Health & Welfare Plans Newsletter

June 11, 2015

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Employee Benefits Jobs

Administration & Compliance Manager
Trust Company of Illinois
in IL

Benefit Consultant
Unified Trust Company, N.A.
in KY

Retirement Plan Administrator
Northeast Professional Planning Group
in NY

Retirement Plan Services Administrator
Hancock Bank
in MS

Retirement Plan Administrator
Bates & Company
in FL

Employee Benefits Senior Associate
First American Bank
in IL

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Webcasts and Conferences

Effective ESOP Communications Committees
RECORDED
(National Center for Employee Ownership)

Voluntary Fiduciary Correction Program Workshop
June 18, 2015 in IL
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Unlocking the Buyout Market: How Price Transparency And Carrier Engagement Lead To Exceptional Deal Outcomes
June 24, 2015 WEBCAST
(Mercer)

Compliance 101: The Risks and Practical Realities of Producing Form 1095
July 8, 2015 WEBCAST
(Employee Benefit News)

Fiduciary Training for Retirement Plan Sponsors 1.0
July 14, 2015 in OR
(AKT Wealth Advisors, LP)

Fiduciary Training for Retirement Plan Sponsors 1.0
July 22, 2015 in OR
(AKT Wealth Advisors, LP)

Alternative Investment Strategies
July 27, 2015 in CA
(International Foundation of Employee Benefit Plans [IFEBP])

View All Webcasts and Conferences



[Guidance Overview]

Guide to Special Enrollment Period Triggers and Timing (PDF)
"This chart is a reference tool for those who are helping people enroll in health coverage.... Many [special enrollment periods (SEPs)] are available when a 'qualified individual' or that person's dependent (for SEP purposes) experiences the triggering event. Other SEPs are available only when an 'enrollee' or the dependent of an enrollee experiences the triggering event. The chart separates which SEPs are available to qualified individuals and which SEPs are only available to enrollees or their dependents" (Center on Budget and Policy Priorities)  


[Advert.]

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Text of Federal District Court Opinion: Retiree Health Benefits Not Vested Under Terms of SPD Nor of Collective Bargaining Agreement
"Plaintiffs cannot rely exclusively upon a [collective bargaining agreement (CBA)] to establish vested benefits. The CBAs are only relevant if a particular SPD specifically references a CBA.... Plaintiffs, however, fail to direct the Court to any particular CBA linked to any particular SPD.... The discussion of quoted language in CBAs, marooned in isolation from any SPD, is unhelpful and irrelevant to Plaintiffs' claim for contractually vested benefits." [Fulghum v. Embarq, No. 07-2602-EFM (D. Kans. June 10, 2015)] (U.S. District Court for the District of Kansas)  

Small Business Health Insurance Coverage in a Post-ACA World (PDF)
"[T]he long-term viability of the small group market needs to be closely monitored. With the continued enrollment in transitional plans, it will be a few more years before the effects of the ACA are fully felt. Additionally, the upcoming expansion of the market to include firms with 51 to 100 workers is likely to have a destabilizing impact.... The exchanges will need to balance the goals of attracting employers to the SHOP and giving small business workers more say in selecting their own health coverage with the risk of adverse selection posed by the more expansive models of employee choice." (National Institute for Health Care Management)  

Dramatic Shift to Consumer-Directed Health Plans
"71 percent of employer health plans have individual, in-network out-of-pocket maximums (OOPMs) of $2,500 or more in 2015, up from 66 percent in 2014 and 58 percent in 2013.... ER copays increased 9 percent, reflecting the rising cost of hospital care as well as the cost-share increase between the plan and participants.... Across the board, out of network preventive service costs were higher with the exception of a routine mammogram." (HighRoads)  

Telemedicine: The Promise and the Challenges (PDF)
"[T]he number of states making telemedicine coverage mandatory for private insurance plans has grown. Coverage was mandatory in five states in 2000, 12 in 2011, and 24 plus D.C. as of May 2015.... Early evidence finds improved access and lower health care costs, but telemedicine continues to face regulatory barriers as well as provider and consumer skepticism." (Alliance for Health Reform)  

Walgreens, Insurers Push Expansion of Virtual Doctor Visits
"The nation's largest drugstore chain is expanding a smartphone application it started testing last December to tablets and personal computers and plans to make it available in 25 states. The growth comes as major insurers UnitedHealth Group and Anthem prepare to expand their own non-emergency telemedicine services to about 40 million more people by next year.... The nation's largest health insurer, UnitedHealth Group Inc., started covering earlier this year telemedicine visits for about a million people with employer-sponsored health plans and expects to expand that to 20 million customers next year. Likewise, the Blue Cross-Blue Shield insurer Anthem Inc. started its LiveHealth Online service in 2013 by offering it to a few thousand people." (USA TODAY)  

Engaging Consumers in Changing Health Behaviors (PDF)
7 pages. "This article summarizes relevant concepts and findings from the fields of psychology, decision research, and social marketing and identifies best practices in developing consumer engagement. Employers can utilize this information when creating health care programs and tools to control costs and improve workforce health and productivity.... Although effective communication is a critical first step, on its own, it will not bring about the behavioral change necessary for consumerism to reduce costs." (Buck Consultants at Xerox)  

50 Things to Know About Healthcare Costs
"The difference between costs, charges and payments ... Healthcare spending on the rise ... Cost of hospital services ... Costs broken down by hospital type and state ... Spending on prescription drugs and physician services is growing ... Out-of-pocket healthcare costs are increasing ... A breakdown of out-of-pocket healthcare costs ... Employer healthcare costs ... Influence of the 'Cadillac tax' on employer healthcare costs." (Becker's Hospital CFO)  

Compliance Checklist for California's Paid Sick Leave Law
"Beginning on July 1, 2015, most California employers are required to offer nearly all of their employees paid sick time under the Healthy Workplaces, Healthy Families Act ... This Advisory provides a checklist for employers to ensure compliance with the Act. In addition, this Advisory includes language for a notice that can be provided to current non-exempt employees in lieu of updating all of their Wage Theft Prevention Act (Labor Code section 2810.5) notices." (Epstein Becker Green)  

Burwell Says It's Up to States, Congress to Help Consumers If Court Strikes Down Subsidies
"[HHS Secretary Sylvia] Burwell said while the administration would be open to considering alternatives that make health care more affordable and accessible, the president would not sign legislation [introduced by] Sen. Ron Johnson, R-Wis. [which] would maintain the subsidies for current beneficiaries through August 2017 but repeal the health law's requirements that most individuals get coverage, that larger businesses offer insurance to their workers or pay a penalty and that plans provide specific types of benefits." (Kaiser Health News)  

Why Are the 2016 Obamacare Rate Increases So Large?
"Texas Blue Cross stands out. The health plan commented in its federal government rate filings that it covered 730,833 Obamacare individuals in 2014 with premium of $2.1 billion and claims totaling $2.5 billion -- for a medical loss ratio of 119%. The plan further commented that, after the '3Rs' reinsurance adjustments, they lost 17% to 20% of premium in 2014 -- that would be about $400 million. And, they are only asking for a 20% rate increase." (Forbes)  

Troubling Trends in Insurance Company Compliance with ACA's Breastfeeding Benefits
"A recent report from the National Women's Law Center (NWLC) has identified several troubling trends in insurance company compliance with the Patient Protection and Affordable Care Act's (ACA) breastfeeding benefits. NWLC found violations such as limiting coverage of breast pump purchases and failing to have in-network lactation counselors." (Wolters Kluwer Law & Business)  

Benefits in General; Executive Compensation

SEC Staff Issues Analysis on Proposed Pay Ratio Disclosure Rule
"[T]he analysis indicates the SEC's potential receptivity to excluding categories of employees from the calculation of the CEO pay ratio, at least up to 20% of the total worldwide workforce. Based on the Staff Report, if the SEC concludes that the exclusion of a category of employees would not have a material effect on the calculation of the CEO pay ratio, presumably the SEC would be inclined to allow for such exclusion in the final rule." (Meridian Compensation Partners, LLC)  

Preparing to Disclose Pay for Performance
"One key decision involves the peer group of companies whose [total shareholder return (TSR)] the company includes in [the proxy's Summary Compensation Table] ... When companies decide on a peer group, they need to consider not only what would work in the current year, but what would work in coming years[.]" (Treasury & Risk)  

Press Releases

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