|
Employee Benefits Jobs
|
|
Webcasts and Conferences
|
|
|
|
|
Hand-picked links to the web's best news articles,
official guidance, jobs, webcasts and more.
|
[Official Guidance]
Text of HHS Final Regs: Notice of Benefit and Payment Parameters for 2015
335 pages. Excerpt: "This final rule establishes updates to the risk adjustment methodology for 2014 to account for certain private market Medicaid expansion alternative plans. It also establishes the counting methods for determining small group size for participation in the risk adjustment and risk corridors programs. Using the methodology set forth in the 2014 Payment Notice, we establish a 2015 uniform reinsurance contribution rate of $44 annually per capita, and the 2015 uniform reinsurance payment parameters -- a $70,000 attachment point, a $250,000 reinsurance cap, and a 50 percent coinsurance rate. We are also finalizing our proposal to decrease the attachment point for 2014 from $60,000 to $45,000... [We] establish a methodology, with certain modifications ... for estimating average per capita premium and for calculating the premium adjustment percentage for 2015, which is used
to set the rate of increase for several parameters detailed in the [ACA], including the maximum annual limitation on cost sharing and the maximum annual limitation on deductibles for health plans in the small group market for 2015.... For 2015, we are finalizing the FFE user fee rate of 3.5 percent of premium."
(U.S. Department of Health and Human Services)
|
[Official Guidance]
Text of IRS Final Regs on Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under Employer-Sponsored Plan
84 pages. Excerpt: "Treasury and the IRS have sought to develop final information reporting rules that will be as streamlined, simple, and workable as possible, consistent with effective implementation of the law.... The final regulations provide that reporting entities must file section 6056 returns electronically if they file 250 returns under section 6056.... [T]he individuals who are full-time employees of an [applicable large employer (ALE)] member for [a] particular calendar month generally may be identified on a weekly basis or a payroll period basis that approximates the calendar month...However, both section 4980H and the premium tax credit are administered based on the calendar month, so ... ALE members are required to report on the basis of the twelve calendar months with respect to the coverage offered (or not offered) to each full-time employee... ALE members with
self-insured group health plans will now use a combined Form 1095-C to satisfy the section 6055 and section 6056 reporting requirements and will therefore only be required to report on a single form information regarding whether an employee was covered. ALE members that provide insured coverage will report information regarding whether an employee was covered once on the section 6056 section of the combined Form 1095-C and will leave the section of the form pertaining to section 6055 information blank."
(Internal Revenue Service)
|
[Official Guidance]
Text of IRS Final Regs on Information Reporting of Minimum Essential Coverage
50 pages. Excerpt: "This document contains final regulations providing guidance to providers of minimum essential health coverage that are subject to the information reporting requirements of [Code] section 6055 ... Health insurance issuers, certain employers, and others that provide minimum essential coverage to individuals must report to the IRS information about the type and period of coverage and furnish the information in statements to covered individuals.... [T]he final regulations retain the rule in the proposed regulations directing reporting entities to provide TINs for all covered individuals and to provide a date of birth only if a TIN is not available after the reporting entity makes reasonable efforts to obtain it... [T]he final regulations provide that applicable large employer members will file a combined return and statement for all reporting under sections 6055 and
6056.... [To] ensure that minimum essential coverage is properly reflected on a decedent's final income tax return and the estate is not held liable for a section 5000A payment, the final regulations do not provide an exception for [providing a statement to] a covered individual who dies during the year.... [T]he final regulations do not permit reporting entities to furnish statements electronically unless an individual affirmatively consents to electronic furnishing.... [R]elief is provided from penalties under sections 6721 and 6722 for returns and statements filed and furnished in 2016 to report coverage in 2015, but only for incorrect or incomplete information reported on the return or statement, including TINs or dates of birth. No relief is provided in the case of reporting entities that do not make a good faith effort to comply with these regulations or that fail to timely file an
information return or furnish a statement."
(Internal Revenue Service)
|
[Official Guidance]
Text of CMS Extension of Health Plan Transitional Policy Through October 1, 2016 (PDF)
7 pages. Excerpt: "CMS ... [has] considered the impact of the transitional policy [announced November 14, 2013] and will extend our transitional policy for two years -- to policy years beginning on or before October 1, 2016, in the small group and individual markets. We will consider the impact of the two-year extension of the transitional policy in assessing whether an additional one-year extension is appropriate. This policy also applies to large businesses that currently purchase insurance in the large group market but that, as of January 1, 2016, will be redefined by section 1304(b) of the [ACA] as small businesses purchasing insurance in the small group market.... States that did not adopt the November 14, 2013 transitional policy, and that regulate issuers whose 2013 policies renew anytime between the date of issuance of this bulletin and December 31, 2014, including any
policies that they allowed to be renewed early in late 2013, may choose to implement the transitional policy for any remaining portion of the 2014 policy year (i.e., this policy could apply to 'early renewals' from late 2013)."
(Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)
|
[Guidance Overview]
Treasury Department Fact Sheet: Final Regs Implementing Information Reporting for Employers and Insurers Under the ACA
"Employers that 'self-insure' will have a streamlined way to report under both the employer and insurer reporting provisions.... [T]he final rules provide for a single, consolidated form that employers will use to report to the IRS and employees under both sections 6055 and 6056, thereby simplifying the process and avoiding duplicative reporting.... For employers that provide a 'qualifying offer' to any of their full time employees, the final rules provide a simplified alternative to reporting monthly, employee-specific information on those employees."
(U.S. Department of the Treasury)
|
[Guidance Overview]
New OCR Guidance Assigns More HIPAA Homework to Health Plans, Providers, Business Associates and Employers
"With [the Office of Civil Rights of the U.S. Department of Health and Human Services (OCR)] stepping up both audits and enforcement and penalties for violations higher than ever since the HITECH Act amended HIPAA, Covered Entities and business associates should ... not only carefully watch for and react promptly to new OCR guidance and enforcement actions, but also document their commitment and ongoing compliance and risk management activities to help support their ability to show their organization maintains the necessary 'culture of compliance' commitment needed to mitigate risks in the event of a breach or other HIPAA violation and take well-documented, reasonable steps to encourage their business associates to do the same."
(Solutions Law Press)
|
Can an Employee Decline FMLA Leave Even though the Absence is FMLA-Eligible?
"At issue in the appeal was whether an employee can affirmatively decline using FMLA leave, even though the underlying reason for leave would have been FMLA protected leave. To this question, the court answered, 'yes.' ... [T]he court focused on the FMLA regulations' expectation that the employer engage in an informal process to obtain additional information about whether the employee is seeking FMLA leave.... [T]he court's reasoning is contrary to the common understanding that employers designate an absence as FMLA leave whenever it is taken for an FMLA-qualifying reason, regardless of what the employee might want.... [T]he regulation states that the employer designates once it knows the absence is for an FMLA-qualifying reason." [Escriba v. Foster Poultry Farms, Inc., No. 11-17608 (9th Cir. Feb. 25, 2014)]
(FMLA Insights)
|
Short-Term Disability: To Be or Not to Be (Self-Funded)? (PDF)
"When considering a switch from an insured plan to a self-funded plan, or vice versa, there is no single all-purpose solution. What is right for a particular employer depends on a slew of considerations, including the employer's size, risk appetite, historical STD experience, desired plan design, cost considerations, and available resources."
(Milliman)
|
The New Health Care Imperative: Driving Performance, Connecting to Value
"U.S. employers experienced the smallest increases in health care costs in 15 years in 2013 (4.1%) after plan changes. That's still twice the rate of inflation. Employer costs are expected to rise 4.4% in 2014. The vast majority of employers are committed to providing benefits in 2015 and beyond, but major changes are on the horizon, including employees and spouses shouldering more costs. Best performers -- whose total plan cost trend averaged 1.6% vs the 5.5% median trend in 2012 -- lead on strategy changes[.]"
(Towers Watson)
|
Year-Two Enrollment Results Show Private Health Exchanges Can Mitigate Costs and Create Greater Individual Accountability
"Forty-two percent of employees chose a moderately-priced Silver plan, which was closest to what they had before enrolling in the private exchange. Thirty-one percent elected a Bronze-level plan, choosing leaner coverage in exchange for lower deductions from their paychecks. More than a quarter of employees chose to purchase richer Gold and Platinum coverage (17 percent and 10 percent, respectively). When choosing a coverage level, most employees said they based their choice on price (32 percent) and the desire to choose a plan that offered coverage similar to their current plan (23 percent). Almost one in five said they chose coverage that they believe offers the best level of medical benefits for them."
(Aon Hewitt)
|
GAO to Probe State-Based Health Exchanges
"The U.S. Government Accountability Office accepted an initial request from a group of House Republicans seeking an audit on how $304 million in federal grants were spent on the Cover Oregon website, which has yet to enroll a single person online without special assistance. The agency said due to similar requests from several members of Congress and congressional committees related to the rollout of online health care exchanges, it would broaden the investigation and issue several separate reports on its findings."
(Associated Press, via National Public Radio)
|
Obama Administration Rewrites ACA Policies by Providing Further Extension
"The rule changes will touch essentially every sector affected by the 2010 health-care law. It will buffer more health plans in insurance exchanges from high patient costs, give states more time to decide whether to run their own marketplaces, and spare certain unions from a fee they have resented. The administration also is raising the possibility that small-business workers in some states might not be given a choice of health plans -- potentially undermining a significant aspect of the law that federal health officials already have delayed once."
(The Washington Post; subscription may be required)
|
Health 'Cost' Growth Is Down, or Not?
"One reason people see health costs differently than experts do is that what they pay for health care has been steadily going up. They pay less attention to the fact that they are going up more slowly than before. For example, the average deductible five years ago in employer plans was $735 per person and by 2013 it had grown to $1,135. Premiums have been growing at historically low rates, but the average family premium in an employer plan in 2008 was $12,680 and in 2013 it was $16,351. Over that time the share of the premium paid by workers rose from $3,360 to $4,560."
(Kaiser Family Foundation)
|
The Health Cost Challenge Presented by Out-of-Network Charges
"[In] New York, a physician billed a patient $115,625 for lumbar spinal fusion -- 62 times the Medicare fee of $1,867. Similar examples were found in all 30 states included in the survey, and there are many examples of even higher variations in charges ... While the issue of how much is appropriate for out-of-network physicians to charge has not been part of the affordability discussion to date, this report demonstrates that it needs to be."
(America's Health Insurance Plans [AHIP])
|
After a Good Start, New York State May Change Health Insurance Exchange Rules
"New York State officials told health insurers last week they may require out-of-network benefits on all plans offered through the state's health exchange, a move that has insurance executives on edge and critics say could cripple one of the most successful health insurance marketplaces in the nation.... If out-of-network doctors and hospitals were required to be reimbursed by the insurer, premiums could rise as much as 30 percent, according to the insurance industry."
(Capital)
|
Unions Can't Get an Obamacare Win, But Insurers Are Getting Help
"Tucked in a 335-page rule ... was the administration's decision not to broaden a proposed exemption on the health-care law's transitional reinsurance program.... [U]nion groups [had] pushed for two major changes: broaden the scope of the exemption and extend it for all three years of the program -- not just for 2015 and 2016. In the end, the administration chose neither... HHS now says insurers' costs stemming from the [ACA's] early tech problems won't count toward their MLR. Wednesday's rule didn't appear to offer specifics on the new carve out, aside from saying that more details are coming."
(The Washington Post; subscription may be required)
|
New York City Sick Leave Law Expanded Prior to April 1, 2014, Effective Date
"The revised Act requires that all employers with at least five employees, and all employers of at least one domestic worker, must provide paid sick time to their employees. All other employees are entitled to unpaid sick leave without penalty under the Act. Employees will be entitled to a minimum of one hour of sick time for every thirty hours worked, up to forty hours of sick time in a calendar year. An employee will be entitled to begin using sick time on the 120th calendar day following the first day of employment or on the 120th day following the effective date of the Act (July 31, 2014), whichever is later."
(Holland & Knight)
|
|
|
U.S. Health Insurance Regulator Gary Cohen to Resign
"Gary Cohen, the top U.S. health insurance regulator accused by congressional Republicans of misleading them before the troubled start of the Obamacare insurance website, will resign. Cohen will step down as director of the Center for Consumer Information and Insurance Oversight at the end of the month, when the first enrollment period for the health-care law concludes[.]"
(Bloomberg)
|
[Opinion]
Almost Anyone Can Claim Obamacare Tax Credits
"Note that an ObamaCare exchange ('Marketplace') has the power to decide the effective date. The exchange may decide that the effective date is the date the enrollee first surfed the website. But there is nothing in the notice that would prevent an exchange from establishing January 1 as the effective date for any enrollee.... The Administration is so far behind enrollment goals that it feels the need to tell people who have not enrolled that they will not suffer financially. The biggest winners are the so-called web-based entities, such as e-Health, Inc., which have been lobbying state-based exchanges to allow them to enroll people. The new rule effectively erases the difference between enrolling in an exchange and enrolling via a web-based broker."
(John Goodman's Health Policy Blog)
|
[Opinion]
Extending the Obamacare Cancelled Policy Moratorium: One More Contortion in the Pretzel
"As a person whose policy is scheduled to be cancelled at year-end, I am happy to be able to keep my policy with a better network, lower deductibles, and at a rate 66% less than the best Obamacare compliant policy I could get. But for the sake of Obamacare's long-term sustainability, this is not a good decision. The fundamental problem here is that the administration is just not signing up enough people to make anyone confident this program is sustainable."
(Bob Laszewski's Health Care Policy and Marketplace Review)
|
[Opinion]
Statement by National Association of Insurance Commissioners on Non-Compliant Health Plan Extensions
"State regulators are committed to ensuring consumers have access to stable insurance markets in every state. We share the President's and Congress' concerns about policy cancellations and the anxiety of the residents of our states when they receive cancellation notices. However, we remain concerned about the negative impact this could have on the overall market. While we appreciate that this delay only applies to renewals and not new sales, thus limiting its adverse impact on the marketplace, it still has the potential to create confusion surrounding available options for health insurance and uncertainty in the restructured marketplace."
(National Association of Insurance Commissioners)
|
|
Benefits in General; Executive Compensation
|
Tenth Circuit Provides Roadmap for How to Win Two Frequent Challenges to ERISA Benefit Denials
"The conflict of interest factor was given only limited weight on whether Bayer abused discretion because 'Bayer took active steps to reduce any potential bias and to promote accuracy' by seeking an independent review of medical records by four different psychiatrists.... Bayer changed the rationale for denial of benefits between the initial and final decisions. That was ok. 'The change is readily explained by the new evidence that came to light only during [the claimant's] appeal' ... Appeal denial letters do not need to tell claimant what additional information is needed." [Fite v. Bayer Corporation, No. 13-7027 (10th Cir. February 4, 2014)
(Lane Powell PC)
|
'409A Day' Comes a Day Early This Year
"March 15 is tax 'Code Section 409A Day.' For employers with calendar fiscal years, that is generally the last day an amount can be paid and still qualify as a short-term deferral that is exempt from 409A's stringent timing and form of payment requirements. But what does one do when March 15 falls on a weekend, as it does this year? You likely aren't cutting payroll checks on a Saturday. Can you wait until Monday to pay? The answer is no."
(Benefits Bryan Cave)
|
|
Press Releases
|
|
|
|
|
|
|
|
|
|
