Retirement Plan Administrator
RCM&D
in MD

Retirement Plan Administrator
Pension Administration, Actuarial & Consulting firm
in TN

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SHOP Marketplace Series
January 20, 2015 WEBCAST
(Centers for Medicare & Medicaid Services [CMS])

Employee Handbooks 101
January 23, 2015 WEBCAST
(Clear Law Institute)

SHOP Marketplace Series
January 27, 2015 WEBCAST
(Centers for Medicare & Medicaid Services [CMS])

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[Official Guidance]

Text of HHS Announcement: Extended Deadline for Selecting 2015 Cost-sharing Reduction Reconciliation Methodology (PDF)
"HHS recognizes that QHP issuers continue to experience operational issues in advance of setting up systems to adjudicate claims under the standard methodology and ... some QHP issuers need more time to be able to estimate whether they would meet the credibility threshold ... for the simplified methodology in 2015. As a result, we are extending the deadline to select a methodology for the 2015 benefit year until March 31, 2015, from December 15, 2014. Issuers that selected the simplified methodology may continue to select this transitional method for 2015 and 2016 benefit years only." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

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[Official Guidance]

Text of OPM Proposed Regs: Federal Employees Health Benefits Program Plan Performance Assessment System
"To establish a consistent assessment system, create a more objective performance standard, and provide more transparency for enrollees, OPM is developing a framework that will utilize a discrete set of quantifiable measures examining key aspects of contract performance and specific criteria for performance factors which will then be linked to health plan premium disbursements. This regulation proposes to replace the current methods of plan assessment with a new framework, in which both experience-rated and community-rated plans utilize the same measurement criteria." (Office of Personnel Management [OPM])  

[Guidance Overview]

Evolution of the Health Plan Coverage Mandates Continues
"Because the current edition of the DSM recognizes the diagnosis of gender dysphoria for person whose gender at birth is contrary to the one with which they identify as a mental disorder, New York is mandating that insurers issuing policies in New York use the 'DSM as the recognized independent standard of current medical practice in determining what constitutes a mental health condition.' ... Employers providing group health plan coverage outside of New York that are subject to the MHPAEA should watch for additional developments in this area, including the new requirements applicable to federal contractors described [in this article]." (Winstead PC)  

[Guidance Overview]

Beneath the Hood of the 'Cromnibus'
"Section 227 of Cromnibus provides that CMS may not transfer other funds from other accounts to pay for the risk corridor program. The CMS program appropriation section, however, does appropriate user fees, which can therefore be used to fund the risk corridor program. Expenditures on the program, however, cannot exceed the funds collected.... A second provision ... provides that if expatriate plans meet certain basic requirements they will qualify as 'minimum essential coverage' for purposes of the individual mandate.... A third provision ... redefines the medical loss ratio requirement applied to Blue Cross/Blue Shield (BCBS) plans ... Cromnibus requires CMS to detail in its 2016 budget all funds that have been spent since the enactment of the ACA and what spending is anticipated for 2016 on a list of activities specified." (Timothy Jost, in Health Affairs)  

[Guidance Overview]

CMS Webinar Slides: Marketplace Payment Process, December 12, 2014 (PDF)
59 presentation slides. "In January, CMS will make payments for the January payment month, including: [1] Payments for the January enrollment month (enrollments effective in January as of December 15, 2014). [2] Payments for restatements to prior months' data (including 2014 data), including updated effectuated enrollment data for prior months and any retroactive enrollment data. In this presentation, CMS will outline how submitters will submit enrollment and payment data for the January payment month and how to update data for prior enrollment months under the interim payment process." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

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[Guidance Overview]

Details on the ACA Employer Reporting Requirements (PDF)
12 pages. "The forms and instructions are drafts intended for reporting in 2015 for coverage offered in 2014. Reporting of coverage is voluntary for 2014. The forms will likely change before employers are required to submit them in 2016, for coverage offered in the 2015 calendar year. Employers will have to report on full-time employees for the entire 2015 calendar year. Employers should begin thinking about how they will collect the required data." (McGraw Wentworth)  

[Guidance Overview]

ACA Resources for Frequently Asked Questions, Updated December 10, 2014 (PDF)
20 pages. "The report provides basic consumer sources, including a glossary of health coverage terms. The next sections focus on health coverage: the individual mandate, private health insurance, and exchanges, as well as public health care programs ... It then lists sources on employer-sponsored coverage, including sources on employer penalties, small businesses, federal workers' health plans, and union health plans. It also provides sources on the ACA's provisions on mental health, public health, workforce, quality, and taxes. Finally, the report lists sources on ACA costs and appropriations, legal issues, the treatment of noncitizens under the ACA, and sources for obtaining the law's full text." (Congressional Research Service [CRS])  

2014 Report to Congress: Compliance with the Mental Health Parity and Addiction Equity Act of 2008
"This second report to Congress updates DOL's initial findings and outlines the next steps under consideration for continued implementation and enforcement of MHPAEA. Since the submission of the initial report, major developments in the MHPAEA infrastructure include the completion of the MHPAEA compliance study and the promulgation of the final rules.... This report provides an overview of these developments and highlights the ongoing efforts being taken in the context of the previously established MHPAEA implementation framework to ensure that parity is accomplished as intended by the law." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

41% of Employers Considering Private Health Insurance Exchange for Benefits Delivery by 2018, 6.4% Have Already Implemented (PDF)
"The Private Exchange Evaluation Collaborative (PEEC) is an initiative launched by four leading nonprofit business coalitions (Employers Health Coalition, Midwest Business Group on Health, Northeast Business Group on Health, and Pacific Business Group on Health) and PwC.... The survey is intended to help employers understand how their peers are thinking about private exchanges, their timelines for consideration and what features they view as critical, and to highlight what types of information about private exchanges are most important to employers." (The Private Exchange Evaluation Collaborative [PEEC])  

Where Employers Use Quality Control to Shape Healthcare
"Most businesses ... are reluctant to manage medical providers as they might other key suppliers. It's different on Puget Sound. Boeing and other major employers here, including Starbucks and Costco, have aggressively pushed local hospitals and doctors to meet the kinds of rigorous standards they use to build airplanes or brew coffee. That has nurtured an unusual relationship between employers and medical centers that has affected the way patients are treated for back pain, how they are counseled for depression, even how they schedule doctors' appointments." (Los Angeles Times)  

Evidence of Reasonable Mailing Method Defeats Claim for Non-Receipt of COBRA Election Notice
"Plan administrators using a TPA to send election notices should verify that the TPA will maintain adequate documentation of what was mailed and when. Additionally, plan administrators should make sure that the TPA contract provides for indemnification if the TPA fails to properly provide required notices, otherwise fails to follow adequate compliance procedures, or fails to document that adequate procedures were followed." [Vangas v. Montefiore Med. Ctr., No. 11 Civ. 6722 (S.D.N.Y. Nov. 5, 2014)] (Thomson Reuters / EBIA)  

Federal District Court Rejects Fiduciary Duty Breach by Claims Administrator Acting on Behalf of Plan Sponsor
"The court determined that an act not typical of a claims administrator's responsibilities performed at the instruction of the plan sponsor and administrator did not establish a fiduciary relationship with the plan's participants and, as such, did not give rise to a claim for breach of fiduciary duty.... Reliance Standard, as the claims administrator, did not have discretionary authority for plan administration purposes and as the [form] mailing was a one-time 'favor to a client' done at [the employer's] instruction, it was not undertaken by Reliance Standard in a fiduciary capacity." [Van Loo v. Cajun Operating Co., No. 2:2014cv10604 (E.D. Mich. Dec. 1, 2014)] (Wilson Elser)  

The 2015 ABC's of Employee Benefits (A-M)
"Given the tremendous amount of activity and volatility in the employee benefits space, 2015's version of EBN's annual benefits ABC's can be summed up in one sentence: Surround yourself with quality, interested and engaged help or else it will be a very long and painful year." (Ed Bray, in Employee Benefit News)  

Bogged-Down Global Benefit Managers Are Missing Opportunities
"Nearly two-thirds (62%) of global pension and benefit managers claim that day-to-day operational activities are limiting their ability to add value and hampering their strategic contribution to the company ... [T]hree-quarters (75%) of [survey] participants also feel that there is increasing pressure for them to do more with less, suggesting they are going to have to change the way they do things if they are to create the time to focus on more value added activities." (Towers Watson)  

ISS Adopts Discretion in Evaluating Management Equity Plan Proposals
"What has not yet caught on despite numerous shareholder proposals are post-termination holding periods. Many of the shareholder proposals require an executive to hold 50% of his/her equity for two years post termination. CEO post-termination holding periods will become more popular starting in 2015 for companies with concerns about the passage of their equity plan proposals." (Orrick)  

NFP Expands Corporate Benefits Capabilities with Acquisition of Benefits Services Group
National Financial Partners Corp. [NFP]

Prudential Retirement Creates Gibraltar Ventures
Prudential Retirement

Appointees to ERISA Advisory Council Announced by US Department of Labor
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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