ERISA Consultant
MassMutual Financial Group
in ANY STATE, AZ, CT, MA

Regulatory Testing Consultant
MassMutual Financial Group
in ANY STATE, AZ, CT, MA, TN

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Law Offices of R. David Danziger
in PA

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The Affordable Care Act: How Applicable Large Employers Should Report Health Care Coverage under IRC Section 6056
August 14, 2014 WEBCAST
(IRS [Internal Revenue Service])

ERISA Developments Affecting Private Equity & Hedge Funds
September 9, 2014 in NY
(New York City Bar Association)

Health and Welfare Benefit Plans
October 9, 2014 in VA
(ABA Joint Committee on Employee Benefits)

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International Foundation of Employee Benefit Plans [IFEBP]

Text of Sixth Circuit Opinion: Michigan Tax on Paid Claims Is Not Pre-Empted by ERISA for Self-Insured Health Plans (PDF)
"SIIA fails to grasp that ERISA guarantees uniformity only with regard to the 'administration of employee benefit plans.' Neither the Act's definition of 'paid claims' nor its reporting and record-keeping requirements conflict with the administrator's 'standard procedures to guide processing of claims and disbursement of benefits.' ... . To the extent that the Act requires reporting and record-keeping, it is only to guarantee that the carriers pay the correct amount of tax.... [S]uch record- keeping requirements accompany all taxes and remain in force despite ERISA." [Self-Insurance Inst. of Am. v. Snyder, No. 12-2264 (6th Cir. Aug. 4, 2014)] (U.S. Court of Appeals for the Sixth Circuit)  

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Electronic Filing Process for HIPAA Opt-outs by State Plans
"Self-funded state or local government plan sponsors may opt out of the Mental Health Parity and Addiction Equity Act, the Newborns' and Mothers' Health Protection Act, the Women's Health and Cancer Rights Act and 'Michelle's Law.' HIPAA's provisions on pre-existing condition exclusions, special enrollment and nondiscrimination were removed from this list by the [ACA].... A complete election consists of the election document, a signed certification and -- unless the filing is for renewal of an existing exemption -- a copy of the required notice to plan enrollees, in Word or .pdf format." (Thompson SmartHR Manager)  

When Does 9.5% Equal 9.56%?
"According to the IRS, premiums have grown more rapidly than incomes. As a result, the 9.5% threshold must be adjusted upward. For 2015, the adjusted percentage will rise to 9.56%. This means that any 'large employer' that is attempting to set employee-only premiums at the maximum level that will still satisfy the 'affordability' standard should be using 9.56%, rather than 9.5%, in its safe-harbor affordability calculations." (Spencer Fane)  

Employer Mandate Implementation on Horizon?
"Although no details were released with these [draft IRS] forms, they may indicate that the administration plans to adhere to previously announced timelines that exempt smaller businesses from the mandate but will require larger companies to offer coverage to at least 95 percent of their employees over the next two years. With only a few months until the requirements will supposedly take effect, businesses are left without much specific guidance or definitive answers but with a lot of guesswork." (HighRoads)  

ACA Calls for Some Workers to Be Automatically Enrolled in Coverage
"Does automatic enrollment help employees help themselves, or does it force them into coverage they don't want and may not need? A group of employers, many of them retail and hospitality businesses, want the provisions repealed, but some experts say the practice has advantages and is consistent with the aims of the health law." (Kaiser Health News)  

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Spending on Mental and Substance Use Disorders Projected to Grow More Slowly Than All Health Spending Through 2020
"[S]pending on mental and substance use disorders, as a share of all health spending, will fall from 7.4 percent in 2009 ($172 billion out of $2.3 trillion) to 6.5 percent in 2020 ($281 billion out of $4.3 trillion).... By 2020 the expansion of coverage to previously uninsured Americans under the [ACA], combined with the projected slowdown in Medicare provider payment rates under the ACA and the Budget Control Act of 2011, are expected to add 2.7 percent to behavioral health spending, compared to spending without these changes." (Health Affairs)  

Out-of-Pocket Premium Analysis, Subsidized vs. Non-Subsidy Consumers (PDF)
"Across all metal levels, the average premium for an individual plan before subsidies were applied was $346 per month. After subsidies were applied, the average premium cost to the consumer was $82 per month.... Among shoppers who used subsidies: More than two-thirds (69%) of individual shoppers selected plans with premiums of $100 or less per month after subsidies were applied; nearly half (46%) had premiums of $50 or less. Among shoppers without subsidies: More than six-in-ten (61%) individual shoppers selected health insurance plans with monthly premiums of $200 or more." (eHealth)  

One Insurer Says Small Employers Are Dumping Health Plans Faster Than Expected
"Already in 2014, WellPoint has watched 218,000 members of its health plans disappear because their employers have ended their group health plans. That's a 12-percent drop in WellPoint's overall small group membership.... WellPoint expects the trend of its small business customers ending their group health plans to play out in just two years, with roughly $400 million in annual profit disappearing." (Indianapolis Business Journal)  

[Opinion]

Unfunded Retiree Healthcare Benefits Are the Elephant in the Room
"The 30 largest American cities had over $100 billion in retiree healthcare deficits in 2013 ... The retiree healthcare deficits of the States were even larger in 2013 -- a total of $528 billion ... At present, only 7 of the 50 States have set aside more than 20% of the assets needed to pay their future healthcare obligations to retirees." (The Brookings Institution)  

[Opinion]

Employer Health Insurance: A Bargain Compared to Government-Sponsored Coverage
"Employer plans' costs aren't just lower -- they've also been rising more slowly. Between 2003 and 2012, employer costs climbed 13.6 percent, after adjusting for inflation, compared with 14 percent for government programs. That difference might seem insignificant. But given that employers spend $579 billion and that government spends more than $1.1 trillion, it translates to billions of dollars." (Sally Pipes, in Forbes)  

[Opinion]

Employer-Based Health Insurance 'Cheaper' Than Government-Sponsored Insurance? Say What?
"[D]oes anyone possessed of a modicum of common sense really believe that the Medicaid population is even vaguely comparable to the population and the services covered by employer-sponsored health insurance? Does anyone sincerely believe that private insurers could cover Medicaid's high risk population for 60% less money than it costs Medicaid?" (Uwe Reinhardt, in Forbes)  

[Opinion]

Medicare Is Not 'Bankrupt' -- Health Reform Has Improved Program's Financing
"The trustees' latest projections are broadly in line with those that the trustees have issued for some time. Since 1970, changes in the law, the economy, and other factors have brought the projected year of Medicare HI insolvency as close as two years away or pushed it as far as 28 years into the future. The latest projection falls near the middle of that spectrum." (Center on Budget and Policy Priorities)  

Did the First Circuit Just Change Its Test for Preemption?
"Historically, courts in the First Circuit have focused on two concepts in deciding whether a state law claim is preempted: [1] whether the state law cause of action seeks to supplement the causes of action available under ERISA itself; and [2] whether the state law claim requires consideration of the ERISA plan to decide the claim or would dictate specific terms or operational procedures for the plan.... [T]he First Circuit [recently] discussed the second concept by, in essence, applying a sliding scale analysis that considered how much impact the state law in question actually had on the ERISA governed plan, finding that too much equals preempted, while too little equals not preempted." [Merit Construction Alliance v. City of Quincy, No. 13-2189 (1st Cir. July 16, 2014)] (Stephen Rosenberg of The McCormack Firm, LLC)  

A Resounding Yes on ASPPA Restructure
ASPPA [American Society of Pension Professionals & Actuaries]

Lockton Expands Employee Benefits Practice in Chicago
Lockton

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