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Employee Benefits Jobs
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Webcasts and Conferences
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[Official Guidance]
Text of IRS, DOL and HHS Final Regs: Amendments to Excepted Benefits
57 pages. "[T]he Departments reiterate that limited wraparound coverage that is an excepted benefit cannot be an account-based mechanism and instead must be a risk-sharing product that covers a defined package of services.... Either the dollar or percent limitation would satisfy the Departments' objective of ensuring that the limited wraparound coverage provides a limited benefit, as required by the statute, and be similar to other limited excepted benefits.... These final regulations adopt the [nondiscrimination] approach outlined in the 2014 proposed regulations... As under the 2014 proposed regulations, limited coverage that wraps around eligible individual health insurance (or BHP coverage) for an individual who is not a full-time employee is required to satisfy three standards relating to plan eligibility.... For limited coverage that wraps around Multi-State Plan coverage, four
requirements would be required to be met under the 2014 proposed regulations.... A self-insured group health plan, or a health insurance issuer offering or proposing to offer Multi-State Plan wraparound coverage, would report to OPM ... information OPM reasonably requires to determine whether the plan or issuer qualifies to offer such coverage or complies with the applicable requirements of this section. In addition, the plan sponsor of any group health plan offering any type of limited wraparound coverage would report to HHS ... information HHS reasonably requires to determine whether the exception for limited wraparound coverage is allowing plan sponsors to provide workers with comparable benefits.... [T]hese final rules specify that wraparound coverage could be offered as excepted benefits if the coverage is first offered no earlier than January 1, 2016 and no later than December 31,
2018. The end date is unchanged ... from the proposal[.]"
(Internal Revenue Service [IRS], U.S. Department of Labor [DOL] Employee Benefits Security Administration [EBSA], and U.S. Department of Health and Human Services [HHS])
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[Guidance Overview]
HHS Explains Application of Annual Cost-Sharing Limit to Family HDHP Coverage
"This interpretation of health care reform's annual cost-sharing limitation effectively embeds an individual out-of-pocket limit in all family group health plans with a higher family deductible -- whether or not the high-deductible coverage is meant to make employees HSA-eligible.... That will likely affect plan costs, so it will probably require sponsors and insurers to reconsider and adjust benefits, premiums, or both.... the FAQ makes it clearer that plans will not have to apply this rule until their 2016 plan years, so sponsors and insurers will have time to respond."
(Thomson Reuters / EBIA)
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[Guidance Overview]
ACA Reporting and Disclosure: The Complexity Continues (Part 3 of 3)
"An employer who inadvertently failed to report a full-time employee would incur a $100 penalty. If the employer also inadvertently failed to provide a statement to that employee, it would incur an additional $100 penalty. If such failures were intentional, the employer's penalty would be $250 per failure ($500 total). Assuming similar violations occurred with respect to other full-time employees, the maximum combined penalty for both violations would be $3,000,000."
(Benefits Bryan Cave)
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High Court Ruling Weakens Retiree Health Rights
"A U.S. Supreme Court ruling in January weakens the 'vested rights' protection of retiree health care based on a labor contract, potentially making it easier for government employers to cut a growing cost.... The new ruling is expected to have an impact in California, where retiree health care often lacks clear authorization, little money has been set aside to help pay future obligations, health costs are growing, benefits are generous, and retirees are living longer." [M&G Polymers USA, LLC v. Tackett, No. 13-1010 (U.S. Jan. 26, 2015)]
(Calpensions)
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No ADEA Claim for Medicare-Eligible Retirees Whose Benefits Were Eliminated or Reduced
"When this litigation began, the EEOC's Medicare coordination regulation (which reversed a previous EEOC policy) had just been finalized. It is now well settled that the practice of coordinating Medicare benefits with group health benefits by altering, reducing, or eliminating health benefits when retirees become eligible for Medicare does not violate the ADEA's age discrimination prohibition." [Fulghum v. Embarq Corp., No. 13-3230 (10th Cir. Feb. 24, 2015)]
(Thomson Reuters / EBIA)
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Cadillac Tax Guidance Will Address Variety of Health Plan Structures
"The [ACA's] excise tax on high-cost health plans is prompting the [IRS] and Treasury Department to figure out how to fit new health coverage structures into a statute that only provides for self-only and non-self-only coverage ... 'Many, many plans today do not have self-only and family. What they have is self-only, and then they have self-plus one, self-plus two, self-plus three,' and so on and 'all of those will fit under non-self-only, so how they fit under that, that's the question,' [said] Kevin Knopf, senior technical reviewer, Internal Revenue Service Office of Chief Counsel, Tax Exempt and Government Entities[.]"
(Bloomberg BNA)
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Stripping the ACA of Both the Carrot and the Stick: Sticking It to Consumers On and Off the Federal Exchange
"[A] finding against the tax credits would mean that as premiums for coverage through the federal exchanges rise, premiums outside the exchanges would rise as well. This could make insurance 'unaffordable' not only for low-income individuals who would have qualified for the tax credits, but also for those who have relied on the non-group market for insurance -- the self-employed, individuals employed by small businesses that do not offer insurance coverage, early retirees, and those in-between jobs."
(Sheppard Mullin)
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Bringing Out-of-Network Costs Into the Light
"For Horizon, the state's largest health insurer, 80 percent of New Jersey's 27,000 doctors are in its network. Of the 5,500 that aren't, Horizon found about 200 of them bill certain services at 1,000 percent of what's allowed under the Medicare fee schedule ... The Newark-based insurer has identified another 2,000 doctors with charges equal to about 500 percent of what's allowed under those same guidelines."
(NJBiz)
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Drugmakers Turn Up Heat on Insurers by Backing Copay Limits
"Rules adopted in four states since last year cap what insurers can charge patients out-of-pocket for expensive medicines -- typically, to $150 a month. Similar legislation is under consideration in at least nine other states ... driven in some cases by patient-advocacy groups supported by companies like Pfizer Inc. under a campaign called Cap the Copay. If successful, the lobbying may short-circuit health insurers' attempts to persuade drug companies to moderate their prices."
(Bloomberg)
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Changes in Health Insurance Coverage After Implementation of the ACA
"This factsheet highlights the changes in health insurance coverage after the ACA's enactment in March 2010, for young adults who were able to gain coverage through their parents' health insurance plan, as well as adults who gained coverage after the start of open enrollment for the Health Insurance Marketplaces in October 2013 through March 4, 2015. Details on people who gained health insurance coverage include race and ethnicity, household income and state Medicaid expansion status, and young adults." [Includes Fact Sheet and Technical Notes.]
(Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])
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Obamacare's Second Open Season: Average Premium Up 23 Percent, Even Counting Subsidies
"Lost in the enthusiasm for Obamacare's new high-water mark are a few uncomfortable facts. First, the average premium -- net of subsidies -- has jumped 23 percent from 2014. In both years, insurers covering almost nine in ten Obamacare subscribers received subsidies to reduce premiums. The average monthly premium, before insurers receive subsidies, across all 'metal' plans, is $364 in 2015. The average subsidy is $263, resulting in a net premium of $101. In 2014, the administration reported an average premium of $346, less an average tax credit of $264, for a net premium of $82. Therefore, the gross premium increased 5 percent but the subsidy declined by a scratch. Due to the power of leverage, this resulted in subscribers seeing an average premium jump of 23 percent."
(National Center for Policy Analysis Health Policy Blog)
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Navigating the Complexities of International Emergency Medical Policies
"U.S. employers may also fail to realize that when their international (non-U.S.) employees leave their home country (whether to come to the U.S. or go elsewhere in the world) they do not automatically have emergency medical coverage under a domestic plan from their home country. So for example, when your German employee comes to the U.S. on a business trip, he or she has no medical coverage while in the states unless a specific policy was purchased for that purpose.... [If] that same German person went to France, he or she would be covered for needed medical services since E.U. countries have treaties with one another that covers this situation.... [S]ome countries, like Germany, legally require travel medical insurance for employees traveling out of country on business. If there is no policy in place you may be violating German labor law with all its related consequences."
(William Gallagher Associates)
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[Opinion]
Individual Mandate Exempt-A-Palooza: Now 32 Ways You Can Opt Out of Obamacare
"We are now up to 32 exemptions from the individual mandate. There are 317 million Americans. Only 4 million will pay Obamacare's individual mandate. That's a whopping 1.26%. But in reality, none of them really needs to pay it either. If they can't make one of the exemptions fit, they just aren't trying."
(Benefit Revolution)
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Benefits in General; Executive Compensation
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Boeing CEO Compensation Jumps Due to Increase in Pension Value
"Boeing Co. said Friday that the total compensation for Chief Executive Jim McNerney climbed 24% to $28.9 million, with two other senior leaders securing threefold increases as changing interest rates boost pension values.... The bulk of Mr. McNerney's higher compensation was in the form of a higher pension value, while equity awards fell 17% compared with 2013. The interest-rate environment has lifted compensation packages across American corporations by boosting the value of executive plans."
(The Wall Street Journal; subscription may be required)
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Press Releases
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