Health & Welfare Plans Newsletter

April 30, 2015

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Employee Benefits Jobs

Account Manager
National Retirement Services, Inc.
in NC

Compliance Analyst
National Retirement Services, Inc.
in NC

ESOP Administrator
Blue Ridge ESOP Associates
in ANY STATE

Vested Interest Senior Relationship Manager
PNC
in OH, PA

Compliance Analyst
Ubiquity Retirement + Savings [formerly The Online 401[k]]
in ANY STATE, CA

Pension Administrator
Cornerstone Retirement Plan Administrators, LLC.
in ANY STATE

Reviewing Actuary
Kravitz, Inc.
in ANY STATE

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Webcasts and Conferences

Update for Employers on the New ACA Section 6055 and 6056 Reporting Requirements
RECORDED
(Miller Johnson)

Just Say No: Why Directors Should Avoid Duties That Will Subject Them to ERISA
May 5, 2015 WEBCAST
(Bloomberg BNA)

HIPAA Compliance and Information Risk Management BootCamp
May 7, 2015 WEBCAST
(Clearwater Compliance)

Risk Response – So You Know Your Risks, Now What?
May 8, 2015 WEBCAST
(Clearwater Compliance)

Form 5500 Update
May 26, 2015 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

Fundamental Series 14: Fiduciary requirements [2015]
June 1, 2015 WEBCAST
(SunGard Relius)

Employee Benefits in Mergers and Acquisitions National Institute
June 22, 2015 in IL
(ABA Joint Committee on Employee Benefits)

View All Webcasts and Conferences



[Official Guidance]

Text of CMS Draft Instructions Related to the ASC X12 820 Transaction: Companion Guide Version 3, April 29, 2014 (PDF)
57 pages. "This companion guide ... clarifies and specifies data content for payment related information transmitted electronically from [CMS] as a part of implementation of Health Insurance Marketplaces ... CMS will use the HIX 820 to communicate Individual, Small Group, and SHOP Marketplace-related payment information to issuers or their designees ... and to also provide APTC and CSR payment information to State Based Marketplaces (SBM) related to issuers within their state. This document details the data elements CMS will send when issuing an explanation of such payments. The funds transfer function is handled separately and details of the actual funds transfer are not included in this companion guide." [CMS has also released two draft code lists referenced in this Guide: ASC X12 HIX 820 X306 Exchange Related Report Type Codes and ASC X12 HIX 820 X306 Exchange Payment Type Codes.] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


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[Guidance Overview]

CMS Presentation: FF-SHOP 820 Transactions (PDF)
61 presentation slides; April 23, 2015. Topics: [1] Introduction to FF-SHOP 820 transactions; and [2] User fees for FF-SHOP issuers. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

Does Your Employer Wellness Program Comply with the ADA?
"The main requirements of the EEOC rules are: [1] Incentives are limited to 30% of employee-only coverage.... [2] Programs must be reasonably designed to promote health or prevent disease.... [3] Participation must be completely voluntary.... [4] Disclosure is limited and confidentiality must be maintained.... [5] The program must provide reasonable accommodations." (Holland & Hart LLP)  

[Guidance Overview]

Final Regulations on Wraparound Coverage as an Excepted Benefit (PDF)
"The wraparound option may be of interest to employers looking to provide valuable benefits for part-time employees or retirees, and their dependents, without disqualifying them from claiming a marketplace premium tax credit. Employers wishing to pursue this option should be mindful, though, of the complicated requirements and restrictions governing this type of coverage." (Buck Consultants at Xerox)  

[Guidance Overview]

New Regs Permit Employers to Offer Limited Wraparound Health Coverage as Excepted Benefit
"Limited wraparound coverage must meet five requirements under the Regulations in order to qualify as an excepted benefit: [1] Providing 'meaningful benefits' ... [2] Maximum cost ... [3] Nondiscrimination ... [4] Plan eligibility requirements ... [5] Reporting." (McGuireWoods LLP)  


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[Guidance Overview]

Philadelphia Issues Poster for Use by Employers to Notify Employees of New Paid Sick Leave Ordinance; New Enforcement Agency Created
"The poster sets forth eligibility requirements for employees and employers in a concise format, but does not note some of the important aspects of the Ordinance, such as the broad definition of 'family member.' ... [T]he poster states that a new 'Philadelphia Sick Leave Agency' will be created by September 2015 where employees can file their specific complaints against employers. There is no indication how complaints are to be made or handled prior to September 2015. The poster also identifies an information email box ... where employers and employees can submit questions and requests for further information. The Ordinance goes into effect on May 13, 2015." (Littler)  

Ninth Circuit: SPD Discretionary Grants Are Ineffective to Invoke Firestone Defense
"The Prichard decision serves as a reminder to plan sponsors that all important plan provisions must not only be described in the SPD, but included in the plan document itself. Plan sponsors may address this issue in a number of ways, including: (i) having a combined plan document/SPD, when appropriate; (ii) incorporating the SPD into the plan document; or (iii) including parallel language in the plan document and the SPD." [Prichard v. Metropolitan Life Ins. Co., No. 12-17355 (9th Cir. Apr. 21, 2015)] (Paul Hastings LLP)  

ACA Reporting Readiness a Concern for Employers
"26 percent of small employers (less than 1,000 employees) are still undecided regarding whether they will implement a solution in-house or an outsourced solution to facilitate reporting, while 37 percent of large employers (5,000 or more employees) reported that they are in discussions with outsourced vendors currently, and 12 percent have not yet considered any solutions or do not know." (HighRoads)  

Data Security for Employer Health Plans Post-Anthem (PDF)
"Anthem and Premera signal a sea change in the threat environment for health plans, a new reality that requires a fresh look at data security. Prudent employers with self- funded group health plans should take that fresh look now, by strengthening the data security provisions in their services agreements with third-party plan administrators (TPAs), and also by updating their HIPAA-required security risk assessments." (Husch Blackwell)  

Aetna Submits 2016 Obamacare Rates with Eye on Supreme Court
"Aetna Inc, the third-largest U.S. health insurer, is submitting 2016 individual insurance rates to state regulators but said it might need to reexamine them after the U.S. Supreme Court rules on the legality of most Obamacare exchange subsidies.... Aetna Chief Financial Officer Shawn Guertin said the company had been submitting proposed rates based on the assumption that the subsidies will stay in place. Even if the Supreme Court rules against them, the government or legislators may be able to keep them in place with a new law or administrative rule." (Reuters)  

King v. Burwell Ruling for Plaintiffs Would Disproportionately Affect Small Businesses
"In addition to the 7.5 million people who could lose their insurance subsidies if the Obama administration loses the case, nearly 3.5 million people on small-business plans would also face 'substantially' higher premiums ... At least 840,000 of those people would become uninsured, [Linda Blumberg, senior fellow for the Urban Institute] wrote in prepared remarks for the Senate Small Business Committee's hearing on the effects of the Supreme Court case King v. Burwell. Families of people who work in small businesses are particularly at risk of feeling the potential aftershock, Blumberg wrote, because they have 'disproportionately benefitted' from the law." (The Hill)  

Benefits in General; Executive Compensation

[Official Guidance]

Text of SEC Proposed Amendment to Item 402 of Regulation S-K: Pay Versus Performance (PDF)
"The proposed amendments would: [1] Require that the executive compensation used in calculating the executive compensation actually paid be total compensation as disclosed in the Summary Compensation Table ... [2] Require registrants to measure financial performance using [total shareholder return (TSR)] ... [3] Require registrants to provide the executive compensation actually paid, total compensation as disclosed in the Summary Compensation Table, TSR, and peer group TSR in a prescribed table ... [4] Require the executive compensation disclosure to be presented separately for the principal executive officer, and as an average for the remaining NEOs identified in the Summary Compensation Table ... [5] Require the disclosure of the relationship between [a] executive compensation actually paid and registrant TSR ... and [b] registrant TSR and peer group TSR, in each case over the registrant's five most recently completed fiscal years ... [6] For smaller reporting companies, require the disclosure of the relationship between executive compensation actually paid and TSR over the registrant's three most recently completed fiscal years ... [7] Require that the disclosure be provided in tagged data format using eXtensible Business Reporting Language (XBRL); and [8] Provide a phase-in of the requirement." (U.S. Securities and Exchange Commission [SEC])  

[Guidance Overview]

Text of SEC Fact Sheet on Proposed Rules to Require Companies to Disclose the Relationship Between Executive Pay and a Company's Financial Performance
"The Securities and Exchange Commission [on Wednesday, April 29] voted to propose rules to require companies to disclose the relationship between executive compensation and the financial performance of a company. The proposed rules, which would implement a requirement mandated by the Dodd-Frank Act, would provide greater transparency and allow shareholders to be better informed when they vote to elect directors and in connection with advisory votes on executive compensation." (U.S. Securities and Exchange Commission [SEC])  

[Guidance Overview]

SEC Issues Proposed Rule on Reporting Relationship Between Pay and Performance
"The proposed rule includes a number of surprises. Many commentators thought (and hoped) that the pay and performance disclosure would solely apply to an issuer's CEO rather than all named executive officers as is the case under the proposed rule. In addition, the SEC ... chose to introduce a new definition of compensation that is only partially based on proxy disclosed compensation. This proposed definition of actually paid compensation would require registrants to make additional calculations to determine the value of stock option awards on the date of vesting and the value of annual pension accruals." (Meridian Compensation Partners, LLC)  

[Guidance Overview]

SEC's Proposed Pay-for-Performance Disclosure Rules Will Require Companies to Perform New Pay Calculations
"The proposed regulations will require virtually every company to provide a new pay-for-performance table. Currently, only about a quarter (27%) of Fortune 500 companies include specific pay-for-performance disclosures in their proxies ... Rather than provide companies complete flexibility to choose a disclosure approach, the SEC proposal calls for companies to follow a strict set of rules in crafting the pay-for-performance table." (Towers Watson)  

SEC Proposes Rules for Disclosures Linking Executive Compensation with Performance
" 'The net result of the proposed rule should be enhanced pay versus performance disclosure in the proxy statement,' Commissioner Kara Stein said in her published remarks. 'It should make it easier for shareholders to locate, understand, and analyze executive compensation information before they have to vote.' Commissioner Daniel Gallagher, who dissented, said that although the rulemaking is required by law, the SEC has other, more pressing issues to tackle. He said the disclosures resulting from the proposed rules are too prescriptive and may be misunderstood by retail investors." (Journal of Accountancy)  

Text of Tenth Circuit Opinion Clarifying Statute of Limitations Applicable for Fiduciary Breach Claim Based on Fraud (PDF)
51 pages. "In their rehearing petition, Plaintiffs have clarified their claims and disavowed raising any claim pursuant to ... the ERISA provision governing claims alleging the denial of benefits.... It is for this reason that the original decision must be reassessed. Because it is now clear the Section 1132(a)(3) claims arise solely from an alleged violation of the duties imposed on plan fiduciaries pursuant to 29 U.S.C. Section 1104, the six-year statute of repose set out in 29 U.S.C. Section 1113, rather than a state statute of limitations, is applicable to Plaintiffs' breach of fiduciary duty claims.... Because Plaintiffs have not argued Defendants concealed their alleged breach of fiduciary duty, it is unnecessary to determine the scope of the concealment element of the statute of repose." [Fulghum v. Embarq, No. 13-3230 (10th Cir. Apr. 27, 2015)] (U.S. Court of Appeals for the Tenth Circuit)  

First Circuit Reviews Top Hat Plan Benefits Denial for Abuse of Discretion
"On appeal, [the employee] argued that the district court ... should have followed decisions from the Third and Eighth Circuits holding that top hat plans are unilateral contracts subject to ordinary contract principles and that determinations made under such plans should be reviewed de novo. The First Circuit declined to consider whether such a categorical rule for top hat plans should apply. Instead, it ruled that the distinction between top hat and other plans has no meaning where, as here, the plan grants discretion to the plan administrator. According to the Court, the grant of discretion, even under ordinary contract principles, confers a reasonableness standard equivalent to the deferential review standard ordinarily applied under ERISA." [Niebauer v. Crane & Co., No. 14-2059 (1st Cir. Apr. 21, 2015)] (Proskauer's ERISA Practice Center)  

Text of Federal District Court Opinion Denying Summary Judgment on Top Hat Plan Status (PDF)
In a 21-page opinion denying summary judgment to both plaintiffs and defendants, the court provides a detailed examination of the various criteria and tests applicable to finding that a "top hat" plan is exempt from ERISA's notice and funding requirements. "Defendants have raised genuine issues of material fact regarding the top hat exemption, requiring this Court to deny Plaintiffs' motion for summary judgment. Defendants fail to prove, however, that the WAP is a top hat plan as a matter of law, and the Court must deny their motion for summary judgment. Resolution of the top hat exemption issue must proceed to trial." [Tolbert v. RBC Capital Markets, No. H-11-0107 (S.D. Tex. Apr. 28, 2015)] (U.S. District Court for the Southern District of Texas)  

BLS Report: Employment Cost Index, March 2015 (PDF)
"Compensation costs for civilian workers increased 0.7 percent, seasonally adjusted, for the 3-month period ending March 2015 ... Wages and salaries (which make up about 70 percent of compensation costs) increased 0.7 percent, and benefits (which make up the remaining 30 percent of compensation) increased 0.6 percent." (U.S. Bureau of Labor Statistics [BLS])  

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