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Employee Benefits Legislative and Regulatory Update
August 6, 2014 WEBCAST
(Worldwide Employee Benefits Network [WEB])

Other Postemployment Benefits (OPEB): For Users of State and Local Government Financial Information
August 8, 2014 WEBCAST
(Governmental Accounting Standards Board [GASB])

Aligning 401(k) Plan Design with HR Strategy
August 27, 2014 WEBCAST
(Kushner & Company)

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[Official Guidance]

Text of CMS Enrollment Bulletin 10: Grace Periods Related to Terminations for Non-Payment of Premiums and Enrollment Through the Federally-Facilitated Marketplace Across Benefit Years (PDF)
"The applicant's failure to pay premiums during previous enrollments is not an exception to [the] guaranteed availability requirement.... [In] connection with a new application for coverage, issuers may not attribute payments made with the intention of effectuating coverage ... to past debt, and then refuse to enroll the applicant based on failure to pay an initial premium ... Issuers also may not attribute payments for the new coverage made subsequent to the binder payment to past debt." [July 16, 2014] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Advert.]

WEB's mission is to further the development of benefits professionals

We are committed to helping define the role of the benefits professional in the 21st century, and as changing market forces reshape the profession, WEB will help its members meet the challenges ahead.

[Guidance Overview]

Important Wellness Plan and Mental Health/substance Use Disorder Parity Effective Dates Have Arrived
"Check the applicable year for all of your health plans and policies immediately! For MHPAEA, for July 1 plan or policy years, contact your advisors to make sure that your plans and policies currently comply with the new MHPAEA rules. For wellness, for plan or policy years beginning from January 1, 2014 to date, contact your advisors to make sure that your plans and policies currently comply with the new wellness regulations." (Mintz Levin)  

[Guidance Overview]

Disclosures with Respect to Preventative Care: DOL Notice Requirement Post-Hobby Lobby
"[FAQ XX] references a 'closely held for-profit company' which pretty clearly indicates that the DOL is applying a very narrow reading of the Court's decision and non-closely held companies would be in for a fight later.... [If] the company is eliminating contraceptive coverage, it has to follow the ACA and ERISA notice requirements for plan changes. The change is not immediate and can only be completed after the appropriate notification time periods. Simply eliminating the coverage will not do." (Fox Rothschild LLP)  

[Guidance Overview]

IRS Final Regs Impose Complex Information Reporting Requirements on Health Insurers and Self-Funded Plans (PDF)
7 pages. Excerpt: "Beginning in 2016 ... insurers and self-funded plans will be required to report information about health coverage provided during the prior year to all enrollees ... The proposed regulations were modified in a few respects in response to comments, but the reporting requirements generally remain complex. [This article addresses] key questions related to the reporting, and summarize[s] the information provided in a chart[.]" (Groom Law Group)  

Exploring the Use of Reference Pricing by Insurers and Employers
"[R]eference pricing may be a promising cost-control strategy when applied to frequently performed, non-emergency tests and procedures where the prices charged vary widely across providers but the quality of results remains largely similar.... However, some experts are concerned about the impact of reference pricing on consumers, particularly the potential for poor communication with plan enrollees, who may unknowingly choose high-cost providers and incur thousands of dollars in medical bills as a result." (Robert Wood Johnson Foundation)  

2014 Mid-Year Supreme Court Case Review
"The 2013-2014 term of the Supreme Court of the United States produced opinions that will have substantial effects on the design and administration of most employee benefits plans. This summary highlights three key decisions, one significant procedural ruling, and an emerging issue likely headed for Supreme Court review, all of which deserve the attention of employee benefits professionals." [Items include Limitations Periods; Presumption of Prudence; Mandated Provision of Contraceptives (Private Companies); Mandated Provision of Contraceptives (Church-Affiliated Organizations); and The Scope of the "Church Plan" Exception.] (Verrill Dana LLP)  

Insurers in U.S. Territories Get Obamacare Exemptions
"Insurance companies in Puerto Rico, Guam, American Samoa, the U.S. Virgin Islands and the Northern Mariana Islands are no longer required to implement a number of ObamaCare measures such as the community rating system, a single-risk pool, the medical loss ratio or guaranteed benefits. Insurers in the territories have argued the requirements put an undue burden on them because residents are not mandated to get coverage and do not receive government subsidies." (The Hill)  

Biggest Insurer Drops Caution, Embraces Obamacare Marketplaces
"UnitedHealthcare, the insurance giant that largely sat out the health law's online marketplaces' first year, ... may sell policies through the exchanges in nearly half the states next year.... UnitedHealthcare sells individual policies through government exchanges in only four states now." (Kaiser Health News)  

Halbig v. Burwell: Potential Implications for ACA Coverage and Subsidies
"[R]esearchers estimate that 7.3 million people, or about 62 percent of the 11.8 million people expected to enroll in federally facilitated marketplaces by 2016, could lose out on $36.1 billion in subsidies. Residents in Texas and Florida would lose the most, $5.6 billion and $4.8 billion respectively in subsidies at risk in this court decision." (Robert Wood Johnson Foundation)  

[Advert.]

BenefitsLink app for iPad, iPhone and iPod touch now available!

Stay up-to-date while you're on the go with the BenefitsLink App -- now available for iPad, iPhone 5, and iPod touch.

Access to Primary and Preventive Health Care Across States Prior to the Coverage Expansions of the ACA
16 pages. Excerpt: "This issue brief compares access to primary care and receipt of preventive care among adults under age 65 by state in 2012, and examines differences by insurance and income within states. The findings reveal wide state differences prior to the major insurance expansions of the [ACA]. It also finds a steep income divide within most states ... [T]his brief provides baseline data for states and the nation to track and assess change in access." [Also available: an 8-slide 'Chartpack'.] (The Commonwealth Fund)  

Text of Testimony of HHS OIG to House Subcommittee on Health: 'Failure to Verify: Concerns Regarding PPACA's Eligibility System' (PDF)
8 pages, for a hearing held on July 16, 2014. Excerpt: "[T]he Federal, Connecticut, and California marketplaces had certain procedures in place to verify an applicants' information, but not all internal controls implemented by the three marketplaces were effective in ensuring that individuals were enrolled in QHPs according to Federal requirements.... [For] the State marketplaces from October through December, 2013; [and] the Federal marketplace ... through February 2014 ... marketplaces were unable to resolve most inconsistencies, which they reported most commonly as citizenship and income." (Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS])  

[Opinion]

The Real Meaning of Halbig v. Burwell
"There's a reason the Obama administration and its supporters are torturing the English language: the statute is clear, the legislative history fully supports the statute's plain meaning, and the administration on the wrong side of the law.... It doesn't count when seven of the law's drafters come forward four years later to claim they intended all along to offer subsidies in federal Exchanges.... And while two federal judges have ruled for the government, they did so only by ignoring statutory language and legislative history fatal to the government's case." (Michael F. Cannon, in Forbes)  

[Opinion]

USA's Biggest Health Insurer Embraces Obamacare After Sitting Out Year 1: A Shrewd Decision
"A carrier laying back the first year will have the advantage of coming into the market after the first year carriers, particularly the big Blue Cross plans, have harvested most of the initial market share and with it all of those first year people who were pretty sick and wanting to take advantage of the new Obamacare underwriting reforms to finally get themselves covered. Yes, these people can change carriers the second year but they likely won't -- particularly if they are sick and worried about their provider relationships.... [UnitedHealthcare's] strategy of laying back a year ... [to make] sure in 2015 to be able to keep and compete for the more healthy pre-Obamacare legacy business looks like a very savvy underwriting move[.]" (Bob Laszewski's Health Care Policy and Marketplace Review)  

2014 Mid-Year Compliance Update
"While 2014 has been a relatively quiet year in terms of new rules affecting retirement plans, the January 1, 2015 effective date for the Affordable Care Act employer shared responsibility mandate is now in sight. This summary discusses a few key developments regarding employee benefit plans -- especially group health plans -- for employers to consider as they move into the second half of 2014." [Items include Benefit Plan Definitions of "Spouse" After the Windsor Decision; PCORI Fee; Breast Cancer Medications; Health Plan Identifier Number Requirement; Information Reporting under Code Sections 6055 and 6056; Amendment Deadline for FSA Limits; Health Care Reform Update; more.] (Verrill Dana LLP)  

Benefits Litigation Update, July 2014 (PDF)
18 pages. Article titles include: [1] Recent Supreme Court Decisions Revise Rules for Stock Drop Cases; [2] Hobby Lobby and the Questions Left Unanswered; [3] Post-Amara Landscape Continues to Evolve; [4] Supreme Court to Decide Whether a Failed Class Action May Extend Deadline to Bring Follow-on Claims by Individual Plaintiffs; [5] Supreme Court Indicates That It Will Review 'Tibble'; [6] Challenges Could Threaten Individual Subsidies and Employer Mandate Penalties in States with Federal Exchanges; [7] Supreme Court Accepts Cert. in Retiree Health Vesting Case; [8] Third Circuit Urged to Correct Misapplication of Fiduciary Deference Standard; and [9] Will the Plaintiffs' Bar Ask the Courts to Declare Deferential Judicial Review of ERISA Benefits Denials Unconstitutional? (Epstein Becker Green and The ERISA Industry Committee [ERIC])  

2014 Benefits Strategy and Benchmarking Survey (PDF)
36 pages. Excerpt: "Only 31% of organizations have quantified the cost of healthcare reform.... Increasing employees' plan contributions was the most popular healthcare cost containment strategy in 2014.... Ninety percent (90%) of organizations do not have a written total rewards or strategic benefits plan with measurable objectives.... Sixty-three percent (63%) of employers reported that their benefit expenses account for 20% or more of their total compensation spend.... Email communications were the most popular benefits communication method for employers with 100 or more FTEs." (Arthur J. Gallagher & Co.)  

AnnuityAdvantage Hails New Regulations From Treasury Department Giving Employees More Options for Retirement Income Planning
AnnuityAdvantage

Castle Rock Announces Hiring of Katherine Brown as a Research Associate
Castle Rock Investment Company

Pension Rights Center Launches New 'Roadmap to Retirement'
Pension Rights Center

Version 2.0 of Data Analytics Tool HealthSpective Now Available
Dynamic Health Strategies

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