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Ascensus
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TPA
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United Retirement Plan Consultants
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AXA
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The Angell Pension Group, Inc.
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The Savitz Organization
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Cadillac Tax: A Regulatory Update on the ACA's 40% Excise Tax on Higher-Cost Employer-Sponsored Coverage
March 24, 2015 WEBCAST
(Ernst & Young, LLP)

Creating Health Engagement & Behavior Change: The New Paradigm in Health & Wellness
April 7, 2015 WEBCAST
(Benefitfocus)

A Practical Guide to Employee Benefit Plan Reporting and Disclosure Requirements Under the ACA, HIPAA, ERISA and the Code
April 21, 2015 WEBCAST
(ABA Joint Committee on Employee Benefits)

Impact of the New CMS ACO Model: Next Generation ACO Implications
April 22, 2015 WEBCAST
(Healthcare Web Summit)

Cadillac Tax Under Code § 4980I: IRS Notice 2015-16 Fills in the Details
April 29, 2015 WEBCAST
(Thomson Reuters / EBIA)

HSAs, HRAs, and Consumer-Driven Health Care
June 3, 2015 in IL
(Thomson Reuters / EBIA)

The Gathering Storm: How Should Plan Fiduciaries Address Health Care Provider Overbilling?
June 9, 2015 WEBCAST
(ABA Joint Committee on Employee Benefits)

ASPPA Regional Conference
July 9, 2015 in MA
(ASPPA [American Society of Pension Professionals & Actuaries])

2018 Enrolled Actuaries Meeting
April 8, 2018 in DC
(Conference of Consulting Actuaries)

View All Webcasts and Conferences

[Guidance Overview]

New HHS Regs 'Clarify' That Health Plans Covering Families Must Have 'Embedded' Individual Cost-Sharing Limits
"[HHS] now requires group health plans to embed an individual cost sharing limit within the family limit.... The HHS clarification is not effective until plan years beginning on or after January 1, 2016. It is important to note that, at the moment, it is unclear whether the HHS clarification is intended to apply to self-insured plans.... Additionally, all previous cost sharing guidance applicable to self-insured plans have been issued jointly by the HHS, Department of Treasury and [DOL]. As of the date of this [article], the Departments of Treasury and Labor have not issued a similar clarification." (Proskauer's ERISA Practice Center)  

[Advert.]

National Employee Benefits Day | April 2, 2015

National Employee Benefits Day 2015 focuses on Wellness 2.0 -- the growing movement to expand employer wellness programs to encompass all areas of total well-being: body, mind, wallet, community and work. Learn more about Wellness 2.0.

[Guidance Overview]

Final Excepted Benefit Rules Address Limited Wraparound Coverage
"These final regulations are intended to offer employers a way to provide certain employees, dependents and retirees who have enrolled in individual market coverage with overall coverage analogous to what they could receive under the employer's group health plan.... [T]he wraparound coverage is subject to a significant set of compliance requirements and design restrictions that may limit its appeal for many employers. However, the government did appear willing to allow a relatively broad set of benefits to be offered as 'meaningful benefits' in the limited wraparound context, as reflected by the additional examples it provided." (Practical Law Company)  

Fifth Circuit: Hospital Enjoys Standing to Seek ERISA Benefits
"The Fifth Circuit ... reasoned that participants have the right to be reimbursed by CIGNA for medical costs incurred at an out-of-network provider, and the fact that participants assigned that right to the hospital 'does not cause [the right] to disappear.' As an express assignee of the patients' rights, the hospital had standing to sue for underpayment of benefits." [North Cypress Medical Center v. Cigna, No. 12-20695 (5th Cir. Mar. 10, 2015)] (Proskauer's ERISA Practice Center)  

Fifth Circuit Clarifies and Approves ERISA Rights for Out-of-Network Providers Regardless of Non-PPO Discount
"According to the appellate court's ruling, Third Party 're-pricing negotiation' agreements and discounts will be preempted by ERISA if: '[t]he contracts by their terms are subject to the underlying ERISA plans.' Even after re-pricing discounts have been negotiated, [out-of-network] providers, with valid and complete assignments, have the right to seek all eligible payments according to the plan terms. The profound impact of this appellate court ruling may fundamentally change the nation's healthcare landscape and existing managed-care model." [North Cypress Medical Center v. Cigna, No. 12-20695 (5th Cir. Mar. 10, 2015.] (AVYM Healthcare Revenue Consultants)  

Nontraditional Wellness Initiatives Emerge
"More traditional wellness initiatives like health risk assessments and flu shots remain popular among workplaces, but [a recent survey] noticed a growing emphasis on more non-traditional initiatives like mental health coverage, vacation time and tuition reimbursement. According to the survey, top non-traditional wellness initiatives include: vacation time/time off use is encouraged (66 percent); mental health coverage (63 percent); tuition reimbursement (63 percent); community charity drives (57 percent); and on-site events/celebrations (50 percent)." (Wolters Kluwer Law & Business)  

[Advert.]

Register -- MBGH Annual Conference for Health Benefits and Health Care

The Midwest Business Group on Health's 35th Annual Conference will be held April 29-30 in Chicago, featuring leading employers and industry experts providing objective, timely and practical information on the latest research, trends and best practices.

Latest Insurance Data Breach More Devastating Than Anthem
"Premera Blue Cross, which serves the Pacific Northwest and Alaska, says it was hacked last May -- and its customers' claims and clinical data were exposed.... Clinical, payment and claims data were not part of the Anthem hack." (Employee Benefit News)  

Premera Cyber-Attack: Defining Your Obligations as an Employer
"For self-insured group health plans that currently contract -- or at any time since 2002 [have] contracted -- with Premera as a third party administrator or TPA, there are a few steps that you may want to consider taking immediately ... Group health plans may be affected because Premera: [1] provides insured health benefits; [2] administers health benefits for a self-insured plan; or [3] administers out of area/network claims. Additionally, employers may have liability for any wellness programs that may have been provided by Premera. This advisory explains the HIPAA and state law consequences and provides practical guidance on what employers need to do to comply with their legal obligations." (Davis Wright Tremaine LLP)  

Montana Tweaks Data Breach Law
"H.B. 74 expands the present definition of PI to now include medical record information (as defined in Mont. Code Ann. sec. 33-19-104), taxpayer identification numbers and issued by the federal Internal Revenue Service. H.B. 74 further requires entities who give notice under Montana's data breach statute to also simultaneously submit an electronic copy of the notice along with the number of in-state individuals who were notified to the Montana Attorney General's Consumer Protection Office." (Privacy & Security Law Blog, from Davis Wright Tremaine LLP)  

Washington State Poised to Set the Bar for Data Encryption Standards and Breach Notification
"The single most important proposed change is the narrowing of the current encryption exemption to the notification requirement. Under the current law, as in many other jurisdictions, notification is not required if the data compromised during the breach is encrypted. HB 1078 would change that by implementing a first-of-its-kind requirement that notice be given to any Washington State resident whose encrypted personal information is compromised, unless the information is encrypted in a manner that meets or exceeds NIST's standard, or is otherwise modified so that the personal information is rendered unreadable, unusable, or undecipherable by an unauthorized person." (Orrick)  

Aging Baby Boomers Make Health Insurer Humana an M&A Target
"Humana and WellCare, both providers of Medicare coverage, are generating record revenue as aging U.S. baby boomers drive an increase in enrollment in the government-sponsored program for the elderly. Insurers are also benefiting from expanded Medicaid coverage for the poor under Obamacare. Larger insurers such as Aetna Inc. and Anthem Inc. would like to continue expanding beyond coverage that's paid for by employers, and could be interested buyers." (Bloomberg)  

Senate Finance Committee Hearing: 'The Affordable Care Act at Five Years'
Page includes video of hearing and links to written testimony from Dr. Douglas Holtz-Eakin, American Action Forum; Holly Wade, National Federation of Independent Business; and Dr. David Blumenthal, The Commonwealth Fund. (U.S. Senate Committee on Finance)  

Chairman's Opening Statement at Senate Finance Committee Hearing: 'The Affordable Care Act at Five Years' (PDF)
"[T]his anniversary presents a perfect opportunity to take a look back and evaluate whether the promises that were made to gain support for the law have been kept. It's also a good time to look forward and consider the many unanswered question s that we still have about the impact and viability of the ACA.... The President and his allies claim that the law is a success, usually by cherry-picking particular data points and ignoring the larger picture... What they don't talk about are the still skyrocketing health care costs that are hitting families across this country. And, they also ignore the widespread frustration and delay caused by this law, which many Americans are finding out about during this tax filling season." (U.S. Senate Committee on Finance)  

Lessening the Impact of Coverage Churn Through Multimarket Health Plans
"While making sure people can enroll in or renew their Medicaid and marketplace plans through a single entry point would reduce breaks in coverage, it would not address the fact that insurers sell different health plans, with different rules and health provider networks, in the Medicaid and exchange markets. This may affect continuity of care ... For this reason, there has been interest in insurers that offer complementary health plans, using a common provider network, for both Medicaid and the marketplaces. Such a strategy could protect people from the health care consequences of what really is only a different source of financial support as they move from one form of subsidized coverage to another." (The Commonwealth Fund)  

[Opinion]

Blue Shield of California Loses Its State Tax-Exempt Status
"Blue Shield of California has annihilated the dream of those who believed that the United States could adopt a universal system of private, non-profit insurance companies like they have in Switzerland. There are many serious problems with the Swiss model, but some believed that a market of well-regulated, non-profit insurers would make optimal patient care a priority. Blue Shield of California has now demonstrated to us that this pipe dream would only become another nightmare in the saga of private insurance markets in the U.S." (Physicians for a National Health Program [PNHP])  

Third Circuit Opinion: Evidence of Fixed Policy of Denying Benefits Is Sufficient to Demonstrate Futility of Administrative Appeals (PDF)
"The Employees misconstrue the futility exception to the exhaustion requirement when they argue that, because exhaustion is an affirmative defense, United bears the burden of proving that it would not be futile... The failure of Hane's appeal, the existence of a fixed policy denying benefits as evidenced by the correspondence between Loughlin and the many TVPs with letters in the record, and the absence of any evidence before us to suggest that an appeal from Loughlin's letter was anything other than time wasted, lead us to conclude that the District Court did not abuse its discretion in applying the futility exception to the exhaustion requirement[.]" [Cottillion v. United Refining Co., No. 13-4633 (3d Cir. Mar. 18, 2015)] (U.S. Court of Appeals for the Third Circuit)  

ERISA Damages: Two Bites from the Same Apple Are Impermissible
"The sole issue before the Sixth Circuit in the en banc rehearing was whether Rochow was entitled to recover under both ERISA Sections 502(a)(1)(B) and 502(a)(3) based only on LINA's denial of benefits.... [T]he court concluded that Rochow only alleged one injury (i.e., the failure to pay benefits due) and that the remedy available under ERISA Section 502(a)(1)(B) was sufficient to resolve that injury. The decision by the Sixth Circuit in the en banc rehearing seems to bring that circuit back into alignment with other federal circuits and the Supreme Court[.]" [Rochow v. LINA, No. 12-2074 (6th Cir. Mar. 5, 2015)] (Porter Wright Morris & Arthur LLP)  

Federal Agencies Monitoring Retirement Plans Try to Work Smarter with Less (PDF)
"DOL has said it will focus its investigations on issues with the greatest impact, and the IRS will zero in on compliance issues with a 'multiplier effect,' issues that will affect many plans. Despite money and manpower constraints, both agencies have been very busy addressing new and existing issues[.]" (ERISAdiagnostics, Inc. via Thompson Pension Plan Fix-It Handbook)  

SunGard Launches Health Information Exchange (HIE) Connectivity Solution for Health Payers
SunGard

HighRoads Hires Mark Manning as SVP and Chief Revenue Officer
HighRoads

Benefitfocus and RedBrick Health Integrate Wellness Programs into Employee Benefits Platform
Benefitfocus

EEOC Seeks Public Input on Plan to Review its Significant Regulations
U.S. Equal Employment Opportunity Commission [EEOC]

Now Available: Transcript from the Regulator’s Panel at 2015 ECFC Annual Conference
ECFC [Employers Council on Flexible Compensation]

Enrollment in Health Benefits Through Towers Watson’s Exchange Solutions Expected to Reach About 1.2 Million in 2015
Towers Watson

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