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Employee Benefits Jobs
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Webcasts and Conferences
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[Guidance Overview]
ACA Information Reporting: An Overview of Forms 1094-C and 1095-C and Instructions (PDF)
51 presentation slides. Topics include: Section 6056 Reporting -- What Data Do You Need? Simplified Methods/Section 4980H Transition Relief; MEC Offer Indicator; FTE and Total Employee Count; Cost of Coverage; Covered Individuals; MEC Reporting for Non-Employees; Simplified Reporting Methods.
(Groom Law Group, for American Benefits Council)
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Cigna Loses Fifth Circuit Appeal Over Treatment of Out-of-Network Providers and Patients
"The ruling against Cigna's 'fee forgiving protocol' allows out-of-network providers the right to sue for ERISA violations in federal court and it also allows out-of-network patients the right to both ERISA discounts and PPO discounts. In an unprecedented turn, the 5th Circuit ruling provides very specific step-by-step ERISA legal guidelines used in determining whether all ERISA plans improperly require collection of full deductible and coinsurance as a pre-condition to complete benefits coverage and whether CIGNA violated [ERISA] in its inconsistent or discriminative out-of-network practice compared to its in-network practice of ERISA plan claims administration services." [North Cypress Medical Center v. Cigna, No. 12-20695 (5th
Cir. Mar. 10, 2015.]
(AVYM Healthcare Revenue Consultants)
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The ACA and Medical Loss Ratios: No Impact in First Three Years (PDF)
"[The ACA] set limits on insurers' overhead, mandating a medical loss ratio (MLR) of at least 80 percent in the individual and small-group markets and 85 percent in the large-group market starting in 2011.... MLRs averaged 83.04 percent in the three years before reform and 83.05 percent in the three years after reform. [The authors] conclude that the ACA had no impact on insurance industry overhead spending."
(Benjamin Day, David U. Himmelstein, Michael Broder, and Steffie Woolhandler, via International Journal of Health Services)
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Achieving High-Performance Healthcare Programs
"To achieve high performance, midsize organizations need to understand the dynamics of the health care marketplace and the actions they can take to shape their health programs so their plans outperform the market and increase in value through better results.... Today, employers have more options available to them, including: [1] Using a systematic measurement process for program assessment ... [2] Defining subsidy strategy.... [3] Linking health care strategy to business objectives.... [4] Choosing the right program partners.... [5] Considering new strategic pathways."
(Towers Watson)
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'Wearable Tech' Could Provide Insurer Opportunity
"The recent debut of the Apple Watch may be more than a heads-up for gadget-hungry technophiles who like the idea of wearable technology. Insurance carriers and rainmakers may be paying attention too. That's because the watch ... is also a device containing digital health and fitness monitors and apps that users can use to track personal health-related activities and data. Wearable fitness trackers already exist, but if the Apple product takes off, that might give a bounce to such tracking, and this could be of interest to insurance professionals."
(InsuranceNewsNet.com)
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ACA CO-OP Program Faces Both Barriers and Opportunities for More Competitive Health Insurance Markets
"Today, there are 23 CO-OPs in 25 states ... Combined, they've received $2.44 billion in low-interest federal loans. In the first year of marketplace enrollment, these plans collectively garnered over 500,000 total enrollees. But the performance of individual CO-OPs was decidedly mixed, and their experiences have been dependent on factors unique to their states and markets.... [S]ome CO-OPs may have been too successful for their own good."
(The Commonwealth Fund)
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Fourth Challenge to Obamacare Hits Supreme Court
"Now the justices are being asked to rule on whether the law is an illegal invasion of privacy. The argument is that its Independent Payment Advisory Board -- which has been dubbed a 'death panel' by critics -- is unconstitutional because it would make life-and-death decisions for patients. The government argued, in a brief that the justices had required, there's no real issue, nothing to determine and the case should be dropped. But the Goldwater Institute says if that happens, it will violate the constitutional rights of Americans and damage them irreparably."
(WND)
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Push for Pregnancy as Qualifying Event Raises Incentives Questions
"[HHS] is being urged to add another qualifying event to the list of ways people can buy an exchange plan in a 'special enrollment period.' ... The addition of pregnancy would add to a list of qualifying life events that includes moving to a new state, drastic changes in income, marriage, divorce and the birth of a baby and adoption. And it seems that HHS has the authority to add pregnancy, as the agency wrote in a recent regulatory summary, although there were no plans to do so. Advocates are also calling on state exchanges, such as Covered California, to adopt a similar policy."
(Healthcare Payer News)
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[Opinion]
King v. Burwell and the Mandates: What Happens If the Supreme Court Rules Against the Executive Branch?
"Absent action by the federal government or states, a ruling for the plaintiffs and against the Obama Administration would mean that individuals for whom insurance coverage became a greater out-of-pocket expense (exceeding 8 percent of their income in any given month) without the premium support tax credit would become exempt from the individual mandate. Furthermore, employers in states that refused to set up Obamacare exchanges would be exempt from the employer mandate because no federal outlays would be made to trigger the penalty. King is a consequential initial step on the road toward dismantling and replacing the ill-considered Obamacare statutory scheme."
(The Heritage Foundation)
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[Opinion]
House Bill Would Provide Tax Deduction for Gym Membership to Combat Obesity
"[T]here are two problems with trying to reduce obesity with an enhanced medical deduction. First, ... few taxpayers would enjoy a tax break resulting from the expanded definition of medical care to include fitness costs, because even with those costs -- and remember, they are capped at $2,000 -- most taxpayers will not generate enough medical deductions to exceed the 10% floor.... [Second,] the likelihood of a taxpayer utilizing itemized deductions increases as income level rises.... Studies have shown that the prevalence of obesity, particularly in women, increases as income decreases."
(Forbes)
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[Opinion]
Wellness Industry Leaders Shockingly Admit that Wellness Is Bad for Morale
"Why, having now read this revelation in [their] own words, that wellness is bad for morale, would any company still want to 'do wellness'? Or as we say ... 'If you're a general, would you rather have troops with high morale or troops with low cholesterol?' Isn't this the best argument for getting rid of your wellness program: You can improve morale and save money?"
(Al Lewis and Vik Khanna)
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Benefits in General; Executive Compensation
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Average Employer Cost for Union Workers Is $46.50 Per Hour
"Private industry employers spent an average of $31.32 per hour worked for employee compensation in December 2014. Wages and salaries averaged $21.72 per hour worked and accounted for 69.4 percent of these costs. Benefits averaged $9.60 and accounted for the remaining 30.6 percent. Total compensation costs for union workers averaged $46.50 per hour worked in December 2014. The average for nonunion workers was $29.83. Benefits accounted for 40.3 percent of compensation costs for union workers, compared with 29.2 percent for nonunion workers."
(U.S. Bureau of Labor Statistics [BLS])
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Sixth Circuit Overturns $2.8 Million ERISA Award for Unjust Enrichment
"The fact that LINA made money off the denied claim did not aggravate Rochow's injury, the circuit court said. The opinion stated that if Rochow's logic held, then all wrongful denials of benefits that enables insurers to make gains could subject plan fiduciaries to ERISA enforcement for disgorgement of profits. The earlier Rochow ruling focused on the company's gain, but that was beyond consideration for ERISA relief. Since there was no showing that the benefit recovery, attorney's fee and (potential) prejudgment interest would be inadequate, the further award was inappropriate." [Rochow v. LINA, No. 12-2074 (6th Cir. Mar. 5, 2015)]
(Thompson SmartHR Manager)
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2015 Workplace Threats Survey: Are Measles or Cyber Attacks the Number One Concern?
"Despite seemingly common workplace fears like disease outbreaks, violence and natural disasters, the number one concern for organizations is a cyber attack.... 37 percent of organizations said a cyber attack was their number one concern, compared to other potential threats. In response, organizations are more financially prepared -- 64% are spending more now than they did 5 years ago for workplace threat prevention."
(International Foundation of Employee Benefit Plans [IFEBP])
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Senate Panel Mulls Changes in Rules on Nonqualified Deferred Compensation
"Sen. Ron Wyden (D-OR), released a report on tax avoidance strategies that outlines possible recommendations for reforming nonqualified deferred compensation (NQDC) as part of an expected tax reform proposal.... The report outlines several options for reforming NQDC, including proposals that would: [1] Include NQDC in gross income for the taxable year in which it vests; [2] Limit the amount of NQDC (for example, to $1 million); and [3] Impose the 162(m) deduction limit on former employees."
(Towers Watson)
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Press Releases
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