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Roadmap to Understanding What Employers and Plans Must Report to the IRS and Employees to Comply with the ACA
June 3, 2014 WEBCAST
(ABA Joint Committee on Employee Benefits)

M&A Due Diligence for ERISA Attorneys: A Case Study
June 6, 2014 in NY
(ABA Joint Committee on Employee Benefits)

Update on Impact of Health Care Reform on H&W Benefit Plans
September 18, 2014 WEBCAST
(TRI-AD)

View All Webcasts and Conferences

[Official Guidance]

Text of CMS Interim Payment Process Payment Timeline for May through September 2014 (PDF)
"Tables 1 through 5 represent the timelines for enrollment and payment data submission and payment processing for the months of May through September 2014. CMS will distribute the latest Enrollment and Payment Data Workbook, Certification Form and instructions to all submitters no later than the 12th of each month." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)  

[Advert.]

Health FSAs and HRAs After Health Care Reform

May 30 live webinar. Learn when a health FSA may be offered to your employees and when not, when an HRA plan may be a stand-alone benefit. Covers other mandates, regulations and requirements to offer these valuable pretax benefits. BenefitsLink discount.

[Guidance Overview]

FAQs Address Implementation of Market Reforms for Individual and Small Group Health Plans
"This information likely will be of primary interest to insurers selling policies in the individual and small group markets, but employers and brokers may also benefit from reviewing the guidance -- particularly those provisions addressing guaranteed availability and the 2016 change to the definition of a small employer." (Thomson Reuters / EBIA)  

[Guidance Overview]

Final HHS Rules Address Exchange and Insurance Standards, Including Option to Delay Employee Choice in SHOPs and Requirements for Enrollment Periods
"This guidance finalizes a wide range of proposals, including modifications to the group health plan mandate opt-out for certain self-insured non-federal governmental health plans. They also finalize, with some changes, rules for allocating funds for the premium stabilization programs. And, completing some housekeeping, they remove HIPAA's guaranteed-availability rules for the individual market to the extent they have been superseded by health care reform's more expansive provisions." (Thomson Reuters / EBIA)  

IRS Bars Employers from Dumping Workers Into Health Exchanges
"Many employers -- some that now offer coverage and some that do not -- had concluded that it would be cheaper to provide each employee with a lump sum of money to buy insurance on an exchange, instead of providing coverage directly. But the Obama administration raised objections, contained in an authoritative question-and-answer document released by the [IRS] ... [which] said employers could not meet their obligations under the health care law by simply reimbursing employees for some or all of their premium costs." (The New York Times; subscription may be required)  

Class Action Complaint Alleges UnitedHealthcare Violated Federal Mental Health Parity Law
"According to the plaintiffs, UnitedHealthcare's internal policies effectively provided that coverage would be denied for residential treatment if a lower level of treatment would be safe, regardless of whether it would be similarly effective. Further, they contended that the internal guidelines focused on 'acute changes' in claimants' circumstances and failed to properly account for 'chronically severe impairments.'" (Bloomberg BNA)  

Designating Leave to Care for a Same-Sex Spouse as FMLA Leave Can Bring Unintended Consequences
"[An] employee who is granted FMLA leave to care for his same-sex spouse despite residing in a state that does not recognize same-sex marriage, and who is later denied additional FMLA leave for his own serious health condition on the grounds that he has used up his FMLA entitlement for the applicable 12-month period, could pursue an FMLA claim against the company. His argument would be that the previous leave to care for his same-sex spouse should not have been counted as FMLA leave, and therefore the incorrect notices from his employer and the subsequent denial of his request for additional FMLA leave interfered with his rights under the FMLA." (Benefits Bryan Cave)  

CMS Update on Enrollment in the Federally-Facilitated SHOP Marketplace (PDF)
28 presentation slides, dated May 20, 2014. Excerpt: "Draft Group Business Service Definition (BSD) and 820 Manuals are complete for the FF-SHOP Marketplace.... Final documents will be posted in June.... The FF-SHOP Marketplace will support maintenance transactions for both Group XML and 834 enrollment transactions.... Some new data elements have been added to both Group XML and 834 Enrollment Transactions." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)  

Health Care Cost-Sharing Works -- Up to a Point
"Though [a recent] study found large initial decreases in health spending, they were not fully sustained. Spending under the high-deductible plan fell 25 percent in its first year, consistent with the 30 percent found in the [1970] RAND study, but much of that reduction in spending evaporated over time ... Yes, saving another 5 percent or so in health care costs is not nothing. But a one-time, 5 percent reduction in costs ... will swiftly be overtaken by annual health care cost inflation. It may delay the moment of reckoning, but won't avoid it." (The New York Times; subscription may be required)  

Insurers Once on the Fence Plan to Join Health Exchanges in 2015
"In New Hampshire, for example, where Anthem Blue Cross is the only insurer offering individual coverage on the state exchange, two other plans, both from Massachusetts, say they intend to offer policies next year.... UnitedHealth Group and Cigna, which were notable in their caution about the exchanges last year, are expected to enter more markets this year. In Washington State, United is among four new insurers that have told state regulators they are interested in offering plans in 2015." (The New York Times; subscription may be required)  

Appellate Court Upholds Multi-Million Dollar Award for TPA's Concealment of Fees
"[T]he appellate court's endorsement reinforces the need for employers and TPAs to be more careful than ever in structuring their arrangements regarding the intended treatment of funds used to pay plan benefits.... [T]he best approach to avoiding plan asset status is to maintain funds in an employer account and grant checkwriting authority to the TPA for paying benefits.... [H]owever, in the event of perceived abuses by a TPA, the courts will likely reach to find plan assets and fiduciary status." [Hi-Lex Controls v. Blue Cross Blue Shield of Michigan, Nos. 13-1773/1859 (6th Cir. May 14, 2014)] (Thomson Reuters / EBIA)  

When Hospital Systems Buy Health Insurers
"St. Louis-based Ascension Health, the country's largest nonprofit hospital system, 'is in talks to acquire an unnamed insurance company that operates in 18 states.' ... More typically, health insurance and health care delivery have been separate businesses -- adversaries, even -- in negotiating over prices. Why are the two sides getting cozy?" (The New York Times; subscription may be required)  

How Long Is an 'Overnight' Stay in the Hospital for FMLA Purposes?
"Plaintiff Bonkowski argued that arriving at the hospital before midnight and leaving the following afternoon constituted an 'overnight stay' and thus a FMLA qualifying serious health condition.... The fact is that the good ole [FMLA] does not define 'overnight'. In making its determination the court considered definitions from the Miriam Webster's Dictionary, the Oxford Dictionary, the Federal Aviation Administration and the Farmer's Almanac." [Bonkowski v. Oberg Industries, No. 12-00812 (W.D. Penn. Jan. 17, 2014)] (FMLA University)  

What We Know About Health Reform in Massachusetts
"The results suggest that the Massachusetts reform has largely succeeded by: reducing uninsurance rates; improving health care access and health outcomes; and inducing more firms to offer coverage, without raising unemployment. At the same time improving access to non-employer coverage may have reduced labor force participation for men age 55-64. Finally, while health care cost growth has slowed in recent years, cost control remains a challenge." (Center for Retirement Research at Boston College)  

[Official Guidance]

IRS Announces Meeting of Advisory Group to the Tax Exempt and Government Entities Division
"The Advisory Committee on Tax Exempt and Government Entities (ACT) will hold a public meeting on Wednesday, June 11, 2014.... Reports from five ACT subgroups cover the following topics: Employee Plans: Analysis and Recommendations Regarding the Pre-Approved and Determination Letter Programs ... Federal, State and Local Governments: The Affordable Care Act and Government Employees." (Internal Revenue Service [IRS])  

As Predicted, Shareholder Proposals on Executive Compensation Return
"The most common shareholder proposals relating to executive compensation continue to be requests for the company to: [1] Adopt (or improve) a compensation clawback policy, including a requirement that the company disclose whether and when it has recouped compensation from any employees; [2] Remove or prohibit the accelerated vesting of equity awards upon a change in control; and [3] [Adopt] a stock retention policy[.]" (Winston & Strawn LLP)  

New Report Finds Huge Opportunities for Health Savings Accounts in Coming Era of Private Exchanges
The Institute for HealthCare Consumerism

Centers for Medicare and Medicaid Services Turn to Accenture Federal Services to Enhance the Small Business Health Options Program (SHOP) and State-based Exchange Transitions
Accenture

Willis Advances Global Strategy With Acquisition of Employee Benefits Leader Max Matthiessen
Willis

Squire Sanders is Pensions Law Firm of the Year
Squire Sanders

Squire Sanders and Patton Boggs Announce Agreement to Combine Firms
Squire Sanders

Wealth & Pension Services Group Announces Expansion into Florida
Wealth & Pension Services Group, Inc.

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