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Employee Benefits Jobs
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Webcasts and Conferences
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[Official Guidance]
Text of CMS Q&A: Clarification of HDHP Policy Limits (PDF)
"[H]ow can issuers offer a family high deductible health plan (HDHP) with a $10,000 family deductible? ... [An] HDHP plan that has a $10,000 family deductible may provide payment for covered medical expenses for a member of the family if that member has incurred covered medical expenses during the year of at least $2,600 (the minimum deductible for a 2015 family HDHP). Under the policy finalized in the 2016 Payment Notice, this plan must also apply the annual limitation on cost sharing for self only coverage ($6,600 in 2015) to each individual in the plan, even if this a mount is below the $10,000 family deductible limit.... [F]amily HDHPs that count the family's cost sharing to the deductible limit can continue to be offered under this policy, as long as the self-only annual limitation on cost sharing is applied to each individual in the plan."
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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[Guidance Overview]
CMS Qualified Health Plan Certification Toolkit: Key Resources For Issuers (PDF)
15 pages. "This toolkit contains factsheets that consolidate important information about the 2016 QHP Application process and provide helpful hints for accessing critical resources, using available tools, and submitting required documentation.... This toolkit is a supplemental resource for issuers and is not intended to replace QHP Application Instructions, User Guides, regulations or guidance."
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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[Guidance Overview]
Summer Interns Probably Must Be Offered Health Benefits by the 90th Day
"The only ways to safely circumvent [the ACA requirement to offer] such benefits to a short-timer or summer intern would be if: [1] The person could be legitimately categorized as a seasonal worker which means that their job can only, by its very nature and definition, be accomplished during a recurring season.... [2] the person will work less than 90 days; or [3] the person will be working less than 30 hours per week. Many [employers] are opting to limit summer interns to a maximum of 29.5 hours a week in order to avoid this issue.... Others are limiting summer interns to 89 or less days to accomplish the same goal. However, that day limit also means you cannot subsequently hire that summer intern inside of 13 weeks[.]"
(Benefit Revolution)
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[Guidance Overview]
Proposed Regs for the ACA Cadillac Tax: What Treasury and IRS Are Considering
"Treasury and IRS expect to include in the proposed regulations, and invite comment concerning, rules regarding the dollar limit adjustments. Treasury and IRS also invite comment concerning: adjustments for retirees who are at least 55 and are not entitled to/eligible to enroll in Medicare, adjustments for high risk professions, and age and gender adjustments. Finally, Treasury and IRS invite comment on possible alternative methods for determining the cost of applicable coverage, including reference to similar coverage available elsewhere -- such as Exchange coverage."
(Jackson Lewis)
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[Guidance Overview]
IRS Gives Certain Premium Reimbursement Arrangements a Temporary Pass (PDF)
"[An employer, other than an applicable large employer (ALE),] who maintained a prohibited premium reimbursement arrangement in 2014 must terminate such arrangement before July 1, 2015 in order to avoid penalties under section 4980H.... ALEs who maintained a prohibited premium reimbursement arrangement in 2014 will be required to self-report this violation on Form 8928, but depending on the circumstances no penalty may be owed. Such reporting will also be required in 2015 unless the employer terminated the arrangement effective December 31, 2014."
(Wilkins Finston Friedman Law Group LLP)
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[Guidance Overview]
Final IRS Forms and Instructions for Reporting Health Coverage Clarify Large Employer Requirements for 2015 and Beyond
"Starting in 2016, Code Section 6055 requires all entities providing 'minimum essential coverage' (MEC) to submit information to the IRS concerning each individual provided MEC in the preceding calendar year. Section 6055 also requires these entities to furnish statements containing equivalent information to certain covered individuals. Starting in 2016, Code Section 6056 requires all large employers to report to the IRS information regarding health coverage, if any, offered to full-time employees in the preceding calendar year. Large employers are also required to furnish statements containing similar information to each full-time employee."
(Snell & Wilmer)
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Supreme Court Remands Notre Dame Contraceptives Case
"If the other courts of appeals fall into line, the case may not return to the Supreme Court. It is possible, however, that a majority of the Court may be seeking further accommodations beyond those it suggested in Hobby Lobby and Wheaton College. It is difficult to see what less could be asked of a religious organization than is required now -- that it simply inform the government of its objection -- but the Court seems very sensitive to religious beliefs on this particular issue[.]"
(Health Affairs)
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2016 HHS Risk Adjuster Coefficient Updates (PDF)
"[C]arriers that enroll a disproportionate share relative to the market of sicker or higher-risk individuals -- or, specifically, individuals with one or more hierarchical condition categories (HCCs) -- are likely to receive higher risk transfer payments under the updated model than under the current model. Conversely, carriers that enroll a disproportionate share of healthier individuals -- or, more specifically, individuals with no HCCs -- are likely to receive lower transfer payments or will have to pay higher amounts to other carriers under the risk adjustment program."
(Milliman)
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New Generation ACO Model Sets Stronger Measures and More Opportunities for Care
"The ACOs in the Next Generation ACO Model will take on greater performance risk than ACOs in current models, while also potentially sharing in a greater portion of savings. To support increased risk sharing, ACOs will have a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure that provides high quality care to patients. The new ACO model encourages greater coordination and closer care relationships between ACO providers and beneficiaries."
(U.S. Department of Health and Human Services [HHS])
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Many Health Plans Sold on Exchanges Violate Mental Health Parity Laws
"About 25 percent of plans sold on health insurance exchanges violate a federal mental health parity law that requires insurers to offer equal benefits to physical and mental healthcare... In particular, there were two problems with the exchange plans -- wide cost differences for physical and mental health services and more stringent requirements for prior authorizations for patients to receive mental services."
(FierceHealthPayer)
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Health Reform to Cover Fewer as Premium Increases Set to Double
"Headlines proclaim that costs are decreasing and cursory reports lead readers to believe that some element of PPACA must be working to reign in the costs of American healthcare.... Our savings are not due to some masterful control in costs but instead to a greater degree of cost shifting, a still struggling economy, and under-utilization due to woefully narrow networks.... CBO is finally starting to acknowledge that the Cadillac Tax on higher value plans, set to begin in 2018, will not yield the revenue they expected it would.... Private healthcare spending per enrollee is going to double from about 4.3% inflation per year per enrollee to about 8.5%[.]"
(Benefit Revolution)
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Benefits in General; Executive Compensation
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Revisiting Rochow: En Banc Sixth Circuit Rejects Earlier $3.8 Million Equitable Award
"The court remanded for a determination of whether prejudgment interest should be awarded under ERISA Section 502(a)(1)(B). However, the court warned that ... an excessive prejudgment interest rate would amount to punitive damages and 'would "contravene ERISA's remedial goal of simply placing the plaintiff in the position he or she would have occupied but for the defendant's wrongdoing." ' There was a concurring opinion, a dissenting opinion, and an opinion concurring and dissenting. Interestingly, all judges seemed to agree that make-whole relief is available under either ERISA Section 502(a)(1)(B) or Section 502(a)(3) but not both. However, even on this point of apparent agreement, there were diverging opinions on whether disgorgement of profits constitutes make-whole relief or punitive relief against the defendant." [Rochow v. LINA, No. 12-2074 (6th Cir. Mar. 5, 2015)]
(Ogletree Deakins)
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Matrimonial Attorneys Should Follow the Bouncing Ball of Beneficiary Designations (PDF)
10 pages. "The point of this article ... is to identify ... the risks and potentially disastrous consequences of a failure to attend to beneficiary designations ... The issues here are exacerbated by the fact that, by the time [they] become apparent, the participant is generally, by hypothesis, deceased and therefore not present or otherwise able to correct the situation....This Article will review the Court's approach in [Kennedy v. DuPont Sav. and Inv. Plan], consider the potential reach and breadth of the issue and discuss the approach taken in various post-Kennedy cases.... [S]imple but critical steps relating to identifying the intent of the parties and conforming the applicable beneficiary designations to that intent will be identified."
(Andrew L. Oringer and Albert Feuer, via Tax Management Compensation Planning Journal)
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BLS Report: Employer Costs for Employee Compensation, December 2014 (PDF)
"Private industry employers spent an average of $31.32 per hour worked for total employee compensation in December 2014 ... Wages and salaries averaged $21.72 per hour worked and accounted for 69.4 percent of these costs, while benefits averaged $9.60 and accounted for the remaining 30.6 percent.... Private industry employer costs averaged $2.54 per hour worked for insurance benefits (life, health, and disability insurance), or 8.1 percent of total compensation."
(U.S. Bureau of Labor Statistics [BLS])
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Say-on-Pay Vote Did Not Create Disclosure Obligation
"Insofar as plaintiff claims that [ARIAD Pharmaceuticals] was injured by the payment of compensation to officers, the claim fails to allege that the underlying corporate transaction (between ARIAD and the compensated executives) required shareholder approval. The proxy statement told the shareholders that their votes were sought on 'an advisory basis' with respect to executive compensation but told them that '[b]ecause your vote is advisory, it will not be binding on our Compensation Committee or our Board of Directors.' " [Liang v. Berger, No. 13-cv-12816-IT (D. Mass. Mar. 9, 2015)]
(Dodd-Frank.com, a blog by Stinson Leonard Street)
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Press Releases
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