Health & Welfare Plans Newsletter

November 5, 2014

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Employee Benefits Jobs

Relationship Manager / Retirement Plans Consultant / Financial Advisor
Plexus Financial Services / The Plexus Groupe LLC
in IL

Data Entry/Clerical Assistant
DF Pensions, Inc.
in FL

Internal Wholesaler
Aspire Financial Services LLC
in CO, FL

Pension Administrator
GF Pension Corp.
in PA

Plan Administrator
Professional Capital Services
in PA

401(k) Administrator
Pollard & Associates, Inc.
in MD

Compliance Manager
General Board of Pension and Health Benefits
in IL

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Webcasts and Conferences

Plan Sponsor Basics: Issues for 401(k) Plan Sponsors with Employer Stock Investment Funds
RECORDED
(Morgan Lewis & Bockius LLP)

Dealing with RMDs: How to Make the Most Out of Required Minimum Distributions
November 19, 2014 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

Global Equity Training Series (GETS) - Globally Mobile Employees
November 19, 2014 in CA
(Baker & McKenzie)

Worksite Wellness: Moving Beyond the Physical Dimension
November 20, 2014 WEBCAST
(International Foundation of Employee Benefit Plans [IFEBP])

View All Webcasts and Conferences



[Guidance Overview]

'Minimum Value' Plans Must Have Hospital and Physician Coverage
"If an employer has entered into a binding written commitment to offer, or has already begun enrolling employees in, a non-hospital/non-physician plan for a plan year that begins no later than March 1, 2015, the employer will not be penalized if the plan is otherwise legal.... Employers that offer only such coverage may not state or imply in any disclosure to employees that such a plan precludes an otherwise eligible employee from receiving premium tax credits. Employers who have already made disclosures stating or implying this must correct such disclosures in a timely fashion." (Health Affairs)  


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[Guidance Overview]

Earned Sick Leave Becomes Law in Massachusetts
"Effective July 1, 2015, employers with more than 10 employees will be required to allow all employees who work in Massachusetts to accrue and use up to 40 hours of paid sick leave per calendar year. Employers with 10 or fewer employees will be required to allow their employees to earn and use up to 40 hours of unpaid sick leave. However, employers that already provide their employees paid time off under a paid time off, vacation, or other paid leave policy are not required to provide any additional paid sick time under this law, provided they permit employees to use at least 40 hours per calendar year for the purposes covered under the law." (Fisher & Phillips LLP)  

[Guidance Overview]

Notice 2014-55 and 2015 COLA Bring New Rules for Cafeteria Plans
"Employers with non-calendar-year plan years may be particularly interested in the new change in status rules. When an employer has a non-calendar-year plan, the plan open enrollment may not align with the Marketplace open enrollment period. Without a change to the employer's cafeteria plan rules, employees who prefer to enroll in a Marketplace plan (instead of the employer's plan) might have to remain uninsured for some period of time (which could trigger an individual mandate penalty) or pay simultaneously for both types of coverage." (Segal Consulting)  

[Guidance Overview]

HHS Issues HPID Non-Enforcement Policy (PDF)
"In a letter to HHS dated September 23, 2014, NCVHS [had] summarized findings from an industry hearing regarding the HPID, noting: [1]  the lack of a clear business need and purpose for using the HPID; [2] confusion about how the HPID would be used in standard transactions; [3] the utility of an HPID for a group health plan that does not conduct HIPAA standard transactions; and [4] the costs to health plans, clearinghouses and providers if software has to be modified to account for the HPID.... If a health plan has obtained an HPID, it should maintain a record of the HPID that has been assigned to the health plan and document the plans it considers 'controlling health plans' and 'sub-health plans.' " (Groom Law Group)  

[Guidance Overview]

Student Employees Under the ACA's Employer Mandate
"Although many laws provide broad exemptions for student employees, only students in federal work-study or similar programs will be exempt from the employer mandate. As a result, colleges and universities will need to address a number of issues, including: [1] How to determine whether a student employee works full-time; [2] Whether to offer employer-sponsored group health coverage to student employees and how to structure and price that coverage; [3] How to take advantage of transitional rules that apply for 2015; [and] [4] How to comply with applicable reporting requirements." (Ballard Spahr LLP)  


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Text of DOL 2014 Annual Report on Self-Insured Group Health Plans (PDF)
"[The ACA] requires the Secretary of Labor to provide Congress with an annual report containing general information on self-insured employee health benefit plans and financial information regarding employers that sponsor such plans.... Appendix A, Group Health Plans Report: Abstract of 2011 Form 5500 Annual Reports Reflecting Statistical Year Filings, provides detailed statistics describing group health plans that file a Form 5500. Appendix B, Self-Insured Health Benefit Plans 2014: Reflecting 2011 Statistical Year Filings, presents a study that explores statistical issues associated with Form 5500 health plan data and analyzes available data on the financial status of employers that sponsor group health plans filing the Form 5500.... Self-insured plans covered approximately 31 million participants in 2011 and held assets totaling about $63 billion." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

EEOC's Third Wellness Lawsuit Focuses on ADA and GINA
"Unlike the previous two lawsuits the EEOC filed against employers' wellness plans, which focused solely on ADA violations, the suit against Honeywell alleges both the ADA and GINA had been violated.... Specifically, according to the EEOC, by imposing a penalty on the employee if the his or her spouse does not participate in the program's biometric screening -- a screening which information related to conditions such as the spouse's hypertension and diabetes -- Honeywell's program is providing a financial inducement to obtain genetic information[.]" (HR Benefits Alert)  

Obama Administration Closing Health Law Loophole for Plans Without Hospitalization
"Responding to industry pleas, the administration agreed to allow those plans for a year if employers committed to them before Nov. 4.... While they lack hospital coverage, low-cost plans that pass the calculator are rich in outpatient benefits such as physician visits. Consultants and employers argue that such insurance is more useful to low-pay workers than the alternative -- coverage with hospitalization that comes with a $5,000 deductible[.]" (Kaiser Health News)  

HPID Requirement Update: A Treat, Without a Trick
"The delay makes sense and is a welcome relief. The NCVHS findings -- from May, June and September of this year -- are essentially that the HPID requirement is unnecessary and that the HPID will not be used for HIPAA standard transactions. The HPID may still be used for other purposes, but this is speculative. Unless CMS finds that there really are other justifications for an HPID, we may have just witnessed the end of the HPID requirement." (Quarles & Brady LLP)  

Californians Vote Against Insurance Commissioner Regulating Health Insurance Costs
"Proposition 45 fell to the 'no' voters, who decided against granting the state commissioner the right to cap insurance costs. The ballot measure also would have required insurance companies to justify any price hikes." (KPBS)  

The Concentration of Health Care Expenditures and Related Expenses for Costly Medical Conditions, 2012 (PDF)
"In 2009, 1 percent of the population accounted for 22.7 percent of total health care expenditures and 5 percent of the population accounted for 50 percent of overall health care spending. The bottom half of the expenditure distribution accounted for only 2.7 percent of spending in 2012.... The top 5 percent of the population based on their health care expenditures also accounted for a large component of the health care expenditures associated with the treatment of the 5 highest cost medical conditions. They incurred about three-quarters of the overall expenditures for the treatment of heart disease and cancer, and ranged from 40 to 60 percent of total expenditures for treatment of trauma-related disorders, mental disorders, and asthma." (U.S. Agency for Healthcare Research and Quality)  

Payers Call for Greater PBM Transparency
"[Witnesses at a November 3 meeting of the ERISA Advisory Council] relayed how the lack of transparency on the part of PBMs have limited their access to data necessary in determining if they are getting the best value from their plan. Many noted that even employing a PBM consultant when initially selecting a PBM may not be of much assistance since many consultants have existing relationships with certain PBMs which they in turn recommend to their clients." (National Community Pharmacists Association [NCPA])  

Why One Insurer Sees a Growing Market for Small-Business Health Insurance
"Blue Directions ... takes inspiration from an obscure provision of the [ACA] regulations that require insurers to make coverage available to any individual or small group that wants it.... Because workers will be able to pay their health premiums with pretax wages, the employees may find the Blue Directions plans less expensive than buying in the individual market, even if their employers can't afford to contribute anything to the purchase." (The New York Times; free registration required)  

Benefits in General; Executive Compensation

Might Shareholders Demand Broader Clawbacks Than Those Mandated by Dodd-Frank?
"Recently, some commentators have suggested that, because Dodd-Frank would require a clawback upon a material financial restatement, the only compensation that would be clawed back would be that tied to Generally Accepted Accounting Principles (GAAP) financial metrics.... Inversely, a performance metric tied to something not GAAP-related -- for example, one based on nonfinancial performance or even one that might feed into a GAAP metric -- would be exempt from the clawback. This possible interpretation raises obvious questions about whether companies might adopt plan metrics that would not subject incentives to a Dodd-Frank clawback. It also raises the question of whether certain incentive plan designs that are currently in vogue -- specifically, relative total shareholder return (TSR) plans -- would be subject to Dodd-Frank clawbacks." (Towers Watson)  

Press Releases

Pension Consultants Expands Out of Midwest
Pension Consultants, Inc.

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