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Employee Benefits Jobs
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Webcasts and Conferences
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Hand-picked links to the web's best news articles,
official guidance, jobs, webcasts and more.
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[Official Guidance]
Text of Final Regs on 90-Day Waiting Period Limitation: Certain Health Coverage Requirements Under the ACA
85 pages. Excerpt: "These final regulations continue to define 'waiting period' as the period that must pass before coverage for an individual who is otherwise eligible to enroll under the terms of a group health plan can become effective. These final regulations also continue to include the clarification that, if an individual enrolls as a late enrollee or special enrollee, any period before the late or special enrollment is not a waiting period.... The final regulations set forth rules governing the relationship between a plan's eligibility criteria and the 90-day waiting period limitation.... Under these final regulations, after an individual is determined to be otherwise eligible for coverage under the terms of the plan, any waiting period may not extend beyond 90 days, and all calendar days are counted beginning on the enrollment date, including weekends and holidays. However ...
the final regulations provide that a requirement to successfully complete a reasonable and bona fide employment-based orientation period may be imposed as a condition for eligibility for coverage under a plan.... The final regulations do not specify the circumstances under which the duration of an orientation period would not be considered 'reasonable or bona fide.' ... these final regulations provide that a former employee who is rehired may be treated as newly eligible for coverage upon rehire and, therefore, a plan or issuer may require that individual to meet the plan's eligibility criteria and to satisfy the plan's waiting period anew, if reasonable under the circumstances (for example, the termination and rehire cannot be a subterfuge to avoid compliance with the 90-day waiting period limitation).... The 90-day waiting period provisions of these final regulations apply to group
health plans and group health insurance issuers for plan years beginning on or after January 1, 2015. For plan years beginning in 2014, the Departments will consider compliance with either the proposed regulations or these final regulations to constitute compliance[.]"
(Employee Benefits Security Administration [EBSA], Department of Health and Human Services, and Internal Revenue Service [IRS])
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[Official Guidance]
Text of Proposed Regs on 90-Day Waiting Period Limitation as Applied to 'Orientation Periods'
"These proposed regulations address orientation periods under the 90-day waiting period limitation of PHS Act section 2708 and solicit comment before promulgation of final regulations on this discrete issue.... These proposed regulations would provide that one month is the maximum allowed length of any reasonable and bona fide employment-based orientation period. During an orientation period, the Departments envision that an employer and employee could evaluate whether the employment situation was satisfactory for each party, and standard orientation and training processes would begin. Under these proposed regulations, one month would be determined by adding one calendar month and subtracting one calendar day, measured from an employee's start date in a position that is otherwise eligible for coverage."
(Employee Benefits Security Administration [EBSA], Department of Health and Human Services, and Internal Revenue Service [IRS])
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[Guidance Overview]
Deadline Nears for Submission of Creditable Coverage Disclosures to CMS
"A plan sponsor must submit a new disclosure to CMS no later than 60 days after the beginning of each plan year -- i.e., by March 1, 2014 for calendar year plans.... In preparing the disclosure to CMS, plan sponsors need to: [1] Identify the number of prescription drug options the plan offers to Medicare eligible individuals. [2] Determine the number of benefit options offered that are creditable coverage vs. non-creditable. [3] Estimate the total number of Medicare eligible individuals expected to have coverage under the plan at the start of the plan year. This includes any health plan enrollees who are Medicare eligible active employees, COBRA enrollees, retirees, or disabled individuals and any of their Medicare-eligible dependents."
(Marsh Consulting Group)
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[Guidance Overview]
Final Play-or-Pay Regulations Include Significant Transition Rules
"Now that the IRS has finalized these play-or-pay regulations, employers ... should ...[1] Identify any affiliated employers that must be considered when counting full-time employees (under the Tax Code's 'controlled group' rules); [2] Determine whether to take advantage of the transition rule allowing full-time employees to be counted over any 6-month period during 2014; [3] If the total full-time employees (including full-time equivalents) during this period will average between 50 and 99, determine whether to take advantage of the available 1-year delay in the effective date of this provision (and, if so, take the steps needed to claim that delay); ... [4] Coordinate with any insurer, third-party administrator, or payroll-service provider that might be involved in the administrative or reporting aspects of these play-or-pay rules; and [5] Prepare to
communicate any changes to plan participants as the next open enrollment period approaches."
(Spencer Fane)
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[Guidance Overview]
Pay-or-Play Relief for Multiemployer Plans (and the Employers That Love Them)
"Absent this guidance, there was concern that employers would question their participation in multiemployer plans because they had no control over whether their full-time employees were actually offered coverage by the multiemployer plan. However, the interim guidance now provides that an employer is treated as offering coverage for all employees for whom it is required to contribute to the multiemployer plan, even those full-time employees who never satisfy that plan's eligibility rules and therefore are never offered coverage."
(Proskauer's ERISA Practice Center)
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[Advert.]
Are Your Retirement & Health Plans on the Right Track?
45+ expert-led sessions prepare you for the challenges of avoiding ACA's Cadillac Tax, boosting employees' physical & financial well-being, understanding exchanges and more. Earn 15 HRCI recertification credits. Register by February 21 to save $100!
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[Guidance Overview]
Final ACA Shared Responsibility Rules Provide Last Pieces for the 2015 Compliance Puzzle (PDF)
32 presentation slides. Excerpt: "[1] Lots (and lots, and lots) of small detail changes that are grounded in comments to the proposed rules and special interest lobbying. [2] Final Regulations are generally 'clean' for 2016 and beyond. [3] Special rules, transition relief, etc. are found in the preamble to the final rules, the preamble to the proposed rules, and releases that predate the proposed rules -- Must, as a result, check multiple sources, particularly for 2015 specifics. [4] Preamble nice overview of law, prior guidance, and proposed rules."
(Morgan Lewis)
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DOL Can Easily Use Large Retirement Plan Filings to Uncover Missing Welfare Plan 5500s
"Some welfare benefit providers prepare the Form 5500 for their clients, others just send the required Schedule A attachments. Large plan sponsors who are not aware of the purpose for the Schedule A sometimes file the form away, not realizing that it is an indication that they must file a Form 5500. In most cases, employers who file a large plan Form 5500 for their [retirement] plan also have a welfare plan filing. The bad news is that electronic filing through EFAST 2 has made it very easy for the [DOL] to locate large plan sponsors who filed a Form 5500 for their retirement plan, but did not do so for their welfare plans."
(Belfint Lyons & Shuman, CPAs)
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Text of 10th Circuit Opinion: Plan Administrator Can't Introduce New Rationale for Benefit Denial During Litigation (PDF)
"The [federal district] court concluded that because Principal 'bases its calculation of benefits owed to [Mr. Garrett] on rationales not relied on by the claims administrator below and has failed to show special circumstances warranting the supplementation of the administrative record, the [c]ourt will not rely on [Principal's] calculation of benefits owed to [Mr. Garrett].' ... We conclude that the district court properly declined to consider Principal's new arguments.... This rule furthers the goal of ERISA to allow plan administrators and beneficiaries to 'hav[e] a full and meaningful dialogue regarding the denial of benefits . . . [and to prevent the plan administrator from] treat[ing] the administrative process as a trial run and offer[ing] a post hoc rationale in district court.'" [Garrett v. Principal Life Insurance Co., No. 13-6087 (10th Cir. Feb. 18, 2014)]
(U.S. Court of Appeals for the Tenth Circuit)
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Spending on Corporate Wellness Incentives to Increase 15 Percent in 2014
"Corporate employers plan to spend an average of $594 per employee on wellness-based incentives within their health care programs this year ... This marks an increase of 15 percent from the average of $521 reported for 2013, and is more than double the average of $260 reported five years ago. The largest increase was among companies with fewer than 5,000 employees, where the per employee average climbed to $595, one-third higher than the average of $444 per employee in 2013."
(Fidelity)
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Advancing Effective Strategies for Addressing Soaring Drug Costs (PDF)
"As a result of this confluence of factors -- increased FDA approvals for specialty drugs, near-monopoly pricing, and the growing need for effective treatments -- experts project that 'spending on specialty drugs is expected to skyrocket over the next decade and beyond ... intensifying the cost and access trade-offs that payers and purchasers already face'.... Health plans have developed a number of strategies in response to sustained cost increases that ensure access to critically important drugs while also holding down cost."
(America's Health Insurance Plans [AHIP])
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Obamacare Enrollments Show Consumers Shun Cheapest Health Plans
"Only 19 percent of enrollees chose the coverage with the cheapest premiums, called bronze, while 7 percent picked the most expensive ... Mid-level silver plans drew 62 percent.... Bronze plans cover only 60 percent of costs, making consumers liable for maximum deductibles of $6,000 a person in medical care.... For a family on a silver plan with an income at 150 percent of the federal poverty level, the cost-sharing assistance reduces a $12,700 annual out-of-pocket maximum to $4,500, and for an individual, from $6,350 to $2,250[.]"
(Bloomberg BusinessWeek)
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Improvements in Health Status After Massachusetts Health Care Reform (PDF)
"In comparing the periods before and after health care reform relative to those in other New England states, we found that Massachusetts residents reported greater improvements in general health (1.7%), physical health (1.3%), and mental health (1.5%).... Adults in Massachusetts households that earned up to 300% of the federal poverty level gained more in health status than did those above that level, with differential changes ranging from 0.2% to 1.3%. Relative gains in health status were comparable among white, black, and Hispanic residents in Massachusetts.... These findings may stem from expanded insurance coverage as well as innovations in health care delivery that accelerated after health reform."
(Philip J. Van Der Wees, Alan M. Zaslavsky, and John Z. Ayanian)
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Fourth Georgia Hospital Closes Due to Obamacare Cuts
"The fourth Georgia hospital in two years is closing its doors due to severe financial difficulties caused by Obamacare's payment cuts for emergency services. The Lower Oconee Community Hospital is, for now, a critical access hospital in southeastern Georgia that holds 25 beds. The hospital is suffering from serious cash-flow problems, largely due to the area's 23 percent uninsured population ... Many hospitals in the 25 states that rejected the Medicaid expansion are facing similar financial problems."
(The Daily Caller)
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GAO Report on Demographics and Service Usage of Certain High-Expenditure Medicaid Beneficiaries
"In fiscal year 2009, states spent nearly a third (31.6 percent) of all Medicaid expenditures on the most expensive Medicaid-only beneficiaries, who were 4.3 percent of total Medicaid beneficiaries. States spent another third (33.1 percent) on all other Medicaid-only beneficiaries, who represented 81.2 percent of total Medicaid beneficiaries.... Overall, hospital services and long-term services and supports in non-institutional and institutional settings comprised nearly 65 percent of the total expenditures for high-expenditure Medicaid-only beneficiaries ... payments to managed care organizations and premium assistance comprised 57.2 percent of total expenditures for all other Medicaid-only beneficiaries."
(U.S. Government Accountability Office)
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[Opinion]
Obama Administration Silences Critics by Using IRS
"The only thing [9 out of 10 mid-size] employers get from last week's rule change is a 'stop complaining' bribe. The Affordable Care Act says employers have to pay a whopping $3,000 each time a worker goes onto the Obama exchanges and gets a taxpayer subsidized plan. Now the administration is offering to waive that penalty. Employers who want this deal must attest to the IRS that they haven't laid off workers or cut hours to squeeze under the 99-worker threshold.... The IRS will forgive changes 'because of the sale of a division, changes in the economic marketplace in which the employer operates, terminations of employment for poor performance, or other similar changes.' It's none of Big Brother's business why you hire or fire."
(Town Hall)
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Benefits in General; Executive Compensation
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When Corporate Transactions Impact Benefit Plans
"Corporate spin-offs present a range of equity compensation, 409A, and employee benefits issues that are often under-appreciated, and lately recognized.... For advance planning, here is a checklist from which to get started[.]"
(Paul Hastings LLP)
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Press Releases
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