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Understanding Benefits Subject to Health Care Reform: Staying Within the Exceptions for Health FSAs, HRAs, Dental/Vision, EAPs, and More
February 20, 2014 WEBCAST
(Thomson Reuters / EBIA)

Private Health Insurance Exchanges for Large Employers - What You Need to Know
February 26, 2014 WEBCAST
(Sutherland Asbill & Brennan LLP)

HCR Update: Final Employer Mandate Regulations
February 28, 2014 WEBCAST
(HUB International)

Understanding Consumer Expectations in the Transforming Benefits Landscape
March 13, 2014 WEBCAST
(Benefitfocus)

View All Webcasts and Conferences

[Official Guidance]

Text of CMS Issuer FAQ 834, Monthly Payment by Employer for SHOP Coverage When Dropping a Participant
"Question: Since employers usually short pay their bill to indicate that they are dropping coverage for a member, how is the FF-SHOP going to communicate and educate consumers about this since it is a very common behavior? Answer: For plan years beginning on and after January 1, 2015, employers will be expected to pay either [1] total invoiced amount, or [2] total account balance. The amount due at anytime will be available online within the FF-SHOP payment portal." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Advert.]

Interaction of the Affordable Care Act with Other Laws

This March 17 webinar will discuss strategies, potential traps for the unwary, and best practices for integrating rules under the ACA with other laws. Special BenefitsLink discount.

[Official Guidance]

Text of CMS Issuer FAQ 830, Stand-alone Dental Plans through SHOP
"Question: For plan years beginning on and after January 1, 2015, will all members of a family be required to enroll in only one dental plan, even if multiple [stand-alone dental pans (SADPs)] are offered by an employer? Answer: Dependents in the FF-SHOP will be required to enroll in the same [qualified health plan (QHP)] and SADP of the employee." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Official Guidance]

Text of CMS Issuer FAQ 825, Small Employer Coverage through SHOP
"Question: The ACA defines a small employer as having 1-100 employees, but gives states flexibility to set the upper threshold of this amount at 50 for plan years prior to 2016. Some states currently define a small employer group as 2-50 employees and do not allow issuers to provide coverage to a group with only 1 common law employee. Must issuers enroll groups of 1 common law employee into SHOP coverage regardless of these state requirements? Answer: SHOP issuers are expected to follow the ACA definition and to enroll groups with only 1 common law employee, regardless of conflicting state requirements." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Guidance Overview]

No Relief Under ACA Pay-or-Play Regs for Misclassification of Workers
"[T]he Treasury Department stated in the preamble to the final regulations that 'the [Section 530] relief requested would serve to increase the potential for worker misclassification by significantly increasing the benefit of having an employee treated as an independent contractor. Accordingly, the final regulations do not adopt this suggestion.' In other words, there is currently no mechanism -- whether in the form of Section 530 relief or otherwise -- for mitigating the impact of a misclassification error on compliance with these provisions of the [ACA]" (Winston & Strawn LLP)  

[Guidance Overview]

Coverage of Dependents: Final Pay-or-Play Regs Exclude Stepchildren and Others
"Solely for purposes of any potential penalties under the pay-or-play mandate, the final regulations exclude from the definition of dependent: foster children; stepchildren; and children who are not U.S. citizens or nationals, unless the children are residents of a country contiguous to the U.S. (Canada or Mexico) or are within a special tax exception that applies to adopted children. This means that employers sponsoring group health plans with exclusions for any of these categories of dependent may retain these exclusions without fear of triggering pay-or-play penalties." (Proskauer's ERISA Practice Center)  

[Advert.]

IHC FORUM & Expo - HealthCare Consumerism: The Solution for HealthCare Reform

The 2014 IHC FORUM & Expo conference is host to industry-wide collaboration and education during one of the most monumental shifts in our industry's history. May 7-9, 2014 - Cobb Galleria Centre in Atlanta, GA
LEARN MORE & REGISTER!

[Guidance Overview]

ACA Employer Mandate: Dependent Coverage
"The final regulations make two important clarifications with regard to this dependent coverage: [1] Employers may, but do not have to, extend dependent coverage to foster children and stepchildren; and [2] Dependent coverage must be continued through the end of the month in which the dependent turns 26." (Mazursky Constantine, LLC)  

[Guidance Overview]

Waiting Periods for Employer-sponsored Health Insurance
"[T]he final rule updates a number of HIPAA coverage rules to accommodate changes made by the ACA. Most significantly, it recognizes that certificates of creditable coverage are no longer necessary because preexisting condition exclusions have been abolished by the ACA ... It does not drop the requirement until December 31, 2014, as plans are not subject to the preexisting condition ban until they begin a new plan year after January 1, 2014." (Timothy Jost in Health Affairs Blog)  

[Guidance Overview]

IRS Issues Final Regs on Pay-or-Play, Including Relief for Multiemployer Health Plans
"The penalty is imposed on an employer. A multiemployer health plan pays for its participants' benefits with employer contributions that are required to be made under collective bargaining agreements. But the plan is not the employer on which a 'pay-or-play' penalty could be imposed. So why would a multiemployer health plan care about 'pay-or-play'?" (Cary Kane ERISA Lawyer Blog)  

[Guidance Overview]

Medicaid Asset Rules and the ACA
"[CMS recently] released a State Medicaid Directors Letter analyzing the application of Medicaid liens, estate recoveries, transfer-of-asset rules, and post-eligibility income rules to individuals who become eligible for Medicaid because of their modified-adjusted gross income (MAGI).... Although the federal and state law governing Medicaid liens and estate recoveries are primarily concerned with recipients who receive high-cost long-term care services, federal law that existed prior to the ACA allows states to recover from the estates of any Medicaid recipient age 55 or over for the cost of any Medicaid services, and a number of states have existing laws that would allow such recoveries. ACA opponents have been spreading the word that if people age 55 or over sign up for expansion Medicaid, the government will recover from their estate when they die. The Memorandum attempts to address these concerns." (Timothy Jost in Health Affairs Blog)  

[Guidance Overview]

CMS Overview of Marketplace Payment Process, February 21, 2014 (PDF)
20 presentation slides. Topics include: 2014 March Payment Timeline; Template Resubmissions and Common Validation Errors; Understanding "Please Review" Status; and Additional Data Issues. (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

Text of 7th Circuit Denial of Injunctive Relief in Notre Dame Challenge to Contraceptive Mandate (PDF)
44 pages. Excerpt: "[T]he question before us is not whether Notre Dame's rights have been violated but whether the district judge abused his discretion in refusing to grant a preliminary injunction.... We imagine that what the university wants is an order forbidding Aetna and Meritain to provide any contraceptive coverage to Notre Dame staff or students pending final judgment in the district court. But we can't issue such an order; neither Aetna nor Meritain is a defendant (the university's failure to join them as defendants puzzles us), so unless and until they are joined as defendants they can't be ordered by the district court or by this court to do anything.... For now the important point is that Notre Dame has failed to demonstrate a substantial burden." [Univ. of Notre Dame v. Sebelius, No. 13-3853 (7th Cir. Feb. 21, 2014)] (U.S. Court of Appeals for the Seventh Circuit)  

ACA's Small-Business Marketplace Not Attracting Many Small Businesses
"Small-business owners, who were supposed to gain more choices and cheaper rates from the new online-health-insurance portals, have been slow to select plans through marketplaces since the rollout started last fall. In part, some say, that is because luring employers to the marketplaces has taken a back seat to fixing technical problems and recruiting individuals and families. As a result, businesses in many states have been left with an online-shopping portal that is only partially functional -- if they have one at all." (The Washington Post; subscription may be required)  

Summary of Proposed and Developing Legislative Attempts to Undo the ACA
"House Republican leaders are developing a proposal to replace the PPACA and will likely move it to the House floor for a vote later this year. Problems with the exchanges, plan cancellations and concerns about the security of health information have prompted multiple committee hearings and investigations. The House is expected to continue to focus on health care reform as the elections approach, especially the law's effect on jobs and the economy." (Towers Watson)  

Government Proposes Cuts to Insurers' Medicare Payments
"[One analyst] calculated the overall rate cut at around 7.8%, compared with her projection of between 6% and 7%, not including an industry fee levied under the health-care law.... The Friday proposal pegged a key measure of Medicare cost growth even lower than the industry had predicted -- at -3.55%, compared with -1.98% in a report commissioned by America's Health Insurance Plans[.]" (The Wall Street Journal; subscription may be required)  

[Opinion]

Narrow Networks: Boon or Bane?
"Narrow networks mean that some newly insured people are no longer covered for visits to previous providers, or, if they didn't have a doctor before, are limited in their new choices.... Welcome to the world of competition in health care, because that is what narrow networks are about. Narrow networks are used by competing plans to control health care costs, and perhaps improve quality as well. In fact, if you don't like narrow networks, you're saying, in effect, that you don't like competitive solutions ... to our health system's problems." (The Commonwealth Fund)  

Survey of Executive Retirement Benefit Practices
"On average, executive benefit plans deliver an additional 5% to 7% of earnings in annual retirement income to a mid-level executive. About half of organizations that sponsor employer-paid nonqualified plans offer only pure restoration executive benefits." (Towers Watson)  

Following Supreme Court, District Court Upholds Plan's Limitations Period Measured from Before Claim Denial
"The [District Court in Alabama] emphasized that the equities in this case favored the insurer since the insurer had complied with ERISA's claims regulations and the participant did not explain why, even after receiving written notice of her right to obtain, free of charge, documents relevant to her claim, she waited more than four years to request a copy of the insurance policy. But the court also expressed some reservations about a rule that could prevent 'reasonable' beneficiaries from seeking judicial review because they did not receive actual notice of the plan's deadline and admonished that the 'cautious approach might well embrace a notice that explains not only that the courthouse door is open but also how quickly the courthouse door will close'[.]" [Wilson v. Standard Ins. Co., No. 4:11-CV-02703-MHH (N.D. Ala. Jan. 31, 2014)] (Thomson Reuters / EBIA)  

AHIP Statement on New Proposed Cuts to Medicare Advantage
America’s Health Insurance Plans (AHIP)

Newton Strategy Group Launches Study on Benefits Administration Trends And Technologies
Newton Strategy Group

LIMRA Secure Retirement Institute: Total Annuity Sales Grow 17 Percent in Fourth Quarter
LIMRA

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