Health & Welfare Plans Newsletter

January 5, 2017

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Health Care Reform
RECORDED
Thomson Reuters / EBIA

Employee Benefits and Medicare Coordination Issues
January 19, 2017 WEBCAST
Frenkel Benefits, LLC

Proposed Form 5500 Overhaul in the Trump Administration: An Insight into the Minds of the Regulators
February 1, 2017 WEBCAST
Practising Law Institute

National Health Policy Conference
March 8, 2017 in DC
America's Health Insurance Plans [AHIP]

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Health and Welfare Plans: Your First To-Do List for 2017
"[1] Privacy notice for wellness program.... [2] 1095-C forms due to employees by March 2, 2017.... [3] New disability claims procedures.... [4] HIPAA special enrollment rights.... [5] Coverage for preventive services.... [6] Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs)."
Warner Norcross & Judd LLP

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Answers to Some Questions about QSEHRAs
"Which employers can offer QSEHRAs? ... What benefits does a QSEHRA cover? ... What are the health plan requirements for employees? ... Can employees be excluded? ... Is a QSEHRA subject to COBRA or ERISA rules? ... Are there administrative requirements for QSEHRA?"
DataPath

2016 Best Practices in Sponsorship of Healthcare Plans
"[E]mployers' confidence that they will offer benefits 10 years from now rose to 54% in 2016 from 44% last year, more than double the lowest confidence levels in 2012 (23%).... [E]mployers continue to focus on controlling costs and adopting solutions to improve the effectiveness of their health care programs.... creating and leveraging best practices, especially superior network and provider contracting strategies, to control costs and improve workforce health.... [This downloadable 36-page report identifies] specific tactics that best-performing companies are doing[.]"
Willis Towers Watson

Health Insurance Coverage for Americans with Pre-Existing Conditions: The Impact of the ACA
"This analysis also offers a first look at how health insurance coverage for people with pre-existing conditions actually changed when the ACA's major insurance market reforms took effect in 2014. It finds that, between 2010 and 2014, the share of Americans with pre-existing conditions who went without health insurance all year fell by 22 percent, a drop of 3.6 million people. The ACA's individual market reforms appear to have played a key role in these gains."
Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]

Can a Continuous Coverage Requirement Produce a Healthy Insurance Market?
"[S]everal Republican proposals preserve the ACA's protections for people with pre-existing conditions -- but only for policyholders who maintain continuous coverage.... Compared to the limited penalties imposed by the individual mandate, the financial penalties and loss of consumer protections for pre-existing conditions may provide a much stronger incentive to purchase insurance."
RAND Corporation

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Now is the time to become a member of ECFC

Sponsored by ECFC [Employers Council on Flexible Compensation]

ECFC is dedicated to maintaining and expanding employee benefit programs on a tax-advantaged basis. Members include employers, TPAs, health plan providers, brokers, payers, providers, payment networks, processors, and financial institutions.


Judge Certifies Insurer's Risk Corridor Case as a Class Action
"The class ... would include all insurers who would have qualified for risk corridor payments under the ACA and implementing rules had Congress not limited risk corridor payments for 2014 and 2015 to funds collected from insurers by using appropriations riders. Under Court of Claims procedures, all members of the class must be notified and decide whether or not to opt in to the class."
Health Affairs

[Opinion]

Building a Better 'Cadillac'
"[T]his paper addresses and proposes improvements for [several] criticisms leveled against the Cadillac tax: ... [Make] adjustments based on employer size, geographic differences, and health status variability across employers.... [R]eplace the current indexing plan with an index based on GDP either before the Cadillac tax is implemented or after a limited number of years.... [Use] some of the revenue raised by the Cadillac tax ... to help cover out-of-pocket medical expenses for those with low or middle incomes.... [An] exclusion cap is somewhat preferable to the Cadillac tax (or any other excise tax on high-cost plans).
Urban Institute

[Opinion]

Fully Repealing Obamacare Will Cost $350 Billion
"Obamacare ... affects the federal budget in three ways: coverage provisions, taxes and fees, and Medicare components.... Getting rid of all three would blow a hole in the budget even before Republicans come up with a replacement plan, which will also need to be funded."
CNNMoney.com

Benefits in General

[Guidance Overview]

DOL Issues Final Regs on Handling Disability-Related Claims
"[T]he Final Rule states that administrators of disability plans: (i) must provide more detail in adverse benefit decision letters (for both initial claim letters and appeal denial letters); (ii) adopt certain additional criteria to ensure independence and impartiality in the decision-making process; (iii) treat most rescissions as adverse benefit determinations; (iv) allow claimants to go directly to court if the claims procedures of the plan does not strictly comply with the requirements of the Final Rule; and (v) make disability claims subject to the same 'culturally and linguistically appropriate' rules as group health plan claims."
Benesch Friedlander Coplan & Aronoff LLP

[Guidance Overview]

Disability Claims Procedure Rules Changed to Require Plan Updates
"ERISA plan sponsors will need to review claim procedure language to determine whether updates are required. Such language may be present in the plan document, summary plan descriptions, or as standalone documents.... Minor regulatory changes ... apply to disability claims filed during a transition period beginning after the January 18, 2017 effective date and extending through December 31, 2017.... The remaining changes implemented under the regulation apply beginning January 1, 2018."
Michael Best & Friedrich LLP

[Guidance Overview]

New Disability Claim Procedures Require Strict Compliance
"If a plan violates any of the rules for disability claims, the claim is deemed denied without the exercise of discretionary authority. This gives the claimant the right to file a lawsuit without further delay and will allow a court to decide the merits of the claim de novo, without any deference to the fiduciary who violated the rules.... A copy of any internal rules and guidelines the plan relied upon must now be affirmatively provided without request to the claimant (or otherwise a statement that such materials do not exist)."
Greensfelder

[Guidance Overview]

IRS Issues Guidance on Safe Harbor Provision for De Minimis Reporting Errors
"Notice 2017-9 contains the requirements for a payee statement or information return recipient to make an election to not have the safe harbor exemption apply. An election to not apply the safe harbor makes the payer subject to penalties, even if the error is de minimis. The safe harbor exemption applies to certain information returns filed with the IRS and payee statements furnished to taxpayers, including Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit Sharing Plans, IRAs, Insurance Contracts, etc., Form 5498, IRA Contribution Information, and Form W-2, Wage and Tax Statement."
Ascensus

Executive Compensation and Nonqualified Plans

Portland to Impose Surtax on High CEO Pay Ratios
"On December 7, Portland, Oregon approved a surtax on public companies reporting that they pay the CEO at least 100 times that of the median worker, becoming the first jurisdiction in the nation to impose a tax based on CEO pay ratios.... The incoming Trump administration or the new Congress may look to undo some or all of Dodd-Frank. If they were to eliminate the CEO pay ratio reporting requirement, Portland would not have the compensation data available to implement its surtax."
Conduent

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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