Health & Welfare Plans Newsletter

June 17, 2015

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MassMutual Financial Group
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Sheet Metal Workers' National Pension Fund
in VA

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MassMutual Financial Group
in IL

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in FL

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Webcasts and Conferences

Employee Benefit Developments Employers Need To Know
June 18, 2015 WEBCAST
(Bond, Schoeneck & King, PLLC)

Overview of the Draft 'AIR Submission Composition and Reference Guide'
June 23, 2015 WEBCAST
(IRS [Internal Revenue Service])

S Corporation ESOPs - Administrative Issues
June 23, 2015 WEBCAST
(National Center for Employee Ownership [NCEO])

IRA Required Minimum Distributions
September 22, 2015 WEBCAST
(Ascensus)

View All Webcasts and Conferences



[Official Guidance]

2015 Draft IRS Form 1095-C: Employer-Provided Health Insurance Offer and Coverage (PDF)
Draft version, dated June 16, 2015. (Internal Revenue Service [IRS])  


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[Official Guidance]

2015 Draft IRS Form 1094-C: Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns (PDF)
Draft version, dated June 16, 2015. (Internal Revenue Service [IRS])  

[Official Guidance]

2015 Draft IRS Form 1095-A: Health Insurance Marketplace Statement (PDF)
Draft version, dated June 16, 2015. (Internal Revenue Service [IRS])  

[Official Guidance]

2015 Draft IRS Form 1095-B: Health Coverage (PDF)
Draft version, dated June 16, 2015. (Internal Revenue Service [IRS])  

[Guidance Overview]

Recent Guidance on Electronic Filing of ACA Information Returns for Applicable Large Employers
"The required format for all ACA Information Returns is XML. Returns will not be accepted electronically in any other format, and there are no online 'fill-in' forms to facilitate small volumes of returns.... Testing is required.... Test files must be submitted in an XML format, and the submitter must verify that the IRS processed the transmission and returned a Receipt ID, acknowledgment and associated error file. According to the IRS, test submissions must exactly match the answer key for each test scenario (including leading, trailing, and embedded spaces; punctuation, and capitalization)." (ADP)  

[Guidance Overview]

DOL Releases Updated FMLA Health Care Provider Certification Forms
"The updated forms now contain a reference to the Genetic Information Nondiscrimination Act of 2008 (GINA). While employers may not request genetic information from an applicant or employee, there is no GINA violation if the employer receives genetic information from a health care provider who is responding to the employer's lawful request for information under the FMLA if an acceptable GINA notice is included in the request." (Holland & Knight)  

Ninth Circuit Declines to Apply California's Insurance Notice-Prejudice Rule to a Benefits Claim Against a Self-Funded ERISA Plan
"The Court of Appeals determined that the Plan's one-year claim submission deadline was reasonable and did not conflict with ERISA. While recognizing a general federal judicial duty to formulate federal common law to supplement the provisions and purposes of ERISA, the Court of Appeals found that no such judicial legislation was required.... California's notice-prejudice rule is exclusively a creature of state insurance law. The Court of Appeals concluded that extending an insurance-based rule to uninsured plans, such as the Plan at issue, would defeat the distinction Congress made between insured and uninsured plans." [Zagon v. Am. Airlines, Inc. LTD Plan, No. 13-55866 (9th Cir. May 21, 2015) ] (Seyfarth Shaw LLP)  

CMS Webinar: FF-SHOP Logo Submission and Enrollment Data Reconciliation, June 9, 2015
68 presentation slides. "Purpose: [1] Provide FF-SHOP issuers with updates and announcements; [2] Review 2015 FF-SHOP issuer enrollment reconciliation FAQs; [3] Provide FF-SHOP issuers with an overview of Financial Management policy-based payments." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

Self-Insured Health Plans: State Variation and Recent Trends by Firm Size, 1996-2013
"[T]he percentage of workers in self-insured plans has been increasing. In 2013, 58.2 percent of workers with health coverage were in self-insured plans, up from 40.9 percent in 1998. Large employers (with 1,000 or more workers) have driven the upward trend in overall self-insurance. There is concern that passage of PPACA will result in an increasing number of smaller employers offering self-insured plans. However, as of 2013, there is no evidence that smaller firms were increasingly self-insuring their health plans." (Employee Benefit Research Institute [EBRI])  

Impact of Carryover Rule on FSA Enrollment
"[A]bout 73% reported that they saw an increase in FSA participation after employers switched to the carryover, while 27% did not notice a change.... About 91% of members either agreed or strongly agreed that employers saw the carryover as increasing the value of offering an FSA, and 83% agreed or strongly agreed that employees who were offered the carryover viewed the change as adding value to participating in an FSA." (Employers Council on Flexible Compensation [ECFC])  

Implementing Value-Based Insurance Products: A Collaborative Approach to Health Care Transformation
"[T]he predominant system of payment for health care providers ... remains based on fee-for-service for specific activities.... Many potentially valuable approaches are not reimbursed or are reimbursed poorly ... To support innovative, less-costly care, health plans and providers have begun to develop, implement, and evaluate a range of financing reforms. These new models use reimbursement that seeks to reward value rather than volume in order to give providers greater support for delivering care that promotes higher quality and lower costs." (The Brookings Institution)  

Fifty Years In, Medicare Has Transformed Health Care. What's in Store for the Next Fifty?
"By 2025 the number of Medicare beneficiaries will have grown from the current 54 million to more than 70. One out of every five Americans will then be enrolled. This will be the most rapid beneficiary expansion in history. Second, experts predict that by 2020, almost half of all Americans will have acquired a chronic illness, such as diabetes, cancer, and heart disease.... Third, the challenge is not only in the numbers of beneficiaries but also in their geographic location. A significant number live in rural and isolated areas where physicians and other caregivers generally do not. Finally, policymakers will be forced to address the cost of Medicare in the coming years." (Health Affairs)  

[Opinion]

Administration Devoting $1.25 Million to Find Ways to Encourage States to Force Employers to Give Paid Leave
"The Obama Administration estimates that 40 percent of private-sector employees work at a company that does not offer sick pay for their own illness or injury and that low- and middle-income workers are much less likely to be offered paid sick leave than highly paid workers. Disregarding concern about the added adverse effect on hiring and wages that business leaders and others say will result if the federal government burdens U.S. employers with additional paid leave, increased minimum wage and other mandates, the Obama Administration is moving forward on its plans to force U.S. employers to provide paid leave to workers." (Solutions Law Press)  

Benefits in General; Executive Compensation

[Official Guidance]

Nonqualified Deferred Compensation Audit Techniques Guide (June 2015)
"A NQDC plan examination should focus on when the deferred amounts are includible in the employee's gross income and when those amounts are deductible by the employer.... The Examiner should also address if deferred amounts were properly taken into account for employment tax purposes. The timing rules for income tax and for FICA/FUTA taxes are different.... It is important to note that Section 885 of the American Jobs Creation Act of 2004 changed the rules governing NQDC arrangements significantly." (Internal Revenue Service [IRS])  

[Guidance Overview]

IRS Updates Audit Guide for Nonqualified Plans (PDF)
"Considering the degree to which the IRS and practitioners have focused on Section 409A since 2005, it is surprising that the June 2015 update to the Audit Techniques Guide provides little insight into how the IRS plans to review for Section 409A compliance during the audit process. While the Guide clearly instructs IRS examiners to look for Section 409A violations, it does not note any areas of particular IRS focus or recommend any specific audit techniques in this area. The lack of detail is notable in light of the IRS's recent audit initiative focused on Section 409A." (Groom Law Group)  

[Guidance Overview]

IRS Provides Online Information on Circular 230
"Tax professionals who represent taxpayers before the IRS should be aware that there were significant revisions made to Circular 230 on June 12, 2014.... The most important Circular 230 provisions for tax professionals to review are either new or are areas where professionals are most likely to make errors including: Diligence as to Accuracy (10.22); Due Diligence Standards for Signing and Advising -- Returns/Docs (10.34); Negotiation of Taxpayer Checks (10.31); Giving False or Misleading Info (10.51(a)(4)); Willfully Assisting, Counseling or Encouraging a Client to Evade Taxes or Payment Thereof (10.51(a)(7)); Conflicting Interests (10.29); Due Diligence for Written Advice (10.37); Competence (10.35); Expedited Suspension (10.82)." (Internal Revenue Service [IRS])  

A Look Ahead to the Supreme Court's 2015-16 Term
"The Supreme Court has demonstrated some enthusiasm for ERISA in recent years. The [Montanile v. Board of Trustees] case represents a significant beginning to the Court's ERISA work for the next term. Given the cases and issues before it, however, the odds are that the Court will consider more ERISA cases in the next twelve months." (Jackson Lewis P.C.)  

It's a Top Hat Plan? Federal District Court Says 'Prove It'
"When employers offer deferred compensation plans to a small group of top of the scale employees to try to tie them more firmly to the company, they know they are offering deferred compensation to a select group of top tier employees, and thus feel quite certain that the plan involved is a top hat plan. To them, it looks like a top hat plan, walks like a top hat plan and quacks like a top hat plan, so it is a top hat plan. That, though, is not enough, as [Tolbert v. RBC Capital Markets Corp.] shows, for a court applying rigorous standards of proof: instead, the elements are going to have to be proven by testimony, data comparing the recipients to the employee pool as a whole, and the like." (Stephen Rosenberg, The Wagner Law Group)  

Press Releases

CalPERS Committee Moves to Recommend 2016 Health Plan Premium Rates
CalPERS [California Public Employees' Retirement System]

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