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National Retirement Services, Inc.
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DailyAccess Corporation
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RCM&D
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Customer Service - Retirement Services
MassMutual Financial Group
in MA

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Ohio National Financial Services
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Senior Director, Employee Retirement Plans
NYC Health & Hospitals Corp.
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Associated Bank
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ATPA
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Actuarial Consulting Services
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Filing Health Care Reform Forms 1094 and 1095: Line-by-Line Guidance on the IRS Forms and Instructions
October 2, 2014 WEBCAST
(Thomson Reuters / EBIA)

Compensation System Design: Developing Pay Ranges to Maximize Your Payroll Investment
October 16, 2014 WEBCAST
(Clear Law Institute)

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[Official Guidance]

IRS Form 1095-C: Employer-Provided Health Insurance Offer and Coverage (PDF)
Draft updated October 1, 2014. "This Form 1095-C includes information about the health coverage offered to you by your employer. Form 1095-C, Part II, includes information about the coverage, if any, your employer offered to you and your spouse and dependent(s). If you purchased health insurance coverage through the Health Insurance Marketplace and wish to claim the premium tax credit, this information will assist you in determining whether you are eligible." (Internal Revenue Service [IRS])  

[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.

[Official Guidance]

IRS Form 1094-C: Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns (PDF)
Draft form, updated October 1, 2014. (Internal Revenue Service [IRS])  

[Official Guidance]

IRS Form 1095-B: Health Coverage (PDF)
Draft form updated as of October 2, 2014. "This Form 1095-B provides information needed to report on your income tax return that you, your spouse, and individuals you claim as dependents had qualifying health coverage (referred to as 'minimum essential coverage') for some or all months during the year." (Internal Revenue Service [IRS])  

[Official Guidance]

IRS Form 1095-A: Health Insurance Marketplace Statement (PDF)
Draft Updated as of October 1, 2014. "This Form 1095-A provides information you need to complete Form 8962, Premium Tax Credit (PTC)." (Internal Revenue Service [IRS])  

[Guidance Overview]

IRS Reminds Employers Value of 'Free' Parking May Be Taxable Fringe Benefit
"Valuation issues generally arise when employers provide their own parking lots. Whatever the employer charges for parking to the general public is generally the amount the employee would have to pay in an arm's length transaction. If the employer does not offer parking to the general public, the employer must consider the amount surrounding parking facilities charge when determining FMV." (Ogletree Deakins)  

[Guidance Overview]

Changes in Look-Back Measurement Metrics (PDF)
"Many employers are struggling with the complicated rules for determining hours worked and full-time status. A key aspect of the employer mandate is determining which employees should be considered full-time. Employers sometimes offer unique work arrangements in which it can be challenging to determine full-time status." (McGraw Wentworth)  

[Guidance Overview]

IRS Provides Methods for Identifying Full-timers through Job Changes for ACA Reporting
"Notice 2014-49 covers situations such as when an employee transfers from a position (such as hourly) using one measurement period to a position (such as salaried) that uses a different measurement period. It also may happen when variable hour employees move from one position to another that has a measurement period with a different start date. It can happen if an employee moves from one subsidiary to another under the same [applicable large employer (ALE)]. The situation also may arise when the [ALE] changes the measurement period applicable to a position. The approach varies depending on whether the transferring employee is in a measurement, stability, or administrative period." (Thompson SmartHR Manager)  

Federal District Court Finds Insurance Contract's Limitation Provision Is Not Reasonable
"[T]he Southern District of California concluded that application of a limitations provision that provided the claimant with 100 days within which to file a complaint in federal court was not reasonable and thus not enforceable.... If the plan's period calls for a lawsuit to be filed prior to the completion of the administrative review, a Heimeshoff argument becomes more difficult to win. But, if the plan's term expired after the administrative review process, chances of success on a statute of limitations argument increase." [Nelson v. Standard Ins. Co., No. 3cv188-WQH-MDD (S.D. Cal. Aug. 26, 2014)] (Seyfarth Shaw LLP)  

Federal District Court Holds That Plan's One-Year Limitations Period Is Unenforceable Under State Law
"While Heimeshoff gave ERISA plan sponsors, administrators and participants guidance that a three-year benefit limitations period (as written in that particular Plan) is reasonable, before relying on a similar provision in Plan documents, consideration must also be given to what the controlling state law states with respect to policy provisions and whether that law could be considered as one that regulates insurance in such a way to defeat ERISA preemption. Likewise, contractual limitations periods should be reviewed to ensure that they are reasonable (as noted by Heimeshoff), but the particular state law at issue may play a significant role as to whether the contractual period will be controlling." [Halpern v. Blue Cross/Blue Shield of Western New York, 12-CV-407S (W.D.N.Y. Sept. 4, 2014)] (Littler)  

Text of Amicus Brief for AFL-CIO to Supreme Court on Appeal of Sixth Circuit Decision Upholding Lifetime Retiree Health Benefits Under Collective Bargaining Agreement (PDF) (PDF)
"The interpretative rule advocated by the Company is contrary to both traditional contract law and to federal labor policy. The Company's rule would impose a particular result with regard to the duration of a retiree health insurance provision regardless of the parties' demonstrated mutual understanding as to the provision's duration.... [T]he 'clear statement rule' advanced by the Company -- requiring a clear, express contractual statement that retiree health insurance coverage continues in force after the general expiration date of the collective bargaining agreement -- would present an unacceptable risk of defeating the parties' mutual understanding of their agreement and is thus contrary to both the accepted principles of traditional contract law and the basic policy of national labor legislation." [M&G Polymers USA, LLC v. Tackett, No. 13-1010 (on appeal from 6th Cir., cert. granted May 5, 2014)] (American Federation of Labor and Congress of Industrial Organizations [AFL-CIO])  

EEOC Challenges the Design of Another Employer's Wellness Program under the ADA
"The EEOC contends that the biometric testing and health risk assessment constituted 'disability-related inquiries and medical examinations' that were not job-related and consistent with business necessity as defined by the Americans With Disabilities Act (ADA). These alleged actions and severe consequences for not providing prohibited information as part of its 'wellness program' violate Title I of the ADA, which prohibits disability discrimination in employment, including making disability-related inquiries." [EEOC v. Flambeau, Inc., No. 3:13-cv-00638 (W.D. Wash. filed Oct. 1, 2014)] (U.S. Equal Employment Opportunity Commission [EEOC])  

Don't Be Tripped Up by Light Duty Obligations Under the FMLA and ADA: A Discussion of Employer Best Practices
"When an employee seeks FMLA leave, an employer can offer a light duty assignment as an alternative (to keep the employee working), but the employee has the right to take FMLA leave instead. The right take FMLA leave is absolute ... In its July 2014 guidance on pregnancy discrimination, the EEOC takes the position (for the first time) that the Pregnancy Discrimination Act (PDA) requires employers to offer temporary light duty assignments to pregnant employees with work restrictions if the employer provides the same accommodation to non-pregnant employees who have similar work restrictions. The EEOC's guidance is groundbreaking, and its impact will affect the manner in which employers provide accommodations to their employees." (FMLA Insights)  

Walgreens Raises Wellness Ante
"WebMD and Walgreens are partnering to launch a series of new products and services aimed at what might be called the consumer wellness market, with the broad and difficult goal of incentivizing consumers 'to make healthier choices at home, work and on-the-go.' The two companies are bringing WebMD's virtual wellness and coaching programs to the nearly 6 million Americans who shop at some 8,000 Walgreens stores each day, and perhaps more. Walgreens is going to incorporate and co-brand WebMD content into its digital and mobile commerce platforms, while WebMD intends to offer visitors to its website -- like individuals Googling their symptoms -- Walgreens prescription refill and clinic appointment scheduling." (Healthcare Payer News)  

The Impact of the ACA on Employment Strategies (PDF)
"78% of the respondents indicated that their health insurance costs have risen (by an average of 7.73%) and 37% reported that their labor costs have increased (by an average of 5.6%) as a direct consequence of the PPACA. Companies have sought to mitigate the increased cost by pushing cost and responsibility to employees, as 73% have moved or will move employees to Consumer Directed Health Plans and 71% have raised or will raise employee contributions toward health insurance. In addition ... 30% of firms have or will move their pre-65 retirees to ACA exchanges, have or will cut back coverage eligibility (27%), have or will more rigorously ensure part-time workers work fewer than 30 hours per week (24%)[.]" (University of South Carolina Darla Moore School of Business)  

2015 Health Plan Cost Trend Survey
"Medical health plan trends for actives and retirees under age 65 are forecast to vary widely for 2015, from a low of 6.2 percent for health maintenance organizations (HMOs) to a high of 10.4 percent for fee-for-service coverage. More closely managed medical plans, like HMOs and preferred provider organizations (PPOs)/point-of-service (POS) plans with primary care gatekeeper models, are forecast to see a 1 percentage-point drop from 2014 projections. Projected 2015 trend rates for PPOs and POS plans combined show regional variations." (Segal Consulting)  

Next Big Bailout May Go to Obamacare Health Insurers
"[I]nsurance experts warn that this program creates the same moral hazard problem for health insurance that we saw in the mortgage market with Fannie Mae and Freddie Mac. The guarantee on bad mortgages encouraged bad mortgages. The guarantee against losses on ObamaCare enrollees encourages insurers to toss sound underwriting standards out the window. This didn't turn out so well with Fannie and Freddie, which received a taxpayer-funded bailout of more than $180 billion after issuing subprime mortgages that should have never been issued." (Investor's Business Daily)  

The Risk Corridor Funding Paradox
"HHS may not get the appropriations for risk corridor payments in fiscal year 2015 -- when the agency intends to administer this year's profit-loss sharing -- and yet the payments have still been signed into contract with private insurers. While this year's budget authorized and allocated monies for the program, HHS intended to both collect and distribute risk corridor funds for fiscal year 2014 in FY 2015. According to the GAO, though, federal law prohibits HHS from using FY 2014 appropriations in FY 2015." (Healthcare Payer News)  

Eastward Ho! More Pioneer ACOs Turn Their Wagons Around
"Providers are quitting for three main reasons: they're losing money, they're unhappy with [CMS's Medicare Pioneer ACO program] design, and they have a lot more ACO control playing locally than federally.... Providers also cite benchmarks and formulas that don't reflect the unique dynamics of their markets or their patient case mix." (HealthLeaders InterStudy)  

California Law Bolsters National Effort to Give Workers Paid Sick Leave
"The California law ... requires large and small employers to provide at least three days paid sick leave annually to employees who work 30 or more days a year.... When it takes effect in July, it's expected to affect 6.5 million workers. Other locations that require paid sick leave include Connecticut as well as San Francisco, Washington, D.C., Seattle, New York City, Portland, Ore., and Newark, N.J., according to the National Partnership for Women and Families. In addition, voters in Massachusetts, Montclair and Trenton, N.J., and Oakland, Calif., will consider ballot measures this fall requiring paid sick leave[.]" (Kaiser Health News)  

UnitedHealth's Latest Blow to Fee-For-Service Medicine: 6 Percent Off Doctor Costs
"United Healthcare's medical home programs in four states shows average third year net savings of 6.2 percent of medical costs, resulting in a return on investment of 6 to 1, largely due to payment model that rewards value ... UnitedHealth earlier this year said it expects its 'accountable care' contracts to total $65 billion by the end of 2018 from $30 billion today.... Blue Cross and Blue Shield plans said they are spending more than $65 billion annually, or about 20 percent of the medical claim dollars they pay on 'value-based' care." (Forbes)  

More Insurance Plans That Don't Meet Obamacare Standards Are Being Discontinued
"Cancellations are in the mail to customers from Texas to Alaska in markets where insurers say the policies no longer make business sense. In some states, such as Maryland and Virginia, rules call for the plans' discontinuations, but in many, federal rules allow the policies to continue into 2017." (The Daily Signal)  

[Opinion]

Revolution or Reform: How the Health System Is Changing
"We have laid the foundation for reducing the number of uninsured from more than 1 out of 7 people to something likely to approach 1 out of 15. We have constructed a health coverage system that very substantially builds on an individual private health market system and on public programs, combined with tax credit premium subsidies for moderate-income families -- which make health coverage much more means-sensitive and progressive. The health insurance system is much more regulated than before -- to the benefit of those who are most in need of health care. And we have initiated the first rudimentary steps for a higher-quality, more value-based health system." (Families USA)  

Ethical and Professional Conduct in an 'Experiment in Anarchy'
"The digital world offers revolutionary means to communicate, store and share data. But using it in a responsible and ethical manner is as important as it is challenging, [according to] Lauren Bloom, an expert on professional ethics and risk management ... She noted that while it offers many advantages, using electronic tools is not a panacea and outlined the challenges professionals face in using them[.]" (American Society of Pension Professionals & Actuaries [ASPPA])  

[Opinion]

ERISA at 40: A Time for Reflection and a Time for Action (PDF)
"Congress's willingness to frequently consider retirement legislation in the absence of a national policy against which such legislation might be measured, demonstrates that we in the benefits community have not yet done a sufficiently good job cultivating retirement policy champions. The challenge ahead is for all who support a robust employer-sponsored benefits system to engage in a thoughtful dialogue with members of Congress from both parties. To enlist a larger group of policy champions who will be effective -- regardless of the particular agenda they may wish to advocate -- will require convincing future political leaders that it is worthwhile to learn the intricacies of ERISA." (American Benefits Council, via Bloomberg BNA Pension & Benefits Reporter)  

Spotlite’s Seven Strategies for Improving Engagement during Open Enrollment
Spotlite

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