Health & Welfare Plans Newsletter

January 7, 2015

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Employee Benefits Jobs


Webcasts and Conferences

Defined Contribution Healthcare & Private Exchanges Summit
January 26, 2015 in FL
(Healthcare Education Associates)

Apprenticeship Plans and Fiduciary Responsibilities
January 28, 2015 WEBCAST
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Recent Trends in Retirement Plan Fee Structures
January 28, 2015 WEBCAST
(Multnomah Group)

Plan Corrections: Fixing the Broken Plan - Norfolk
February 19, 2015 in VA
(SunGard Relius)

Restatement and Design Workshop - Norfolk
February 20, 2015 in VA
(SunGard Relius)

EBIA’s Advanced Cafeteria Plans and Benefits Conference 2015
July 15, 2015 in MN
(Thomson Reuters / EBIA)

View All Webcasts and Conferences



[Guidance Overview]

Excepted Benefits: Final Regs Provide Guidance on Dental, Vision and Employee Assistance Plans
"Under both the 2013 proposed regulations and the final regulations, for a dental or vision plan to be an excepted benefit plan, the requirement that participants must pay an additional premium amount has been removed.... As well, the Agencies clarified that the limited scope dental and vision do not have to be offered alongside a separate employer offer of medical coverage to meet the 'not an integral part of a group health plan' requirement. The final regulations indicate that this requirement is met if the participant may decline the dental or vision coverage or if the claims are administered under a separate contract." (Thompson Coburn)  


[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]

Rules Attempt to Streamline ACA Benefits Summary
"The rule proposed ending the safe harbor for SBCs that do not specify whether the health care reform's standards for minimum essential coverage or minimum value are being met. However, other items were removed from the proposed template, reducing the SBC from four to two-and-a-half double-sided pages.... The proposed rules also address duplication and delegation issues that arose in the group health plan context." (Thompson SmartHR Manager)  

[Guidance Overview]

Ring in the New Year with New Summary of Benefits and Coverage Requirements
"Updated SBCs are not required during coverage negotiations.... New SBCs are not required again upon application if provided prior to application.... An SBC must be provided upon automatic re-issuance or re-enrollment.... A 'safe-harbor' may be available for SBCs delivered by a third party." (Sutherland Asbill & Brennan LLP)  

[Guidance Overview]

Expat Act Expands Relief from ACA Requirements
"Expatriate plans are permanently exempt from many of the ACA requirements ... [and are] deemed to satisfy the individual and employer mandates. While in the past, these provisions were only extended to fully insured plans, the new law provides relief from ACA requirements to self-insured expat plans as well. However, expat plans must meet specific participation and coverage requirements in order to be eligible." (William Gallagher Associates)  

House Approves Bill Exempting Certain Employees from ACA Threshold Count
"On [January 6, 2015], the House of Representatives voted unanimously in favor of the Hire More Heroes Act of 2015 (H.R. 22), a bill that would exempt employees covered under TRICARE or other health insurance provided by the Veterans Administration from being counted toward the [ACA's] 50-employee employer mandate threshold.... Given the new composition of the Senate, it is possible this measure will clear that chamber as well." (Littler)  

Text of CBO and JCT Cost Estimate for H.R. 22, 'Hire More Heroes Act of 2015' (PDF)
"CBO and JCT estimate that enacting H.R. 22 would reduce revenues, and thereby increase budget deficits, by $858 million over the 2015-2025 period.... CBO and JCT expect that enacting the bill would reduce the number of employers that would be required to make such employer responsibility payments, thus reducing federal receipts." (Congressional Budget Office [CBO])  

Onsite Clinics Are a Key Component to a Successful Health Benefits Strategy
"A majority of respondents of all sizes said the financial objectives for their onsite clinics are being met, with 64% seeing a reduction in medical care costs, almost 70% realizing reduced time lost by employees leaving work to see outside medical providers, and 63% had reduced use of the emergency room.... While most employers do not charge for clinic services, many are unaware of the need to charge employees with Health Savings Accounts a fee reflective of market prices. Over a third of employers with clinics do not consider their onsite clinics as part of their benefits plan, and there is uncertainty in how to value a clinic for purposes of the ACA's excise tax computations." (National Association of Worksite Health Centers [NAWHC], via Midwest Business Group on Health)  

Start-Up Helps Employers Determine Whether Employees Are Medicaid-Eligible
"By enrolling in Medicaid, low-wage workers benefit from low- or no-cost health coverage since the program typically has no monthly premiums and few out-of-pocket costs. Employers benefit because they don't have to pay a share of workers' insurance premiums or risk incurring penalties." (Kaiser Health News)  

Text of CBO and JCT Cost Estimate for H.R. 30, 'Save American Workers Act of 2015' (PDF)
"H.R. 30 would change how penalties are imposed under the [ACA] on employers that do not offer insurance (or offer insurance that does not meet certain criteria) and that have at least one full-time employee receiving a subsidy through a health insurance exchange. The legislation would raise the threshold that defines full-time employment from 30 hours per week under current law to 40 hours per week, and it would apply that higher threshold in two ways in the calculation of penalties.... As a consequence of the changes in penalties and in people's sources of insurance coverage, CBO and JCT estimate that enacting H.R. 30 would increase budget deficits by $18.1 billion over the 2015-2020 period and by $53.2 billion over the 2015-2025 period." (Congressional Budget Office [CBO])  

California 'Emergency' Regs Take on Narrow Networks
"[T]he regulations cover eight aspects of provider networks in individual and small group health plans.... As more health plans, particularly exchange plans, offered tiered and narrow networks, such as exclusive provider organization plans, [California Insurance Commissioner Dave Jones] said he wants to make sure the plans are offering access to essential health benefits at a reasonable cost." (Healthcare Payer News)  

[Opinion]

Obamacare's Effect on Uninsured is Trivial
"The drop in uninsured is only impressive when compared to 2011, when the uninsured rate was higher than it has been since Medicare and Medicaid were launched.... Look, on the other hand, at what happened in the early 1960s: A dramatic increase in coverage -- to 80 percent of the population -- before the institution of Medicare and Medicaid in 1965. Indeed, it looks like Medicare and Medicaid just hitched a ride on the secular increase in health insurance during the post-war boom." (National Center for Policy Analysis Health Policy Blog)  

Benefits in General; Executive Compensation

EBSA Fact Sheet: 2014 Fiscal Year Agency Results
"In FY 2014, EBSA closed 3,928 civil investigations with 2,541 of those cases (64.7%) resulting in monetary results for plans or other corrective action, exhibiting its ability to effectively target ERISA violators in the employee benefit plan universe.... In FY 2014, EBSA closed 365 criminal investigations.... During FY 2014, EBSA received 457 applications from Qualified Termination Administrators and closed 538 applications, with 456 plans making distributions of $18.4 million directly to participants.... In FY 2014, EBSA's Benefits Advisors closed more than 213,000 inquiries and recovered $356.2 million in benefits on behalf of workers and their families through informal resolution of individual complaints." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

ISS Releases FAQs on New Equity Plan Scorecard for 2015 (Part 1)
"[An equity plan scorecard (EPSC)] score of 53 or higher (out of a total 100 possible points) generally will result in a positive recommendation for the proposal (absent any overriding factors). EPSC factors are not equally weighted. Each factor is assigned a maximum number of potential points, which vary slightly depending on whether the S&P 500, Russell 3000, or Non-Russell 3000 model applies to the company. The FAQs include [a chart] summarizing the scoring basis for each factor." (Winston & Strawn LLP)  

Press Releases

TRA Names Emily Hooyman Plan Installation Manager
The Retirement Advantage [TRA]

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