Retirement Services Program Director
Nationwide
in CA, OR, WA

Director of Plan Administration
Employee Fiduciary, LLC
in AL, FL

Pension Administrator
Karel-Gordon & Associates
in IL

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[Guidance Overview]

Wrap Coverage Gets an Update with Second Round of Proposed Rules
"The opportunity to sponsor health coverage that qualifies as an excepted benefit is important for two reasons: [1] the employer sponsor does not risk penalties for violating the market reform requirements that apply to group health plans but not to excepted benefits and [2] the employees who are offered the excepted benefit are still eligible for tax credits in the Exchange (which is not the case when offered group health coverage)." (Hill, Chesson & Woody)  

[Advert.]

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Fourth Circuit: Plan Administrator Must Affirmatively Obtain 'Readily Available Information' in Claims Determination
"The Fourth Circuit held that by not contacting Ms. Harrison's psychologist, Wells Fargo 'chose to remain willfully blind' to readily available information that might have confirmed her claim of disability. The court noted that ERISA requires that an administrator use a 'deliberate, principled reasoning process' in claims determination. It does not require that the plan administrator 'scour the countryside in search of evidence' to bolster a participant's claim. But where potentially relevant information is readily available, the court noted, ERISA does not permit an administrator to 'shut his eyes' to that information." [Harrison v. Wells Fargo Bank, No. 13-2379 (4th Cir. Dec. 5, 2014)] (Benefits Bryan Cave)  

Health Law Mandate Hits Employers Unevenly
"Despite the concerns surrounding the mandate, it won't hit all businesses hard, nor will it provide coverage to all uninsured workers. Instead, just like the rest of Obamacare, its impacts will be felt unevenly, among some industries and employees more than others. Think restaurants, retail and low-wage workers." (The Sacramento Bee)  

U.S. Opposes Oklahoma Bid to Join Supreme Court Case
"In asking the Supreme Court to join its appeal with King v. Burwell, Oklahoma's lawyers argued that the Court should review the issue in a case in which a state government is directly involved, and should take on another case in the event that the King case could wash out without a decision. The Obama administration, in its new brief, argued that neither of those claims would justify linking the two cases.... Moreover, the administration brief contended, there are questions about Oklahoma's own legal right to be a challenger and that, plus other procedural complications, would only expand the Court's review unnecessarily to address those jurisdictional questions." (SCOTUSblog)  

December 23 GDP Estimate Includes Massive Upward Revision in Health Spending
"The real dollar change in seasonally adjusted GDP (at annual rates) from the 2nd quarter to the 3rd quarter was estimated at $153.7 billion in the second estimate. The third estimate revised this up to $195.2 billion, a change of $41.5 billion (27 percent). Health spending was revised up from $8.6 billion to $20.7 billion, an increase of $12.1 billion. That is, the upward revision of health spending accounted for almost one third of the entire GDP revision." (National Center for Policy Analysis Health Policy Blog)  

87 Percent of Those Who Selected 2015 Plans in First Month of Open Enrollment Are Getting Subsidies
"More than 3.4 million people selected a plan through December 15 in the 37 states that are using the HealthCare.gov platform for 2015, including Oregon and Nevada. Of those: 87 percent selected a plan with financial assistance compared to 80 percent in the early months of the first open enrollment period. 33 percent were under 35 years of age compared to 29 percent in the early months of the first open enrollment period.... Of the 3.4 million plan selections, 48 percent (1.6 million) reenrolled in a Marketplace plan and 52 percent (1.8 million) signed up for the first time." (U.S. Department of Health and Human Services [HHS])  

Health Insurance Marketplace 2015 Open Enrollment Period: December Enrollment Report (PDF)
33 pages. "This report provides preliminary data for enrollment-related activity in the individual Marketplace during the first month of the 2015 Open Enrollment period for all 50 states and the District of Columbia." (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])  

Auto-Renewal in the FFM: Quantifying the Importance of Active Plan Selection (PDF)
5 pages. "Consumers who enrolled in a marketplace plan in 2014 were auto-renewed on 12/15/2014. 70% of the plans that increased in premium from 2014 to 2015 had at least one better alternate plan. There were 4.8 better alternate plans for every plan that increased in premium. Consumers can find themselves with a lower premium in 2015 than they had in 2014, if they actively comparison shop for a better alternative." (HealthCare.com)  

Implementing the ACA: State Approaches to Premium Rate Reforms in the Individual Health Insurance Market
"Most states took the opportunity to customize at least some aspect of their rating standards. Interviews with state regulators reveal that many states pursued implementation strategies intended primarily to minimize market disruption and premium shock and therefore established standards as consistent as possible with existing rules or market practice. Meanwhile, some states used the transition period to strengthen consumer protections, particularly with respect to tobacco rating." (The Commonwealth Fund)  

ACA Faces Key Court Test Over Its Future
"A decision that places eligibility for tax subsidies onto state-run exchanges will put the onus on the states to ensure that affordable health care remains available to people on open exchanges.... States that set up exchanges faced many of the same difficulties as the federal exchange, including clunky websites and language that deterred potential shoppers." (The Tennessean)  

[Opinion]

ACA Countdown to Compliance for Employers, Week 0 -- Final Thoughts
"The Affordable Care Act is the single most important piece of Federal social legislation in more than a generation. While there was and is broad agreement on the law's principal goals -- to expand medical coverage, increase the quality of medical outcomes, and constrain costs -- there is little agreement on the 'means whereby.' This is perhaps both unavoidable and unfortunate." (Mintz Levin)  

[Opinion]

Rethinking the Gruber Controversy: Americans Aren't Stupid, But They're Often Ignorant -- and Why
"How many politicians, for example, would forthrightly and bluntly proclaim on the campaign trail that, to control the growth of health spending, they favor the rationing of health care by income class, that is, by price and ability to pay? Yet that is precisely what they and their advisors are advocating when they promote health-insurance policies with very high deductibles and coinsurance. As any well-trained economist knows and some good textbooks in economics are careful to point out, prices in a market economy are instruments to ration scarce resources among people. So a market economy in health care that relies on high deductibles and coinsurance is not an alternative to rationing. It is just one of several methods of rationing." (Uwe E. Reinhardt, in Health Affairs)  

Ninth Circuit Softens Its Position on Surcharge, But Defers Its Scope for Another Day
"In its recently issued amended ruling, the Ninth Circuit explained that because the district court concluded the plaintiff wasn't entitled to monetary relief, it didn't consider whether plaintiff was entitled to surcharge. The court noted that under Amara, the proper approach is to vacate the judgment and remand to the district court. 'Consistent with' sister circuits, the court did just that." [Gabriel v. Alaska Electrical Pension Fund, No. 12-35458 (9th Cir. Dec. 16, 2014)] (Seyfarth Shaw LLP)