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Employee Benefits Jobs
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Webcasts and Conferences
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[Official Guidance]
Text of CMS Proposed Federal Funding Methodology for Basic Health Program, for Program Year 2016
"This document provides the methodology and data sources necessary to determine federal payment amounts made in program year 2016 to states that elect to establish a Basic Health Program [BHP] under the [ACA] to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through Affordable Insurance Exchanges.... We propose that the total federal BHP payment amount would be based on multiple 'rate cells' in each state. Each 'rate cell' would represent a unique combination of age range, geographic area, coverage category ... household size, and income range as a percentage of [federal poverty level].... [We] would develop BHP payment rates that would be consistent with those states' rules on age rating. Thus, in the case of a state that does not use age as a rating factor on the Exchange, the BHP payment rates would not vary by age."
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)
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[Guidance Overview]
What's an Employer to Do with Marketplace Notices?
"Some employers may get hundreds, even thousands, of Section 1411 Certifications, many of which may relate to variable hour employees who have not yet reached (and may not ever reach) full-time status.... While the reporting rules are designed to recognize these employees for purposes of the assessable payment calculations, the process may not work perfectly. Thankfully, an employer may wait until the IRS contacts them to inform them of their potential liability to explain why a tax is not owed with respect to one or more employees. Thus, an employer may -- but is not obligated to -- appeal each and every Section 1411 Certification as it is received. Or, to put it another way, the employer is not prejudiced for failing to engage in the initial appeals process under Code Section 36B."
(Mintz Levin)
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[Guidance Overview]
Understanding the Qualified Health Plan Federal Exchange Participation Agreement
"The agreement expressly recognizes that QHP insurers have developed their products based on the assumption that advance premium tax credits and cost-sharing reduction payments will be available through the marketplace and that QHP insurers could have cause to terminate the agreement if this assumption ceases to be valid. This could be interpreted as a reference to the Halbig/King litigation which currently threatens the availability of tax credits and cost-sharing reduction payments through the FFE, but could also have been included in recognition of the likely Republican takeover of the Senate and the possibility that the Republicans may accomplish through budget reconciliation or
otherwise their longstanding goal of repealing the ACA."
(Health Affairs)
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[Guidance Overview]
New California Paid Sick Leave Law May Cause Headaches for Employers
"The new law requires any employer -- however large or small -- to provide most of their employees with at least three paid sick days. The law provides any employee who works at least 30 days in California within his or her first year of employment with paid sick leave, regardless of whether the employer is located in California or where the employee resides. While there are exceptions to the new law, the exceptions are very narrow."
(Ford & Harrison LLP)
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District Court Determines that Employer's FMLA Notice Sent by Email is Not Reliable
"[T]he court noted that the FMLA regulations only require that the employer provide the employee oral notice of the need to provide recertification. The court apparently found this method to be the most desirable, since it guarantees person-to-person communication. (Of course, the court glosses over the fact that this method sets up a he-said/she-said situation virtually every time.) As to FMLA notice sent by email, the court framed it up this way: ... 'The transmitting of an email, in the absence of any proof that the email had been opened and actually received, can only amount to proof of constructive notice.' And with that quick stroke, the court refused to dismiss [the employee's] FMLA claims." [Gardner
v. Detroit Entertainment, LLC dba MotorCity Casino, No. 12-14870 (E.D. Mich. Oct. 15, 2014)]
(FMLA Insights)
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Few Self-Insured Plans Will Avoid Paying ACA Reinsurance Fee
"[S]elf-insured plans will lose the exemption if the plan uses a TPA for even one of four core claim-paying and adjudication functions. These include: [1] repricing claims; [2] sending out explanations of benefits; [3] cutting checks for providers; and [4] negotiating provider discounts. Nov. 15 is the deadline for submitting information and scheduling payments for the fee. The payments are not due on Nov. 15, but employers must upload their information by that date."
(Thompson SmartHR Manager)
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Ebola and the FMLA
"[W]hat about the employee who is exposed or potentially exposed to Ebola, and, as a result, is requested or required -- or even just volunteers, based on potential exposure -- to be in quarantine? And what about employees who have not been exposed but who are fearful of contracting Ebola in the workplace and refuse to come to work?"
(Benefits Bryan Cave)
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71% of Obamacare Signups Traced to Expansion of Medicaid
"In the states that adopted and implemented Medicaid expansion under Obamacare, enrollment skyrocketed as an additional 5.7 million Americans signed up for coverage. In 21 states opting out of Medicaid expansion, however, enrollment was strikingly lower.... 355,674 Americans signed up for Medicaid in those states. In all, Medicaid enrollment increased by 6 million individuals for the first half of 2014."
(Melissa Quinn, in The Daily Signal)
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How the Supreme Court Could Still Wreak Havoc on Obamacare
"If you have Obamacare without the subsidies, it would essentially wreak major havoc on the individual insurance market ... Premiums would be 43.3 percent higher on average in the individual market in 2015, while enrollment -- on and off the exchanges -- would drop by 68 percent ... In all, 11.3 million fewer Americans would have health insurance[.]"
(The Washington Post; subscription may be required)
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Benefits in General; Executive Compensation
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Press Releases
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