Health & Welfare Plans Newsletter

January 12, 2017

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HSAs, HRAs and Consumer-Driven Health Care
RECORDED
Thomson Reuters / EBIA

New Fiduciary Rules: What Do You Need to Know and Do Now?
January 31, 2017 WEBCAST
Investment Management Consultants Association [IMCA]

5 Steps for Selecting and Monitoring Investment Advisors
February 21, 2017 WEBCAST
Fiduciary Supply Management Association [FSMA]

Investments Institute
March 13, 2017 in AZ
International Foundation of Employee Benefit Plans [IFEBP]

Palm Beach 2017 Compliance Conference
June 21, 2017 in FL
NCS Regulatory Compliance

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[Official Guidance]

Text of CMS Technical Release: Standards for Self-Insured Non-Federal Governmental Health Plans and Health Insurance Issuers Offering Group and Individual Health Coverage Using the HHS-Administered Federal External Review Process (PDF)
Unnumbered document, dated Jan. 11, 2017. "This Technical Release outlines the requirements for group health plans and health insurance issuers that are subject to the HHS-Administered Federal external review process ... External review is available for enrollees in non-grandfathered individual health insurance coverage and participants and beneficiaries in non-grandfathered group health plans.... for adverse benefit determinations (including final internal adverse benefit determinations) by a plan or issuer that involve medical judgment ... as well as any rescission of coverage. External review is not available for participants and beneficiaries in group health plans to resolve disputes about eligibility to participate in the group health plan, other than those disputes that are related to rescissions."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Official Guidance]

FEHB Program Carrier Letter for 2018 Contracts (PDF)
"This is our annual call for benefit and rate proposals from Federal Employees Health Benefits (FEHB) Program carriers. You should submit your benefit and rate proposals for the contract term beginning January 1, 2018 on or before May 31, 2017. Please send your proposals to your Health Insurance Specialist via overnight mail, FAX, or email. We expect to complete benefit and rate negotiations by mid-August to ensure a timely Open Season."
U.S. Office of Personnel Management [OPM]

EBSA MHPAEA Enforcement Fact Sheet for FY2016 (PDF)
"EBSA closed 330 health investigations in FY 2016 (and 3,100 health investigations since FY 2011). Of these 330 closed investigations in FY2016, 191 involved plans subject to [the Mental Health Parity and Addiction Equity Act (MHPAEA)] and were, therefore, reviewed for MHPAEA compliance. Of these 191 investigations where MHPAEA applied, EBSA cited 44 violations for MHPAEA noncompliance.... The EBSA MHPAEA enforcement process ... Examples of MHPAEA enforcement actions."
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Text of Eighth Circuit Opinion: ERISA Preempts Iowa Requirement for Reporting by Pharmacy Benefit Managers (PDF)
13 pages. "Iowa's law compels PBMs as third-party administrators to report to the commissioner and to network pharmacies their methodology for establishing reimbursement amounts paid to pharmacies for providing certain generic drugs to plan participants.... [This statute] imposes mandates and restrictions on a PBM's relationship with Iowa and its pharmacies that run counter to ERISA's intent of making plan oversight and procedures uniform.... ERISA's express preemption clause requires invalidation of the statute as applied to PBMs in their administration and management of prescription drug benefits for ERISA plans." [Pharmaceutical Care Management Association v. Gerhart, No. 15-3292 (8th Cir. Jan. 11, 2017)]
U.S. Court of Appeals for the Eighth Circuit

COBRA Administration: Back to Basics
"Over the past two years, courts have approved settlements for COBRA violations that range from $290,000 to $1 million.... Much of the recent COBRA litigation pertains to whether qualified beneficiaries have been given the initial COBRA notice (sometimes referred to as the General Notice) and/or the COBRA Election Notice in a timely manner, or whether the contents of these notices were adequate."
Morgan Lewis

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Six Ways to Promote Wellness Program Participation
"Organize a Wellness Team ... Recognize team sports.... Offer gym membership discounts ... Start a 'Biggest Loser' contest ... Offer healthy snack choices ... [Offer programs on financial] wellness."
DataPath

ACA Repeal Puts Health Benefit Income Tax Exclusion at Risk
"[A]ll the Republican proposals that are likely to have a significant role in shaping repeal-and-replace legislation seek to collect more taxes by modifying the tax exclusion on employer-sponsored health benefits in some way.... Options under consideration include: [1] Keeping the 'Cadillac tax' but modifying the tax amount and creating a 'safe harbor' based on a plan's actuarial value.... [2] Imposing a cap on the existing employee exclusion for employer-sponsored coverage.... [3] Limiting the amount of the employee exclusion based on actuarial levels."
The Alliance

States Mull Contraception Coverage as Obamacare Repeal Looms
"Growing numbers of U.S. states are seeking to ensure that women have continued access to free birth control in case the insurance benefit is dropped as part of President-elect Donald Trump's vow to repeal and replace the [ACA].... California, Maryland, Vermont and Illinois since 2014 have enacted statutes codifying the [ACA]'s contraception mandate in state law and expanding on the federal law's requirements. Democratic lawmakers in New York, Minnesota, Colorado and Massachusetts said they are pursuing similar measures this year[.]"
Reuters

Senate Takes First Step Toward ACA Repeal
"The Senate has passed a measure to take the first step forward on dismantling President Barack Obama's health care law... The nearly party-line 51-48 vote early Thursday came on a nonbinding Republican-backed budget measure that eases the way for action on subsequent repeal legislation as soon as next month.... The House is slated to vote on the measure on Friday, though some Republicans there have misgivings about setting the repeal effort in motion without a better idea of the replacement plan."
InsuranceNewsNet.com

Legislative Actions to Repeal, Defund, or Delay the ACA (PDF)
26 pages. "This report summarizes legislative actions taken through the end of the 114th Congress to repeal, defund, delay, or otherwise amend the ACA. The information is presented in three tables. Table 1 summarizes the ACA changes that have been signed into law. Table 2 lists all the House-passed ACA bills. Table 3 summarizes the ACA provisions in the vetoed reconciliation bill." [Report R43289, Jan. 9, 2017.]
Congressional Research Service [CRS]

Court Dismisses Participant Action for ACA Violations by Non-Compliant Group Health Plan
"An action against a group health plan whose terms violated both ERISA and ACA was properly dismissed under Article III of the Constitution due to lack of constitutional standing by the participants, a federal Appeals Court has ruled. The mere fact that the participants paid money into a non-compliant plan did not satisfy the injury-in-fact requirement of constitutional harm necessary to establish standing." [Soehnlen v. Fleet Owners Insurance Fund, No. 16-3124 (6th Cir. Dec. 21, 2016)]
Wolters Kluwer

Benefits in General

[Guidance Overview]

DOL Finalizes Disability Claims Procedure Rules (PDF)
"The DOL has finalized regulations that will change the procedures ERISA plans must follow in adjudicating claims for benefits conditioned on a determination of disability, including claims for disability retirement benefits. The final rules, which generally follow the proposed regulations, add a requirement that notices of an adverse benefit determination on review set out specific information about plan-mandated deadlines for bringing lawsuits under ERISA."
Conduent

Executive Compensation and Nonqualified Plans

[Guidance Overview]

January 31 Reporting Deadlines for Exercises of ISOs and Transfers of Stock Acquired under Employee Stock Purchase Plans
"IRS Form 3921 is used for the reporting of exercises of incentive stock options.... The deadline for furnishing Form 3921 to an employee (or former employee) who exercised an ISO in 2016 is January 31, 2017.... IRS Form 3922 is used for the reporting of initial transfers of stock acquired by an employee (or former employee) pursuant to the terms of an ESPP.... The deadline for furnishing Form 3922 to an employee for an initial transfer of stock in 2016 that was acquired pursuant to an ESPP is January 31, 2017."
Andrews Kurth

Sustained, Consistent Performance Continues to Drive Long-Term Incentive Plan Design
"Most companies are embracing performance-based LTI plans that meet five primary objectives: [1] Retain key employees; [2] Link rewards to organization success over a multiyear period; [3] Align reward program with shareholder expectations; [4] Provide wealth accumulation opportunities; [5] Deliver market-competitive total compensation."
Willis Towers Watson

Press Releases

CalPERS Names Scott Terando Chief Actuary
CalPERS [California Public Employees' Retirement System]

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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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