Health & Welfare Plans Newsletter

January 6, 2015

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Employee Benefits Jobs

ERISA Consultant
MassMutual Financial Group
in CT, MA

Retirement Plan Administrator
Williams Benefit Consulting, LLC
in ANY STATE

Account Executive - Group Medical
Fringe Benefit Group
in TX

Sr. Retirement Plan Administrator
IRON Financial
in IL

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Webcasts and Conferences

Employee Benefit Issues in Mergers & Acquisitions
January 13, 2015 in CO
(Western Pension & Benefits Council - Denver Chapter)

ERISA in the Courts: Developments in Fiduciary Litigation
January 20, 2015 in CA
(Western Pension & Benefits Council - San Diego Chapter)

Advanced RMD Issues
January 21, 2015 WEBCAST
(McKay Hochman Co., Inc.)

Election Changes in 2015 and Beyond: What Employers and Administrators Need to Know
January 22, 2015 WEBCAST
(Thomson Reuters / EBIA)

Affordable Care Act: Important Information about Your Health Coverage
January 22, 2015 WEBCAST
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Identifying Common-Law Employees: Implications for Employer Group Health Plans
January 29, 2015 WEBCAST
(Thomson Reuters / EBIA)

Plan Corrections: Fixing the Broken Plan - St. Louis
February 12, 2015 in MO
(SunGard Relius)

Restatement and Design Workshop - St. Louis
February 13, 2015 in MO
(SunGard Relius)

View All Webcasts and Conferences



[Official Guidance]

Text of IRS Publication 502: Medical and Dental Expenses, for Use in Preparing 2014 Returns (PDF)
Dated December 31, 2014. "What's new: ... You may be eligible to claim the premium tax credit if you, your spouse, or a dependent enrolled in health insurance through the Health Insurance Marketplace.... Advance payments of the premium tax credit may have been made to the health insurer to help pay for the insurance coverage of you, your spouse, or your dependent. If advance payments of the premium tax credit were made, you must file a 2014 tax return and Form 8962." (Internal Revenue Service [IRS])  


[Advert.]

Health Care Management Conference -- April 13-15, 2015

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Attend the Health Care Management Conference in Santa Monica, CA. Learn the latest news, legal requirements and strategies plans are taking to implement the Affordable Care Act through case studies and action-oriented sessions. Register Today!



[Official Guidance]

Text of OPM Proposed Reg for Federal Employees Health Benefits Programs: Enrollment Options Following the Termination of a Plan or Plan Option
"Current regulation ends an employee's enrollment in the FEHB Program if he or she fails to make an enrollment election during the time period provided by OPM following a plan termination. This proposed regulation amends 5 CFR 890.301 to require the employing office to enroll automatically these employees into the lowest-cost nationwide plan option based on the enrollee share of the cost of a self-only enrollment. Under the proposed regulation, a plan will not be considered the lowest-cost nationwide plan option if it is a High Deductible Health Plan (HDHP) or if it requires a membership fee or an association fee." (Office of Personnel Management [OPM])  

[Official Guidance]

Text of OPM Proposed Reg for Federal Employees Health Benefits Programs: Subrogation and Reimbursement Recovery
"This proposed regulation reaffirms that a covered individual's entitlement to FEHB benefits and benefit payments is conditioned upon, and limited by, a carrier's entitlement to subrogation and reimbursement recoveries pursuant to a subrogation or reimbursement clause in the FEHB contract. This proposed regulation also reaffirms that a FEHB carrier's rights and responsibilities pertaining to subrogation and reimbursement relate to the nature, provision and extent of coverage or benefits and benefit payments provided under title 5, United States Code Chapter 89, and therefore are effective notwithstanding any state or local law or regulation relating to health insurance or plans. This interpretation comports with longstanding Federal policy, lowers the cost of benefits, and creates greater uniformity in benefits and benefits administration." (Office of Personnel Management [OPM])  

[Official Guidance]

Text of OPM Proposed Reg for Federal Employees Health Benefits Programs: Rate Setting for Community-Rated Plans
"This proposed rule makes three changes to the requirements for [similarly-sized subscriber groups (SSSGs)]. In the past, OPM has required that plans identify two non-FEHB subscriber groups (employer groups covered by an issuer) that are closest in size to the FEHB group and, if either or both of those groups received a discounted rate, the carrier must provide the largest discount to FEHB. This proposed rule defines the entities whose groups may be selected for comparison as an SSSG. In addition, this rule states any SSSG must also be rated [traditional community rated (TCR)] in order to maintain alignment between the TCR-rated FEHB group and the subscriber group used for comparison. Last, OPM is requiring plans to identify one, rather than two, SSSG subscriber groups used for the comparison. OPM considers it unnecessary to re quire more than one comparison group if the SSSG must also be rated TCR[.]" (Office of Personnel Management [OPM])  

[Guidance Overview]

CMS Releases Key Proposals for the 2016 Qualified Health Plan Application Process
"While the [Draft 2016 Letter to Issuers in the Federally-facilitated Marketplaces] largely mirrors the provisions of its 2015 predecessor, or restates proposals from the proposed 2016 Notice of Benefit and Payment Parameters, CMS does propose several significant changes ... [including] the use of an earlier timeline for application submission, review, and approval, as well as a more extensive review of benefit offerings for compliance with non-discrimination requirements." (Epstein Becker Green)  


[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 Now Requires Health Insurers to Cover Telehealth Services
"On December 29, 2014, Governor Andrew Cuomo signed into law legislation requiring health insurers, including Medicaid, to pay for covered services delivered through telehealth and telemedicine technology as long as the services and providers of the services are otherwise covered under the patient's insurance contract or policy. The law provides that coverage for telehealth services may be subject to annual deductibles and coinsurance, and other terms and conditions of coverage, including, but not limited to, utilization management and other managed care tools, as long as such conditions are consistent with those established for the same services when not provided via telemedicine or telehealth." (Nixon Peabody LLP)  

[Guidance Overview]

Fifteen Q&As on California's New Paid Sick Leave Law (AB 1522)
"For what purposes must paid sick leave be provided under AB 1522? ... Which employees are covered by the Paid Sick Leave law? ... How do the use, accrual, and carry-over requirements of the Paid Sick Leave law interact? ... Does a non-exempt employee accrue sick leave for overtime hours? ... How does providing paid sick leave time upfront at the beginning of each 12-month period impact an employer's obligations under AB 1522? ... Does the Paid Sick Leave law provide employers with the ability to verify an employee's need to use sick leave? Are employers precluded from requesting such information? ... Does an employer have to reinstate accrued paid sick leave for former employees who are re-employed within one year? ... Are employers prohibited from requiring employees to find substitute employees for the time they are out on covered paid sick leave?" (Liebert Cassidy Whitmore)  

Fourth Circuit: When Is a Plan Administrator Obligated to Obtain Medical Records?
"This is an expanding trend in the circuits. When the record does not refute the claimant's alleged disability, and [the plan administrator is] on notice of a treater who may have information related to the claim, either: [1] obtain a release and secure the 'readily-available' records, or [2] alert the claimant of what specific records are missing." [Harrison v. Wells Fargo Bank, No. 13-2379 (4th Cir. Dec. 5, 2014)] (Lane Powell PC)  

In Like a Lion or a Lamb? ACA Compliance Begins
"As we move through 2015, an employee who achieved full-time status during the 2014 measurement period may begin to average fewer than 30 hours per week over the 2015 measurement period. But that does not mean they lose coverage. They may lose eligibility for coverage in the 2016 plan year (which is why it is important to track their hours over the 2015 second measurement period), but they maintain that eligibility for the 2015 first stability period because of their status in the 2014 initial measurement period." (Fox Rothschild LLP)  

Health Care Fixes Backed by Harvard's Experts Now Roil Its Faculty
"Members of the Faculty of Arts and Sciences, the heart of the 378-year-old university, voted overwhelmingly in November to oppose changes that would require them and thousands of other Harvard employees to pay more for health care. The university says the increases are in part a result of the [ACA], which many Harvard professors championed.... [T]he anger on campus remains focused on questions that are agitating many workplaces: How should the burden of health costs be shared by employers and employees? If employees have to bear more of the cost, will they skimp on medically necessary care, curtail the use of less valuable services, or both? ... Harvard says its plan pays 91 percent of the cost of services for the covered population, while the most popular plans on the exchanges, known as silver plans, pay 70 percent, on average[.]" (Robert Pear, in The New York Times)  

ACA Prompts Employers for Pre-65 Retiree Medical Changes
"Cost trends for Medicare-eligible retirees after plan changes (3.9%) are similar to trends for active employees (4.0%). However, survey results show that trends for pre-65 retirees after plan changes are much higher (5.5%), highlighting the total cost of providing medical coverage to these younger retirees without the benefit of Medicare. In addition, 73% of employers offering medical benefits to retirees under 65 said their 2015 plan costs already exceed the cap for the plan.... [C]onfidence is growing that public exchanges will be a viable alternative for employer-sponsored coverage for pre-Medicare retirees: While only 8% are confident for 2015, confidence rises sharply to 35% for 2017." (Towers Watson)  

Many Health Insurers Do Not Cover FDA-Approved Weight-Loss Drugs
"[E]ven though two-thirds of adults are overweight or obese -- and many may need help sticking to New Year's weight-loss resolutions -- there's a good chance their insurer won't cover ... anti-obesity drugs.... about a third of companies don't cover anti-obesity drugs at all, a third cover all FDA-approved weight-loss drugs, and a third cover approved drugs, but with restrictions to limit their use. The Medicare prescription drug program specifically excludes coverage of anti-obesity drugs." (Kaiser Health News)  

Medical Costs over the Long Run: 1850-2050
"Although costs have been rising rapidly as long as most health policy experts can remember, this was not always the case. Physicians and economists writing in the 1950s considered costs to be stable at about 4% of GDP, having risen modestly if at all during the prior 25 years. Extending the record back to 1850 ... reinforces the conclusion that health spending was rising only slowly during the century before 1950, keeping pace with wages or perhaps exceeding them by 0.5% a year (i.e., doubling every 75-150 years rather than in less than 25 years, as costs did from 1955 until recently)." (Altarum Institute)  

ACA at Risk When Supreme Court Reviews King v. Burwell
"[A] Court decision adverse to the government will be ... a perfect storm for the ACA in 34 States: no federal funding for the exchanges in those States after January 1 means a near certainty that none of them will move in the direction of setting their own up; without federal tax subsidies the individual mandate would not be in effect for those residents who could not afford coverage without them; the employer mandate would then not be in effect for that population; and adverse selection would force premiums up for those who did access exchange coverage." (Mintz Levin)  

House Races Toward Vote on Changing Employer Health Insurance Coverage Threshold
"This week, a measure addressing employer requirements for health insurance coverage will be quickly printed and heads toward a scheduled House vote on Thursday. The bill adjusts the Affordable Care Act's definition of a full-time employee requiring insurance coverage from 30 hours a week to 40 hours. Supporters of the adjustment claim that the 30-hour rule entices employers to stop hiring or reduce employee hours below the 30-hour threshold." (Roll Call)  

[Opinion]

Health Reform Not Causing Significant Shift to Part-Time Work
"[R]aising the law's threshold from 30 hours a week to 40 hours would make a shift toward part-time employment much more likely -- not less so. That's because only a small share of workers today -- 7 percent -- work 30 to 34 hours a week and thus are most at risk of having their hours cut below health reform's threshold. In comparison, 44 percent of employees work 40 hours a week, and another several percent work 41 to 44 hours a week. Thus, raising the threshold to 40 hours would place many more workers at risk of having their hours reduced." (Center on Budget and Policy Priorities)  

[Opinion]

Open Enrollment in Obamacare's Second Year: Early Lessons Learned
"[We] can take three early lessons away from the first six weeks of open enrollment: [1] Obamacare's enrollment target of 9 million to 10 million for 2015 (reduced from 13 million) is still very optimistic. [2] Inertia rules: It appears that two-thirds of 2014 enrollees have auto-enrolled in the same plan, although most could have saved on premiums if they had shopped around. [3] On average, each new 2015 enrollee is receiving a bigger subsidy than the average 2014 enrollee. So, even though there are fewer Obamacare dependents than initially expected, the total cost to taxpayers may not go down." (National Center for Policy Analysis Health Policy Blog)  

Benefits in General; Executive Compensation

Maximizing Employee Appreciation: A Look at Total Compensation Statements (Part 1) (PDF)
"While benefits have played an important role in the workplace for decades, today's total rewards programs offer employees significantly more than the typical benefits provided just a few short years ago.... An increased focus on work-life balance benefits, which may include flexible work arrangements, along with performance recognition and career development tools, has greatly expanded the inventory of rewards available to today's workforce. Thanks to this expansion, both the private and public sectors have experienced growth in the ratio of nonwage benefits to cash compensation." (Bryan, Pendleton, Swats & McAllister, LLC)  

ERISA@40: Gen Z and the Workplace of 2054 -- No Longer Science Fiction (PDF)
"Forty years from now -- on ERISA's 80th birthday -- Generation Z will begin retiring. By 2054, the workplace and employee benefits will have adapted to a new generation's knowledge and assumptions, expectations and behavior, and ways of learning, working, and exiting the workforce. The workplace and employee benefits will also have adapted to social influences, new legislation, and technological advances.... [A chart in this article] shows how GenZ compares to previous generations ... Many of these characteristics are only accelerations of trends that already exist, such as technological prowess, real-time and on-demand information sharing, intelligence, and global awareness. Others are entirely new and will present exciting opportunities and challenges for their future employers and colleagues." (Buck Consultants at Xerox)  

Press Releases

ABD Insurance Adds VP to Retirement Services Team
ABD Insurance & Financial Services

PSCA Undergoes Leadership Change
PSCA [Plan Sponsor Council of America]

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