Health & Welfare Plans Newsletter

September 15, 2014

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Webcasts and Conferences

ERISA at 40: Successful Middle Age or Midlife Crisis?
September 17, 2014 WEBCAST
(Morgan Lewis & Bockius LLP)

Transitional Reinsurance Program: Supporting Documentation Job Aid Review and Updating Reinsurance Contribution Filings
September 17, 2014 WEBCAST
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Defined Benefit Plan Update
September 18, 2014 WEBCAST
(IRS [Internal Revenue Service])

5500 Filing: Easier, Faster, No Stress with ASC
September 22, 2014 WEBCAST
(ASC [Actuarial Systems Corporation])

ERISA Audits: What We All Knew but Forgot
September 25, 2014 WEBCAST
(Clear Law Institute)

Employers' Guide to California's New Paid Sick Leave Law
October 9, 2014 WEBCAST
(Ogletree Deakins)

12th Annual Made In America: 2015 Taft-Hartley Benefits Summit
January 19, 2015 in NV
(Financial Research Associates)

8th Annual Opportunities in the DCIO Market
January 22, 2015 in MA
(Financial Research Associates)

View All Webcasts and Conferences



[Official Guidance]

Text of CMS Bulletin 10: Grace Periods Related to Terminations for Non-Payment of Premiums and Enrollment Through the Federally-Facilitated Marketplace Across Benefit Years, Updated September 12, 2014 (PDF)
"[The] revised bulletin is based on the same underlying policy and process as outlined in the initial Bulletin #10, released on July 16, 2014. The updated content adjusts [the CMS] interpretation of when coverage for the 2015 benefit year is a renewal, as opposed to a new enrollment, and includes other minor revisions and examples to make the overall process clearer." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


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[Guidance Overview]

ACA Administrative Simplification Provisions for Health Plans: Time to Apply for an HPID and Prepare for Certification of Compliance
"The level of control a plan has over its own activities determines whether it must apply for its own HPID or whether it might be able to rely on the HPID of another health plan. If the HPID requirement applies, large health plans must obtain one by November 5, 2014, and small health plans must do so by November 5, 2015. In addition, HHS has issued proposed regulations regarding the 'certification of compliance' with HIPAA's electronic transaction standards required by ACA Section 1104(h). Most health plans must file the first of two certifications with HHS by December 31, 2015. While much detail regarding this certification remains to be developed, health plans should begin planning so that they can complete the certification's required testing process when final regulations are issued." (Alston & Bird, LLP)  

[Guidance Overview]

ACA Employer Shared Responsibility Payments and Reporting Requirements Under Code Sections 6055 and 6056
"[E]ven if an employer offers coverage to 70 percent of its FTEs for 2015 and 95 percent of its FTEs for 2016 and beyond, the employer could still be subject to penalties under Section 4980H(b) if the coverage is unaffordable or does not provide minimum value. Also, even if an employer meets the 70/95 percent threshold, it still faces the potential for the $3,000 Section 4980H(b) penalty for every FTE who isn't offered coverage (i.e., the 30/5 percent safe harbor employees) if that employee receives an exchange subsidy for insurance he/she purchases through the Marketplace Exchange." (McDermott Will & Emery)  

Flaw in Federal Software May Allow Employers to Offer Plans Without Hospital Benefits
"The [online minimum-value calculator provided by HHS] appears to allow companies enrolling workers for 2015 to offer inexpensive, substandard medical insurance while avoiding the [ACA's] penalties ... Employer insurance without hospital coverage 'flies in the face of Obamacare,' said Liz Smith, president of employee benefits for Assurance, an Illinois-based insurance brokerage. At the same time, a kind of catch-22 bars workers at these companies from subsidies to buy more comprehensive coverage on their own through online marketplaces." (Kaiser Health News)  

2014 ERISA Welfare Plan Automatic Participant Disclosures Checklist
"[Many employers who] sponsor ERISA welfare benefit plans ... are currently in the throes of planning and preparing their open enrollment process and related participant communications. To assist ... with that process, [here is] an Automatic Participant Disclosures Checklist for use during open enrollment and throughout the plan year." (Bass, Berry & Sims)  

Closely Related Plans Cannot Be Unbundled for ERISA Safe Harbor Exception Analysis
"The bundling of the basic and supplemental benefits was not necessarily the sole deciding factor here -- there were other indications that the two types of coverage were closely related. And there was no suggestion that the employer intended that the supplemental coverage fall within the safe harbor. But the court's decision underscores the importance of not bundling (either intentionally or inadvertently) a voluntary program with employer-sponsored coverage if the voluntary coverage is not intended to be part of the ERISA plan." [Menkes v. Prudential Ins. Co. of America, No. 13-1408 (3d Cir. Aug. 6, 2014)] (Thomson Reuters / EBIA)  

Employers Interested in Offering Voluntary Benefits
"7 in 10 employers offer voluntary benefits to improve morale for their existing employees and to attract and retain new talent.... [E]mployers are generally happy with their voluntary benefits advisors. Six in ten employers feel that agents/brokers/consultants usually or always deliver on their voluntary benefit promises. Only eight percent feel that advisors rarely or never live up to their promises. Advisor satisfaction ranks highest at companies with 20 to 99 employees." (LIMRA)  

Many May Be Confused by Upcoming Notice of Automatic Renewal for Marketplace Plans
"Millions of consumers will soon receive notices from health insurance companies stating that their coverage is being automatically renewed for 2015, along with the financial assistance they received this year from the federal government. But consumer advocates and insurers say they see a significant potential for confusion because some of the information will be out of date and misleading on costs and other aspects of coverage.... Federal officials told insurers this month to send out standard renewal notices written by the government.... In many cases, insurers will notify consumers that they face higher premiums but will not provide them any information about higher subsidies in 2015[.]" (The New York Times; subscription may be required)  

Legislative Actions to Repeal, Defund, or Delay the ACA, Updated September 12, 2014
"This report summarizes legislative actions taken to repeal, defund, delay, or otherwise amend the ACA since the law's enactment.... To help provide context for the information presented in the appendices, the report continues with some background on the core provisions of the ACA. That is followed by an overview of the law's impact on federal spending. This report is updated periodically to reflect legislative and other developments. A companion CRS report summarizes administrative actions taken by CMS and the IRS to delay, extend, or otherwise modify implementation of certain ACA provisions." (Congressional Research Service [CRS])  

The Federal Courts' Role in Implementing the ACA
"All of this litigation has altered, or has the potential to alter, the way in which the ACA is implemented and consequently could affect the achievement of the law's policy goals, such as the number of people who obtain affordable health insurance, and what is required to be included in a health plan. This issue brief examines the federal courts' role to date in interpreting and affecting implementation of the ACA, with a focus on the provisions that seek to expand access to affordable coverage." (Henry J. Kaiser Family Foundation)  

ERISA: The Secret Weapon for Collecting Unpaid Patient Bills (PDF)
"It's a mistake to assume network provider contracts and billing code manuals are controlling for the purpose of getting paid.... It's a mistake to have patient intake forms that fail to assign the provider the patient's legal rights under ERISA.... It's a mistake not to have an ERISA-driven internal claims process.... It's a mistake not consider ERISA as a defense to audits and recoupments.... It's a mistake to rely on consultants to analyze ERISA claims instead of a lawyer." (Nelson Mullins)  

14 Steps for Employers to Prepare for Section 6055 and 6056 Reporting
"First, remember these [forms] are drafts and subject to change before being finalized before year end. Second, if self-funded, determine if you are ready to report on each person to whom you provided minimum essential coverage in 2015 [Section 6055]. And third, if an applicable large employer, assess your readiness to report on your compliance with the Employer Shared Responsibility provisions [Section 6056]." (Findley Davies)  

Recent FMLA Cases Address Rights of Employers to Enforce Medical Leave Policies (PDF)
"The key takeaway from [several recent] cases is that employees do not receive a 'free pass' to violate policies simply because they have requested, are on, or have taken FMLA leave. Rather, employers have a right to expect all employees to comply with established policies, even when the FMLA is implicated in some way with respect to the policy violation at issue. That said, employers should keep in mind [certain] principles when evaluating whether to take action against an FMLA-protected employee who has violated an employment policy[.]" (Bryan Cave LLP)  

City of Chicago Retirees to See 40 Percent Health Insurance Hike
"Last year, [Chicago Mayor Rahm] Emanuel announced plans to save $108.7 million a year by phasing out the city's 55 percent subsidy for retiree health care and forcing retirees to make the switch to Obamacare. For the city, the Year One savings was $25 million. For retirees, that translated into an increase in monthly health insurance premiums in the 20 percent and 30 percent-range. On [September 12], city retirees and their dependents got hit again -- only this time, even harder. The city notified them of a 30-percent to 40-percent increase that will cost most of the retirees between another $300 to $400 a month." (Chicago Sun-Times)  

Companies Cut Back on Dependent Coverage
"Amid growing public concern that an unintended result of the [ACA] might be a broad elimination of corporate-sponsored health benefits, it appears that ... the value of coverage for spouses and dependents is beginning a slow fade. In a recent survey ... 22% of 1,234 responding employers have already reduced their subsidies for covered dependents. The kicker is that an additional 50% expects to cut back over the next five years." (CFO)  

In Employer Health Insurance Costs, Stability Is the New Normal
"Premiums for family policies in the group market grew 72% between 1999 and 2004; 34% between 2004 and 2009; and 26% between 2009 and 2014. Even as premium growth moderated, health insurance costs still outpaced inflation and wage growth. But this year premiums grew 3%, about the same rate as wages and inflation. Despite fears that premiums would rise in the group market because of the [ACA], they have remained stable." (The Wall Street Journal; subscription may be required)  

[Opinion]

Why Do Large Employers Want to Control Their Employees' Health Benefits?
"Large companies believe it is the best bulwark against government-monopoly, single-payer health care. They simply do not see a third option, individually owned health insurance, because it is not widely discussed in the public space.... Larger firms have human resource (HR) bureaucracies within them to manage health benefits. ... Forcing workers to get health benefits through their employers gives large businesses a competitive advantage over smaller rivals, which do not have the same HR capacity." (National Center for Policy Analysis Health Policy Blog)  

[Opinion]

Limiting Choice to Control Health Spending: A Caution
"Seeking to end the rapid rise in health care costs, in the 1990s employers embraced managed care plans -- plans, like health maintenance organizations, that restricted consumers' choices with narrow networks, as well as requirements for preapproval for some forms of treatment.... These cost-saving measures became increasingly unpopular. The backlash was swift and severe. Today's new narrow network plans also restrict choices, so will they suffer the same fate as 1990s managed care?" (Austin Frakt, in The New York Times; subscription may be required)  

Press Releases

Health Policy Briefing Now Archived
National Institute for Health Care Management Foundation

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