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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 DOL Frequently Asked Questions, Part XX: Notice Requirements for Cessation of Coverage of Contraceptive Services
"Q. My closely held for-profit corporation's health plan will cease providing coverage for some or all contraceptive services mid-plan year. Does this reduction in coverage trigger any notice requirements to plan participants and beneficiaries? Answer: Yes. For plans subject to [ERISA] ERISA requires disclosure of information relevant to coverage of preventive services, including contraceptive coverage. Specifically, the [DOL's] longstanding regulations at 29 CFR 2520.102-3(j)(3) provide that, the summary plan description (SPD) shall include a description of the extent to which preventive services (which includes contraceptive services) are covered under the plan."
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
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[Official Guidance]
Text of CMS Letter to Puerto Rico and other U.S. Territories on the Definition of 'State' for Purposes of ACA (PDF)
"Currently, the Department uses the existing Public Health Service Act (PHS Act) definition of 'state' for new PHS Act requirements and funding opportunities included in title I of the [ACA]. Under this definition, the new market reforms in the PHS Act apply to the territories. We have been informed by representatives of the territories that this interpretation is undermining the stability of the territories' health insurance markets.... After a careful review of this situation and the relevant statutory language, HHS has determined that the new provisions of the PHS Act enacted in title I are appropriately governed by the definition of 'state' set forth in that title ... [T]he following [ACA] requirements will not apply to individual or group health insurance issuers in the U.S. territories: guaranteed availability ... community rating ... single risk pool ... rate review ... medical
loss ratio ... and essential health benefits[.] " [Identical letters also sent to Northern Mariana Islands, Guam, American Samoa and U.S Virgin Islands.
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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[Guidance Overview]
EEOC Issues Pregnancy Discrimination Enforcement Guidance But Two Commissioners Object
"Commissioners Constance Barker and Victoria Lipnic issued public statements opposing the Guidance. Both commissioners questioned the EEOC's decision not to make the draft guidance available for public review and comment before it was issued. In addition, they questioned the Guidance's timing, given the Supreme Court's decision to hear [Young v. UPS] in its next term. Commissioner Barker ... argued that the majority's interpretation of the PDA is without legal basis.... Commissioner Lipnic noted that the Guidance regarding contraception requires review in light of the Supreme Court's decision in Hobby Lobby Stores, which held that certain employers may not lawfully be compelled to provide all forms of contraception."
(Morgan Lewis)
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[Guidance Overview]
Patient Centered Outcome Institute Fees Due by July 31, 2014
"While the actual fee can be easily calculated (rate x average number of covered lives), determining what plans are subject to the fee and the average number of covered lives can be quite complicated. In some cases, a single individual may count as more than one covered life."
(Belfint Lyons & Shuman, CPAs)
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[Guidance Overview]
PCORI Fees Due by July 31, 2014
"Plan sponsors and insurers should use IRS Form 720, Quarterly Federal Excise Tax Return, to report and pay PCORI fees. Although Form 720 is a quarterly filing, if there are no other excise taxes due, Form 720 is only required to be filed once a year. If there are other liabilities due for the second quarter of 2014, such liabilities and the PCORI fees should be filed on the same form. Form 720 may be filed electronically or manually."
(Clifton Budd & DeMaria, LLP)
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For nearly 20 years, we've helped employers find the best-informed candidates to fill their benefits job openings -- ask us how!
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[Guidance Overview]
California Progresses Towards Parity with ACA Waiting Period Rule
"[O]nce passed the bill will: [1] permit California-licensed carriers and HMOs to administer employer-imposed eligibility waiting periods so long as they do not exceed the ACA's 90-day limit, and [2] prohibit such carriers and HMOs from imposing any separate, additional affiliation or waiting periods. Pending passage of this bill, it appears that California carriers and HMOs are writing coverage without requiring that employers limit waiting periods to 60 days in accordance with AB 1083 as codified in the California Insurance and Health and Safety Codes. Those provisions went into effect on January 1, 2014 but almost immediately met resistance from brokers and benefit advisors and their clients."
(E is for ERISA)
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HSA Products: Spiraling Traps for Unwary Participants
"When the employee's compliance and tax ramifications are on the hook, employers choose custodians who distribute funds, upon employee request! ... How many save properly itemized receipts? How many accountholders know the ins/outs of 213(d) eligible expenses? How many save properly itemized receipts? If receipts are saved, are they archived and accessible for the long haul, say 20 years? How many even understand that documentation and compliance are completely their responsibility? How many executive accountholders (who are using HSAs as a supplemental retirement savings plan for post-retirement) understand that they will need a long documented history to support eventual distributions?"
(INNOVA BENEFIT Services, LLC)
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Courts Will Need to Determine Boundaries of Supreme Court's Hobby Lobby Decision
"[It] remains to be seen whether the challenges may expand to other faith-based objections.... [A] group of religious leaders has already written a letter to President Obama in light of Hobby Lobby arguing for a RFRA exemption to a pending executive order that would prohibit federal contractors from discriminating against LGBT individuals in hiring practices. However, the courts may cast a critical eye on these claims, as Justice Alito's opinion cautioned that the decision should not be read to provide a shield for discrimination[.]"
(Seyfarth Shaw LLP)
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The Health Care Reform Shared Responsibility Excise Tax Missing Link: Employer Rights
"How does an employer have access to information necessary to accurately determine any payment assessed, when the statute prohibits the agencies from sharing any taxpayer return information with the employer, except 'whether or not the employee's income is above or below the threshold by which the affordability of the employer's health insurance coverage is measured'? ... There seems to be a presumption that the IRS is going to start assessing Section 4980H excise taxes against employers in mid-2016.... Is it even possible to craft procedures that will protect employers' rights in accordance with the Constitution and the provisions of the statute?"
(Porter Wright Morris & Arthur LLP)
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Catastrophic Health Claims Increase Ten-fold
"Individual health claims of $1 million or more have increased tenfold over the past four years due to new medical technologies, advanced drug therapy and more Americans insured under health care reform.... The rise in the number of catastrophic claims came from complications surrounding infants, premature births and newborns with congenital anomalies. The diagnoses stemmed from normal pregnancies that then turned into catastrophic claims[.]"
(InsuranceNewsNet.com)
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A Survey of State Policies on Provider Market Power (PDF)
60 pages. Excerpt: "[T]his paper catalogues existing state statutes and regulations that address the contracting practices of health plans and providers likely to reduce competition and lead to higher prices. In doing so, this paper provides insight into the current scope of state authority to regulate and monitor health care prices. In addition, because states may pursue policies that would not be captured in a review of laws and regulations, this paper also explores efforts beyond the legislative realm by states taking an active role to address these issues."
(National Academy of Social Insurance [NASI])
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The Global Slowdown in Medical Costs: More Than Obamacare
"The rate of health cost growth has slowed substantially since 2000 in every high-income country, including the United States, Canada, Britain, France, Germany and Switzerland ... The synchronized slowdown offers reasons to be skeptical about neat explanations for the trends in any one country, be it local changes in medical practices or Obamacare's various attempts to slow cost growth.... What's behind the pattern?"
(The New York Times; subscription may be required)
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Senators Introduce Bill Providing Tax Incentives for Offering Paid Leave
"On July 16, Senators Deb Fischer (R-NE) and Angus King (I-ME) introduced the Strong Families Act (S. 2618), a bipartisan measure that would create a 25% non-refundable employer tax credit for each hour of paid leave provided to employees, capped at $4,000 per year for each qualified employee. To be eligible, the employer must offer at least four weeks of paid leave."
(Littler)
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Senate Fails to Pass Bill to Overturn Hobby Lobby Decision
"In a 56-43 vote, which was largely along party lines, Democrats came up short of the 60 votes needed to advance their legislation. It sought to prevent companies from relying on a religious-freedom law to avoid complying with the Affordable Care Act's requirement to cover all forms of contraception approved by the government without charging workers a copayment."
(The Wall Street Journal; subscription may be required)
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Federal Employees to Get More Flexibility for Dental and Vision Coverage
"Federal employees who get married on the job, or return to work after a period of leave without pay, soon will be able to enroll for dental and vision coverage outside of Open Season.... [The] final rule [makes] it easier for feds with certain 'qualifying life events' to change their dental and vision benefits close to when the event occurs, rather than waiting for the annual open season window in November. The purpose of the 'expanded enrollment opportunities' is to 'better align' the Federal Employee Dental and Vision Insurance Program with enrollees' overall health care plan when their life circumstances change[.]"
(Government Executive)
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Benefits in General; Executive Compensation
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When Did Benefits Become a Burden?
"[A]ccording to the Bureau of Labor Statistics, only 73% of private industry workers who were offered employer-sponsored medical benefits choose to participate, and 64% of all private workers have access to a retirement plan in which 49% of all private workers with or without access participate, for a take-up rate of 76% ... The fact that HR departments are spending more time and resources coupled with the fact that employee benefit plans are not being fully utilized by employees can create a frustrating combination."
(PLANSPONSOR)
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ERISA's Governmental Plan Exemption Applies to Plan of Staffing Agency 'Intertwined' with Government Hospital
"The plan sponsor, a staffing company, was a nonprofit corporation whose sole member was a hospital created by the state of Florida as a 'special taxing district.' The staffing company employed the hospital's entire workforce.... The plan's insurer, seeking to keep the case in federal court, argued that the plan was subject to ERISA because its participants were not state employees. The court disagreed, finding that the staffing company was sufficiently intertwined with the hospital -- which the parties had agreed was a political subdivision of the state -- that it was an agency or instrumentality of the state." [Gunn v. United of Omaha Life Ins. Co., No. 6:13-cv-1731-Orl-36TBS (M.D. Fla. May 22, 2014)]
(Thomson Reuters / EBIA)
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[Opinion]
Congress Needs to Boost Disability Insurance Share of Payroll Tax by 2016
"SSDI's anticipated trust fund depletion does not indicate that the program is out of control or that it is 'bankrupt;' if the trust fund were depleted and policymakers took no action, the program could still pay about 80 percent of benefits. But cutting benefits by one-fifth for an extremely vulnerable group of severely disabled Americans is unacceptable.... [It] would be best to replenish the DI trust fund as part of a package that restores solvency to the Social Security program as a whole -- that is, that extends the solvency of both trust funds well beyond 2033. That prospect seems highly unlikely to occur, however, between now and 2016."
(Center on Budget and Policy Priorities)
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Press Releases
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