Pension Consultant
Oneida Savings Bank [Pension Admin. Division]
in NY

Customer Care Specialist
Concordia Plan Services, The Lutheran Church--Missouri Synod
in MO

Director, Marketing
Transamerica Retirement Solutions
in ANY STATE

Plan Consultant
TPA firm in Stamford CT
in CT

Defined Benefit Administrator
Growing TPA Firm in Suffolk County, New York
in NY

Investment-Qualified Relationship Manager and Administrator
NestEggs, Inc.
in FL

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Importance of Operating Controls for Employee Benefit Plans
August 20, 2014 WEBCAST
(McGladrey LLP)

Implementing VM-20: A Practical Approach Seminar
August 27, 2014 in NY
(Society of Actuaries)

ERISA Turns 40: The Past, Current and Future State of Pension Plans
September 9, 2014 WEBCAST
(ABA Joint Committee on Employee Benefits)

Fiduciary Training Mini-Conference
September 18, 2014 in FL
(PSCA [Plan Sponsor Council of America])

View All Webcasts and Conferences

[Guidance Overview]

IRS Adjusts Coverage Affordability Percentage for Tax Credit
"Plan sponsors should be aware that the adjustment of the contribution percentage under the Rev. Proc. is limited to the Tax Credit; it does not necessarily apply to the affordability safe harbors for plan sponsors as provided by the final 'play-or-pay' regulations under the [ACA], which specifically reference a contribution percentage of 9.5 percent as applied to W-2 wages, the employee's rate of pay, or the federal poverty line. Pending any reconciliation of this issue by the IRS, plan sponsors that intend to rely on the play-or-pay safe harbors should continue to apply the 9.5 percent percentage when measuring the affordability of coverage." (Haynes and Boone, LLP)  

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District Court Finds Verbal COBRA Notice Sufficient (PDF)
"The purpose of the notice and the COBRA right to continue coverage is to allow a discharged employee to continue coverage under a group policy for a period of time which is generally cheaper than an individual policy and provides continuous coverage where some preexisting condition (such as Plaintiff's esophageal cancer) would make obtaining new coverage difficult, expensive, and probably impossible.... [T]he statute does not specify the form the notice must take. Here, the Defendants verbally notified Plaintiff of her right to continue coverage at the time she was discharged which kept her as an insured under the company's policy by accepting her premium payments. Therefore, the notice was adequate." [Madonia v. S 37 Management, Inc., No. 14-C-678 (N.D. Ill. Aug. 14, 2014)] (U.S. District Court for the Northern District of Illinois)  

Hospitals and Insurers Fighting Over Whether to Allow Hospital Payment of ACA Plans for Large Claimants
"Some hospitals in New York, Florida and Wisconsin are exploring ways to help individuals and families pay their share of the costs of government-subsidized policies purchased though the health law's marketplaces -- at least partly to guarantee the hospitals get paid when the consumers seek care. But the hospitals' efforts have set up a conflict with insurers, who worry that premium assistance programs will skew their enrollee pools by expanding the number of sicker people who need more services." (Benefit Revolution)  

Early 2014 Stakeholder Experiences with Small-Business Marketplaces in Eight States
"Sources reported that there is a tremendous lack of awareness of the SHOP at the most basic level within the small-employer community, and that many of those who are aware of it do not understand its function or role in the market.... [D]eveloping an accurate, convincing description of the added value of SHOP has been challenging because of limitations of the reach of the small business tax credit, early renewals, extensions of non-ACA compliant plans, and other issues." (Robert Wood Johnson Foundation)  

Large Employers Trimming Healthcare Spending
"Big companies are taking a broad range of actions to cut spending on employee healthcare benefits. That means higher costs for workers, a push for more consumer engagement, and greater use of telemedicine." (HealthLeaders Media)  

Pharmacies Turn Drugs Into Profits, Pitting Insurers vs. Compounders
"It may be the biggest thing in diaper rash treatment, a custom-made product to soothe a baby's bottom at the eye-popping price of $1,600.... Does it work better than the common treatments? There is little evidence either way. But the sky-high prices commanded by such compounded medicines are drawing the ire of health insurance companies that must pick up the bill. They say the industry is profiteering at their expense." (The New York Times; subscription may be required)  

$10 or $10,169? Wide Variation in Hospital Charges for Blood Tests Called 'Irrational'
"One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test charged $10,169 -- over 1,000 times more. For another common blood test called a basic metabolic panel, the average hospital charge was $371, but prices ranged from a low of $35 to a high of $7,303, more than 200 times more.... Researchers said their analysis found no rational explanation for the stark variation in listed prices, though teaching hospitals and government hospitals generally set lower charges than other facilities." (Kaiser Health News)  

When It Comes to an FMLA Notice, the Post Office May Not Deliver for You in the Third Circuit
"Ignoring the practical reality that many employees who go out on FMLA leave are not available to meet in person to receive the required written notification of rights under the FMLA, the court has essentially created the extra burden -- one it deems 'negligible' -- of requiring some form of tracking or certification of delivery of FMLA notices for employers to obtain summary judgment. Under this new precedent, an employer's motion for summary judgment on the issue of notice will likely always be denied if an employee simply denies receiving the letter." [Lupyan v. Corinthian Colleges Inc., No. 13-1843 (3d Cir. Aug. 5, 2014)] (Littler)  

Rising Tide of FMLA Claims Unlikely to Recede
"[I]ntermittent leave can present a daunting administrative challenge for employers, as longer periods of absence are easier to keep track of, management-side lawyers say, adding that more leave requests translates to more chances for an inadvertent compliance failure.... The relative ease with which a worker can prove an FMLA claim -- as opposed to a Title VII bias claim -- and the possibility of recovering attorneys' fees under the FMLA have helped make the statute increasingly popular with the plaintiffs bar[.]" (Law360 via Mintz Levin)  

ACA Employer Penalties: Another Reason to Make Sure Workers Are Properly Classified as Employees or Independent Contractors
"The amount of penalties to which an applicable large employer is vulnerable also depends substantially on the number of fulltime employees it has and how many of those employees obtain subsidized Exchange coverage.... Many employers have workers who perform services under individual or third party contract arrangements (written or otherwise).... They may or may not be on the employer's payroll. They may or may not receive a Form W-2 from the employer. They may or may not be offered coverage under the employer's benefit plans. And they may or may not be employees." (Jackson Lewis)  

Wal-Mart Wants to Be Your Doctor
"Wal-Mart's decision to have these clinics act as a primary care provider is notable because of the company's footprint in rural areas, where access to care can be a major challenge. It's also an area that retail clinics historically haven't been in.... As millions more low- and middle-income people gain insurance under the [ACA], retail clinics can appeal to especially cost-conscious consumers looking for basic health-care services." (The Washington Post; subscription may be required)  

Four Key Takeaways from the Medicare Trustees' Report
"[1] For the second year in a row, per person costs in Medicare were essentially flat.... [2] Long-range projections are fraught with uncertainty.... [3] If you look at the first 20 years of the forecast, there is positive news.... [4] The report was noteworthy for having a more realistic perspective on physician payments." (Health Affairs)  

College Student-Athletes Tell NCAA to Share the Wealth: Potential Tax Implications
"Section 117 of the Internal Revenue Code provides an exclusion for certain qualified scholarships for individuals who are candidates for a degree at an educational institution, provided that the amount received does not represent payment for 'other services' required as a condition for receiving the qualified scholarship. The IRS has ruled that athletic scholarships are not considered payments for 'other services,' and are excludible from gross income. Therefore, if the stipend payments were characterized similarly to an athletic scholarship, the student-athletes would not recognize income upon the disbursement of trust funds to pay for educational expenses.... The stipend payment, on the other hand, is compensation, not for the benefit of a student's intellectual advancement, but for the licensed use of a student-athlete's name, image, and likeness. Therefore, if the stipend is characterized as compensation for services, then it cannot be excluded from income as a qualified scholarship." (Bloomberg BNA)  

[Opinion]

New Jersey Bill Would Harm Smaller Employers' Health Care Plans
"If the [New Jersey] Legislature is serious about preserving employer-sponsored health care for workers and their families, it should amend the state's 10-year old MEWA law and permit employers to choose the plans that best meet their needs and bear the risk that they can afford.... [A] bill improvidently passed by the Assembly and now in the Senate would require MEWAs to be regulated as insurance companies. This is a mistake, considering that MEWAs already provide coverage for most state-mandated benefits, including hearing aids, mental health services and autism benefits." (NJ.com)  

Text of First Circuit Opinion: Claimant Entitled to Attorney's Fees Because Procedural Victory Increased Likelihood of Successful Benefit Claim (PDF)
"[A] remand for a second look at the merits of her benefits application is often the best outcome that a claimant can reasonably hope to achieve from the courts.... [T]he question in each case is whether the claimant has achieved something more than trivial or procedural success. When an ERISA beneficiary has earned a second look at her claim based on a deficient first review, her success can be equally consequential whether or not the identified flaw is explicitly linked by the remanding court to a statute or regulation[.]" [Gross v. Sun Life Assurance Co. of Canada, No. 12-1175 (1st Cir. Aug. 14, 2014)] (U.S. Court of Appeals for the First Circuit)  

ISS Launches New Data Verification Portal Allowing Companies to Check Their Equity Plan Data
"The noble goal is to ensure that ISS' proxy analyses will better reflect the latest and most accurate data for each company receiving a proxy recommendation.... ISS is encouraging affected companies to register to receive notification of the availability of their data. Upon notification by ISS, companies will have two business days to verify the data and/or request modifications." (Winston & Strawn LLP)