Health & Welfare Plans Newsletter

December 31, 2014

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Employee Benefits Jobs

ESOP Administrator
Blue Ridge ESOP Associates
in ANY STATE

Retirement Plan Administrator
Downeast Pension Services, Inc.
in ME

Retirement Plan Consultant
BPC, Inc.
in IL

Defined Contribution Client Manager
Milliman
in OR

Pension Administrator
Retirement Strategies, Inc.
in GA

Senior New Business Analyst
Employee Fiduciary, LLC
in AL, FL

Benefits Project Manager
Publix Super Markets, Inc.
in FL

Conversion Specialist
BlueStar Retirement Services
in ANY STATE, FL

Plan Document Specialist/Plan Administrator
BlueStar Retirement Services
in ANY STATE, FL

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Webcasts and Conferences

Investments Institute
March 9, 2015 in CA
(International Foundation of Employee Benefit Plans [IFEBP])

View All Webcasts and Conferences



[Guidance Overview]

Agencies Propose Streamlined Health Plan SBC and Glossary
"Under the proposed rule, the SBC for a standard group health plan would be shortened to two-and-a-half double-sided pages for summarizing plan coverage and costs.... The proposed rule would also make a number of changes to the content of the SBC and uniform glossary to reflect the ACA's private insurance market reforms.... The proposed rule would help prevent unnecessary duplication by requiring only a single SBC per group health plan when the plan sponsor: [1] Uses a binding contractual arrangement in which a third party assumes responsibility to provide the SBC. [2] Uses two or more insurance products provided by separate issuers to insure benefits with respect to a single group health plan." (Society for Human Resource Management [SHRM])  


[Advert.]

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

Sponsored by 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]

New York City Department of Consumer Affairs Provides Guidance Regarding the Earned Sick Time Act
"Under the rules, any sick leave policy must be in writing and must meet the following requirements: Minimum daily increment ... Advanced notice ... Medical documentation ... Employee verification ... Front-loading ... Payout of unused sick leave ... Donation of unused sick leave ... Other leave policies." (Ogletree Deakins)  

New York Employers Must Provide Unpaid Leave to Volunteer Emergency Responders During Declared Emergencies
"Effective December 22, 2014, New York employers must provide unpaid leave to employees who serve as volunteer firefighters or volunteer ambulance personnel whenever the governor declares a state of emergency.... Employees requesting emergency response leave must provide written documentation from the head of the employee's fire department or volunteer ambulance service notifying the employer of the employee's status as a volunteer emergency responder." (Ogletree Deakins)  

Proposed Legislation Would Kill Obamacare's HRA Restrictions for Some
"The Small Business Health Relief Act of 2014 would exempt stand-alone HRAs offered by small businesses from the current Obamacare regs prohibiting [stand-alone HRAs].... [S]mall employers (those with 49 or fewer employees) could: [1] use pre-tax dollars to give workers a defined contribution; [2] allow employees to use those pre-tax funds in an HRA to purchase healthcare coverage on the individual market and for qualified out-of-pocket medical expenses, and [3] avoid financial penalties for providing these types of funds to employees." (HR Benefits Alert)  

High Performance at an On-Site Corporate Health Center
"Worksite clinics, along with other health care delivery management strategies, have sparked widespread interest, but there is little evidence that quantifies value. Looking at a full-service health and wellness center clinic at BP's Houston WestLake campus, the authors take a holistic approach to evaluating medical center performance -- using a comprehensive value-chain approach to compare utilization, clinical outcomes, and medical and pharmacy costs for nonusers and users. What they find amplifies the need to shift community-delivered services to the worksite medical center." (Towers Watson)  

Effects of the New Federal Spending Package on the Health Sector
"Among other provisions affecting insurance, the Act mandates that the ACA's risk corridor program be budget neutral.... A second insurance-related provision amends section 833 of the Internal Revenue Code, which grants tax benefits to Blue Cross and Blue Shield plans, as well as certain other qualifying health care organizations.... The Act's amendment aligns section 833's MLR definition with that provided by section 2718 of the ACA, pursuant to which costs associated with activities to improve health care quality may be counted in the numerator alongside medical claims." (Sheppard Mullin)  

As Health Care Consumerism Grows, Costs Slow
"[G]rowth in health-benefits costs has slowed considerably, although that's partly because employers have taken the initiative by encouraging consumerism and emphasizing a culture of employee health. The average per-employee cost of health benefits rose only 3.9% in 2014 ... While that was slightly larger than last year's historically low increase of 3.7%, it is still well below the 7% average rate of growth over the past 15 years." (CFO)  

Getting Higher Quality at Lower Costs: The Biggest Health Story You May Have Missed This Year
"Spending growth per enrollee has remained slow across Medicare, Medicaid, and privately insured people, and indications are that growth has remained slow through the first half of 2014 as well, even as the number of people with insurance coverage has expanded dramatically. Leading measures of growth of employer benefit costs show continued slow growth as well, and the prices of health care services have continued to rise at historically slow rates." (The White House Blog)  

Amicus Brief of the States of Oklahoma, Alabama, Georgia, Nebraska, South Carolina and West Virginia to Supreme Court in King v. Burwell (PDF)
"Congress drafted the ACA like it does most other cooperative federalism legislation -- with a variety of incentives offered to States willing to assume the burden of implementing the federal program.... Congress's conditioning of the tax credits came as no surprise to the States.... [T]he plain text of Section 36B plainly described the incentive, and other sections of the Act plainly describe the consequences of declining to accept the incentives ... In promulgating its rule, the IRS ignored the longstanding presumption -- legislatively established by Congress in the McCarran-Ferguson Act of 1945 ... that health insurance regulation is a matter of traditional state control. Because that is so, to regulate in this area Congress must specifically and unambiguously state its intent to do so.... Absent such a 'clear statement,' a Court must adopt a reading of the challenged statute that leads to the least amount of federal incursion." [King v. Burwell, No. 14-1158 (4th Cir. July 22, 2014; cert. pet. granted Nov. 7, 2014)] (Supreme Court of the United States)  

[Opinion]

Obamacare Hits Small Business Hard in Gloomy 2015; Costs to Rise
"Many grocers and restaurants have opted to pay the fine rather than swallow the larger cost of buying coverage for all workers. Others are cutting back worker hours to duck the law altogether. Universal health care is hardly 'free,' and its costs hit both employees and customers hard. Service companies -- including even garbage collectors -- are passing on the added cost to customers in the form of higher bills." (Investor's Business Daily)  

Benefits in General; Executive Compensation

Text of Eighth Circuit Opinion: SPD Language Granting Discretion to Plan Administrator Is Enforceable to Determine Standard of Review (PDF)
"[T]he district court concluded, and Johnson argues on appeal, that the grant of discretion appearing only in the Summary Plan Description (SPD) was insufficient to vest discretion in United.... Unlike the policy and SPD in [Jobe v. Medical Life Insurance Co.], there is no conflict here because a reasonable participant would have read the policy to have integrated the SPD along with the discretionary statement contained therein. The face of the policy in this case states, '[t]he Certificate of Insurance ... is made a part of the Policy.' The SPD was included in the Certificate of Insurance as the final part of the consecutively-paginated booklet.... Accordingly, we reject the district court's expanded reading of Jobe, and we conclude that under the policy and the integrated Certificate of Insurance, discretion was granted to United to determine eligibility for benefits." [Johnson v. United of Omaha Life Ins. Co., No. 13-2645 (8th Cir. Dec. 30, 2014)] (U.S. Court of Appeals for the Eighth Circuit)  

[Opinion]

Lame Duck Congress Finds Courage to Repeal ERISA; Employers to Use Honor System (PDF)
[BenefitsLink note: A bit of holiday humor.] "Under the new honor system, employers can deduct on their income tax returns whatever amounts they deem appropriate for their health care and retirement plan contributions, instead relying upon their notions of reasonableness, patriotism and government utility as their guide. No longer shackled with eligibility, vesting, investment, nondiscrimination, disclosure or any rules of any kind, employers and fiduciaries should now redesign their plans and operate them as their conscience and business acumen dictate." (The ERISA Law Group)  

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