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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 CMS Qualified Health Plan Application Instructions for 2015
"A complete set of instructions for the 2015 plan year [Qualified Health Plan (QHP)] Application are now available.... The instructions cover general QHP application instructions, including issuer module, benefits and service area module, rating module and justifications. Note that stand-alone dental plan instructions and network adequacy instructions are forthcoming."
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)
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[Guidance Overview]
Deciding Whether to Play or Pay Under the ACA: 2014 Updates
"[1] What is the employer mandate? [2] Who is eligible for a premium tax credit or cost-sharing reduction? [3] When is the employer mandate effective, and what transition rules apply? [4] Which employers are subject to the employer mandate? [5] Who must be offered coverage? [6] What are the methods for determining 'full-time' status? [7] What health coverage satisfies the employer mandate? [8] What is the penalty for noncompliance and how is it collected?"
(Jones Day)
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[Guidance Overview]
Coordination of Severance Benefits, COBRA, and the ACA
"In a severance situation, it is not uncommon for the employer to also pay, pre-tax, the COBRA premium for a few months, enabling the employee to have additional time to consider the available health plan options. While this situation is common and seems straightforward, the coordination of health coverage under COBRA and the ACA contains a number of potential traps for both the employer and the employee."
(Davis Wright Tremaine LLP)
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[Guidance Overview]
Recent CMS Releases: Medicaid and CHIP Enrollment, Data Verification, and Applications for 2015 Qualified Health Plans
"The instructions cover the 13 areas of requirements that QHP applicants must meet, including, for example, licensure, accreditation, actuarial value, network adequacy, prescription drugs, plans and benefits, and others. Also included in the release are rating tables and rating business rules insurers must follow, as well as forms to be used for insurers to provide justifications if issues arise from their application, such as cost sharing or formulary outliers.... [T]he 65-page section on plans and benefits ... sets out the elements that CMS expects will be shown to consumers in 'plan compare' on healthcare.gov for 2015."
(Timothy Jost in Health Affairs Blog)
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Consultant Warns of New DOL Audits Eying Compliance with Key Parts of ACA
"'What are they looking for? They are looking for information, documentation and operational compliance,' [said Jerry Kalish, president of National Benefit Services Inc.]. 'I would maintain that, functionally, preparing for a [DOL] audit for health and welfare plans is not different, but for the subject matter, than what it is in a 401(k) or a qualified plan audit.' ... Kalish warned plan sponsors to prepare for a wide range of health and welfare issues beyond the ACA -- such as ones involving [ERISA, HIPAA and COBRA] -- if they are notified of an audit."
(Bloomberg BNA)
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Employee Takes the Cake -- and Doesn't Get COBRA
"The employee alleged that she had been terminated because she was a woman, but the court disagreed finding no substantial evidence that the alleged basis for her termination was a pretext for gender discrimination.... Employers should be careful in trying to rely on gross misconduct as a basis for denying COBRA and consult counsel to make sure their basis is as solid as it can be in this relatively undeveloped area." [Mayes v. Winco Holdings, Inc., No. 4:12-CV-00307-EJL-CWD (D. Idaho Apr. 23, 2014)]
(Benefits Bryan Cave)
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Insurers Fill Gaps in Health Insurance Policies
"The insurers that are expanding their networks said they aren't responding to complaints. Instead, they said, the tweaks reflect more willingness by some health-care providers to join the new networks, which often pay them less than traditional employer plans, as well as adjustments to serve the specific populations who enrolled.... But insurers also note that limiting the array of doctors and hospitals where services are covered can be a key tactic in keeping down costs."
(The Wall Street Journal; subscription may be required)
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Connecticut Legislature Makes Changes to Paid Sick Leave Law
"The 2012 version of the law required employers with 50 or more employees in Connecticut during any of the previous year's quarters to provide paid sick leave to qualifying employees. In contrast, under Public Act 14-128, employers must determine if they meet the 50-employee threshold based on the number of employees on their payroll during the week containing October 1, annually."
(Ogletree Deakins)
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How to Make Reference Pricing Work for Consumers (PDF)
"If implemented effectively, reference pricing programs can give consumers the information they need to compare providers based on both price and quality, and they can encourage consumers to receive care from providers that deliver the best care at the best price (high-value care). More importantly, reference pricing programs have the potential to pressure overly expensive providers to set more competitive prices."
(Families USA)
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Access to Health Insurance and the Use of Inpatient Medical Care: Evidence from the ACA Young Adult Mandate
"[C]ompared to those aged 27-29 years, treated young adults aged 19-25 years increased their inpatient visits by 3.5 percent. Visits related to mental illness increased 9.0 percent. The prevalence of uninsurance among hospitalized young adults decreased by 12.5 percent; however, it does not appear that the intensity of inpatient treatment changed despite the change in reimbursement composition of patients."
(National Bureau of Economic Research [NBER])
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[Opinion]
Government Spending on Uncompensated Care Is Less Than One-half of One Percent of Government Health Spending
"A new analysis ... estimates that providers delivered $84.9 billion worth of medical care to uninsured people, for which they were not directly paid. However, federal, state, and local governments compensated providers $35.9 billion, leaving $49.0 billion truly uncompensated.... If government stepped up and compensated the remaining $49.0 billion, the total payout would amount to about one percent of all government health spending.... Is this really something we should be turning ourselves inside out over?"
(John Goodman's Health Policy Blog)
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Benefits in General; Executive Compensation
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[Official Guidance]
Text of IRS Rev. Rul. 2014-18: Section 457A -- Nonqualified Deferred Compensation from Certain Tax Indifferent Parties (PDF)
"Issue: Whether a nonstatutory stock option or a stock-settled stock appreciation right with respect to common stock of a nonqualified entity is a nonqualified deferred compensation plan subject to taxation under section 457A of the Internal Revenue Code[.] ... Law and Analysis: ... [N]either stock right [in the scenario presented in this ruling] with respect to common shares of Service Recipient granted to Service Provider is a nonqualified deferred compensation plan for purposes of section 457A(a) because each is either a nonstatutory stock option that meets the requirements of 1.409A-1(b)(5)(i)(A) or a stock appreciation right that meets the requirements of 1.409A-1(b)(5)(i)(B) and at all times by its terms must be settled, and is settled, in service recipient stock. The stock rights granted to Service Provider are accordingly exempt from section 457A."
(Internal Revenue Service [IRS])
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Press Releases
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