Health & Group Sales Manager
Milliman
in TX

Non-Qualified Retirement Plan Administrator
The Hebets Company
in AZ

Sr. Plan Administrator/Consultant
RetirementPlans.com, LLC
in TX

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Employee Benefits Breakfast Briefing
November 4, 2015 in NY
(Nixon Peabody LLP)

Effects of Class Action Litigation on Retirement Plan Fiduciaries
November 9, 2015 in NY
(Jackson Lewis LLP)

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[Official Guidance]

Text of IRS Notice 2015-60: Insured and Self-Insured Health Plans -- Adjusted Applicable Dollar Amount for Fee Imposed by Sections 4375 and 4376 (PCORI Fee) (PDF)
"The applicable dollar amount that must be used to calculate the fee imposed by Sections 4375 and 4376 for policy years and plan years that end on or after October 1, 2015, and before October 1, 2016, is $2.17. The increase from the prior amount is calculated by multiplying the adjusted applicable dollar amount for policy years and plan years ending in the previous Federal fiscal year, $2.08, by the percentage increase of the 3 projected per capita amount of National Health Expenditures published by HHS on July 22, 2015." (Internal Revenue Service [IRS])  

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[Official Guidance]

Text of CMS Announcement: Early Reinsurance Payments for the 2015 Benefit Year (PDF)
"[CMS] will make an early payment under the transitional reinsurance program for the 2015 benefit year to issuers of reinsurance-eligible plans. We anticipate making this early payment in March, 2016. Reinsurance funds not paid out through this early payment will be paid out in late 2016 ... CMS will make the early payment at a coinsurance rate of 25 percent. For the 2015 benefit year, the reinsurance attachment point is $45,000, and the reinsurance cap is $250,000.... We expect to announce the final 2015 coinsurance rate in June 2016." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Official Guidance]

Text of IRS Pub. 5165: Guide for Electronically Filing ACA Information Returns for Software Developers and Transmitters for Processing Year 2016 (PDF)
47 pages. 'Early Look' Version 1.0, dated October 2015. "[This publication] outlines the communication procedures, transmission formats, business rules and validation procedures for returns transmitted electronically through the AIR system. To develop software for use with the AIR system, Software Developers, Transmitters, and Issuers should use the guidelines provided in this publication along with the Extensible Markup Language (XML) Schemas published on IRS.gov." (Internal Revenue Service [IRS])  

[Guidance Overview]

ACA Reporting by Governmental Health Plans
"For purposes of Section 6055 reporting, a government employer that maintains a self-insured group health plan may enter into a written agreement with a related governmental unit, agency, or instrumentality that participates in the plan through which the other governmental unit, agency, or instrumentality is designated as responsible for the reporting. For purposes of Section 6056 ALE reporting, an ALE that is a governmental unit (or any agency or instrumentality thereof) may delegate its 6056 ALE reporting to a related governmental unit -- such as the government unit that maintains the plan -- by obtaining a written designation by January 31, 2016 that contains specific language and information, and is signed by both parties.... What does this mean for a large governmental plan that covers both employees of related agencies and also those of unrelated political subdivisions and instrumentalities? Confusion." (Morgan Lewis)  

District Court Awards Nearly $75,000 in Penalties for Failure to Timely Furnish Requested Plan Documents
"Distinguishing cases where a single document functions both as the ERISA plan and the SPD, the court explained that the relevant inquiry is whether the plan document is also a controlling document. Even if (as asserted by the plan administrator) the plan document did not specifically address the life insurance benefit or conflict with the policy or SPD, the fact that other documents stated that the plan document controlled any conflicts made it necessary for the beneficiary to read the plan document to determine her rights. The court also emphasized that the imposition of penalties does not depend on bad faith or prejudice[.]" [Harris-Frye v. United of Omaha Life Ins. Co., No. 1:14-cv-72 (E.D. Tenn. Sept. 21, 2015)] (Thomson Reuters / EBIA)  

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Amicus Brief of National Coordinating Committee for Multiemployer Plans to Supreme Court on Tracing Requirement for ERISA Benefit Overpayments (PDF)
"If adopted by this Court, Montanile's position would make an ERISA plan's reimbursement and subrogation provision unenforceable -- effectively nullifying the provision -- whenever a beneficiary dissipates the money he or she recovers from a tortfeasor, or would otherwise place significant administrative burdens on an ERISA plan whenever it seeks to enforce an equitable lien." (National Coordinating Committee for Multiemployer Plans [NCCMP])  

DOL and New York Attorney General Team Up on Health Plan Oversight
"The agreement will allow the attorney general and EBSA to collaborate on enforcement efforts involving New York insurance companies violating state and federal law. They will share information, work cooperatively, cross-refer cases and conduct joint investigations in an effort to protect the rights of participants in employee health plans, whether they are members of plans offered by insurance companies or self-insured plans created by private employers for employees." (Blitman & King LLP)  

Huge Price Differences for Health Procedures in the 30 Largest U.S. Cities
"In New York City, there was an astounding 76x difference between what consumers paid to have the same lipid panel (cholesterol test) done, ranging from $14 to $1,070. That was the highest national range among the eight procedures.... In Washington, D.C., the price for a head/brain CT scan ranged from $78 to $1,673, a 21x difference. However, with an average price of $592, the D.C. area was the least expensive for the procedure.... In New York City, the price of a lower-back MRI ranged from $334 to $3,939, nearly a 12x disparity.... In Chicago, the price to get a routine exam at a primary care physician was the widest of any city, ranging from $50 to $423, an 8x difference." (Castlight Health)  

What's Driving Healthcare Spending? It's the Drugs
"Overall, health spending was up 5.7% in August 2015 from August 2014. While spending increased across all major categories, the biggest increase was in spending on prescription drugs, which rose 9.2% in the same year.... Prescription drug costs also showed the highest growth over the previous 12 month period at 12.7%. Home health care rose the least at 1.2%." (American Journal of Managed Care)  

Drugs Could Soon Come with a Money-Back Guarantee
"The government and private insurers have been trying for years to move away from the fee-for-service system that pays doctors and hospitals based on the volume of tests they perform and treatments they prescribe. They want to replace it with contracts that reward quality and better outcomes.... The changes in the reimbursement model are rippling out to manufacturers of drugs and devices. The shift could help address a long-standing problem with medical advances: The benefits observed in carefully designed clinical trials don't always materialize when a treatment is deployed in the real world." (Bloomberg)  

Cadillac Tax Necessary, White House Economic Chief Says
"[Jason Furman, chairman of the White House Council of Economic Advisers,] disputed claims that as employers find ways to reduce the cost of their plans, employees will be faced with higher cost sharing. 'Instead, I think a lot of what the high-cost excise tax is going to do is drive the types of alternative payment models' that Medicare is pushing, and it will give employers more incentive 'to exercise their market power to slow the actual cost growth of health care,' he said." (Bloomberg BNA)  

ACA Excise Tax: Cutting Family Budgets, not Healthcare Budgets (PDF)
13 pages. "Almost 90 percent of large employers are taking steps to try to prevent their company from having a plan that triggers the excise tax in 2018 ... Almost 19 percent of large employers were already curtailing or eliminating employee contributions to flexible spending accounts (FSAs) in order to avoid triggering the excise tax ... Among employers who are going to reduce the values of their plans as a result of the excise tax, 71 percent of employers said that they probably would not provide a corresponding wage increase; 16 percent said they would." (American Health Policy Institute [AHPI])  

A 2015 Healthiest Employer Shares Insight on Starting and Improving a Wellness Program
"How you keep people from falling off the wellness wagon: We have committed volunteers on our wellness committees to help spread the word.... Advice you wish you'd gotten before you started your wellness program: Pick your wellness vendor very carefully.... Hardest part about starting a wellness program: Getting the financial resources, buy-in and support from leadership. We have faced a lot of employee concerns about privacy. When you first start it's a big issue. Especially with biometric screening." (Orlando Business Journal)  

Blue Shield of California's Deal with Regulators on $1.2-Billion Acquisition Draws Fire
"Beleaguered insurer Blue Shield of California won state approval for its $1.2-billion acquisition of a Medicaid health plan ... Ending a high-stakes and lengthy battle, the company agreed to permanently relinquish its longtime state tax exemption. The San Francisco insurer also pledged to spend $200 million over the next decade on several initiatives aimed at providing better patient care. And Blue Shield agreed to improve its poor health plan ratings over time and fix inaccuracies in its provider directories." (Los Angeles Times)  

Termination of a Nonqualified Retirement Plan with a Traditional Defined Benefit Formula
"The most interesting aspect of this case is how willing the court was to read a broad grant of authority into a very simple and concise reservation of an employer's right to terminate a nonqualified retirement plan. The court was willing to infer that the power to terminate necessarily includes the power to commute annuity payments to lump sums and to discount the value of those annuity payments using appropriate actuarial assumptions, including discount rates." [Taylor v. NCR Corp., No. 1:14-cv-2217-WSD (N.D. Ga. Sept. 23, 2015)] (Benefits Bryan Cave)  

DOL Obtains Consent Judgment Restoring More Than $40K in Contributions to 401(k) Plan of Dental Practice in Douglassville, Pennsylvania
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Morningstar to Acquire Portfolio Rebalancing Firm Total Rebalance Expert
Morningstar, Inc.

2016 Supplement to the Governmental Plans Answer Book Published
Calhoun Law Group, P.C.

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