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Employee Benefits Jobs
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Webcasts and Conferences
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[Guidance Overview]
Mismatch Between EEOC Proposed Rules and HIPAA/ACA Limits Will Affect Wellness Program Design
"To a significant degree, the regulations dovetail with guidance on wellness program incentives issued under other nondiscrimination laws, in particular, [HIPAA] and the [ACA]. However, they differ in ways that could materially affect how employers design and operate their wellness programs.... The HIPAA/ACA limit applies only to health-contingent wellness programs in a health plan ... The EEOC limit applies to wellness programs across the board.... If family members can participate in a wellness program, the HIPAA/ACA limit may be based on the cost of the coverage tier selected by the employee (self-only, employee plus one, etc.). The ACA rules base their limit exclusively on the cost of self-only coverage.... The HIPAA/ACA limit may be expanded to 50 percent of the cost of group health coverage to the extent that the wellness program addresses tobacco cessation. The EEOC limit does not
allow for that extension."
(Ballard Spahr LLP)
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[Guidance Overview]
EEOC Issues Guidance for Some Employer-Provided Wellness Programs
"The proposed rule applies only to employer wellness programs that include disability-related inquiries or medical examinations. Other types of wellness programs, such as education programs and programs that provide employees with general health information, are not subject to the proposed rule. However, HIPAA nondiscrimination requirements (for example, the requirement to provide a reasonable alternative standard for an activity-only wellness program) may apply to these other types of programs.... Certain parts of the proposed rule apply only to wellness programs provided by an employer in connection with a group health plan (whether insured or self-insured), whereas other parts of the proposed rule apply to all health programs."
(McDermott Will & Emery)
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CMS Announces 2015 Compliance Priorities for Federally Facilitated Exchange Plans
"A new priority for 2015 is prescription drug formulary compliance, including meeting drug coverage minimums and the provision of a process to allow enrollees to request and access clinically appropriate drugs not included in the formulary. All other areas of focus are the same as those identified as 2014 priorities, including: [1] complying with issuer participation standards, [2] maintaining a sufficient provider network, [3] ensuring access to Essential Community Providers, [4] not employing marketing practices or benefit designs that discourage enrollment of individuals with significant health needs, and [5] ensuring compliance of appointed agents/brokers."
(Epstein Becker Green)
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Six Million Employees Enrolled via Private Exchanges in 2015
"Many employers did not drop coverage in 2015, as initially forecasted. In fact, an Accenture survey shows 76 percent of consumers with employer-sponsored coverage see health insurance as a primary factor for continuing to work at their current employer, limiting some employers' ability to drop or defund health coverage. As employers seek a compelling alternative, private exchanges will emerge for some as a compelling model to reduce costs and administrative burden."
(Wolters Kluwer Law & Business)
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[Opinion]
New Drug Plan Regs Protect Pharmacies, Harm Consumers (PDF)
"Considering the benefits of safe and affordable prescription drugs, lawmakers are unwise to impose stifling regulations on drug plans, boosting costs to consumers and employers. These regulatory initiatives purportedly 'protect consumers', but are actually designed to protect local pharmacies from competition. State regulations reducing competition often boost the profits of local stakeholders. These profits generally come at the expense of insurers, employers, pharmacy benefit managers and consumers."
(National Center for Policy Analysis [NCPA])
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[Opinion]
After King v. Burwell, Could New State Exchanges Qualify for Subsidies?
"The fight in [King v. Burwell] is about the meaning of a provision of the Internal Revenue Code linking the subsidies to the cost of a plan purchased on " 'an Exchange established by the State under 1311.' Section 1311, in turn, says that '[e]ach State shall, not later than January 1, 2014, establish an American Health Benefit Exchange.' Did the states have to hit that January 2014 deadline in order to establish exchanges 'under 1311'? ... If the Supreme Court sides with the plaintiffs, it will have taken a highly literal approach to the ACA -- an approach that might give juice to the argument that post-King exchanges haven't been properly established 'under 1311.' "
(The Incidental Economist)
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Benefits in General; Executive Compensation
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[Guidance Overview]
IRS Approves Transfer of 401(h) Surplus Assets to Provide Retiree Medical Benefits After Pension Settlement
"A recent IRS private letter ruling (PLR 201511044) addressed whether a Section 420 transfer of surplus pension assets to a Section 401(h) account could be used to provide medical benefits to retirees following a settlement of their pension obligations.... [The] result is consistent with a 1991 IRS information letter on surplus transfers, which indicated that surplus pension assets could be transferred for any employee who received a pension distribution, is receiving a distribution or is entitled to such a distribution in the future, including those who received a lump sum distribution many years earlier."
(Towers Watson)
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Press Releases
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