Benefits Manager
East Bay Regional Park District
in CA

Document Compliance Consultant
TIAA CREF
in NC

Director, Client Executive
Transamerica Retirement Solutions
in IA, IL, MI, MN, MO, WI

Retirement Plan Services Manager
Smith Elliott Kearns & Company, LLC
in PA

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Plan Restatement Issues and Design Possibilities
RECORDED
(ASPPA [American Society of Pension Professionals & Actuaries])

Voluntary Fiduciary Correction Program Workshop
RECORDED
(ASPPA [American Society of Pension Professionals & Actuaries])

2014 Affordable Care Act Tax Provisions for Individuals, Families and Small Businesses
RECORDED
(IRS [Internal Revenue Service])

Biometrics: Incorporating Health Risk Assessments and Outcome Based Wellness Incentives Into Your Health Plan
November 10, 2014 WEBCAST
(Lorman Education Services)

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[Official Guidance]

Text of FAQ on Affordable Care Act Implementation, Part XXI: Reference Pricing and Maximum Out-of-Pocket Limitations (PDF)
"Based on comments received, set forth [in this document] is an additional FAQ regarding the [maximum out-of-pocket (MOOP)] requirements. This FAQ addresses only group health plans' and group health insurance issuers' obligations under section 2707(b) of the PHS Act. For non-grandfathered health plans in the individual and small group markets that must provide coverage of the essential health benefit package under section 1302(a) of the Affordable Care Act, additional requirements apply.... Pending issuance of future guidance, for purposes of enforcing the requirements in PHS Act section 2707(b), the Departments will consider all the facts and circumstances when evaluating whether a plan's reference-based pricing design (or similar network design) that treats providers that accept the reference-based price as the only in-network providers and excludes or limits cost-sharing for services rendered by other providers is using a reasonable method to ensure adequate access to quality providers at the reference price, including: [1] Type of service .... [2] Reasonable access .... [3] Quality standards .... [4] Exceptions process .... [5] Disclosure .... The Departments will continue to monitor the use of reference-based pricing and may provide additional guidance in the future[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

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[Guidance Overview]

IRS Draft Instructions on ACA Reporting Help Clarify Requirements for Multiemployer Plans
"[T]he multiemployer plan will report the actual months that the employee was covered under the plan on Form 1095-B, [which] the multiemployer plan (as a provider of minimum essential coverage) must give to its plan participants and file with the IRS.... One of the biggest challenges may be collecting Social Security numbers for covered dependents ... Plan administrators that have not previously requested these numbers should request them twice before the end of 2014 (e.g., once during open enrollment, if any, and once before December 31, 2014) in order to be treated as making a reasonable attempt to collect them." (Segal Consulting)  

[Guidance Overview]

HHS Guidance Recognizes HIPAA Privacy Rights of Same-Sex Spouses and Dependents
"The guidance from HHS clarifies that for purposes of the HIPAA privacy rules, the term 'spouse' includes individuals who are in a legally valid same-sex marriage sanctioned by a state, territory or foreign jurisdiction (as long as a U.S. jurisdiction would also recognize the marriage) whether or not they live or receive services in a jurisdiction that recognizes their marriage. Similarly, the guidance provides that the term 'marriage' includes both same-sex and opposite-sex marriages. Finally, the guidance recognizes that the term 'family member' includes dependents from those marriages." (Benefits Bryan Cave)  

[Guidance Overview]

Changes Coming to Connecticut's Paid Sick Leave Law on January 1, 2015 (PDF)
"Under current law, employees accrue one hour of sick leave for every 40 hours worked during a calendar year. Under the amended law, employers will not be restricted to using the calendar year for accrual purposes.... This change will allow employers to start the paid sick leave benefit year on any date (such as on the employee's anniversary date or the beginning of the employer's fiscal year), and to align the accrual period for paid sick leave with other paid time off policies and timekeeping systems." (Buck Consultants at Xerox)  

Eighth Circuit Finds Health Insurance Costs Could Be Proxy for Age When Employer Laid Off 'Oldest and Sickest'
"Evidence that an employer asked its health insurer for lower rates because it laid off its 'oldest and sickest' employees, that it disciplined an employee for poor performance after she refused to choose Medicare rather than the company health plan, and that she was the only one to have been issued a reprimand and put on probation could suggest that age was the but-for cause of her termination and that her purported performance issues were merely pretext, ruled an Eighth Circuit panel, reversing summary judgment for the employer on her ADEA discrimination and retaliation claims." [Tramp v. Associated Underwriters, Inc., No. 13-2546 (8th Cir. Oct. 7, 2014)] (Wolters Kluwer Law & Business)  

EEOC Tries to Ground HIPAA-Compliant Wellness Programs Through Litigation
"Nothing in the ADA restricts wellness programs to those that are 'voluntary.' To the contrary, the ADA contains a benefit plan safe harbor that limits ADA applicability in the benefit plan context to claims that a plan is used as a subterfuge for disability-based discrimination in non-benefit aspects of employment. The EEOC conveniently ignores this safe harbor." (Seyfarth Shaw LLP)  

Study Finds Savings Low for Employers Who Cap Payments for Certain Treatments
"While the idea, known as 'reference pricing,' does highlight the huge variation in what hospitals and other medical providers charge for the same services ... it does little to lower overall health care spending.... The use of price limits has also drawn concern from consumer groups that it might lead to confusion -- and end up sticking patients with large, unexpected bills if the programs are not clearly explained." (Kaiser Health News)  

CMS Requests Input on Health Plan Innovation Initiatives
"CMS is specifically seeking information on stakeholder experiences with and perspectives on the following Medicare and/or Medicaid product types: Stand-Alone Medicare PDPs; Medigap and Retiree Supplemental health plans; MA and MA Prescription Drug (MA-PD) plans; [and] Medicaid managed care plans The information gathered will help CMS assess whether mechanisms used in the non-Medicare/Medicaid markets to reduce costs, improve quality, and enhance beneficiary satisfaction should be tested in the referenced product types." (Epstein Becker Green)  

What's an Employer to Do About Health Care Coverage and Excise Taxes?
"The [ACA] has led to debates about specific provisions and political wrangling, but relatively little has been written to show employers how to use their own numbers to determine whether it's cheaper to provide coverage or pay the ACA excise taxes for not doing so. This article uses examples, formulas and realistic figures to prepare you to plug in your own numbers to see how some of your company's current and future decisions could affect finances." (Grant Thornton)  

Private Exchanges Already Cover at Least 2.5 Million People
"Fifteen percent of large employers either have adopted or are considering the adoption of a private exchange approach to employee health coverage ... [It] is estimated that at least 2.5 million people already get their health coverage through private exchanges, including approximately 1.7 million group plan enrollees, 700,000 individual Medicare enrollees, and 100,000 individual enrollees, (not including the purely e-broker individual market). Kaiser further predicts that the market is expected to grow." (Wolters Kluwer Law & Business)  

Trends in Employment-Based Health Insurance Coverage: Evidence from the National Compensation Survey
"Although the reasons employers have historically been so central in providing health insurance in the United States are complex, the fact that they do play such a role means that health insurance has important effects on the labor market. Health insurance makes up the biggest share of noncash benefits received by private industry workers, and that share has grown from 32 percent in 1991 to 39 percent in 2012. Not only has it grown in importance among all noncash benefits, but the increase in costs employers pay for health insurance has outstripped the affected workers' wage growth: health insurance paid by employers tripled from 1991 to 2012, while wages paid increased by 83 percent." (U.S. Bureau of Labor Statistics [BLS])  

Health Care Coverage and Premium Tax Credits After 2014 (PDF)
48 presentation slides. Topics include: [1] Updates on beyond the basics; [2] Open enrollment and the coverage landscape post 2014; [3] Eligibility for premium tax credits; and [4] Calculation of premium tax credits. (Center on Budget and Policy Priorities)  

[Opinion]

Text of Letter from House Energy and Commerce Committee to CMS Regarding Medicaid in Massachusetts and Puerto Rico (PDF)
"We believe it an inappropriate use of federal Medicaid funds to temporarily enroll thousands of individuals in Medicaid, especially since CMS knows that many of these individuals are not eligible for Medicaid coverage. Additionally, there are serious questions regarding CMS' legal authority to take such action. We estimate this has cost taxpayers $330 million more than may have been previously reported." (Energy & Commerce Committee, U.S. House of Representatives)  

Employers Must Prepare for Scrutiny as Federal and State Labor Departments Join Together to Fight Employee Misclassification
"[The DOL] has embarked upon a 'Misclassification Initiative' under which it has signed a Memorandum of Understanding (MOU) with the Internal Revenue Service and with numerous state Departments of Labor. These include Alabama, California, Colorado, Connecticut, Hawaii, Illinois, Iowa, Louisiana, Maryland, Massachusetts, Minnesota, Missouri, Montana, New York, Utah, and Washington. Under these agreements, the agencies will work together and share information to reduce the incidence of misclassification, to help reduce the tax gap, and to improve compliance with federal labor laws. The agencies want to level the playing field for law-abiding employers who are finding it increasingly difficult to compete in the marketplace." (Goldberg Segalla)  

Seven Practical Tips for a Less Stressful, More Successful Open Enrollment
"[1] Test and tune the system in advance through pilot groups ... [2] Encourage early enrollment and avoid last-minute traffic jams ... [3] Make it easy for employees to log into the system ... [4] Be prepared to handle end-of-year life events ... [5] Give carriers plenty of time to process your EDI files ... [6] Solicit feedback both during and after open enrollment ... [7] Reduce stress by giving your employees and yourself a break." (bswift)  

Five High-Level Issues to Consider in Shaping Your Organization's Employee Benefit Offerings (PDF)
"[1] There is a 'retirement crisis' in America.... [2] Healthy employees are more productive and less likely to be absent.... [3] Offer benefits programs that appeal to a multigenerational workplace.... [4] Prudent outsourcing can assist plan sponsors manage benefit plans.... [5] Address employee benefits early in corporate transactions." (Epstein Becker Green)  

American Business Owner Optimism Reaches Highest Point in 3 Years
Principal Financial Group

AMA Study Finds WellPoint to be the Largest Health Insurer in Many Local Markets
American Medical Association [AMA]

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