Health & Welfare Plans Newsletter

January 13, 2017

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RPC CPAs + Consultants, LLP
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Webcasts and Conferences

Self-Funded Health Plans: What Employers Need to Know About Advantages and Risks
RECORDED
HRWebAdvisor

Specialty Medications - Simple Tips to Control Costs for You and Your Employee
February 8, 2017 WEBCAST
Worldwide Employee Benefits Network [WEB] - Houston Chapter

Understanding the Math of Your Health Plan Renewal
February 17, 2017 WEBCAST
Lorman Education Services

ERISA Audits: What We All Knew but Forgot
February 27, 2017 WEBCAST
Lorman Education Services

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[Official Guidance]

Text of ACA Implementation FAQs, Part 37: Health Reimbursement Arrangements and Application of Code Section 162(m)(6) to Certain Clinical Risk-Bearing Entities (PDF)
"Q1: May a family HRA be integrated with a non-HRA group health plan sponsored by the employer of the employee's spouse that covers all of the individuals covered by the family HRA if that non-HRA group health plan otherwise meets the applicable integration requirements ? Yes.... Q2: May a family HRA be integrated with a combination of [1] self-only coverage of the employee by a qualifying non-HRA group health plan sponsored by the employer and [2] qualifying non-HRA group health plan coverage sponsored by the employer of the employee's spouse that covers all members of the family covered by the family HRA (other than the employee)? Yes."
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL] and U.S. Treasury Department

[Advert.]

Online Learning Course: COBRA

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Even though the ACA has made health care coverage easier for individuals to obtain, group insurance plans must continue to offer COBRA coverage. This course will explain the technicalities of COBRA, including who is entitled and how it must be administered.


[Guidance Overview]

The Mental Health Parity and Addiction Equity Act: Does Your Plan Comply? (PDF)
"Why should health plan sponsors be concerned? ... What plans are subject to MHPAEA? ... What does MHPAEA require? ... What are DOL and HHS looking for? ... What are the courts saying? ... Compliance steps."
benefits Magazine, published by the International Foundation of Employee Benefit Plans [IFEBP]

[Guidance Overview]

Medicare Part D Disclosures Due By March 1 For Calendar Year Plans (PDF)
"This disclosure requirement applies when an employer-sponsored group health plan provides prescription drug coverage to individuals who are eligible for coverage under Medicare Part D. The plan sponsor must complete the online disclosure within 60 days after the beginning of the plan year. For calendar year health plans, the deadline for the annual online disclosure is March 1."
Cowden Associates, Inc.

[Guidance Overview]

The Ball Dropped on New Year's Eve for Some ACA Section 1557 Nondiscrimination Rules
"Because the injunction was issued at the final hour, many of those entities subject to the regulations had already made necessary changes to their group health plans in order to comply by the January 1, 2017 deadline. Those entities will need to decide whether it makes business sense to suspend, alter, or reverse those changes pending any subsequent legal developments."
Ogletree Deakins

2016 DOL Form M-1 Highlights Penalty Increase
"The 2016 Form M-1 is essentially identical to the 2015 version. A key point reflected in the instructions is the increase in the maximum per-day penalty for Form M-1 filing failures (which include late or inaccurate filings) from $1,100 to $1,502, which was generally effective as of August 1, 2016 and is to be adjusted annually for inflation[.]"
Thomson Reuters / EBIA

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Time Waits for No One: OCR Announces First HIPAA Settlement for Lack of Timely Breach Notification
"Presence Health agreed to pay a settlement amount of $475,000. It is noteworthy that Presence Health is a relatively large health system, but the settlement is well below the average of recent settlements (the average 2016 resolution agreement was approximately $2 million). Presence Health also agreed to enter into a two-year corrective action plan, which requires new policies and procedures and training, but does not include internal or external monitoring like some prior settlements."
Davis Wright Tremaine LLP

OPM Asks FEHBP Carriers to Focus on Rising Prescription Drug Use and Costs
"All insurance carriers participating in the Federal Employees Health Benefits Program [FEHBP] in 2018 should continue their efforts to effectively manage prescription drug use among beneficiaries while trying to rein in escalating costs ... OPM wants carriers to 'reexamine' opportunities to reinforce or add to management techniques that help balance those dual goals, since rising drug prices and more prescription drug use in health care are driving up FEHBP premiums. According the agency, 25.5 percent of the FEHBP health care budget was spent on drugs in 2015."
Government Executive

CVS, Cigna Decisions Encourage Use of Cheaper EpiPen Alternatives
"Shortly after Cigna announced it would stop covering the name-brand EpiPen, CVS declared it would begin selling a cheaper generic version of the costly epinephrine injector.... Cigna issued a statement explaining its decision to revise its covered drug list in hopes that it would 'encourage use of the generic version as it will deliver more overall value to customers and clients.' "
American Journal of Managed Care

[Opinion]

Negotiating Trumped Up Drug Costs
"Investors were clearly unsettled after hearing [President-Elect Trump's] remarks and claims to negotiate drug pricing, but what does 'negotiate drug pricing' really mean? ... To negotiate, one needs leverage. To get leverage, alternatives are needed.... Drug costs need more transparency and those costs must be more visible to the user."
Frenkel Benefits

[Opinion]

Deals Will Be Cut for ACA Replacement -- Who Wants What?
"While [AHIP] has put forward a long list of concerns ... there are two key assurances health insurers want in order to support an ACA replacement plan. The top priority of health insurers is predictability.... The second priority of health insurers is some requirement for consumers to make consistent payment of premiums."
Morning Consult

Benefits in General

Nearly Three-Quarters of U.S. Employees Would Like a Customized Benefits Package
"[O]nly half of workers are satisfied with their current employer benefits. Married workers are more satisfied than non-married workers (55 percent vs. 45 percent) and workers who use a financial advisor are more likely to be satisfied with their benefits (62 percent vs. 46 percent).... Employees ranked health care coverage, retirement savings accounts and vacation as the three most popular workplace benefits."
Wolters Kluwer Law & Business

Executive Compensation and Nonqualified Plans

[Guidance Overview]

Preparing for CEO Pay Ratio Disclosure (PDF)
"When will companies first disclose the Pay Ratio? ... What companies are subject to the Pay Ratio rule? ... What is the purpose of the Pay Ratio rule? ... What factors should companies consider in determining whether to use their total employee population or a statistical sampling, as allowed under the rule? ... How do companies identify the median employee? ... Outline some considerations in developing the messaging and narrative around a company's disclosure, for instance, if the ratio is a big number.... [W]ill the incoming Trump administration repeal the CEO pay ratio?"
Meridian Compensation Partners, for Nasdaq

[Guidance Overview]

IRS Memorandum Reveals Approach for Avoiding Section 409A for Matched Elective Deferrals
"Chief Counsel Memorandum (CCM) 201645012 involved a nonqualified deferral arrangement under which participants could voluntarily elect to defer a portion of their salary. The amounts deferred were matched by the employer and made subject to service-based vesting conditions. The CCM concluded that because the deferrals were credited with a 25% match, the ongoing vesting conditions to which these deferrals were subject posed a 'substantial risk of forfeiture' for purposes of Section 409A. Because the deferrals were paid shortly after vesting, this conclusion meant that the arrangement qualified to be exempt from 409A."
Willis Towers Watson

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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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