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Employee Benefits Jobs
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Hand-picked links to the web's best news articles,
official guidance, jobs, webcasts and more.
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[Guidance Overview]
Final Play-or-Pay Regulations Include Significant Transition Rules
"A new employee whose hours equal or exceed the 130-hour threshold must be treated as full-time by the end of the third full calendar month after the employee's date of hire. To avoid being subject to a play-or-pay penalty with respect to such an employee, his or her employer must then make an offer of health coverage by the following day (i.e., the first day of the fourth full calendar month after employment). Note, however, that this deadline applies only for purposes of the play-or-pay provision. If an employee is hired into a position that is otherwise eligible to participate in the employer's health plan, the employer must allow that employee to enroll in the plan within 90 days after being hired. Otherwise, the employer will face a different ACA penalty."
(Spencer Fane)
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[Advert.]
How Confident Are You about Your Company's Compliance with HIPAA?
The law requires HHS to audit organizations for HIPAA compliance. Employers who offer health insurance to employees must comply with the final Privacy & Security Rules. We have helped hundreds of companies comply. Talk to us before HHS talks to you!
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[Guidance Overview]
Proposed IRS Regs Address Affordability of Employer-Sponsored Group Health Coverage (PDF)
"Any reward amounts tied to an incentive to reduce tobacco use should be included when determining affordability. This means non-smoker premium contributions would be used to determine if the plan is affordable to a taxpayer. Any other wellness rewards should not be considered when determining affordability.... The proposed rules also request comments on how to determine affordability when an employer offers a full 'cafeteria' plan. In such plans, the employer offer funds to employees to purchase an array of benefits with pre-tax and post-tax dollars. Typically, employer-sponsored health plans are part of the menu of choices. However, there is no requirement that the funds be spent on the medical plan."
(McGraw Wentworth)
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[Guidance Overview]
ACA Employer Shared Responsibility Rules: Top 10 Changes
The articles uses a chart format to compare the proposed version of the regulations to the recently released final version. Topics include: "Definition of 'seasonal employee' ... Exclusions from definition of 'Hour of Service' for volunteers ... Clarification of whether and when an employer can test compliance month-by-month vs. under the look-back measurement method ... Definition of 'part-time employee' ... Rules for stability periods that are longer than the associated measurement period ... Hours of service for adjunct faculty ... Break-in-service rules ... Definition of Dependent ... Proposed regulations -- transitional relief ... New transitional relief."
(Mintz Levin)
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[Guidance Overview]
IRS Final Regs Partially Delay ACA Employer Shared Responsibility Requirement
"The IRS is continuing to consider how to determine hours of service, including layover hours, for airline industry employees and other employees whose hours of service are difficult to track. Until further guidance is issued ... [E]mployers must use a method of crediting hours of service for those employees that is reasonable under the circumstances and consistent with the employer responsibility provisions.... The final rule does not include special rules for short-term and high-turnover positions."
(Littler)
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CMS Report Says Rising Premiums May Hit Two-Thirds of Small Employers
"The report, from the Centers for Medicare and Medicaid Services Office of the Actuary ... concluded that about 65% of small businesses, or plans covering 11 million people, would see an increase in insurance premiums under these so-called community-rating provisions of the health law. About 35% of employers would see a decrease for plans covering six million people."
(The Wall Street Journal; subscription may be required)
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[Advert.]
Give an opinion on benefit administration trends and technology, win an iPad
The Newton Strategy Group, a market research firm, is surveying benefit administration brokers and advisors to better understand professionals' views on the technologies available for healthcare benefits enrollment and eligibility determination. Respondents will be entered to win an iPad mini.
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Report to Congress on the Impact on Premiums for Individuals and Families with Employer-Sponsored Health Insurance from the Guaranteed Issue, Guaranteed Renewal, and Fair Health Insurance Premiums Provisions of the ACA (PDF)
"There is considerable uncertainty as to whether small employers will decide to terminate their existing offer of health insurance coverage and send their employees to individual market Exchanges. Many factors may be relevant to their decisions.... Once the new premium rating requirements go into effect, it is anticipated that the small employers that offer health insurance coverage to their employees and their families would have average premium rates. Therefore, we are estimating that 65 percent of the small firms are expected to experience increases in their premium rates while the remaining 35 percent are anticipated to have rate reductions.... This results in roughly 11 million individuals whose premiums are estimated to be higher as a result of the ACA and about 6 million individuals who are estimated to have lower premiums."
(Office of the Actuary, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)
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Employers Remain Uncertain About Private Exchanges
"50 percent of employers have begun to evaluate new private exchange options, while 71 percent of employers are looking into adopting a self-insured model.... 50 percent of employers were unsure of how private exchanges would impact recruiting and/or retention, while 20 percent believed it would have a significant impact and 10 percent believed that there would be no impact. The majority (67 percent) of employers agree that private exchanges are a viable option, but that it will just be considered another offering in a suite of benefits choices."
(HighRoads)
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Handling Administrative Appeals of Denied Claims: Make Your Explanations Complete
"[The federal district] court ordered payment of the claim in full. But the plan administrator then argued that if it was covered, the payment would have to be subject to deductibles and also reduction for length of stay and for going to a non-preferred provider. The Court of Appeals affirmed the lower court's decision denying the reduction, saying that the only thing that could be considered was the rationale denying the claim, not other justifications. In other words, the plan could not submit new evidence to supplement the administrative record. It was stuck with its original administrative record and had to pay the full face value of the claim." [Garrett v. Principal Life Insurance Co., No. 13-6087 (10th Cir. Feb. 18, 2014)]
(Fox Rothschild LLP)
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Hardly Strict Tracing after the 2006 Sereboff Opinion
"[For] most of the country, if an ERISA plan's terms allow for reimbursement from a beneficiary, the likely outcome in most cases will be that the recovery will be permitted, even if the funds cannot be strictly traced. However, ERISA plan sponsors and insurers in the Ninth Circuit must be prepared to face a higher hurdle when attempting to recover funds from a beneficiary."
(Seyfarth Shaw LLP)
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Can Oscar Succeed in Making Health Insurance Fun? Maybe Not Just Yet, But the Startup Is Shaking Things Up
"As NPR reported last month in a story about [the venture-capital-backed start-up health insurance company Oscar Health], 'it's been years since a new, for-profit health insurance company launched in the U.S.', but the [ACA] created a window of opportunity for new entrants.... In addition to an improved user experience that incorporates increased price transparency, Oscar heavily emphasizes telemedicine, with the goal of giving every customer the feeling of having 'a doctor in the family.'"
(The Health Care Blog)
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Aetna CEO Bertolini Outlines 'Creative Destruction' of Healthcare
"Not too far away from now -- in the next 6-7 years -- 75 million Americans will be retail buyers of healthcare. And they'll come to the marketplace with their own money and either a subsidy from their employer or a subsidy from their government. And it doesn't much matter -- they'll be spending their money."
(Forbes)
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Aetna CEO: We Can't Afford It
"What is required, [Aetna CEO Mark] Bertolini asserted, is a change in the current mindset around health care, a system that was designed in 1945.... Bertolini gave three prescriptions for America's ailing health care system: aligned incentives (payment reform), changing the way chronically ill are cared for, and investing in wellness for the next 25 to 30 years."
(Employee Benefit News)
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Even Low Income Families Will Pay Thousands of Dollars in Obamacare Taxes
"[F]amilies in the lowest income 20% receive 3.1% of after tax income, yet will bear 7.3% of Obamacare's tax burden. To be sure, many of these same families will be recipients of massive subsidies through Medicaid and the Exchanges. But it's important for such families to understand that quite a bit of what's being given by the right hand of government is being taken right back by the left hand of government in the form of all sorts of taxes on health services, health insurance and other goods and services that will be passed right back to them in the form of higher prices."
(Forbes)
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House Subcommittee to Examine Benefits of Self-Insured Health Plans February 26
"Although stop-loss insurance is regulated by the states, in February 2013 the New York Times reported Obama administration officials 'were considering regulations to discourage small and midsize employers' from using stop-loss insurance. In correspondence with the committee, the administration has refused to confirm or deny whether it will issue a regulation affecting stop-loss insurance. [This] hearing will provide members an opportunity to examine the benefits of self-insurance and discuss concerns about regulating stop-loss insurance at the federal level."
(Committee on Education and the Workforce, U.S. House of Representatives)
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Humana Leads Insurer Gains on Proposed Medicare Payments
"Health insurers who run Medicare Advantage, the private version of the government's managed-care program for the elderly and disabled, face a base payment cut of about 3.55 percent next year, the U.S. government said on Feb. 21. Humana [on Feb. 24] estimated the final reduction will be 3.5 percent to 4 percent, a smaller decline than the ... company's previous estimate of 6 to 7 percent."
(Bloomberg)
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[Opinion]
Text of Comments by U.S. Chamber of Commerce to DOL on Proposed Amendments to Excepted Benefits Regs (PDF)
"[T]he Chamber has significant questions and concerns about the Proposed Rule's addition of a limited wraparound coverage excepted benefit.... While we support the concept of offering employers a variety of options and increased flexibility in benefit design and coverage choices, this proposal contains many elements that would require additional examination and extensive discussion. We urge the Departments to withdraw this provision of the rule and continue discussions with stakeholders on this topic on a separate track to ensure appropriate input and feedback."
(U.S. Chamber of Commerce)
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Benefits in General; Executive Compensation
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[Official Guidance]
Text of IRS Final Regs: Property Transferred in Connection with the Performance of Services under Section 83
"These final regulations provide several clarifications regarding whether a substantial risk of forfeiture exists in connection with property subject to section 83. Specifically, the final regulations clarify that [1] except as specifically provided in section 83(c)(3) and 1.83-3(j) and (k), a substantial risk of forfeiture may be established only through a service condition or a condition related to the purpose of the transfer, [2] in determining whether a substantial risk of forfeiture exists based on a condition related to the purpose of the transfer, both the likelihood that the forfeiture event will occur and the likelihood that the forfeiture will be enforced must be considered, and [3] except as specifically provided in section 83(c)(3) and 1.83-3(j) and (k), transfer restrictions do not create a substantial risk of forfeiture, including transfer restrictions that
carry the potential for forfeiture or disgorgement of some or all of the property, or other penalties, if the restriction is violated."
(Internal Revenue Service)
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Form 8822-B Responsible Party Deadline for a Few Employee Benefit Plans and Trusts: March 1, 2014
"What is the penalty for failing to timely file a Form 8822-B? Nothing at this point. However, if you fail to provide the IRS with your current mailing address or the identity of your responsible party, you may not receive a notice of deficiency or a notice of demand for tax, and penalties and interest will continue to accrue on any tax deficiencies.... [If] an employee benefit plan (including any qualified retirement plan) or trust (such as a retirement plan trust or VEBA) uses its own EIN, we need to consider whether a filing is required. How do you know whether your plan or trust has a separate EIN? We suggest you look at your tax forms (Form 5500 or Form 990), and summary plan descriptions."
(Porter Wright Morris & Arthur LLP)
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House Bill Would Extend Reach of 162(m) to All Employees and Eliminate (Significant) Exemption for Performance-Based Compensation (PDF)
6 pages. Excerpt: "The proposed legislation would effectively eliminate the corporate deduction for any compensation paid in excess of $1 million during any tax year beginning after December 31, 2013 to any current or former employee or director.... [T]he payment of annual and long-term cash incentives, the exercise of stock options and the settlement of performance shares would be subject to the $1 million deduction cap. For the largest public companies where proxy-disclosed officer salaries often equal or exceed $1 million (especially for the CEO), such companies would be precluded from taking a corporate deduction for any annual or long-term incentive payments made to such officers (or any other similarly situated employees)."
(Meridian Compensation Partners, LLC)
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Press Releases
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