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[Guidance Overview]
Reminder: Non-Grandfathered Plans Must Implement Embedded Out-of-Pocket Maximums
"[A]s employers plan for 2016 open enrollment, they must ensure that their benefit structures are consistent with this new rule. This includes updating their summary plan descriptions and contacting their vendors to ensure that the administration is consistent with this rule. Particular attention must be paid to non-grandfathered high deductible health plans (HDHPs), to which this new rule also applies. High deductible plans often have no embedded limit, applying the family out-of-pocket maximum to all family members in the case of family coverage."
(Proskauer's ERISA Practice Center)
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[Guidance Overview]
Final Rules Issued on Coverage of Preventive Services
"[T]he final regulation continues to provide that when a recommended preventive [service] is not billed separately or tracked separately from an office visit, plans may look to the primary purpose of the office visit to determine whether cost sharing may be imposed ... [The final regulation] provides that a plan must provide coverage for recommended preventive items and services for the entire plan year, even if the recommendation or guideline is changed during the year ... Plans do not need to make changes to coverage and cost sharing requirements based on a new recommendation or guideline until the first plan year beginning on or after the date that is one year after the new recommendation or guideline goes into effect."
(The ERISA Industry Committee [ERIC])
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HSA Balances, Contributions, Distributions, and Other Vital Statistics, 2014 (PDF)
28 pages. "Enrollment in HSA-eligible health plans is estimated to be about 17 million policyholders and their dependents, and it has also been estimated that there are 13.8 million accounts holding $24.2 billion in assets as of Dec. 31, 2014. Almost 4 in 5 HSAs have been opened since the beginning of 2011. The average HSA balance at the end of 2014 was $1,933, up from $1,408 at the beginning of the year. Average account balances increased with the age of the owner of the account.... About 6 percent of HSAs had an associated investment account.... Four-fifths of HSAs with a contribution also had a distribution for a health care claim during 2014."
(Employee Benefit Research Institute [EBRI])
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The Consumer Finance of Health Savings Accounts (PDF)
24 pages. "More than 40 percent of HSA account holders save nearly all of their annual contributions within a 12-month period. About 30 percent of account holders spend nearly all of their contributions. The remaining account holders spend or save in relatively equal proportions.... Only 4 percent of account holders eligible to invest their HSA balances actually chose to invest.... The median account holder with an employer contribution defers over 200 percent more into an HSA than the median account holder without an employer contribution ... About 5 percent of account holders contributed the maximum amount allowed by the IRS to their HSA[.]"
(HelloWallet)
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HSA vs. FSA: What's the Difference, and Which Should I Use?
"Both accounts have benefits that can make managing your out-of-pocket medical expenses easier throughout the year. But you should opt for an HSA if you qualify, if for no other reason than the limits are higher and you can carry over your contributions from year to year. If you don't qualify, sign up for the FSA."
(Forbes)
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Health Plan Networks and Specialty Hospitals
"Consumers have access to specialty hospitals through health plan contracts with these facilities, centers of excellence, and processes to access out-of-network care when necessary. A recent AHIP analysis found striking differences between the average charges of specialty versus non-specialty hospitals for many routine procedures. Maintaining flexibility for health plans to design their provider networks is essential to promoting access, affordability, and value for consumers."
(America's Health Insurance Plans [AHIP])
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[Opinion]
Paying the Deductible Year After Year
"Of health plan members or their family members who were in the top 10 percent of spending in a given year, 43 percent were still in the top 10 percent the following year, and an astonishing 34 percent were still in the top 10 percent five years later.... When you think about the financial protection that you should be receiving from your health plan, it is deplorable that one-third of those who have the greatest needs for health care are exposed to years of recurrent, persisting financial burdens simply because of the fundamentally flawed design of our private health plans."
(Physicians for a National Health Program [PNHP])
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Benefits in General; Executive Compensation
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[Guidance Overview]
IRS Penalties for Information Returns Have Doubled
"Examples of information returns affected by the new law are Forms W-2, 1098, 1099 series and 1042. Under the [ACA], providers of minimum essential coverage are required to file Forms 1095-B and 1094-B and failures are subject to the penalty.... The burden of the penalty increase is duplicated when one considers that the penalty applies to both the failure to file the information return with the IRS and the failure to furnish the payee's copy of the return to the payee.... Each inaccurate Form 1099 will then cost a payor $500. The penalty is doubled if the failure to file/furnish is intentional."
(McGladrey)
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[Guidance Overview]
SEC Releases Proposed Rule on Mandatory Clawbacks
"[T]he potential retroactive application the Proposed Rule to already granted compensatory awards could result in the recoupment of compensation in violation of the terms of such award under an existing award agreement or employment contract. The SEC dismisses this potential issue by asserting that a company may unilaterally amend existing awards without an award holder's consent 'to accommodate recovery.' Despite this assertion, the potential retroactive application of the Proposed Rule to existing awards could result in an Executive Officer (particularly a former Executive Officer) challenging a company's recovery attempt in court."
(Meridian Compensation Partners, LLC)
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Clawback Rule Could Backfire
"In theory, the new rule should make executives more accountable.... In practice, however, the new rule, on which the SEC is seeking public comment, is causing some head-scratching because its language could lead to a different, perverse consequence. Instead of acting as a check on compensation and accountability, the new law increasingly looks as if it could drive up base salaries -- and make executives less aligned with shareholders -- or increase incentive pay to even higher levels to account for the risk of any potential clawback."
(The New York Times; subscription may be required)
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Press Releases
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