jenner & Block, in Employee Relations Law Journal)  

Out-of-Network, Out of Luck? Growing Body of Case Law Says 'No'
"While ERISA preemption in some cases may allow insurers to delay reimbursement, it is not an impediment to a provider's ability to obtain full and fair reimbursement ... [E]ven the presence of an anti-assignment clause is not, in and of itself, dispositive of the standing issue.... [C]ourts have recognized a number of exceptions to the exhaustion requirement[.]" (K&L Gates, LLP)  

Antitrust Lawsuits Target Blue Cross and Blue Shield
"Blue Cross and Blue Shield health insurers cover about a third of Americans, through a national network that dates back decades. Now, antitrust lawsuits advancing in a federal court in Alabama allege that the 37 independently owned companies are functioning as an illegal cartel.... The suits, which name all of the Blue Cross and Blue Shield companies as defendants as well as the Blue Cross Blue Shield Association, have already survived the insurers' first major legal challenge." (The Wall Street Journal; subscription may be required)  

Implications of Proposed Changes to the ACA in Response to King v. Burwell (PDF)
5 pages. "A temporary extension of premium subsidies would only delay the market disruption. Eliminating the individual mandate could threaten the viability of the health insurance market. Depending on the extent of other ACA changes, allowing for insurance to be sold across state lines could result in adverse selection, but also could increase competition. Allowing for association health plans (AHPs) also could raise adverse selection concerns." (American Academy of Actuaries)  

Congress Could Revive Health Coverage Tax Credit
"Last week as part of a broader trade bill, H.R. 1314, the Senate agreed to renew the Health Coverage Tax Credit [HCTC] through the end of 2019.... Until its expiration [at the end of 2013], the HCTC paid 72.5% of health care premiums for eligible beneficiaries: individuals who lost their jobs due to foreign competition, and retirees age 55 through 64 whose pension plans were taken over by the [PBGC].... The House of Representatives is expected next week to begin consideration of the trade bill to which the renewal of the HCTC is attached." (Business Insurance; free registration required)  

Early Marketplace Enrollees Were Older and Used More Medication Than Later Enrollees
"Medication use may provide an early indicator of the health needs and access to care among Marketplace enrollees.... Among Marketplace enrollees ... those who enrolled earlier (October 2013-February 2014) were older and used more medication than later enrollees. Marketplace enrollees, as a whole, had lower average drug spending and were less likely to use most medication classes than the employer-sponsored comparison group. However, Marketplace enrollees were more likely to use medicines for hepatitis C and particularly for HIV." (Health Affairs)  

West Coast Port Contract with Union Has Employers Covering 'Cadillac Tax'
"Under the [five-year] contract, the Pacific Maritime Association, a group of port terminal operators and shipping companies, will provide full health care benefits for members of the International Longshore & Warehouse Union, their dependents and retirees including full coverage with no premiums, no in-network deductibles or co-pays, $1 prescriptions and 100% coverage of hospital care." (The Wall Street Journal; subscription may be required)  

[Opinion]

Preventive Care Does Not Want to Be 'Free'
"Women are clearly not responding solely to financial incentives for screening. Under Obamacare's Essential Health Benefits, osteoporosis screening is only indicated as 'free' preventive care for women over 60 with certain risk factors. For women on Medicare (that is, most women 65 and older), screening is 'free'. And yet, the actual incidence is upside down." (National Center for Policy Analysis Health Policy Blog)  

Benefits in General; Executive Compensation

Ethical Considerations for Employee Benefits Attorneys (PDF)
146-page text outline of presentation to the Employee Benefits Institute Workshop, University of Missouri-Kansas City School of Law. Topics include: [1] Who is the client? [2] Representing entities; [3] Representing multiple parties; [4] Attorney-client privilege; [5] Work product doctrine; [6] Handling settlement proceeds subject to subrogation claim; [7] Plan participants' ability to sue law firm for legal malpractice; [8] Law firm as fiduciary of client's plan; [9] Multijurisdictional Practice; and [10] Circular 230 Revisions. (Utz & Lattan, LLC)  

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