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Administrative Appeals Process for Risk Adjustment Payments/Charge and Reinsurance Payments
May 27, 2015 WEBCAST
(Centers for Medicare & Medicaid Services [CMS])

Strategies for Executive Compensation in Today’s “Pay for Performance”
June 2, 2015 in MA
(Directors Roundtable)

Pay-for-Performance Disclosure
June 4, 2015 WEBCAST
(Towers Watson)

Voluntary Fiduciary Correction Program Workshop
June 5, 2015 in UT
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Overpayments, Underpayments, Fiduciary Duty and IRS Qualification
June 11, 2015 WEBCAST
(American Bar Association [ABA])

7th Annual Employee Benefits Symposium
June 25, 2015 in DC
(AFS 401[k] Retirement Services)

View All Webcasts and Conferences

[Guidance Overview]

DOL: Plans Must Cover All Contraceptives, Not Just Some
"Plans and insurers must cover all 18 contraception methods approved by the [FDA] ... 'Reasonable medical management' still may be used to steer members to specific products within those methods of contraception. A plan or insurer may impose cost-sharing on non-preferred items within a given method, as long as at least one form of contraception in each method is covered without cost-sharing. However, an individual's attending provider must be allowed to override the plan's drug management techniques if the provider finds it medically necessary to cover without cost-sharing an item that a given plan or insurer has classified as non-preferred[.]" (Thompson SmartHR Manager)  

[Advert.]

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Explore the advantages of a Self-Funded Health Plan! By bringing together cutting edge cost containment strategies, excellent service and outstanding resources, IPMG's EBS division can help you make a difference for your plan.

[Guidance Overview]

Chart of Minimum Contraceptive Coverage Requirements as Clarified by HHS Guidance
"New HHS clarification on ACA contraceptive coverage requirement specifies that insurance plans must cover at no cost to women at least one of the 18 contraceptive methods approved by the FDA. If a provider recommends a specific option or product, plans must cover it at no cost as well." (Henry J. Kaiser Family Foundation)  

[Guidance Overview]

Agencies Issue Guidance on Wraparound Coverage and Supplemental Insurance Products as Excepted Benefits
"The IRS, DOL and HHS ... have gradually, but cautiously, expanded the list of 'excepted benefits' in an effort to preserve the reach of the insurance market reforms without inadvertently rendering enrolled individuals ineligible for premium subsidies. Recent guidance provides additional clarification on two forms of 'excepted benefits' -- supplemental insurance coverage and limited wraparound coverage." (Seyfarth Shaw LLP)  

[Guidance Overview]

The Cadillac Tax: Not Just for 'Luxury' Health Plans (PDF)
"Because the implementation of the tax is less than three years in the future, it's important for employers to focus on it today ... This [article] walks you through the potential impact of the tax and provides practical advice for how you can prepare your organization. While [the authors] use examples to illustrate the challenges related to the tax, ... most employers will attempt to design their benefits programs so as not to trigger the tax. This will likely result in employers doing away with health flexible spending accounts (FSAs) and pretax health savings account (HSA) contributions if they are brushing up against the tax thresholds." (Lockton)  

The 'Cadillac' Tax Will Soon Hit Many Cities and States
"Most states and cities offer generous healthcare plans to their civil servants during their working years and through their retirement until they go on Medicare. In general, local governments offer their employees a broad range of high-quality medical services with little or no co-payments and minimal deductibles. And local governments pay most, if not all, of the annual premiums for such generous healthcare plans." (The Brookings Institution)  

Incentives for Workplace Wellness Programs Increase Employee Participation, But Building a Better Program Is Just as Effective
"Employers that did not use incentives reported lower participation rates -- a median of just 20 percent. Uptake appears to increase with the use of rewards, such as access to a higher-value health plan, with a median participation rate of 40 percent. Framing incentives as penalties, such as higher insurance contributions for smokers, was associated with an even higher median participation rate of 73 percent. Program configuration also influenced participation. Employers with comprehensive programs reported the highest participation rate, at 59 percent. Participation in these programs was less sensitive to choice of incentive scheme." (RAND Corporation)  

Self-Insured Health Plans Should Seek Return of Plan Assets After Supreme Court Decision
"[I]t is extremely critical for all self-insured health plans and TPAs to understand the implications of the Supreme Court decision rejecting BCBSM's $6.1 million appeal. Furthermore, in accordance with the Supreme Court Hi-Lex decision and the reopening of pending cases, all self-insured health plans nationwide should look to recover at least $30 to $45 billion in Plan Asset refunds from the past 10 years of successful plan assets TPA/ASO anti-fraud recoupments and managed care savings in the private sector." [Hi-Lex Controls v. Blue Cross Blue Shield of Michigan, Nos. 13-1773/1859 (6th Cir. May 14, 2014; cert. denied Oct. 20, 2014)] (AVYM Healthcare Revenue Consultants)  

An Introduction to Health Insurance: What Should a Consumer Know? (PDF)
"This report provides an overview of private-sector (as opposed to government-provided) health insurance. It serves as an introduction to health insurance from the point of view of many consumers under the age of 65. No background in health insurance is assumed, and all terms are defined in the body of the report." [CRS Report R44014] (Congressional Research Service [CRS])  

How Lawmakers Could Reduce Health Insurance Costs
"What the administration continues to try to hide, but which most Americans now recognize is that the Affordable Care Act imposed new regulations that made health insurance more expensive. The law's subsidies were intended, in part, to mask those effects.... [R]emoving the Affordable Care Act's three most costly insurance requirements (the age rating restrictions, benefit mandates and minimum actuarial value requirements) could reduce premiums for the least expensive plans by as much as 44 percent for younger adults (the group most likely to be uninsured) and about 7 percent for pre-retirement age adults." (The Daily Signal)  

Economic Growth Improved Health Coverage More Than Obamacare Did
"The RAND Corporation ... analysis of Obamacare's effect on health insurance... [shows] employer-based benefits have been restored as jobs have started to come back.... The good news is the number of people with employer-based benefits increased by 8 million, from 111.9 million to 119.9 million (The total population is adjusted for death, aging and migration over the period.) Digging deeper, it looks like this improvement would have been much higher, but for Obamacare." (National Center for Policy Analysis Health Policy Blog)  

Secure Disposal of Paper PHI: An Ongoing Concern for HIPAA Covered Entities and Business Associates
"A recent Resolution Agreement and Corrective Action Plan between a stand-alone pharmacy and the [HHS] Office for Civil Rights (OCR) highlights the ongoing importance of secure disposal of paper medical records. HIPAA covered entities and business associates of every size should be aware that disposal of hard-copy media, including paper and film, remains a legitimate privacy and security concern, and merits ongoing vigilance even as businesses hone their e-PHI practices.... OCR investigations and enforcement actions involving the disposal of paper records highlight the particular vulnerabilities of hard-copy media: covered entities, business associates, and workforce members may be less attuned to or focused on appropriate disposal procedures (because it looks like ordinary trash, it may inadvertently be treated like ordinary trash), and there is no equivalent to encryption for paper records 'at rest' or 'in motion.' " (Ice Miller LLP)  

Expense-Paid Vacations: The Next Corporate Benefit?
"A handful of companies have pushed the boundaries of fringe benefits by offering subsidized travel on top of the more familiar policies promising paid time-off and the avant-garde employers promising unlimited vacation time.... At most workplaces experimenting with subsidized leisure travel, all employees are eligible to nab a free or almost-free trip. But reimbursement usually comes with stipulations." (Treasury & Risk)  

Hawaii State Insurance Exchange to Shut Down
"The exchange site will cease new enrollment this week, discontinue its outreach programs at the end of May and transfer its technology assets to the state by Sept. 30 ... The exchange's 37,000 enrollees can re-enroll on the federal Healthcare.gov exchange for the 2016 plan year." (FierceHealthPayer)  

DOL Burdens Davis-Bacon Contractors With Employee Lodging Costs
"The Department of Labor's Administrative Review Board (ARB) released its long-awaited opinion in the Weeks Marine case.... [The decision] made one thing clear -- when federal construction contractors use employees who must travel away from their homes and live near the job site, the Davis-Bacon Act requires that they be paid for their housing. At least that is the case when the employees' traveling to, and living near, the job site is for the benefit of the employer/contractor. The ARB made clear that should the ALJ on remand re-determine that the lodging was for the benefit of the employer, the employees needed to be awarded their actual costs, less any payment specifically made to defray those costs that were not used to otherwise satisfy the Davis-Bacon prevailing wage/benefit obligations." (Sherman & Howard)  

[Guidance Overview]

162(m) Deduction Limitation and Post-IPO or S-1 Grants of RSUs and Phantom Stock
"A company needs to take particular care in granting RSUs and phantom stock in the transition period after becoming public. For any grant made on or after April 1, 2015, pursuant to a plan or agreement in effect while the company was private, unless the RSU or phantom stock vests and is distributed or paid during the transition period, the transition relief will not apply. Instead, the company will need to avail itself of another exemption, most likely the exemption for qualified performance-based compensation." (Chiesa Shahinian & Giantomasi PC)  

The Future of ERISA Litigation
"On April 20, 2015 ... the Supreme Court agreed to decide ... whether Article III of the Constitution allows Congress to permit lawsuits over a statutory violation where the violation does not necessarily result in a plausible claim of concrete injury.... [This case] arises under the Fair Credit Reporting Act, not ERISA. But the Constitutional question presented to the Supreme Court has equal applicability to ERISA claims." (Seyfarth Shaw LLP)  

How to Win a Say-On-Pay Proxy Fight Despite a 'No' Recommendation from ISS or Glass Lewis
"[If] you received a 'no' recommendation from either ISS or Glass Lewis, it is critical that you take a proactive approach and promptly put in place a shareholder outreach plan to directly engage your larger institutional shareholders to discuss your pay decisions ... If the Company wants to win the Say on Pay proposal, it has two options. Depending on what the Company hears from shareholders, the Company can: [1] Not change anything but issue a supplemental proxy explaining how the pay decisions are in the shareholders' best interests and continue the dialogue with the undecided or negative shareholders; or [2] Reduce compensation and/or add performance conditions and file an 8-K regarding these changes to try to get ISS to change its 'no' recommendation and the large institutions to vote 'yes.' " (Orrick)  

Towers Watson Acquires Acclaris to Expand Benefits Administration to Consumer-Driven Account-Based Benefits
Towers Watson

MassMutual RetireSmart App Introduced for Smartphones
MassMutual

Pro-ESOP Bill, S. 1212, Introduced in Senate
ESOP Association

Securities and Exchange Commission Sues Retirement Planners for Making False Claims to Investors
U.S. Securities and Exchange Commission

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