Senior Retirement Plan Administrator
Third Party Administrator Firm
in FL

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[Guidance Overview]

PPOs and Other Non-HMO Products Now Require Approval and Periodic Reviews of Network Adequacy in New York
"The New York Legislature recently enacted legislation that will require all health insurance plans that issue policies that provide for the use of a provider network to obtain network adequacy certification.... The standard for network adequacy is described as whether the network is sufficient to meet the health needs of the insureds and provide an appropriate choice of providers sufficient to render the services covered under the policy or contract." (Epstein Becker Green)  

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Employers Can No Longer Reimburse the Cost of Employee Individual Health Policies on an After-Tax Basis
"For decades, employers have had a considerable amount of flexibility in helping their employees obtain coverage under individual health insurance plans. Unfortunately, this flexibility is gone, and employers who are unaware of the changes are potentially exposed to a Draconian penalty ... The employers can give the employees a general increase in their compensation, but only the increase is not contingent upon the obtaining or maintenance of individual health coverage. It would ... behoove the employer in this situation to leave a very clear record that the compensation increase is in no way conditional upon the health coverage." (Baker Newman Noyes)  

Millennials More Receptive Than Other Generations to Wellness Outreach
"More than half (52 percent) of Millennials said 'living or working in a healthy environment' is influential to their personal health, compared to 42 percent of Generation X and 35 percent of Baby Boomers. Millennials were also more open to having their direct manager play an active role in encouraging them to get and stay healthy (53 percent), compared to 47 percent of Generation X and 41 percent of Baby Boomers, and are most likely to participate in an employee assistance program (16 percent) compared to Generation X (10 percent) and Baby Boomers (8 percent)." (Society for Human Resource Management [SHRM])  

Premium and Deductible Cost Growth Slowed Post-ACA, But Employer Health Insurance Still Claiming Bigger Share of Workers' Income
"Premiums for employer-sponsored health insurance grew 4.1 percent per year between 2010 and 2013, following passage of the [ACA], compared to 5.1 percent per year between 2003 and 2010, before the law was passed ... But since U.S. family incomes have grown even more slowly, workers are spending more of their income on their employer health insurance.... While premiums rose 60 percent between 2003 and 2013, incomes grew only 11 percent. Employee premium contributions, meanwhile, increased 93 percent over this period." (The Commonwealth Fund)  

How the Healthcare Reform 'Bailouts' Work and How Some Insurers Are Farming Them
"The big difference between the Three Rs is that the first two Rs (the reinsurance and risk adjustment programs) either have a delineated flow of revenue support (the $63 tax on all health plans) or the payouts are to be limited to what the program takes in (all transfers are slated to balance out in the risk adjustment program - at least for now). The risk corridor program, however, has no set source of revenue. This means that if more insurers underprice their Obamacare plans in an effort to gain market share than plans who over-price, there will be a PPACA shortfall on this third R. Where would that money come from?" (Benefit Revolution)  

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Undocumented Worker Can Cause Health Plan Problems
"The stop loss carrier claimed that the employee was not eligible for coverage under the plan because he was not eligible to work in the United States. The plan claimed that the employer had received from the employee a facially valid permanent resident card which the employer believed made the employee eligible to work in the United States.... California has a statute that explicitly provides certain protections and benefits to employees who are undocumented. Based on that statute, the court found that the stop loss carrier could not deny benefits based solely on the undocumented status of the worker." [Bay Area Roofers Health and Welfare Plan Trust v. Sun Life Assurance Co. of Canada, No. 13-cv-04192 (N.D. Cal. Nov. 6, 2014)] (Stinson Leonard Street)  

Consumers May Miss Out On Subsidies Due To Confusion About Job-Based Coverage
"Some of the confusion relates to the similar-sounding bureaucratic names for these different health law standards. Minimum value coverage means the plan pays for 60 percent of allowed medical charges, on average. Minimum essential coverage, which can include a range of things from grandfathered health plans to some of the prevention-only plans being offered by large employers, refers to what large employers must offer to avoid paying penalties for not offering coverage, as well as what individuals must carry to comply with the law's coverage requirement." (Kaiser Health News)  

Federal Health IT Strategic Plan, 2015-2020 (PDF)
"The first two goals of this Plan prioritize increasing the electronic collection and sharing of health information while protecting individual privacy. The final three goals focus on federal efforts to create an environment where interoperable information is used by health care providers, public health entities, researchers, and individuals to improve health, health care, and reduce costs. This Plan aims to remain flexible to our evolving definitions of health and health care." (Office of the National Coordinator for Health Information Technology [ONC], U.S. Department of Health and Human Services [HHS])  

What Do Employers and Employees Really Think About Private Exchanges?
"83 percent of employers reported that their exchange has helped them control benefits costs. 90 percent of employees were satisfied with the number of choices available on their exchange or wanted even more; in fact, 24 percent said there can never be too many choices. 79 percent of employees expressed satisfaction with the shopping and enrollment experience overall." (The Institute for HealthCare Consumerism [IHCC])  

Eleventh Circuit: Claim Barred by Statute of Limitations Even When Administrator Cannot Produce Denial Letter
"For 12 years [the employee] did not challenge the termination of benefits. Then, in 2009 [he] wanted to know where his benefits were. He claimed he never received the termination letter [issued in 1997].... MetLife's decision to cease providing benefit payments after April 30,1997, and for 12 years thereafter, constitutes 'clear and continuing repudiation of [the employee's] rights' ... By agreeing to review the terminated claim [in 2012], MetLife did not waive the statute of limitations defense.' " [Witt v. Met Life Ins. Co., No. 14-11349 (11th Cir. Nov. 25, 2014)] (Lane Powell PC)  

How Are Companies Stacking Up? Assessment Framework Highlights Possible Priorities for Executive Compensation
"[T]he breadth of many companies' [pay for performance (P4P)] assessments appears rather limited in terms of pay definitions, performance measures and regularity. Moreover, the results indicate that few companies are leveraging P4P analyses to test if they are getting the downside of pay 'right' (i.e., ensuring pay outcomes track with performance when performance weakens)." (Towers Watson)  

Checklist of Items to Review for the 2015 Annual Meeting and Reporting Season (PDF)
17 pages. "Incorporate lessons from 2014 say-on-pay results.... Assess potential impact from recent compensation-related litigation.... Consider recent trends in compensation recoupment policies.... Comply with IRC Section 162(m)." (Skadden, Arps, Slate, Meagher & Flom LLP)  

Fiduciaries of National Multi-employer Benefit Plan Based in Cherry Hill, N.J., Ordered to Pay $4.7 million in Assets and Interest
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Year-End Content At myStockOptions.com Helps Employees With Stock Compensation Plan For The Ongoing Impact Of Tax Changes
myStockPlan.com, Inc

Northern Trust Enhances Asset-Liability Risk Reporting for Pensions
Northern Trust

New Fellows - December 2014
Society of Actuaries

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