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"Aggregation Aggravation - Who's the Employer?" Web Seminar
February 19, 2014 WEBCAST
(SunGard Relius)

"The Zen of Controlled Groups: So What?" Web Seminar
February 20, 2014 WEBCAST
(SunGard Relius)

"403(b) Plans for 401(k) Practitioners" Web Seminar, 3 parts
February 25, 2014 WEBCAST
(SunGard Relius)

2014 Webinar: Understanding and Processing Transfers and Rollovers
March 6, 2014 WEBCAST
(Ascensus)

2014 Webinar: IRA Reporting
March 13, 2014 WEBCAST
(Ascensus)

HIPAA Compliance BootCamp
March 17, 2014 in MI
(Clearwater Compliance)

Final IRS Regulations on Employer Play or Pay: Health Care Reform’s Shared Responsibility Provision
March 20, 2014 WEBCAST
(Thomson Reuters / EBIA)

Case Studies in Ethics: An Interactive Approach
March 25, 2014 in FL
(ASPPA Benefits Council (ABC) of North Florida)

COBRA Compliance for Group Health Plans
April 25, 2014 in CA
(Thomson Reuters / EBIA)

Cross-Testing Techniques and Plan Design
May 1, 2014 WEBCAST
(American Society of Pension Professionals & Actuaries (ASPPA))

Prototype Plans Seminar
May 20, 2014 in MA
(McKay Hochman Co., Inc.)

View All Webcasts and Conferences

[Guidance Overview]

'Pay-or-Play' and Contingent Workers: Final Regs Provide Clarity But Not Complete Relief
"IRS so-called 'Section 530' relief for identifying common law employees ... provides that no penalties or interest will be incurred as the result of worker misclassification if the employer (i) consistently treated the workers in question as independent contractors, (ii) complied with the Form 1099 tax reporting requirements for the independent contractors and (iii) had a reasonable basis for treating the workers as independent contractors. The ACA regulations specifically reject the availability of Section 530 relief for purposes of the pay-or-play requirements.... [E]mployers should carefully review their contractual arrangements with service providers to ensure that they have been properly classified as independent contractors as opposed to common law employees under the more traditional common law tests." (Proskauer's ERISA Practice Center)  

[Advert.]

Intuitive, web-based Welfare Plan Document Solutions

Simplify the time-consuming tasks involved in plan document administration with ftwilliam.com. Provide quick and accurate service for your clients whether you're preparing Cafeteria, HRA, POP, Wrap or Section 132 plan documents.

[Guidance Overview]

ACA Shared Responsibility Penalties: Am I Subject to (b) or Not to (b)? That Is the $3,000 Question!
"The '(b)' penalty could apply if the employer does offer coverage, but that coverage is either unaffordable or does not provide 'minimum value' as defined by regulation.... Could an employer that offers coverage to at least 70% of its full-time employees in 2015 still be subject to the '(b)' penalty for 2015? If so, would that penalty apply only to the employees who are actually offered coverage that is either unaffordable or fails to provide minimum value? Or, does that '(b)' penalty also potentially apply to the group of employees who had no offer of coverage at all, i.e., those in the up to 30% group to whom coverage does not have to be offered under the transition rule?" (Proskauer's ERISA Practice Center)  

[Guidance Overview]

Final 'Pay or Play' Regs Retain Core Structure But Make Many Changes
"The new regulations are notable for the numerous relief provisions and industry-specific items they include. Most significantly, there is a 1-year delay for certain mid-sized employers ... There is also a 'grab bag' of industry-specific guidance that is generally helpful to educational organizations, tax-exempt and governmental entities, staffing companies, agricultural and recreational organizations that use seasonal employees, companies that employ home care workers, companies with employees working internationally, and companies that contribute to multiemployer health plans." (Quarles & Brady LLP)  

[Guidance Overview]

Applying the 'In Anticipation of Divorce' Rule under the COBRA Regs
"Under this rule, which is included in the COBRA regulations (but not the COBRA statute), a plan is required to make COBRA continuation coverage available to a spouse following a divorce -- even if that spouse is not enrolled in the plan at the time of the divorce -- if the spouse's coverage was eliminated by the covered employee in anticipation of the divorce (or legal separation if the separation would trigger a loss of coverage under the terms of the plan).... Even if not overlooked, the rule is difficult to administer because it requires the plan administrator to make a judgment call about why the employee dropped his or her spouse from coverage." (Foley & Lardner LLP)  

[Guidance Overview]

The First Pieces of Health Reform's Pay or Play Penalty Puzzle
"This is just one piece of the puzzle, but it is a key piece for employers because it ... provides the definition of the parameters of the testing and the records an employer must maintain to defend against the assessment of the pay or play penalty. Employers must know who is a full-time employee and the dependents and spouses of such employee to know on whom they must report to the IRS regarding to whom coverage was offered and provided." (Winstead PC)  

[Advert.]

Feb. 26 Webinar -- Private Health Insurance Exchanges for Large Employers

We will discuss the Mechanics of private exchanges for large employers; benefits and potential drawbacks of private exchanges; legal implications of private exchanges - what we know and what you should know when talking to private exchange providers.

[Guidance Overview]

ACA FAQs Address Preventive Services, Cost-Sharing Limits, Fixed Indemnity Insurance, Wellness Programs and Expatriate Health Plans (PDF)
"[P]lans may divide the annual limit on [out-of-pocket (OOP)] costs across multiple categories of benefits, rather than reconcile claims across multiple service providers, as long as the combined amount of any separate OOP limits applicable to [essential health benefits] under the plan does not exceed the annual OOP limit for that year ... The FAQ makes it clear that there is some flexibility for plan sponsors to ensure that the OOP limits are met, without necessitating complicated monitoring of various service providers. Note, however, health plans must be careful not to implement separate OOP limits for different benefits in a way that violates the mental health parity rules." (Alston & Bird, LLP)  

[Guidance Overview]

District of Columbia Greatly Expands Paid Sick Leave Coverage, Enforcement, and Penalties
"Once fully effective, the law will permit all workers who have worked at least 90 days to use accrued leave, allow former temporary workers to claim credit for time worked with their employer on a trial basis, and require employers to reinstate accrued leave banks for individuals who transfer out of the District and return within one year. The law will also dramatically increase the penalties for noncompliance, create a private right of action to enforce the law (in addition to the existing administrative remedy), and create a rebuttable presumption that any employee who experiences an adverse employment action within 90 days of taking leave or protesting an employer's administration of the leave policy has been the victim of retaliation." (Littler)  

[Guidance Overview]

Final Regs Issued for Mental Health Parity and Addiction Equity Act of 2008
"The interim regulations established a mathematical test (quantitative parity analysis) for the definition of predominant [provisions that apply to medical/surgical benefits]. A temporary exemption is available for group health plans if the cost of compliance exceeds two percent in the first year and one percent for each subsequent year. Plans that claim the exemption must send a notice to plan participants and beneficiaries and to the appropriate federal agency. The exemption is not effective until 30 days after the notice has been sent." (ERISAdiagnostics, Inc.)  

Some Plans Refuse to Cover Medical Costs Related to Suicide Despite Federal Rules
"Mental health advocates and government experts point to the HIPAA rules, noting that source-of-injury exclusions aren't allowed if they're the result of a medical condition. So if someone is severely depressed and sustains injuries from a self-inflicted gunshot wound, for example, the health plan can't deny claims for medical treatment, say experts, if the plan would generally cover the treatment for someone whose wounds were not self inflicted." (Kaiser Health News)  

1.7 Million Reasons for Health Plans to Hasten Eligibility Decisions
"Here, because the hospitals were 'faultless' and the payment of refunds in the past 'could not have lulled the Kolbe plan into thinking it took no risk in conducting a dilatory investigation into the eligibility of a child with a very serious medical condition bound to cost a great deal to treat,' Judge Posner declared that to infer the provider agreement contains an implied refund provision 'is to infer absurdity.' Consequently, the court denied the plan's claim [for $1.7 million]. The outcome of this case serves as a warning to plan sponsors of the dangers of failing to make eligibility determinations quickly." [Kolbe & Kolbe Health and Welfare Ben. Plan v. Medical College of Wisconsin, Inc., Nos. 12-3837 & 12-3929 (7th Cir. Feb. 5, 2014)] (Stinson Leonard Street)  

Verify Eligibility Before Paying Benefits: Court Denies Reimbursement for Mistakenly Paid Claims
"In denying the plan's claims against the hospital, the Court essentially affirmed that even though the child was not eligible as a participant, there was no valid claim against the hospital. No claim for 'unjust enrichment' could survive because services were rendered, and a breach of contract claim could not survive because, even though there was a provider agreement in place, it did not obligate the provider to reimburse the plan simply because the plan neglected to determine eligibility before the payment was made. So the hospital got to keep the money and the plan was left with nothing more than a possible claim against the individual participant." [Kolbe & Kolbe Health and Welfare Ben. Plan v. Medical College of Wisconsin, Inc., Nos. 12-3837 & 12-3929 (7th Cir. Feb. 5, 2014)] (Fox Rothschild LLP)  

Humana Settles 'Forced Bundling' Allegations
"Humana agreed to pay about $1.8 million in fines divided between 10 states and use the other $2.7 million for a consumer restitution pool, to compensate employers who were apparently required to buy life insurance along with group health policies." (Healthcare Payer News)  

California Bill Would Extend Health Coverage to All Residents Including Illegal Immigrants
"[A] California state senator has proposed legislation that would offer health insurance for all Californians, including those living here illegally. The bill would extend state-funded Medi-Cal to low-income immigrants who, because they are in the country without permission, are now eligible only for emergency and pregnancy coverage. It would also create a marketplace similar to Covered California to offer insurance policies to higher income immigrants who lack legal status." (Kaiser Health News)  

Text of Amicus Brief by Economic Scholars Supporting Availability of Premium Subsidies in Federally-Run Health Insurance Exchange (PDF)
"According to Appellants, Congress wanted to allow premium subsidies only for individuals who purchased policies in State-implemented Exchanges to motivate States to set up those Exchanges. This construct entirely misunderstands the role of premium tax credits in the ACA reforms. The ability to offer subsidies is not a gratuitous 'carrot' dangled in front of States to lure them to set up their own Exchanges. Rather, subsidies are a crucial component of the ACA legislative scheme, without which no Exchange can operate successfully, and without which Congress's goal of broad, affordable coverage cannot be achieved. In sum, Appellants ask this Court to believe that Congress adopted a framework for backstop federally-run Exchanges that would doom them to failure from the outset and thereby frustrate the fundamental goals of the ACA." [Halbig v. Sebelius, No. 14-5018, on appeal from the U.S. District Court for the District of Columbia] (48 Individual Economic Scholars; brief prepared by Jenner & Block)  

Does Mandatory Health Insurance Make People Sick?
"[Data from a 1933 study] suggest that decades of insurance coverage had more than doubled recorded illness and sick days in Germany and England. It had produced more visits to physicians, though German insurance physicians estimated that 50 to 75 percent of visits were for conditions that did not need medical treatment. It had increased patient drug use, causing English physicians to complain of 'bottle addicts' who demanded prescriptions in order to get something back from the insurance scheme that they had paid into. [The study's authors] also detail how requiring physicians act as policemen for employers and gatekeepers for medical treatment paid for by others sows distrust between patient and physician, increases neuroses, and makes it almost impossible for physicians to provide 'good medical service.'" (John Goodman's Health Policy Blog)  

[Opinion]

Can the 'Better Care, Lower Cost Act' Live Up to Its Name?
"Last month, Senators Wyden, Isakson, Welch, and Paulsen introduced an ambitious bill for Medicare reform.... [T]he bipartisan proposal aims to shift the program away from fee-for-service by amplifying the ACO model.... The text of the new bill seems to emphasize a role for telemedicine and remote patient monitoring, but the most successful programs identified by the CBO -- which still didn't achieve net savings for Medicare -- employed significant in-person interaction between patients and physicians or care managers. Initiatives that relied primarily on telephone interaction had little to no effect on spending or hospital admissions, on average." (The Incidental Economist)  

[Opinion]

How Much Is Health Care Worth?
"Healthcare in the U.S. does not have a value problem. Like higher education, it does not need to demonstrate that our system outperforms others of the world in availing caregivers the latest technologies and life-saving heroics. We are quite proficient in declaring our value; we are quite challenged to assert and validate our relative value. And that's what our market is asking." (The Health Care Blog)  

Benefitfocus Achieves Web-Based Entity Certification to Offer Employers a Whole Workforce Solution
Benefitfocus

Segal Group Hires National Communications Practice Leader
The Segal Group

New Survey To Provide Essential Benchmarks For Employers Coping With Health Care Reform Compliance And Cost Management Decisions
United Benefit Advisors

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