Health & Welfare Plans Newsletter

January 10, 2017

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Employee Benefits Jobs

Retirement Plan Field Associate
Cultural Institutions Retirement System
in NY

Business Development Officer II - Institutional Asset Management
PNC
in GA, IL, MO

Executive Director / Secretary
MBTA Police Association Retirement Plan
in MA

Retirement Plan Compliance Analyst QKA
Newport Group
Telecommute

ERISA Attorney
Pentegra Retirement Services
in NC, NY, OH

Retirement Planning Consultant - Saginaw, MI
Transamerica
in MI

AVP Sales Desk - Outbound Life
Transamerica
in CO

AVP Sales Desk - Inbound Life
Transamerica
in CO

Bi-lingual Education Consultant
Milliman
in TX

Client Service Associate
Milliman
in TX

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Webcasts and Conferences

HIPAA Privacy and Security
RECORDED
Thomson Reuters / EBIA

Voluntary Fiduciary Correction Program
January 11, 2017 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Getting It Right - Know Your Fiduciary Responsibilities
February 15, 2017 in AZ
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Anatomy of a Benefit Appeal--A Discussion and Primer on the Best Practices for Handline Benefit Appeals
February 23, 2017 WEBCAST
International Foundation of Employee Benefit Plans [IFEBP]

Certificate Series Orlando
February 27, 2017 in FL
International Foundation of Employee Benefit Plans [IFEBP]

EBIA Employee Benefits Seminar
May 9, 2017 in MA
Thomson Reuters / EBIA

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[Guidance Overview]

DOL Finalizes Disability Benefit Plan Claims Regs
"The finalized regulations require: Independence and impartiality in decision-making ... Improved disclosure ... Rights to review and respond to new information or new rationale before final decision ... Disclosure of any contractual limitations period in denial notices ... Deemed exhaustion of claims and appeals processes ... Retroactive rescissions of coverage are appealable ... 'Culturally and linguistically appropriate' notices."
Trucker Huss

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[Guidance Overview]

Who is a HIPAA 'Business Associate'?
"The extension of business associate status to subcontractors can ensnare unsuspecting individuals and organizations because prior to the Omnibus Rule subcontractors were untouched by the HIPAA Rules. Many could still be unaware that they are performing functions for covered entities or dealing with PHI.... OCR has specifically reminded covered entities and business associates that using a cloud service provider to maintain ePHI without entering into a business associate agreement violates the HIPAA Rules. In addition, risk analysis and risk management need to account for ePHI stored in the cloud, whether on servers within the U.S. or overseas."
McDonald Hopkins

[Guidance Overview]

Paid Sick Leave Obligations May Apply to 2017 Federal Contracts
"Covered employees are entitled to accrue 1 hour of paid sick leave for every 30 hours worked on or in connection with a covered contract -- up to 56 hours in a year or at any point in time.... [C]ontractors can provide a covered employee with at least 56 hours of paid sick leave at the beginning of each accrual year rather than having the employee accrue leave based on hours worked. Employers are permitted to integrate the paid sick leave requirements with existing paid time off plans."
Morgan Lewis

Seventh Circuit Lists Ways to Inoculate Claims Denials from Allegations That a 'Conflict of Interest' Affected Your Decision
"[A] record showing that the claims administrator changed its decision over time can help disprove allegations that a 'conflict of interest' played a role in the claims decision. [A] recent case ... explains four ways to inoculate claims from allegations that a conflict of interest affected the claims decision." [Geiger v. Aetna Life Ins. Co., No. 16-2790 (7th Cir. January 6, 2017)]
Lane Powell PC

Court Enjoins Part of Final ACA Nondiscrimination Rule (PDF)
"The injunction would prohibit OCR from enforcing, for example, the transgender services requirements in the regulation, but would not prevent an individual from bringing a private lawsuit to enforce those requirements. As such, at least for the time being, issuers and plan sponsors should exercise caution in changing plan designs based on the decision." [Franciscan Alliance v. Burwell, No. 16-108 (N.D. Tex. Dec. 31, 2016)]
Groom Law Group

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The Scoop on Wellness Regulations: Vendor Edition
"[E]mployers must obtain 'prior, knowing, voluntary, written authorization' from spouses of employees if your wellness program asks the spouse about current or past 'manifestations of disease and disorder.' ... What does 'prior, knowing, voluntary, written authorization' actually mean? The guidance is a bit unclear, but employers should be careful to make sure that any wellness vendors you work with have an eye on these regulations as well."
Frenkel Benefits

More Employers Adopt 'Narrow Networks' of Health Care Providers
"Despite employers' slow adoption of narrow networks, more are considering limiting their plans' in-network health providers and selecting those that make the cut based on whether they offer pricing discounts for their services ... So-called high-performance networks limit providers to those that have high-quality ratings for their services, although the two approaches to selecting covered providers -- price and quality -- are not mutually exclusive."
Society for Human Resource Management [SHRM]

Specialty Pharmacies Say Benefit Managers Are Squeezing Them Out
"Three companies -- Express Scripts, CVS and Optum, owned by UnitedHealth -- now handle 75 percent of all prescription claims ... [I]ndependent pharmacies say that Express Scripts is unfairly wielding that market power to steer business to [its specialty pharmacy,] Accredo. Express Scripts patients typically cannot have their drugs covered by insurance if they use a pharmacy that is not in the network."
The New York Times; subscription may be required

Hospital's ERISA Claim Against Insurance Company Can Go Before a Jury
"A federal judge on Jan. 7 found that the hospital's claim for fiduciary breach under Section 502(a)(2) of [ERISA] could go before a jury because the hospital was 'merely attempting to recover overpayments' that it was forced to make due to the administrator's alleged breach. Because those losses were 'unconnected to distribution of benefits,' the judge found the claim legal in nature and thus suitable for a jury trial." [Keokuk Area Hosp., Inc. v. Two Rivers Ins. Co., No. 16-66 (S.D. Iowa, Jan. 7, 2017)]
Bloomberg BNA

No More Out-of-Network Coverage for California Anthem Blue Cross Members
"As of January 1, Anthem converted its 2016 PPO (Preferred Provider Organization) health plans, which provide coverage for out-of-network doctors and hospitals, to EPO (Exclusive Provider Organization) health plans with no out-of-network coverage. Many members are still likely unaware that their PPO plan is now an EPO because Anthem sent out misleading notices in September 2016."
Consumer Watchdog

Benefits in General

Fortune 1000 Companies: Accounting for Pensions and Other Postretirement Benefits, 2016
"At fiscal year-end (FYE) 2015, the average discount rate used to calculate the present value of pension obligations increased to 4.34%, compared to last year's rate of 3.98% for companies in this year's report. The salary scale assumption at FYE 2015 used to project current pay remained essentially unchanged at an average value of 3.60%. For companies in this year's report, the expected rate of return on asset assumptions decreased 18 basis points, down to 6.95% from FYE 2014 to FYE 2015."
Willis Towers Watson

Executive Compensation and Nonqualified Plans

Stock Compensation and the Secretary of State Nominee
"Incentive compensation awards for senior executives at ExxonMobil [where Secretary of State nominee Rex Tillerson currently is its CEO] are not paid out until 10 years after retirement and cannot be accelerated for any reason except death, a rare requirement that strongly encourages (or even forces) long-term alignment between shareholders and executives.... In exchange for the surrender and the cancellation of these grants, the company will make a cash payment into an irrevocable ethics-compliance trust equal to the value of the company stock under a market-based formula ... The trust also has an interesting type of clawback provision that will be triggered if Tillerson ever again works in the oil and gas industry while there are still undistributed funds in the trust."
myStockOptions.com

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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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