Health & Welfare Plans Newsletter

April 23, 2015

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Employee Benefits Jobs

Defined Benefit Plan Coding Specialist
Prudential
in CT, MA

Manager of Health & Welfare Vendor Relations
University of California Office of the President
in CA

Document Specialist
Verisight
in CA, MN

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Webcasts and Conferences

The New Tools in the EPCRS Box
April 28, 2015 WEBCAST
(SunGard Relius)

Big Changes Ahead: Prepare Your Canadian Drug Benefit Plan Now
April 30, 2015 WEBCAST
(International Foundation of Employee Benefit Plans [IFEBP])

Tribal Plans
May 1, 2015 WEBCAST
(SunGard Relius)

Conflict of Interest Proposal: How it Works and What it Means
May 5, 2015 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

Affordable Care Act - Containing the Chaos
May 12, 2015 WEBCAST
(Business Insurance)

Spring 15 Retirement, Annuity, and Life Insurance Benefit Planning
May 14, 2015 in NY
(New York State Bar Association)

Wellness & Benefits: A Winning Combination
May 20, 2015 WEBCAST
(myInertia LLC)

View All Webcasts and Conferences



[Official Guidance]

Text of CMS Guidance on Annual Eligibility Redeterminations and Re-Enrollments for Marketplace Coverage for 2016 (PDF)
8 pages, dated April 22, 2015. "These procedures incorporate some modifications from the alternative procedures specified by the Secretary for benefit year 2015, to accommodate the programmatic and operational experience gained during the process for 2015, and will be implemented by each Federally-facilitated Marketplace (FFM). Like the alternative procedures specified by the Secretary for benefit year 2015, the alternative procedures ... preserve a core feature of the annual redetermination process, namely, that in general, an enrollee may take no action and retain coverage for 2016[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


[Advert.]

Employer's Guide to Health Care Reform, 2015 Edition

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Find step-by-step guidance to keep up with the rapid changes affecting health plans! This comprehensive book guides employers through the latest reform developments and provides detailed explanations of the issues that require compliance. Order Now.



[Guidance Overview]

Transitional Reinsurance Program: Refund Requests Must be Submitted by April 30 (PDF)
"Plan sponsors who made their 2014 submission by the December 5, 2014 deadline must request a refund by April 30, 2015, which provides very little time for action. A plan sponsor that correctly applied one of the counting methods cannot make a request to change its enrollment count or payment after the reporting deadline for a particular benefit year." (Buck Consultants at Xerox)  

[Guidance Overview]

EEOC Requests Comments on Plan Design, Best Practices and Practical Effects of Proposed Wellness Program Regs
"EEOC asks stakeholders to comment on a number of issues pertaining to wellness programs ... including: ... [1] Whether incentives provided in a wellness program that asks employees to respond to disability-related inquiries and/or undergo medical examinations are coercive to the extent they render health insurance coverage unaffordable under the [ACA].... [2] Which best practices ensure that wellness programs are designed to promote health and do not operate to shift costs to employees with health impairments or stigmatized conditions? ... [3] What will be the practical effect of adopting the specific incentive limit set forth in the proposed rule? Specifically, what, if any, will be the impact of the proposed rule's 30% limit on incentives offered with respect to wellness programs intended to prevent or reduce tobacco?" (Mintz Levin)  

[Guidance Overview]

Proposed EEOC Guidance May Force Design Changes on Existing Wellness Programs
"According to the preamble to the EEOC rules, the provisions of the EEOC rules (other than the new notice provision discussed above) apply to all wellness programs that include medical examinations or disability related inquiries, regardless of whether the wellness program is part of a group health plan. However, it is uncertain how some of the EEOC rules would be applied in practice; for example, it is unclear how the 30% limit on wellness program incentives would apply to a wellness program that is not a part of a group health plan. It may be that the EEOC will interpret the EEOC rules to prohibit any incentives that are not de minimis in the case of wellness programs not tied to a group health plan." (Polsinelli PC)  

[Guidance Overview]

'Reasonable Accommodation' Requirement in EEOC's Proposed Wellness Program Regs Will Pose Challenges for Employers
"The need to provide reasonable accommodations in this context would invariably require employers to engage in the interactive process with affected employees to determine whether a reasonable accommodation or alternative to participation in the wellness program is available. Complying with the ADA's reasonable accommodation and interactive processes are already some of the most challenging workplace issues facing employers today. Extending these requirements to wellness program participation will likely create increased challenges and burdens for employers as they attempt to structure incentives and the methods by which those incentives can be achieved." (Crowell Moring)  

[Guidance Overview]

IRS Traded in Your Chevy for a 'Cadillac (Ac-Ac-Ac-Ac-Ac) Tax': Agency Issues First Guidance on the Implementation of Code Section 4980I
"The first section of this article provides a general overview of the Cadillac Tax, including its background and purposes. The second section explores the key terms, calculations, and details related to the imposition of the tax. Part three discusses the areas in which the IRS seeks comment from affected employers and addresses beneficial steps employers can take to prepare for final regulations." (Ogletree Deakins)  

[Guidance Overview]

Philadelphia Joins Growing List of Cities with Paid Sick Leave Laws
"The Ordinance ensures that Philadelphia employers provide employees with paid sick time ... An 'employee' under the Ordinance includes any individual who works at least 40 hours per year within the city of Philadelphia.... The Ordinance defines 'family member' broadly ... The Ordinance does not require employers to pay for accrued, unused sick time upon termination, resignation, retirement, or separation." (Epstein Becker Green)  

Text of Ninth Circuit Opinion: Insurance Certificate Cannot Be Superseded by Terms of SPD (PDF)
"MetLife would have us dismiss the insurance certificate as containing nothing more than the 'terms of the insurance contract between MetLife and IBM,' under which IBM made an election to have MetLife fund the Plan's benefits.... [C]ontrary to MetLife's assertions, the certificate contains the Plan's relevant 'terms and provisions' and is clearly issued to and written for IBM 's employees who are beneficiaries under IBM's long-term disability plan.... [T]he SPD itself declares that 'official plan documents ... remain the final authority ' and 'shall govern' in the event the SPD's terms conflict with those of official Plan documents. Accordingly, the district court clearly erred in finding that 'the SPD, and not the insurance certificate, constitutes the Plan document.' " [Prichard v. Metropolitan Life Ins. Co., No. 12-17355 (9th Cir. Apr. 21, 2015)] (U.S. Court of Appeals for the Ninth Circuit)  

Broad Reach of Cadillac Tax Could Have Significant Impact on Employers
"After analyzing its plan, CalPERS found that if the tax were in place today, its Blue Shield Access+ plan offered through Blue Shield of California in the San Francisco area and the Anthem Traditional HMO plan in Sacramento would both trigger the tax because they cost more than the limit. The purchasing coalition estimated it would pay $3.9 million in excise taxes." (HealthLeaders InterStudy)  

Senator Murray Launches New Tool to Hear Stories on Paid Sick Days
"Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Patty Murray (D-WA) launched #HFAnow: Share Your Story, a new tool to hear from workers and business owners in Washington state and across the country on why paid sick days are so important. This effort is the latest in Senator Murray's fight to get more Senate support for the Healthy Families Act, her legislation that would expand access to paid sick days to millions of workers." (Committee on Health, Education, Labor and Pensions, U.S. Senate)  

[Opinion]

Hospital Ratings Create More 'Confusion Than Clarity'
"[H]igh reputation hospitals are correlated with higher costs (not higher quality). Is this because they are able to leverage those billboards and cable commercials to become 'must haves' in insurance company networks? So, not only are the prominent hospital rankings confusing indicators of what happens to patients, they also may be driving up your costs by creating plan member perceptions based on that confusion." (Chelko Consulting Group)  

Benefits in General; Executive Compensation

[Guidance Overview]

Practical Advice for Compliance with Recent Amendments to Section 162(m) Regulations
"Public companies that want to preserve both the flexibility of their pre-IPO equity plans ... and the tax deductibility of their equity award grants may want to consider the following grant practices: [1] Grant performance-based restricted stock in lieu of performance-based RSUs during the reliance period.... [2] Grant only stock options during the reliance period. [3] Grant a lesser number of RSUs with modified vesting schedules such that all or a portion of the RSUs will be settled in stock during the reliance period.... Public companies that want flexibility with their plans can have a single limit for all equity grants or separate limits for different classes of equity[.]" (Orrick)  

Measured Matters: The Use of 'Big Data' in Employee Benefits
"This article summarizes the presentations and discussion at the Dec. 11, 2014, EBRI policy forum held in Washington, DC, on the topic 'Measured Matters: The Use of "Big Data" in Employee Benefits': the use of massive amounts of data and computer-driven data analytics to determine how people behave when it comes to health and retirement plans, which programs work or do not, and how to get better results at lower cost." (Employee Benefit Research Institute [EBRI])  

2015 Global Employee Benefit Trends: Shifting Dynamics of $50 Oil (PDF)
7 pages. "In a market where operators can ask or demand that a drilling company renegotiate a rig contract, cost control becomes a critical consideration.... Wringing savings out of plan suppliers/vendors and cost shifting to employees will be a staple of consideration. U.S. cafeteria plan requirements may limit all but the very desperate from making mid-year plan changes, leaving 401(k) contributions as the most significant available cost reduction lever (after actual headcount reductions) available to employers." (Ascende)  

Press Releases

US Labor Department Sues Jessup, Maryland-based Contractor to Recover Nearly $19,000 to 401(k) Plan
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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