Health & Welfare Plans Newsletter

October 9, 2015

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[Guidance Overview]

California Scheduled to Expand Small Group Definition Despite PACE Act
"Although the PACE Act repeals the federally-mandated expansion of the 'small employer' definition, it leaves states the discretion to expand the definition on their own schedule.... California already enacted legislation in 2012, A.B. 1083, that expands the definition of small employer to employers with 1 to 100 employees, effective for plan or policy years beginning on or after January 1, 2016. And in S.B. 125, earlier this year, California also adopted the use of the ACA's full-time and full-time equivalent method of counting employees towards the small employer threshold." (E is for ERISA)  


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[Guidance Overview]

Another Change to ACA: States Can Decide on Small Group Expansion
"California, Colorado, Maryland, New York, Virginia, Vermont and the District of Columbia have enacted laws or issued regulatory guidance changing their small group definition to the 1-100 employee definition in 2016. Most states will be reverting back to 50 lives for community rating, however, these states will need to enact legislation prior to considering a change." (Frenkel Benefits)  

[Guidance Overview]

ACA Reporting Requirements for Multiemployer Plans
"The 2014 version of the Instructions for Forms 1094-C and 1095-C required ALEs that contribute to a multiemployer plan on behalf of full-time employees to obtain information from the multiemployer plan about covered employees. In addition to creating a myriad of logistical problems for contributing employers, this created compliance concerns regarding the HIPAA privacy rules. As a solution, the IRS's 2015 draft Instructions directed contributing employers to use Code 1H (no offer of coverage) on Form 1095-C, Line 14 for any month in which the employer claimed the multiemployer plan transition relief made available in the preamble to the final Code Section 4980H regulations." (The Wagner Law Group)  

[Guidance Overview]

From EBSA: An Employee's Guide to Health Benefits Under COBRA
"This [web page] explains your rights under COBRA to a temporary extension of employer-provided group health coverage, called COBRA continuation coverage. This [page] will: [1] Provide a general explanation of your COBRA rights and responsibilities; [2] Outline the COBRA rules that group health plans must follow; [3] Highlight your rights to benefits while you are receiving COBRA continuation coverage." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

[Guidance Overview]

The FMLA Marriage Penalty: When Spouses Work for the Same Employer
"Plenty of employers understand that the spouses split 12 weeks of FMLA for bonding time, but plenty more employers forget that the FMLA sharing also occurs when one or both of the spouses care for a parent.... Notably, the DOL has acknowledged that this provision does not apply to unmarried couples." (FMLA Insights)  


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HHS Finds Substantial Improvements to Mental Health and Substance Use Disorder Coverage in Response to the Mental Health Parity and Addiction Equity Act of 2008 (PDF)
"A recent study commissioned by the Office of the Assistant Secretary for Planning and Evaluation has found that large employer-based plans made substantial changes to their benefit designs in response to enactment of the Wellstone-Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and issuance of the interim final rule (IFR) . Most plans removed most financial requirements that did not meet the requirements of the federal parity statute and its implementing the IFR.... However, there is room for improvement. A minority of large employer-based plans -- one in five -- still required higher copays for in-network outpatient MH/SUD services than for comparable medical/surgical benefits in 2011." [Detailed study results and additional information are available online.] (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])  

D.C. Introduces Nation's Most Generous Paid Leave Law
"As currently envisioned, the bill creates a system comparable to unemployment compensation in which D.C. employers would pay a percentage of employees' annual pay into a D.C.-administered fund. The fund then administers and pays out benefits for eligible paid leave claims that are submitted to it.... Because the benefits fund does not yet exist, claims for benefits would not be administered until one year after the law becomes effective or until D.C.'s chief financial officer certifies that the fund can begin paying out claims while remaining solvent." (Vorys, Sater, Seymour and Pease LLP)  

Why 16-Week Paid Parental Leave Policies Are Revolutionary for U.S. Workers
"[E]ven with paid leave, there are still barriers to parents' taking more leave. Some employers might frown on parents taking as long as four months off, and employees might reasonably worry about the impact on their careers. So perhaps fathers might take just a week or two more than they do now, not the full 16 weeks. But even such a small increase would have an important impact." (The Washington Post; subscription may be required)  

Risk Assessment for Taft-Hartley Health and Welfare Plan Claim Payments
"In considering the completeness and accuracy of the benefit payment expense in Taft-Hartley health and welfare plan financial statements, an auditor must consider what can go wrong.... Testing benefit payments can be challenging due to the highly specialized nature of the adjudication process." (Belfint Lyons & Shuman, CPAs)  

Protecting Your Information at HealthCare.gov
"Today, we launched a simple way to give you more control over the information you choose to share with us -- a new privacy manager. We're also supporting the Do Not Track browser setting for our digital advertising.... [The privacy manager] makes it easy for you to opt-in or out of the different types of third-party tools used by HealthCare.gov -- Advertising, Analytics, or Social Media. If you choose to opt-out, you'll still have access to everything on the site, but we won't use information from your visit to analyze the site's technical performance or use digital advertising to remind you about helpful information like deadlines." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Opinion]

The New Congressional Effort to Undermine the ACA
"The key elements in the [reconciliation package], developed by three House Committees (Ways and Means, Energy and Commerce, Education and the Workforce) include: ... [1] Eliminating the ACA requirement that large employers must auto-enroll their workers into company health insurance plans, now scheduled to take effect in 2017; [2] Repealing the ACA's health insurance mandates on individuals and employers; [and] [3] Repealing the ACA's tax on high-cost health insurance plans called the 'Cadillac Tax'[.]" (Health Affairs)  

Benefits in General; Executive Compensation

[Guidance Overview]

SEC Adopts CEO Pay Ratio Disclosure Rules
Topics include: [1] Where and how to make pay ratio disclosures; [2] Identifying the median employee; [3] How often must companies identify the median employee? [4] Limited exceptions for non-U.S. employees; [5] Calculating annual total compensation; [6] Must disclose methodology, assumptions and estimates; and [7] Exempt companies and transition periods. (Perkins Coie LLP)  

Vast Majority of Companies Provide Enhanced Severance Benefits Below the NEO Level in a Change in Control
"The survey responses suggest that enhancing severance for terminations in conjunction with a CIC is widespread. The vast majority (93%) of respondents indicated they do so for some portion of employees below the NEO level, with two-thirds (67%) of those companies offering enhanced cash compensation (salary and/or bonus) and accelerated vesting of equity and about a quarter (26%) offering only accelerated vesting of equity." (Towers Watson)  

Press Releases

NAGDCA Elects 2015 – 2016 Executive Board
National Association of Government Defined Contribution Administrators

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