Health & Welfare Plans Newsletter

June 30, 2015

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Part Time On Call Retirement Planning Consultant
Transamerica Retirement Solutions
in AR, CA, FL, GA, HI, IL, MI, MO, NJ, NY, TN, TX, UT

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PlanTech, LLP
in AL, GA, TN

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Nationwide
in TX

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Ingham Retirement Group
in FL

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Touchstone Retirement Group
in GA

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Associated Builders & Contractors, Inc.
in DC

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Webcasts and Conferences

Who’s the Employer/Employee? 02: Shared/Leased Employees
July 6, 2015 WEBCAST
(SunGard Relius)

QDROs
July 10, 2015 WEBCAST
(SunGard Relius)

13th Annual Congress on On-Site Employee Health Clinics
July 13, 2015 in IL
(Global Media Dynamics)

Easy Low-Cost Ways to Start Your Small Business Retirement Plan
July 14, 2015 WEBCAST
(IRS [Internal Revenue Service])

Matching Funding Policy With Investment Policy for Defined Benefit Plans
July 22, 2015 WEBCAST
(Pension 360)

Taking the Mystery Out of Retirement Planning
July 29, 2015 WEBCAST
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

IRA Academy 2015
August 4, 2015 in DC
(PenServ Plan Services, Inc.)

View All Webcasts and Conferences


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[Official Guidance]

Text of IRS Letter Clarifying ACA Health Insurance Providers Fee and MLR Rebates: July 15 Deadline for Corrected Filing of Form 8963 (PDF)
"Starting in 2014, with initial reporting due at the end of the contract period (December 2015, after the 'Part D reconciliation and calculation of risk corridor payments' are performed), the ACA requires Medicare Advantage and Medicare Part D plan insurers to meet a minimum MLR requirement. If the insurer does not meet the requirement, they must refund an amount back to the Federal Government.... In determining net premiums written for the 2015 fee year, which is based on 2014 data, covered entities must take into account on an accrual basis any MLR rebates for Medicare Advantage and Medicare Part D plans and for Medicaid in the states or contracts that require MLR computations.... Any entity that must correct a previously submitted Form 8963, 'Report of Health Insurance Provider Information,' to account for additional MLR rebates accrued in 2014 as described in this letter must file a corrected Form 8963 during the correction period, no later than July 15, 2015." [This undated letter was posted on IRS website June 29, 2015.] (Internal Revenue Service [IRS])  

[Guidance Overview]

Montgomery County, Maryland Passes Earned Sick and Safe Leave Bill
"All employees based or working in the County are entitled to accrue safe and sick leave at a rate of one [1] hour for every thirty [30] hours worked, subject to caps. The Bill provides that employers with five [5] or more employees must provide up to 56 hours per year of paid sick and safe leave to employees. Employers with fewer than five [5] employees are only required to provide up to 32 hours of paid sick and safe leave and twenty-four [24] hours of unpaid sick and safe leave per year.... Employers are permitted to decide whether to provide the entire balance of sick leave to employees at the beginning of the year or whether to provide the leave as it accrues throughout the year." (Proskauer's Law and the Workplace)  

[Guidance Overview]

Massachusetts Paid Sick Leave: Final Regs Issued
"The ballot measure originally required employees only to make a good faith effort to give advance notice of foreseeable use of paid sick leave. However, the regulations now clarify that employees must give notice, except in particular situations in which advance notice might be infeasible. For unforeseeable absences, the employee must give notice that is reasonable under the circumstances." (Proskauer's Law and the Workplace)  

CMS Webinar: Administrative Appeals Process for Risk Adjustment Payments/Charges and Reinsurance Payments (PDF)
50 presentation slides. Topics include: [1] Stages of the appeals process; [2] Request for reconsideration; [3] Submitting a request for reconsideration; [4] Informal hearing before a CMS hearing officer; and [5] CMS administrator review. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

Supreme Court to Consider ERISA Implications of Vermont Health Care Claims Database
"Vermont argued that these types of databases -- which several states use to collect information from medical providers and insurance companies -- are useful in shaping health-care policy, evaluating existing health-care programs and improving the quality and affordability of patient care. VHCURES hit a roadblock in 2014, when the U.S. Court of Appeals for the Second Circuit issued a split ruling striking the program down as preempted by ERISA. According to the two-judge majority, VHCURES placed a significant burden on reporting, which the majority called a 'core ERISA function'." [Gobeille v. Liberty Mutual Ins. Co. (2d Cir. Feb. 4, 2014, cert. pet. granted June 29, 2015) (Bloomberg BNA)  


[Advert.]

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ACA and Narrow Networks
"[A]lthough only 36% of networks are narrow with respect to primary care physicians, for oncologists 59% of networks are narrow. Thus, access to high cost oncology services is more limited. It is not clear whether narrow networks are moving patients towards oncology specialist or simply reducing patient access to care." (Healthcare Economist)  

Five Lingering Threats to Obamacare
"[1] Repeal ... [2] Marketplaces failing ... [3] Rising costs ... [4] Enrollment challenges ... [5] Another lawsuit." (The Hill)  

[Opinion]

The Uncertain Effect of Obamacare on Employer Sponsorship of Health Plans
"Before Congress passed the Affordable Care Act in 2010, many experts anticipated that it would lead to a hemorrhaging of employer-based benefits, as businesses and their employees figured out that going into ObamaCare's exchanges would reduce their net tax burden. Unfortunately, the data so far are inconsistent and even contradictory." (National Center for Policy Analysis Health Policy Blog)  

[Opinion]

What's Next for the ACA? Life After King v. Burwell
"The ACA's increased stability ... is not simply the result of judicial interpretation, politics, or serendipity. Its stability also reflects significant accomplishments and reforms.... There are numerous improvements in health coverage and care that should receive increasing attention. They include: Improving the value of the care we receive ... Closing the coverage gap that harms the poor ... Eliminating the 'family glitch' ... Ensuring that out-of-pocket costs are affordable ... Advancing equity in health and health care." (Health Affairs)  

Benefits in General; Executive Compensation

[Official Guidance]

Interim Web Notice on Cross-Reference Changes to Parts 2560, 2570 and 2571 of DOL Regs
"ERISA authorizes the Secretary of Labor to assess civil monetary penalties for certain statutory violations and to make certain other determinations. EBSA regulations specify the Department's procedures for such actions.... EBSA intends to amend its procedural regulations to update the cross-references. In the meantime, the chart below indicates the correct section of the OALJ rules that should be used in applying EBSA's procedural regulations. With the exception of the outdated cross-references, the EBSA rules cited above remain in effect." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

Same-Sex Marriage: A Practical Guide for Employers
"While issues will continue to arise, here are a number of things all employers should consider: Employee handbooks ... Taxes ... Health insurance ... Other benefits ... COBRA ... FMLA ... Pensions, qualified retirement accounts, and IRAs." (Goldberg Segalla)  

The Same-Sex Marriage Ruling: Key Employee Benefits Take-Aways
"State insurance laws may require insurance carriers to offer same-sex spouses the same coverage and benefits that they offer to opposite-sex spouses.... A self-funded medical plan that is not subject to state insurance laws, but is subject to non-discrimination laws, may be required to cover same-sex spouses if the plan covers opposite-sex spouses.... Same-sex spouses would ... be able to obtain Qualified Domestic Relations Orders assigning portions of retirement plan accounts to current or former spouses or to the children of the same-sex marriage.... Same-sex couples will be able to adopt children as couples ... so benefit plans that provide coverage to adopted children of an employee will cover the children of the family.... Children of a same-sex spouse probably will be step-children of the employee and entitled to benefits offered to step-children." (Ogletree Deakins)  

Recent U.S. Supreme Court Decisions Impacting Your Benefit Plans and Plan Administration: Final Word or Just Another Chapter?
"[P]lans should review their documents definition of spouse and the procedures they have related to spousal rights, such as delivery of QJSA, QPSA and QOSA notices, delivery of COBRA notices, QDRO procedures and beneficiary designations to be sure that they are consistent with the recognition of all spouses required to be recognized under federal laws and the state laws which have not been ruled unconstitutional. As always, the Court's decision does not come with an effective date or any limitations on retroactivity."[Obergefell v. Hodges, No. 14-556 (U.S. June 26, 2015)] (Winstead PC)  

Press Releases

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Centre for Fiduciary Excellence [CEFEX]

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