Health & Welfare Plans Newsletter

January 11, 2017

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Pension Actuary
TPA Firm
in AZ, Telecommute

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Aon Hewitt Investment Consulting
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Retirement Plan Administrator
Warren Averett, LLC.
in AL, FL

Sr. Retirement Plan Consultant
The Meltzer Group
in MD

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[Official Guidance]

Text of IRS Q&As on Information Reporting by Health Coverage Providers (Section 6055), Updated January 11, 2017
[Information has been added under Q&A 20 about the extension of time for 2016 reporting.] "IRS has extended the due date for furnishing 2016 Forms 1095-B to individuals, but has not extended the due date for filing the 2016 Forms 1094-B with the IRS.... The extension applies automatically and does not require the submission of any request or other documentation to the IRS. In view of this automatic extension, the rules allowing the IRS to grant extensions of time of up to 30 days to furnish Form 1095-C will not apply to the extended due date.... [T]he extended furnishing due date also applies for purposes of section 6056 reporting for 2016 (Forms 1094-C and 1095-C). Although IRS has not extended the due date for filing 2016 Forms 1094-B and 1095-B, note that Notice 2016-70 does not affect the normal provisions regarding automatic extensions of time for filing information returns, which can be obtained by submitting a Form 8809, Application for Extension of Time To File Information Returns, and it also does not affect the provisions regarding additional extensions of time to file."
Internal Revenue Service [IRS]

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[Guidance Overview]

Administration Sticks with Current Accommodation for Employers Objecting to Contraceptive Coverage
"The Supreme Court had suggested a procedure under which the objecting employers would contract with insurers to cover their employees but inform their insurers that they did not want to include contraceptive coverage to which they objected. The insurers would then separately provide contraceptive coverage to the employees without any involvement or payment from the objecting entity employers. The administration concluded based on comments it received that this compromise was not feasible for insurers."
Timothy Jost, in Health Affairs

[Guidance Overview]

EEOC Issues Guidance on New Wellness Notice Mandated for 2017
"The [EEOC Q&As] clarify that an employer is not required to provide the [new model notice] if the employer currently provides a notice that informs an employee what information will be collected via the wellness program, who will receive it, how it will be used, and how it will be kept confidential. However, if all of this information is not included in the existing notice or if the existing notice is not easily understood, the employer must provide the new wellness program notice. The Q&As also note that, while a third party provider may provide the notice on behalf of any employer, it is the employer who is ultimately responsible for making sure that employees receive the new notice."
Thompson Coburn

FMLA Interference Claim Shot Down by Court of Appeals
"The circuit court stated that there must be a 'logical nexus' between the past practices and [the employee's] claim in order to be able to offer those past practices as evidence. The appeals court named three important factors to consider when comparing a prior incident to a present claim: [1] How much time has passed since the prior incident. [2] Whether the prior incident involved the same supervisors or managers. [3] Whether the employee in the prior incident was treated similarly as the employee in the present case." [Gaige v. SAIA Motor Freight Line LLC, No. 15-6191 (10th Cir. Nov. 29, 2016)]
Society for Human Resource Management [SHRM]

Health Plans Shift Toward Paying Doctors for Value Provided
"The use of high-performance networks is up from 11 percent in 2015, with another 39 percent potentially adding them over the next three years.... Other plan design features expected to be adopted more widely ... include: Reducing point-of-care costs for the use of high-value services.... Increasing point-of-care costs for the use of commonly overused services.... Requiring employees who undergo certain types of medical procedures to pay a higher cost share if they do not get a second opinion."
Society for Human Resource Management [SHRM]

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UnitedHealth Group to Buy Outpatient Surgery Chain for $2.3 Billion
"While the acquisition is a relatively small one for UnitedHealth, whose annual revenues last year were around $180 billion, it marks the latest step in the company's evolution from a traditional insurer to a diversified health services company."
The New York Times; subscription may be required

The Future of the ACA, Part 5: The Rep. Tom Price Plan(s)
"This [article] focuses principally on Price's replacement bill, the Empowering Patients First Act. [The authors] examine the bill's underlying policy prescriptions in an effort to discern how the legislation would deal with six key features of the ACA ... [1] the individual mandate; [2] premium subsidies; [3] access to coverage (exchanges/marketplaces); [4] the employer mandate; [5] insurance reforms and underwriting rules; and [6] coverage for low-income individuals, children, and the aged (Medicaid)."
Mintz Levin

The Future of the ACA Under the Trump Presidency and GOP-Controlled Congress (PDF)
62 presentation slides. "Even with GOP control of the Presidency and Congressional majorities, a complete repeal of the ACA is unlikely. Many ACA changes require a filibuster-proof majority vote in the Senate (60). A small number of changes (albeit significant ones) do not require overcoming the filibuster -- largely those related to taxes and spending (reconciliation). However, the Executive Branch can make at least some ACA changes unilaterally."
Trucker Huss

IRS Commissioner Report to Members of Congress Regarding 2016 Tax Filings Related to ACA Provisions (PDF)
"About 5.3 million taxpayers claimed approximately $19.2 billion in [premium tax credit (PTC)], reporting an average credit of $3,620.... Approximately 3.3 million taxpayers reported excess [advance premium tax credit (APTC)] (meaning APTC paid during the year exceeded PTC). The average amount reported as excess to be repaid was about $870, for a total of $2.9 billion.... The statutory repayment caps affected approximately 921,000 taxpayers or about 28 percent of those who reported excess APTC.... [A]pproximately $874 million in excess APTC for tax year 2015 was above the statutory caps."
Internal Revenue Service [IRS]

Two New Reports Challenge GOP Criticism of ACA
"The double-digit jump in premiums this year on the health law's exchanges was a one-time correction, and a brisk pace of sign-ups shows the marketplaces are on solid ground, the Obama administration said ... A report from the Council of Economic Advisers asserts that the premium increases for 2017 were a one-time event and will return to sustainable levels.... A separate report released [by CMS] shows sign-ups for coverage on the health law's exchanges are eclipsing last year's pace."
The Wall Street Journal; subscription may be required

The Employer Stop-Loss Insurance Marketplace Since the Affordable Care Act
"ACA has considerably increased the need for and expanded employer interest in stop-loss coverage due to several factors: [1] Removal of annual and lifetime maximums ... [2] Removal of pre-existing condition exclusions ... [3] The individual mandate and extending dependent coverage to age 26 have all increased membership in employer-sponsored plans; [4] Expanded taxes on fully insured health plans."
Milliman

[Opinion]

ACA 'Repeal and Delay' Would Leave a Narrow Window to Stabilize Exchanges
"Even if policymakers believe interim measures would in fact bring stability to the Exchange market for the transition period following 'repeal and delay,' legislators and the executive branch will have a narrow window to influence the 2018 coverage decisions facing health plans. Given the extended time it takes health plans to price coverage options and complete the regulatory review and approval process, actions intended to stabilize the market for 2018 would need to occur as early as the first calendar quarter of 2017 or shortly thereafter if they are to have their intended effect."
Health Affairs

[Opinion]

Get Health Insurance Through Your Employer? ACA Repeal Would Affect You, Too
"Although most large employer plans were relatively comprehensive and affordable before the ACA, some plans offered only skimpy coverage or had other barriers to accessing care, leaving individuals -- particularly those with costly, chronic health conditions -- with big bills and uncovered medical care. For that reason, the ACA extended several meaningful protections to employees of large businesses."
Health Affairs

Benefits in General

Bankrupt CEO Owes $67,000 for Failing to Send Paycheck-Deducted Premiums to Health Insurer
"A company CEO could not avoid a $67,839 judgment through bankruptcy where it was undisputed that he directed the company to pay his personal expenses even though he knew that insurance premiums withheld from employee paychecks had not been remitted to the insurer, which had demanded payment by month's end or the plan would be canceled.... [The court] explained that the funds withheld from paychecks constituted a trust, that the CEO was a fiduciary with respect to the trust, and that he committed defalcation in directing the payment of his expenses rather than past due premiums." [In re Harris, No. 16-6024 (B.A.P. 8th Cir. Jan. 6, 2017)]
Wolters Kluwer

Executive Compensation and Nonqualified Plans

[Guidance Overview]

2017 Deadlines Approach to Furnish ISO and Employee Stock Purchase Plan Information Statements and Returns
"Section 6039 of the Internal Revenue Code requires a corporation to furnish a written statement to any employee or former employee who either [1] exercised an incentive stock option within the meaning of Section 422 of the Code (ISO) during 2016 or [2] during 2016 first transferred legal title to shares acquired under the corporation's employee stock purchase plan within the meaning of Section 423 of the Code (ESPP). This requirement applies to both privately held and publicly traded corporations. The corporation must furnish these statements on Forms 3921 and 3922 no later than January 31, 2017."
DLA Piper

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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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