Health & Welfare Plans Newsletter

April 16, 2015

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Groom Law Group
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Northeast Based Consulting Firm
in DE, NJ, PA

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in CO

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Webcasts and Conferences

Cost, Concerns and Solutions to the Retiree Health Care Crisis
April 23, 2015 WEBCAST
(International Foundation of Employee Benefit Plans [IFEBP])

2015 Second Quarter Update
May 6, 2015 WEBCAST
(McKay Hochman Co., Inc.)

401(k) Plan Workshop 2015
May 14, 2015 in IL
(SunGard Relius)

Minimizing the Impact of a Cyberattack: Strategies for Hospitals and Health Plans
May 14, 2015 WEBCAST
(Atlantic Information Services, Inc.)

Form 5500 Workshop 2015
May 15, 2015 in IL
(SunGard Relius)

View All Webcasts and Conferences



[Official Guidance]

Text of Agency FAQs on ACA Implementation (Part XXV): Wellness Programs (PDF)
"[A] health-contingent wellness program must be reasonably designed to promote health or prevent disease. A program complies with this requirement if it [1] has a reasonable chance of improving the health of, or preventing disease in, participating individuals; [2] is not overly burdensome; [3] is not a subterfuge for discrimination based on a health factor; and [4] is not highly suspect in the method chosen to promote health or prevent disease ... The fact that a wellness program that complies with the Departments' wellness program regulations does not necessarily mean it complies with any other provision of the PHS Act, the Code, ERISA, (including the COBRA continuation provisions), or any other State or Federal law, such as the Americans with Disabilities Act or the privacy and security obligations of [HIPAA] ... Satisfying the rules for wellness programs also does not determine the tax treatment of rewards provided by the wellness program[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]; Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; and Internal Revenue Service [IRS])  


[Advert.]

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Workplace Wellness Programs: Services Offered, Participation, and Incentives (PDF)
"The goal of this report was to leverage existing data to explore patterns of wellness program availability, employers' use of incentives, and program participation and utilization among employees. This report will be of interest to national and state policymakers, employers and wellness program vendors, employer and employee advocacy organizations, health researchers, and others with responsibilities related to designing, implementing, participating in, and monitoring workplace wellness programs." (RAND Corporation, for Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

IRS Publication 5215: Understanding Reporting Requirements of the Health Care Law (April, 2015) (PDF)
2-page brochure. Topics: Types of minimum essential coverage; About reporting; Who is the MEC provider? What information is reported; Form 1095-B's sections. (Internal Revenue Service [IRS])  

Study Suggests Many ACA Exchange Plans Violate Federal Parity Laws
"According to a new study focusing on consumer information, nearly 25 percent of group health plans provided through [ACA] exchanges may be violating federal mental-health parity laws.... [B]ecause mental-health and substance-use disorder services are often more expensive than medical/surgical services, insurers may benefit when consumers are dissuaded from joining plans with more generous mental-health and substance-use disorder benefits." (Crowell & Moring LLP)  

2015 ADP Annual Health Benefits Report
"Over the five-year period studied, the percentage of full-time employees (as designated by the employer) who were eligible for employer-provided health benefits rose by 2.0%. Despite a rise in eligibility, the number of eligible employees who opted to take insurance dropped by -1.7% during the same period, keeping the overall participation rate steady at 69.3%." (ADP)  


[Advert.]

Wellness Programs: EEOC Enforcement Actions and Complying with Federal and State Laws

Sponsored by Lorman and BenefitsLink

April 24 live webinar: HIPAA nondiscrimination regulations, case law, design and taxation of incentives, laws that prohibit discrimination based on health factors, and exceptions for certain wellness and supplemental plans. BenefitsLink discount.



Seven Cost-Cutters You'll Need to Fight Emerging Healthcare Trends
"[1] Only offer a CDHP.... [2] Control rising drug costs.... [3] Add a spousal surcharge.... [4] Focus on chronic conditions.... [5] Review your life and disability plans.... [6] Link disability data to your wellness strategy.... [7] Use your data." (HR Benefits Alert)  

Public vs. Private Health Insurance on Controlling Spending
"[It] appears that public programs control per capita spending somewhat more effectively than private coverage does. That may be just the opposite of what many would presume in a country where the private market is generally expected to outperform the public sector." (The Wall Street Journal; subscription may be required)  

The Payment Reform Landscape: Impact on Consumers
"[As] we focus on reforming how we pay for health care, it is vital that we address key questions involving the very consumers who receive that care: How many consumers are directly touched by payment reform? How does payment reform impact employees and consumers and their experience with care? What, if anything, do consumers need to know about payment reform? As health plans implement a growing number of reforms to payment, these questions will only become more relevant." (Health Affairs)  

Health Insurers Call for Stronger Rules on Medical Devices
"Nearly all U.S. medical devices ... reach the market through an FDA system known as 510(k), which clears tools deemed substantially similar to ones already on the market. That process typically doesn't require clinical studies on people to prove safety and effectiveness.... America's Health Insurance Plans called for strengthening the 510(k) system and efforts to track devices." (The Wall Street Journal; subscription may be required)  

IRS Chief: No Backup Plan If Obamacare Tax Subsidies Struck Down
"IRS Commissioner John Koskinen told a Senate Homeland Security Committee that he is not preparing for the high stakes case, King v. Burwell. That responsibility, he said, rests with the White House, Congress and the states. 'We basically play the hand we're dealt. The court will make a decision, and then we will respond,' Koskinen said at a hearing on the agency's challenges in implementing the Affordable Care Act." (The Hill)  

New Jersey Cities Pass Paid-Sick-Leave Laws Despite Governor's Opposition
"Gov. Chris Christie opposes requiring businesses to give workers paid sick days, calling it another onerous regulation that deters companies from investing in New Jersey. That hasn't stopped officials in nine municipalities, including Newark, Jersey City and Montclair, from passing paid-sick-leave laws and enforcing them ... Now the business community is seeking to nullify the ordinances, saying the cities didn't have the authority to act.... Judge Mary Jacobson of State Superior Court is expected to hear a group of state business organizations argue in favor of overturning the benefit in the city of Trenton." (The Wall Street Journal; subscription may be required)  

Benefits in General; Executive Compensation

[Guidance Overview]

SEC Proposes Rules on Dodd-Frank Anti-Hedging Policies
"A company that permits hedging transactions by some, but not all, of its employees and directors must disclose the categories of persons who are permitted to engage in hedging transactions and those who are not. If a company does not permit any hedging transactions or permits all hedging transactions, it can simply state that fact and need not describe them by category. A company must disclose the categories of hedging transactions it permits and those it prohibits. In disclosing these categories, a company may disclose that it prohibits or permits particular categories and permits or prohibits, respectively, all other hedging transactions." (Winston & Strawn LLP)  

2015 Workplace Benefits Report: Helping Employees Live Their Best Financial Lives (PDF)
20 pages. "[F]inancial wellness has evolved from a buzzword to reality and is likely to grow in importance in the future. Meanwhile employers face a challenging environment in which the complexities of benefits offerings require greater expertise from HR professionals, and rising health care costs force hard decisions about how to spend valuable benefits dollars. This report provides a clear picture of the data, trends and new ideas related to workplace benefits today. It uncovers new insights related to financial wellness, health care, incentives, the use of total rewards portals and employers' attempts to engage a multi-generational workforce." (Bank of America Merrill Lynch)  

Closing the Retirement Health Care Planning Gap?
"While many expect Medicare to address the bulk of health related expenses in retirement, the program only covers approximately 50 percent of total health care costs. With health care cost inflation expected to return to more normalized levels of around six percent, lower Social Security COLAs, more health care cost sharing in retirement, fewer retirees with pensions and health care benefits, and longer life expectancy, future retirees will see a much greater portion of their budgets consumed by health care than previous generations have experienced.... There are a number of key steps that should be part of a modified planning process that addresses health care[.]" (Insured Retirement Institute [IRI])  

Recent Developments in Employee Benefits Law (PDF)
"This article surveys recent developments in employee benefits law from fall 2013 through fall 2014.... The first portion of the survey reviews two important Supreme Court cases from last term, Fifth Third Bancorp v. Dudenhoeffer and Heimeshoff v. Hartford Life & Accident Insurance Co. ... The second portion of the survey reviews eight important decisions issued by the appellate courts during the last year[.]" (Alston & Bird LLP, via Tort Trial and Appellate Practice Law Journal)  

Press Releases

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