Health & Welfare Plans Newsletter

March 20, 2015

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Groom Law Group Chartered
in DC

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Monroe Bank & Trust
in MI

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in FL

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Retirement and Pension Plan Company
in CT, NJ, NY

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in DC

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Webcasts and Conferences

Final IRS Forms 1094 and 1095: Line-by-Line Analysis for Employers and Advisors
RECORDED
(Thomson Reuters / EBIA)

How to Develop Your HIPAA-HITECH Policies and Procedures
March 26, 2015 WEBCAST
(Clearwater Compliance)

Pension Problem Solvers
April 23, 2015 in NY
(Drinker Biddle & Reath LLP)

GRACE Team Care Approach in Managing High-Risk Medicare Populations
April 29, 2015 WEBCAST
(Healthcare Web Summit)

ERISA Compliance for Health & Welfare Plans
June 3, 2015 in IL
(Thomson Reuters / EBIA)

Retirement Plan Insights Seminar
June 9, 2015 in IL
(McKay Hochman Co., Inc.)

View All Webcasts and Conferences



[Guidance Overview]

Agencies Expand Definition of Excepted Benefits to Cover Certain Types of Limited Wraparound Coverage
"Limited coverage that wraps around eligible individual health insurance for non-full-time employees must meet three standards regarding plan eligibility ... For limited coverage that wraps around a multi-state plan, four eligibility requirements must be satisfied[.]" (Littler)  


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[Guidance Overview]

New Guidance Issued on Excepted Benefits (PDF)
"The Departments have provided an enforcement safe harbor for plans that are designed to fill gaps in the primary coverage.... The Departments also intend to propose regulations clarifying the circumstances under which supplemental insurance products that do not fill in cost-sharing under the primary plan may be considered designed to fill gaps in primary coverage. This guidance will allow additional categories of benefits to be covered by a supplemental plan." (Marsh & McLennan Agency LLC)  

Health Coverage for Staffing Firm Employees: Who Is Responsible?
"If the worker receives an offer of coverage under the staffing firm's health plan, that offer will be treated as an offer of health coverage by the recipient employer so long as the staffing contract provides that the fee the recipient employer pays to the staffing firm for employees enrolled in the health coverage is higher than the fee the recipient employer would pay for the same employee if he or she did not enroll in the health coverage. The regulations do not specify how much higher the fee must be (so it is possible that even a nominal amount would be sufficient), but the increased fee can only apply to those who elect the staffing firm health coverage, and cannot be spread across all full-time employees." (Drinker Biddle)  

Health Law Brings No Drop in Insurance Enrollment At Work, Study Finds
"Part of the explanation for the stable results stems from the fact that most employers were already in compliance ... In 2014, employees had to work 25 hours a week on average to be offered health insurance, according to Mercer. That figure has edged up since 2011, when it was 23 hours weekly, but is still well below the law's 30-hour threshold.... Food and lodging companies were most affected by the new rules, with the average percentage of workers who were eligible for coverage increasing from 57 to 60 percent." (Kaiser Health News)  

Proposed Wellness Plan Legislation Responds to Lawsuits Filed by EEOC
"[The] House of Representatives Education and the Workforce Committee ... will conduct a hearing on March 24, 2015 about the House version of ... the 'Preserving Employee Wellness Programs Act' (S. 620) (H.R. 1189).... The Bill seeks to respond to two positions taken by the EEOC: (i) that a wellness program that offers incentives or rewards in compliance with the ACA may still violate the ADA or GINA, and (ii) offering incentives for the collection of an employee's spouse's genetic information for participation in the employee's wellness program violates GINA.... As proposed, the Bill would be retroactive to March 23, 2010 -- the date that the ACA was signed into law." (Jones Day)  


[Advert.]

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

Sponsored by Midwest Business Group on Health [MBGH]

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.



Bills Providing Paid Leave, Flexible Schedules Introduced in U.S. House and Senate
"[T]he Family and Medical Insurance Leave (FAMILY) Act (H.R. 1439, S. 786), was introduced in the Senate by Sen. Kirsten Gillibrand (D-NY) and in the House by Rep. Rosa DeLauro (D-CT). This legislation would establish a national, gender-neutral paid family and medical leave insurance program.... The push for paid leave has been growing at the state and local levels. While the federal measure is not likely to move this congressional term, expect more states to introduce and enact paid leave bills over the coming year." (Littler)  

House-Senate Lawmakers Unveil Bipartisan 'Doc Fix' Bill
"With participating physicians facing a 21 percent pay cut on April 1, lawmakers released a bill to replace Medicare's 'Sustainable Growth Rate' formula and end the so-called 'doc fix' -- temporary patches that Congress has approved 17 times to prevent slashing pay to doctors. The language in the bill is similar to one introduced last year: It would repeal the SGR while instituting an 0.5 percent payment increases for five years while Medicare transitions doctors to a new system that emphasizes quality care over volume of care. The bill also requires doctors to receive at least 25 percent of their Medicare revenue through the so-called Alternative Payment Models by 2019-2020." (McClatchyDC)  

Senators Urge Anthem to Notify All 78.8 Million Americans Affected by Cyber Attack
"More than a month after discovery of the breach, the vast majority of Americans affected by this attack -- more than 50 million in fact -- have yet to receive notice directly from Anthem that their personal information has been compromised, or information about the services that are available to them to protect themselves and their loved ones from resulting security threats like identity theft.... This slow pace is of particular concern given that many of the individuals whose information has been compromised are not Anthem customers and may still be unaware that their information was contained in the attacked database." (Committee on Health, Education, Labor and Pensions, U.S. Senate)  

Five Years Later: Administration Unilaterally Altering Obamacare's Flaws
"From confusing businesses and American workers by twice delaying the job-killing employer mandate, to having to implement a transition clause so the promise that 'If you like your health care plan, you can keep your health care plan' could ring true, to numerous other exemptions and special enrollment periods, the Administration has repeatedly had to amend their own law in order to avoid adverse fallout from patients and businesses -- all at the expense of hardworking American taxpayers. Here's a look at the most consequential unilateral changes the Administration has made in attempt to salvage their own flawed law[.]" (U.S. Senate Committee on Finance)  


[Advert.]

Changes to Cafeteria Plans: What You Need to Know to Prepare - March 26 webinar

Sponsored by Lorman and BenefitsLink

This webinar explores design choices to consider within the regulatory framework established by the IRS, and provides tools to ensure that plan design, documentation and administration are in compliance with applicable requirements. BenefitsLink discount.



The 'Next Generation' Accountable Care Organization Model
"Next Generation ACOs will be able to choose among several financial arrangements, including capitation, which will permit assuming higher levels of risk and, in return, an opportunity for greater financial rewards for performance. Next Generation ACOs can choose between two risk arrangements. One arrangement provides for an 80% sharing rate in performance years 1 through 3 and an 85% sharing rate in performance years 4 and [5] The other provides for 100% risk for Part A and Part B expenditures per year. Both arrangements provide for a 15% savings/losses cap." (Nixon Peabody LLP)  

State Insurance Commissioner Calls Out Blue Shield for 'Second Tax Dodge'
"California Insurance Commissioner Dave Jones (D) on Wednesday said Blue Shield of California has been dodging taxes for years. Jones spoke Wednesday after the Franchise Tax Board revealed it had revoked Blue Shield's tax-exempt status in August 2014.... Jones said Blue Shield avoids payment of premium taxes through a loophole in state law that allows Blue Shield to choose its regulator, and it chooses the Department of Managed Health Care [DMHC] ... According to Jones, DMHC collects only corporate taxes (which Blue Shield did not have to pay because of its previous exempt status, he said) while the Department of Insurance collects taxes on premiums." (California Healthline)  

[Opinion]

Let the States Fix Obamacare
"[The ACA] sought a template for insurance rules, benefits and other structural features that would be the same from Vermont to Texas and Florida to Alaska. That was unwise. The continuous political warfare since the enactment of the legislation reflects the fact that different parts of the country have very different views of how health care should be organized.... The solution to these conflicts over engineering is to allow different structures to be adopted.... Different approaches also permit regional diversity within the broad bounds of national values and goals.... Amending the ACA to unleash federalism and permit states much greater flexibility to innovate is the way to achieve such a truly American health system." (The Brookings Institution)  

Benefits in General; Executive Compensation

Fiduciary Breach Claim Based on Oral Representation Can Proceed
"According to the district court, nothing in Third Circuit precedent precludes oral misrepresentations from supporting a breach of fiduciary duty claim under ERISA. The court added that even if the oral representations could not support Lees' breach of fiduciary duty claim under ERISA, Lees had alleged sufficient facts on which to base his claim and further discovery into his employee file could reveal written materials to support the claim." [Lees v. Munich Reinsurance Am., Inc., No. 14-2532 (D.N.J. Mar. 9, 2015)] (Proskauer's ERISA Practice Center)  

Press Releases

US Labor Department Reaches $84 Million Settlement with BNY Mellon
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

NAPA Announces the Top DC Wholesalers for 2015
American Retirement Association

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