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Goldleaf Partners
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Southern California TPA Firm
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IRI Retirement Plan Forum
July 1, 2015 in DC
(Insured Retirement Institute [IRI])

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[Guidance Overview]

Proposed Changes to Summary of Benefits and Coverage, Uniform Glossary
"The proposed regulations and accompanying documents incorporate much of [the] interim guidance, and they update the 2012 rule to take account of the changes made in insurance markets by the 2014 reforms.... Under earlier guidance, plans or insurers were allowed to provide information about whether coverage offered minimum essential coverage or minimum value through a cover letter or similar disclosure and did not need to put this information on the SBC itself. Under the proposed rule, this information must be in the SBC, and separate provision is no longer sufficient.... [T]he proposed regulations do not require disclosure of premium information, although plans may disclose premiums.... Whereas the content of the SBC has been reduced under the proposal, the glossary has been expanded from four to six pages, with the addition of over a dozen new terms[.]" (Timothy Jost, in Health Affairs)  

[Advert.]

24th Annual National Health Benefits Conference & Expo (HBCE)

Plan now to attend the National Health Benefits Conference & Expo, January 27-28 in Clearwater Beach, Florida. The conference provides cutting-edge case studies and advanced cost control strategies presented by national thought leaders. Register Now!

[Guidance Overview]

Proposed Regs Would Expand Definition of Excepted Benefits to Cover Certain Types of Limited Wraparound Coverage
"Under the proposed rules, limited wraparound coverage would be considered an excepted benefit if the following requirements are satisfied: [1] The coverage is specifically designed to wrap around eligible individual health insurance and provides meaningful benefits beyond coverage of cost-sharing. [2] The coverage costs no more than the maximum annual contribution for health flexible spending accounts. [3] The coverage does not impose a pre-existing condition exclusion, discriminate based on health status or discriminate in favor of highly compensated employees. [4] The sponsor of the coverage satisfies reporting requirements that will be set forth in later guidance; and [5] The coverage meets certain additional eligibility requirements." (Littler)  

[Guidance Overview]

Proposed SBC Rules Would Apply in Late 2015
"The proposed regulations include clarifications regarding when and how plans and insurers must provide SBCs.... The proposed regulations would add a new rule under which an insurer that automatically re-enrolls participants and beneficiaries must provide a new SBC for the plan in which the participant or beneficiary will be automatically enrolled (following the same timing rules that apply in the case of renewal or reissuance)." (Practical Law Company)  

[Guidance Overview]

ACA Outlook: What Will 2015 Hold for Employers?
"Although employer-sponsored group health plans other than insured plans in the small group market are not required to offer a package of 'essential health benefits,' the 'minimum value' component of the play-or-pay penalty is effectively being used a back door to impose similar requirements.... Despite the detailed discussion of the lookback measurement and method in the final rule, a number of questions and ambiguities remain.... Although some efforts were made to simplify the reporting requirements for employers, the reporting obligations remain complex, burdensome and, in some respects, unclear." (Society for Human Resource Management [SHRM])  

[Guidance Overview]

January 1 Deadline to Notify Your Employees of California Paid Sick Leave Law (PDF)
"Employers must display a poster regarding the paid sick leave requirement in a conspicuous place at each workplace of the employer (the state has provided a model poster). While the California mandate does not limit itself to employees whose primary workplace is in the state, it seems reasonable for an employer to display the poster only at its California locations. Employers must provide new employees (other than those exempt from California's overtime pay requirements) written notice of their paid sick leave rights at time of hire (the state has provided a model notice). These notice requirements apply Jan. 1 even though the requirement to provide paid leave does not become effective until July 1, 2015." (Lockton)  

Federal District Court Says Church Plan's Code Section 410(d) Election Caused ERISA to Apply to Disability Claim (PDF)
"Plaintiff contends that a [Code section] 410(d) election may only be made with respect to a church pension benefits plan, as opposed to a church welfare benefits plan. For support of this proposition, Plaintiff relies on two Department of Labor Advisory Opinions... Several courts have analyzed this issue and found that a Section 410(d) election may be made with respect to a church welfare benefits plan.... [T]his Court in its review of the case law ... finds that an irrevocable election may be made under Section 410(d) [by the Ascension Health Long Term Disability Plan]." (U.S. District Court for the Eastern District of Missouri)  

Proposed Changes to the SBC: New and Improved?
"The bulk of the proposed regulations simply incorporate the sub-regulatory guidance that has been published by way of numerous FAQs since the final rules were published February 2012.... Revisions have also been proposed for the uniform glossary that is required to be made available and provided upon request to plan participants and beneficiaries. Terms such as individual responsibility requirement, minimum value, cost-sharing reductions, premium tax credit, and preventative care will be included." (Hill, Chesson & Woody)  

In Surprise Decision, Governor Stops Vermont's Move Towards Single-Payer
"Vermont Governor Peter Shumlin stunned Vermonters last week when he retreated from implementation of single-payer, explaining that converting to such a system isn't affordable.... Shumlin said he asked his team to find alternatives, but none met service criteria or they were unaffordable.... Vermont's efforts to become the first state with a single-payer health care system are being scrutinized nationally." (Physicians for a National Health Program [PNHP])  

Premiums Up Six Percent on ACA Exchanges, McKinsey Finds
"Despite an influx of new carriers and plans, premiums for health insurance plans sold on [ACA] exchanges rose 6 percent between 2014 and 2015 ... In all, 125 products are available on public exchanges for 2015, compared to 98 last year. The average number of plans available in any one U.S. county is 40, compared to 31 last year.... If all exchange enrollees were to renew the insurance they purchased in 2014, the vast majority -- 85 percent -- would have higher premiums." (FierceHealthPayer)  

So Far, 6.4 Million Obtain Health Care Coverage for 2015 in Federal Marketplace
"New customers accounted for 30 percent of the total, or 1.9 million. For 2014 enrollees who took no action by Dec. 15, coverage was automatically renewed for 2015 by the federal government. [Secretary of HHS] Sylvia Mathews Burwell said she did not know how many people had been automatically re-enrolled by her department. But she and her aides suggested that the number was in the range from 2.7 million to three million." (The New York Times; subscription may be required)  

[Opinion]

Progressive Politics and Fiscal Limitations Collide: Vermont Slams the Brakes on Single-Payer Healthcare
"During the debate on the [ACA] in 2009, several of the more progressive political players on Capitol Hill publicly applauded the Act as the best way to take America to a universal coverage platform ... But if Vermont's lesson is indicative of the cost to the nation of a federal universal coverage initiative, one might legitimately question just how a nation barreling toward a $20 trillion national debt could afford such an initiative without crushing tax increases or doubling down on our aggressive borrowing." (Lockton)  

[Opinion]

Vermont's Lessons for Fans of Single-Payer Health Care
"[S]ingle-payer systems may well allow you to control the rate of health-care cost growth, thanks to government price controls on supplies and services, along with rationing or denial of expensive treatments. What it doesn't allow you to do is easily cut the rate of health-care spending. None of the single-payer systems that are frequently held up as models for the U.S. have ever managed sustained cuts in health-care spending. All they've done is prevent it from growing so fast." (Megan McArdle, in Bloomberg View)  

[Opinion]

What the Insurance Industry Can Do to Fix Health Care
"[We] need someone to cut through the complexity of the current system, demand true value from providers, and create better options for consumers. Insurers increasingly look like the folks who can do the job and reinvent their business at the same time.... Here are some specific ideas ... Act as true partners to value-based providers.... Offer options for low-cost, convenient care.... Cover new wellness- and prevention-oriented treatments.... Explode the PPO model.... Sell convenience and personalized service.... Power healthy behavior change.... Serve as the bridge between new tools and consumers." (Harvard Business Review)  

[Opinion]

HHS Won't Say If It's Preparing for a Supreme Court Obamacare Nightmare
"It's hard to understate the potential impact of an adverse ruling for the administration. In 2014, almost 9 in 10 people who bought coverage through the federal-run exchange, or close to 5 million people, received financial assistance. If that suddenly goes away in June, when a ruling is expected, that instantly makes their coverage less affordable.... It could be that the administration doesn't want to give the Supreme Court any indication that it could provide an easy fix to the law in the event of an adverse ruling. But it's hard to believe that people in the department aren't planning for this scenario." (The Washington Post; subscription may be required)  

Text of Second Circuit Opinion in Amara v. CIGNA, Upholding District Court's Reformation of Pension Benefits Plan (PDF)
"We agree with the district court that, because the CIGNA Pension Plan is part of a compensation package for employees that stems from their employment agreements, plaintiffs have given consideration for their participation in the retirement plan so that it is appropriate, to the extent this plan constitutes a trust, to analyze reformation under contract principles.... By hiding the truth about the plan, CIGNA prevented all of its employees from becoming disaffected, spreading knowledge regarding the plan to others who stood to lose more from the benefit conversion, and from planning for their retirement. Therefore the district court did not err in determining that CIGNA committed fraud or inequitable conduct against all of the class members... Finally (and contrary to defendants' claim), reforming the CIGNA retirement plan partly in light of the misleading representations made in the SPDs and other plan communications is consistent with the applicable principles of reformation." [Amara v. Cigna, Nos. 13-447-cv and 13-526 (2d Cir. Dec. 23, 2014)] (U.S. Court of Appeals for the Second Circuit)  

History of the Employee Benefit Research Institute, Part 1
"This is the first part of a history of the Employee Benefit Research Institute (EBRI), which the EBRI board has asked Dallas Salisbury to fully document between now and his move from EBRI President (after 37 years in that position) to EBRI President Emeritus in 2016.... EBRI opened its doors on December 4, 1978. The Institute's early work supported the 1978 President's Commission on Pension Policy, which generated visibility for both retirement issues and EBRI and led to an expansion of EBRI's membership and horizons." (Employee Benefit Research Institute [EBRI])