Health & Welfare Plans Newsletter

May 20, 2015

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Employee Benefits Jobs


Webcasts and Conferences

ERISA Fiduciary Developments
June 2, 2015 in MA
(ASPPA Benefits Council [ABC] of New England)

Federal Enforcement of the Employer Mandate: What to Expect and How to Prepare
June 3, 2015 in IL
(Seyfarth Shaw LLP)

Navigating Paid Sick Leave Laws: Challenges, Practical Implications, and Best Practices
June 10, 2015 in NY
(Seyfarth Shaw LLP)

Affordable Care Act Compliance Assistance
June 10, 2015 WEBCAST
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Current Retirement Plan Topics
June 18, 2015 in TX
(ASPPA Benefits Council [ABC] of Dallas/Fort Worth)

Certificate in Health and Welfare Plans
July 20, 2015 in IL
(International Foundation of Employee Benefit Plans [IFEBP])

Voluntary Fiduciary Correction Program Workshop
July 28, 2015 in CA
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Employers and Telemedicine
August 12, 2015 in IL
(Midwest Business Group on Health)

View All Webcasts and Conferences



[Official Guidance]

Text of IRS Q&As on Reporting of Offers of Health Insurance Coverage by Employers (Section 6056), updated May 20, 2015
Topics include: [1] Basics of Employer Reporting: Questions 1-4; [2] Who is Required to Report: Questions 5-12; [3] Methods of Reporting: Questions 13-17; [4] How and When to Report the Required Information: Questions 18-31. (Internal Revenue Service [IRS])  


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[Official Guidance]

Text of IRS Q&As About Employer Information Reporting on Form 1094-C and Form 1095-C
18 Q&As, covering: [1] Basics of Employer Reporting: Questions 1-5; [2] Reporting Offers of Coverage and other Enrollment Information: Questions 6-13; [3] Reporting for Governmental Units: Questions 14-15; and [4] Reporting Offers of COBRA Coverage: Questions 16-18. (Internal Revenue Service [IRS])  

[Official Guidance]

Text of OPM Final Regs: Federal Employees Health Benefits Program -- Subrogation and Reimbursement Recovery
"[OPM] is issuing a final rule to amend the Federal Employees Health Benefits (FEHB) Program regulations to reaffirm the conditional nature of FEHB Program benefits and benefit payments under the plan's coverage as subject to a carrier's entitlement to subrogation and reimbursement recovery, and therefore, that such entitlement falls within the preemptive scope of the FEHA Act. FEHB contracts and brochures must include, and in practice already include, a provision incorporating the carrier's subrogation and reimbursement rights, and FEHB plan brochures must contain an explanation of the carrier's subrogation and reimbursement policy." (Office of Personnel Management [OPM])  

[Guidance Overview]

Draft IRS Publication 5164: Test Package for Electronic Filers of ACA Information Returns (PDF)
Updated May 19, 2015. "[This publication] contains general and program-specific testing information for use with ACA Assurance Testing System (AATS). AATS refers to both the process and the system used to test software and electronic transmissions prior to accepting Software Developers, Transmitters and Issuers into the AIR System.... Forms Covered by the Test Package: ... [1] Form 1094-B, Transmittal of Health Coverage Information Returns; [2] Form 1095-B, Health Coverage; [3] Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns; [4] Form 1095-C, Employer-Provided Health Insurance Offer and Coverage." (Internal Revenue Service [IRS])  

Essential Health Benefits: List of the Largest Three Small Group Products by State, Updated May 19, 2015 (PDF)
"This document provides information to facilitate States' selection of the benchmark plans that will serve as the reference plan for the essential health benefits (EHB). Using data from HealthCare.gov and States, this document provides a list of the three largest small group insurance products ranked by enrollment in the first quarter of 2014 for each State. In addition, we are providing a list of the three largest nationally available Federal Employee Health Benefit Program (FEHBP) plans, which is another benchmark option under 45 CFR 156.100(a). We are also providing the single largest Federal Employees Dental and Vision Insurance Program (FEDVIP) dental and vision plans respectively, based on enrollment in the first quarter of 2014." (Center for Consumer Information and Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


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Text of Seventh Circuit Opinion: Injunction Again Denied to Notre Dame in Contraceptive Mandate Case (PDF)
50 pages. "[B]ased on the sparse record before us, there is a strong argument that given the government's legitimate interest in the provision of contraceptive coverage to women without cost to them, notice to the government would strike the proper balance between legitimate governmental and sincere religious interests. That was the accommodation sought and received by Wheaton College... All of Notre Dame's suggested alternatives would impose significant financial, administrative, and logistical obstacles by requiring women to sign up for separate coverage either with a government agency or with another private insurer. Such obstacles were considered by the Supreme Court in Hobby Lobby in support of the same accommodation that Notre Dame refuses to accept.... The burden of establishing an entitlement to a preliminary injunction was of course on the university, not on the government. The burden has not been carried." [Notre Dame v. Burwell, No. 13-3853 (7th Cir. May 19, 2015)] (U.S. Court of Appeals for the Seventh Circuit)  

Notre Dame Birth Control Protest Denied Again
"In a two-to-one ruling, the U.S. Court of Appeals for the Seventh Circuit cleared the way for a trial of the university's challenge but denied any immediate religious exemption. This marked the first time that a federal appeals court had rejected a claim that the Supreme Court's ruling last June in the case of Burwell v. Hobby Lobby Stores should shield a non-profit religious organization from any role whatsoever in carrying out the [ACA's] contraceptive mandate. The issue seems certain to return to the Justices, probably next Term, although Notre Dame could try to get some temporary relief by returning quickly to the Supreme Court." [Notre Dame v. Burwell, No. 13-3853 (7th Cir. May 19, 2015)] (SCOTUSblog)  

Aetna Fined for Violating Autism Coverage Law
"Aetna Life and Health Insurance will pay up to $4.5 million to settle claims they failed to cover diagnosis and treatment of autism spectrum disorders. [Missouri] Gov. Jay Nixon announced the settlement Tuesday, which includes the state's largest fine ever for insurance law violations.... In the settlement, Aetna admitted that it failed to offer autism coverage in some cases.... Aetna also admitted it violated the autism mandate in 2012 and paid a $1.5 million fine under a settlement agreement, which required it to undertake a full and complete audit to ensure compliance. Aetna admitted it did not perform the full compliance audit." (Courthouse News Service)  

Companies Look to Transition Retirees to Health Exchanges
"Challenges and opportunities created by the Affordable Care Act are prompting two-thirds of companies to consider altering their pre-65 retiree health strategies over the next few years ... Of those, 35 percent are favoring sourcing health coverage through the public exchanges under a defined contribution approach. Twenty-eight percent are considering eliminating pre-65 retiree coverage and subsidies altogether." (Aon Hewitt)  

Achieving Medication Adherence Through Value-Based Health Plan Design (PDF)
"Five main features of value-based insurance design plans were found to be associated with higher rates of medication adherence: [1] Plans that provide more generous coverage; [2] Plans that target high-risk patients; [3] Plans that offer wellness programs; [4] Plans that do not offer disease management programs; [5] Plans that make the benefit available only for medication order by mail." (Robert Wood Johnson Foundation)  

California Pressured to Explain Why It Revoked Blue Shield Not-for-Profit Status
"The California Franchise Tax Board decided in August that Blue Shield of California, the state's third-largest health insurer, no longer qualified for exemption from state taxes as a not-for-profit company. The decision was noted in government records but the public didn't hear about it until March this year when a newspaper reported the change.... Blue Shield of California covers about 3.4 million people, making it the state's third-largest health insurer behind not-for-profit Kaiser Permanente and for-profit Anthem. Blue Shield, with about 5,000 employees, reported $13.6 billion in revenue last year." (Kitsap Sun)  

[Opinion]

Subcommittee Chairman's Statement at Hearing on the Use of Administrative Actions in ACA Implementation
"The question before us is not whether the Administration is implementing the healthcare law. It's whether the Administration is undermining the rule of law. And the answer is yes. This Administration is too eager to take unilateral actions to resolve thorny political problems. It has created a false narrative that Congress is unwilling to take on these challenges. In fact, as we will hear today, Congress has amended the Affordable Care Act over a dozen times. The Administration's problem is that they are acting out of expediency, but not following the Constitution. So, the old phrase comes to mind, 'the road to Hell is paved with good intentions.' " (Subcommittee on Oversight, Committee on Ways and Means, U.S. House of Representatives)  

[Opinion]

American Bankers Association HSA Council Comment Letter to IRS on 'Cadillac Tax' (PDF)
"[T]his ability to use your own money as you see fit is what constitutes ownership and ownership has to mean something; it can't be the case that the excise tax rules lump HSAs into the same category as every other product, because HSAs are the only product where someone other than the employer owns a portion of the dollars being counted.... [T]he IRS has the necessary discretionary authority to characterize employee contributions to the employee's HSA, even if facilitated by the employer through Section 106 authority, as 'excludable' without also being included in the definition of 'applicable coverage' precisely because employers don't own any of the money in an employee's HSA." (American Bankers Association Health Savings Account Council)  

Benefits in General; Executive Compensation

Tips for Preparing for Your Employee Benefit Plan Audit
"Start by understanding the provisions in your plan documents and adoption agreements.... Schedule a meeting with all of your service providers... Ask your auditors for a planning letter specifying what information and in what format they will need for the audit.... Delegate a gate-keeper to keep track of all audit information... Understand what the auditors will be testing.... Compare your Form 5500 to your financial statement so that you can identify and resolve any discrepancies prior to the audit." (DiCicco, Gulman & Company LLP)  

Press Releases

Fiduciary Restores More than $10K to SGH Communications, Inc. SIMPLE Plan in Lakeville, Minnesota
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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