Defined Contribution Retirement Plan Consultant
Swerdlin & Company - Penret Services
in MA

Health and Welfare Benefits Compliance Coordinator
Publix Super Markets, Inc.
in FL

Stable Value DCIO External Wholesaler
Fiduciary Capital Management
in ANY STATE, CT

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[Official Guidance]

Text of CMS Unified Rate Review Instructions: 2016 Rate Filing Justification (PDF)
69 pages. "Section 2794 of the Public Health Service Act (PHSA) and the implementing regulation ... establish requirements for health insurance issuers (issuers) offering health insurance coverage for non-grandfathered products in the small group and/or individual markets to submit rate filing information on rate increases to [CMS].... [A] Rate Filing Justification for single risk pool compliant plans consists of the following three parts: Part I: Uniform Rate Review Template (URRT) ... Part II: Written Description Justifying the Rate Increase ... Part III: Rating Filing Documentation (Actuarial Memorandum)." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Advert.]

State and Local Government Benefits Association (SALGBA)

(SALGBA) is the premier organization providing educational and collaborative support for public sector employee benefits professionals, such as national and regional conferences, member directory, and more. For a complete list visit www.salgba.com.

[Official Guidance]

Text of CMS Rate Review Justification Requirements for Transitional Policies and Student Health Plans (PDF)
22 pages. "This manual provides the technical instructions for issuers to submit the Preliminary Justification in the Rate Review Justification (RRJ) module of [Health Insurance Oversight System (HIOS)] for non-grandfathered transitional plans and SHPs in the individual and small group markets. Issuers must submit the Preliminary Justification for all proposed rate increases that are subject to review (i.e., rate increases that are 10% or greater)." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

Text of IRS Publication 974: Premium Tax Credit, Revised March 30, 2015 (PDF)
51 pages. "The following changes have been made under Self-Employed Health Insurance Deduction and PTC. [1] Lines 4a and 25 of Worksheet W have been revised. [2] New line 28 has been added. [3] Additional instructions are provided for individuals who have more than one trade or business under which an insurance plan is established. [4] The list of deductions and exclusions under Step 1 on pages 36 and 38, and on page 40 has been reordered, and the domestic production activities deduction has been added to the list." (Internal Revenue Service [IRS])  

Informal EEOC Discussion Letter Addresses ADEA Implications of Paying Employees' Medicare Premiums
"The letter explains that the EEOC and some courts have found that distinctions based on Medicare eligibility are based on age, since most individuals qualify for Medicare by reaching age 65. However, the ADEA prohibits only conduct that treats older workers adversely; providing older workers with more advantageous options than younger workers does not violate the ADEA. Whether an arrangement provides more advantageous options to older workers or treats them adversely cannot be determined without a factual investigation." (Thomson Reuters / EBIA)  

Federal Judge Stops DOL's Enforcement of New FMLA Rule
"The plaintiffs argued that the DOL's final rule should be enjoined in states that do not recognize same-sex marriages. Section 2 of DOMA, which survived the Supreme Court's scrutiny in Windsor, provides that states may refuse to recognize same-sex marriages performed under the laws of other states.... According to the court, DOL's rule on same-sex marriages appears to improperly pre-empt state laws forbidding the recognition of same-sex marriages." [State of Texas v. U.S., No. No. 7:15-cv-00056-O (N.D. Tex. Mar. 26, 2015)] (The Wagner Law Group)  

[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.

A Shared Nationwide Health IT Interoperability Roadmap (PDF)
166 pages. "This draft Roadmap proposes critical actions that the public and private sector need to take to advance the country towards an interoperable health IT ecosystem over the next 10 years.... [T]he Roadmap focuses on actions that will enable a majority of individuals and providers across the care continuum to send, receive, find and use a common set of electronic clinical information at the nationwide level by the end of 2017." (National Coordinator for Health Information Technology)  

[Opinion]

Brief on the Sad Status of Narrow Networks
"The complex policies behind narrow provider networks were not designed for patients. They were designed for the private insurance companies.... Narrow provider networks are only one more tool to reduce the cost of health care in order to keep their premiums competitive. As this report indicates, insurers select their network providers based on the lowest prices that they can negotiate -- not on quality." (Physicians for a National Health Program [PNHP])  

Limiting Participant Claims with Plan and SPD Language
"Without clear language in the plan document and SPD addressing these issues, a plan and its fiduciaries run the risk of (i) being forced to respond to claims and lawsuits that otherwise could have been avoided and (ii) defending lawsuits in distant and unfavorable locations. Some important considerations are: [1] How can a claim be submitted? ... [2] When does a claim need to be brought or a lawsuit need to be filed? ... [3] Where can suit be filed?" (Mazursky Constantine LLC)  

Section 162(m) Final Regs Clarify Requirements for Exemptions to $1 Million Deduction Limitation
"Shares issued upon settlement of restricted stock units, performance shares or other similar stock-based deferred arrangements will not qualify for relief under the IPO transition rule unless the share issuance occurs during the transition period -- i.e., these types of awards will not be treated as 'paid' upon the date of grant. Fortunately, this change will only apply to restricted stock units, performance shares or other similar stock-based deferred arrangements that are issued on or after April 1, 2015. A less generous transition rule had been provided under the proposed regulations." (McDermott Will & Emery)