Benefits/HRIS Specialist
Arnold & Porter LLP
in DC

Plan Document Specialist
Lincoln Financial Group
in ANY STATE

Stock Plan Administrator
PolyOne Corporation
in OH

ESOP Consultant
Principal Financial Group
in CA, IA, IL, MA, MD, NY, TX, WA

Senior Actuarial Analyst
Verisight
in TX

Conversions Consultant
Verisight
in CA

Internal Sales Consultant, Compliance
Verisight
in NC

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Transamerica
in ANY STATE, MN

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The Newport Group
in TX

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DOL Proposal On ERISA Fiduciary Status For Investment Advisers
RECORDED
(Wagner Law Group P.C.)

Advanced Issues in Distributions
August 4, 2015 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

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[Official Guidance]

Text of OPM Carrier Letter for FEHB Program, Requiring Coverage of Transgender and Gender Transition Care (PDF)
"Effective January 1, 2016, no carrier participating in the Federal Employees Health Benefits Program may have a general exclusion of services, drugs or supplies related to gender transition or 'sex transformations.' This letter clarifies OPM's earlier guidance recognizing the evolving professional consensus that treatment may be medically necessary to address a diagnosis of gender dysphoria." (U.S. Office of Personnel Management [OPM])  

[Advert.]

Now is a great time to join Worldwide Employee Benefits Network (WEB)

WEB members represent more than 25 professions and 30 areas of expertise within the pension and benefits industry-including administrators, consultants, attorneys, accountants, investment managers, communications experts and benefits managers. Join today.

[Official Guidance]

CMS Fact Sheet: The Accountable Care Organization Investment Model
"The ACO Investment Model is a new model of pre-paid shared savings that builds on experience with the Advance Payment Model to encourage new ACOs to form in rural and underserved areas and current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk.... The ACO Investment Model will be available to: New Shared Savings Program ACOs that joined in 2015 or are joining in 2016.... [and] ACOs that joined the Shared Savings Program starting in 2012, 2013 or 2014." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

Wellness Programs: New Proposed Regulations Add More Compliance Requirements (PDF)
28 presentation slides. Topics include: [1] Two types of programs, nine main compliance requirements: HIPAA and ADA; [2] GINA; [3] ACA market reforms; [4] ERISA; [5] COBRA; [6] HIPAA Privacy/Security; [7] ADEA and FLSA. (ABD Insurance & Financial Services, and Trucker Huss, APC)  

[Guidance Overview]

Final Revised SBC Regulations Issued
"The anti-duplication rules have been expanded. In particular, the regulations explain that a plan administrator may contract to require another entity to provide the SBC. The requirements for electronic distribution of SBCs are clarified. The SBC must state whether the plan offers minimum essential coverage and meets the minimum value requirement. The requirements for the SBC when the terms of coverage are not yet finalized are explained." (The Wagner Law Group)  

Class Action Suit Alleges Employee Work Hours Cut to Skirt ACA Obligation to Offer Health Coverage
"In the first lawsuit of its kind, a purported class of approximately 10,000 workers at Dave & Buster's, the restaurant chain, filed a lawsuit in the Southern District of New York (Marin v. Dave & Buster's, Inc., S.D.N.Y., No. 1:15-cv-03608) alleging that their employer reduced the workers' hours to keep them from attaining full-time status for the purpose of avoiding the requirement to offer them health coverage under the Affordable Care Act's (ACA's) employer mandate." (Franczek Radelet P.C.)  

Did Your Plan Receive 28% in Retiree Drug Subsidies? (PDF)
"According to CMS, subsidy payments should equal 28% of a qualifying retiree's allowable prescription drug costs. But many plans are receiving a reduced subsidy because of incomplete or inaccurate cost reporting for the subsidy. This shortfall can be remedied by conducting an audit of the cost reporting that goes well beyond the standard RDS reconciliation performed after the end of the plan year." (International Foundation of Employee Benefit Plans [IFEBP])  

Obamacare Ruling May Have Just Killed State-Based Exchanges
"Now, with the Supreme Court ensuring that every state's consumers will have equal access to federal subsidies, it is becoming clear that more of those states will revert to a federal system for enrolling people in health insurance.... As the law envisioned, state exchanges would provide an opportunity for state insurance regulators to oversee their markets, a role they have long performed. The state exchange system would also allow a greater degree of policy flexibility and control, so state officials could customize the marketplaces for local conditions. What few people grasped was the technical and logistical challenge of building a complex website and customer service operation from scratch." (The New York Times; subscription may be required)  

Legal Hurdle Cleared -- The ACA Will Survive
"[A]ny employer with 50 or more full-time employees (including equivalent employees) will need to comply with the law in 2016. The transition relief that largely limited the Play or Pay Mandate to employers with 100 or more full-time employees (including equivalent employees) concludes at the end of 2015.... [At] the beginning of 2016 employers will have Form 1094 and 1095 reporting obligations.... [In] 2016 no employer will be able to rely solely on the MV Calculator to demonstrate that a non-hospital/non-physician services plan provides minimum value. Consequently, some employers will have to reassess the plan(s) they are offering their workforce." (Health Care Attorneys P.C.)  

Context Is King: Analysis of the U.S. Supreme Court Decision in King v. Burwell (PDF)
8 pages. "The bigger question now, with King v. Burwell in the rearview mirror and most of the ACA intact, is whether President Obama will be willing to consider legislative proposals to improve the law.... The large employer community, unions and other patient groups are already speaking out against the looming ['Cadillac'] tax, which does not take effect until 2018. Legislation to modify the definition of full-time employee from 30 to 40 hours is high on the Republican list of priorities, but has earned limited Democratic support to date. Action to address unintended consequences that have emerged through implementation of the law could also see a renewed sense of urgency." (Squire Patton Boggs)  

Supreme Court Rules That ACA Tax Subsidies Are Available Through Federal Exchanges (PDF)
6 pages. "The Court held that there was no dispute that a federal Exchange qualified as an 'Exchange' within the meaning of the ACA ... [and] found that although the statutory language was ambiguous, the role of federal Exchanges when read in the context of the ACA as a whole indicated that Congress viewed federal Exchanges as equivalent to state Exchanges. Significant to this conclusion is the ACA's mandate that HHS 'establish such Exchange' when a state declines to do so. According to the Court, 'By using the phrase 'such Exchange,' [the ACA] instructs [HHS] to establish and operate the same Exchange that the State was directed to establish[.]' " [King v. Burwell, No. 14-114 (U.S. June 25, 2015)] (Groom Law Group)  

Supreme Court Upholds Tax Credits on the Federal Exchange
"As the Chief Justice had observed at the oral argument, had the Court simply deferred to the agency, a future administration could have changed the rule. The Court's decision means that if Congress wants to limit tax credits to state-operated exchanges, Congress itself will have to amend the law. The Court proceeded to determine itself what the statute meant. In doing so, the Chief Justice relied throughout on the text, context, and purpose of the ACA, not on legislative history or some abstract notion of congressional intent." [King v. Burwell, No. 14-114 (U.S. June 25, 2015)] (Timothy Jost, in Health Affairs)  

Humana Said to Pursue Sale as Court's Ruling Gives Insurers a Lift
"A new round of consolidation in the health insurance industry appeared closer as companies seek to grow larger, driven in part by cost-cutting and opportunities that are part of the Affordable Care Act. In the latest jockeying, Humana, the smallest of the big five insurers, is pursuing a deal to sell itself and could reach an agreement by next week ... Among those in the running to buy it are two bigger competitors, Aetna and Cigna." (The New York Times; subscription may be required)  

[Opinion]

Most Exchange Plans Will Not See Double-Digit Rate Hikes in 2016
"Critics of the ACA in recent weeks have said the law is to blame for the large increases.... [One] analysis found that preliminary premiums for 2016 benchmark silver plans increase by 4.4% in large metropolitan areas in 10 states and Washington, D.C. Meanwhile, a separate ... analysis released this month projected that silver exchange plans would increase by 5.8% in eight states.... [T]hose rates are much lower than what some expected but higher than the 2% rate increase seen nationwide last year." (California Healthline)  

[Opinion]

Obamacare: As American as Apple(Sauce) Pie
"Scalia, unsurprisingly, felt that the majority had transcended their powers of statutory construction by failing to limit their analysis to specific and clear language in the statute -- namely, crystal clear language that provided that an exchange for which someone would be eligible for credits had to be one 'established by the State.' ... Scalia [called] the majority's reasoning 'pure applesauce' and [stated] that they had resorted to the usage of somersaults of statutory interpretation in reaching their conclusion. Most poignant, however, was Scalia's articulation that the Court had engaged in 'interpretive jiggery-pokery.' " [King v. Burwell, No. 14-114 (U.S. June 25, 2015)] (Bloomberg BNA)  

Employee Benefits Effects of Supreme Court Same-Sex Marriage Decision
"On June 26, 2015, the Supreme Court struck down all state bans on same-sex marriage ... For employers, this decision raises the issue of what changes must be made in employee benefits ... [This article] will look at three categories of employers: those that have already been offering benefits to same-sex spouses, those that have not previously offered benefits to same-sex spouses, and those that have been offering benefits to domestic partners." [Obergefell v. Hodges, No. 14-556 (U.S. June 26, 2015)] (Calhoun Law Group, P.C.)  

[Opinion]

Frederick W. Cook & Co. Comment Letter to SEC on Pay-for-Performance Disclosure (PDF)
8 pages. "[T]he burden imposed by the Rule varies by company with considerably more time and effort required for companies that grant stock options and/or have pension plans.... More importantly, and based on our sample study, we do not believe the disclosure (prepared according to the Rule) will accurately portray the relationship between executive compensation actually paid and the financial performance of the registrant (which was the directive of the statute)[.]" (Frederic W. Cook & Co., Inc.)  

Wayne Kamenitz Joins Mitchell & Titus as Executive Director
Mitchell & Titus, LLP

LOMA Secure Retirement Institute Introduces Fourth Course in FSRI Designation: Successful Retirement Outcomes
LIMRA LOMA Secure Retirement Institute

OneAmerica to Acquire BMO’s U.S. Retirement Services Business
OneAmerica Financial Partners

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