Health & Welfare Plans Newsletter

August 18, 2015

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Webcasts and Conferences

2015 SOA Annual Meeting & Exhibit
October 11, 2015 in TX
(Society of Actuaries)

2015 IHC Forum & Expo Las Vegas Conference
November 16, 2015 in NV
(Institute for HealthCare Consumerism)

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[Official Guidance]

Text of IRS Publication 5165: Guide for Electronically Filing ACA Information Returns (AIR) for Software Developers and Transmitters, for Processing Year 2015 (PDF)
48 pages; revised July 2015. "[This publication] outlines the communication procedures, transmission formats, business rules and validation procedures for returns transmitted electronically through the AIR system.... The procedures in this publication should be used when the following information returns are transmitted electronically: Form 1094-B, Transmittal of Health Coverage Information Returns; Form 1095-B, Health Coverage; Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns; and Form 1095-C, Employer-Provided Health Insurance Offer and Coverage. Note: This publication does not contain information or procedures for filing Forms 1095-A." (Internal Revenue Service [IRS])  


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[Official Guidance]

Text of IRS Publication 5164: Test Package for Electronic Filers of ACA Information Returns (PDF)
20 pages; revised August 2015. "[This publication] contains general and program specific testing information for use with ACA Assurance Testing System (AATS). AATS refers to both the process and the system used to test software and electronic transmissions prior to accepting Software Developers, Transmitters and Issuers into the AIR System. Software Developers are required annually to pass pre-defined AATS submissions and test scenarios for the forms that they will support. Transmitters and Issuers are required to pass communication tests for the forms they will file." (Internal Revenue Service [IRS])  

[Guidance Overview]

Employers: Are You Ready to Report Social Security Numbers for ACA?
"If the plan sponsor cannot obtain a covered individual's Social Security number, that person's date of birth may be used instead, as long as the reporting entity makes a reasonable effort to obtain the Social Security number. A plan sponsor should make a reasonable effort in order to avoid penalties for incomplete or incorrect reporting." (International Foundation of Employee Benefit Plans [IFEBP])  

[Guidance Overview]

Cadillac Tax Still on the Assembly Line
"[E]mployers (yes, employers) are required to determine the cost of the coverage, regardless of who the provider is. The IRS does recognize that some time will be needed to process run-out claims after the end of the year for the employer to be able to calculate the cost of coverage. However, the timing of the tax may influence how long of a run out period a plan is able to have.... Note that the cost is actually determined on a monthly basis. So what does this mean for FSAs, HRAs, or HSAs that receive a bulk contribution from the employer at the beginning of the year?" (Benefits Bryan Cave)  

[Guidance Overview]

Myriad Sick Leave Laws Create Headaches for Employers
"Some states have recognized that having multiple laws not only creates confusion for employers, but also creates a competitive disadvantage. Eleven states ... have passed laws that prohibit local governments from passing sick leave laws. Employers in every other state face the possibility of having to comply with a patchwork." (Fox Rothschild LLP)  

[Guidance Overview]

New Final Regs and FAQs Provide Guidance on Preventive Services Coverage
"What employers should do: [1] Ensure that their plans and summary plan descriptions do not contain provisions that contradict the FAQ or final regulation ... [2] Review preventive services coverage annually to ensure that preventive services remain covered throughout the full policy or plan year, unless the service is downgraded to a 'D' rating or is recalled for safety reasons (or is deemed a significant safety risk); and [3] Analyze plan administration procedures and communicate with outside administrators to confirm that all claims administration and communications with plan participants are consistent with the FAQ and final regulation guidance." (Proskauer's ERISA Practice Center)  

House Calls: An Insurer's New Tool in Managing Risk
"In the past, it may have been possible to get away with skipping a doctor visit or failing to renew prescriptions with little more than nagging by your significant other (and your conscious). However, health insurers are now starting to take an interesting role in reminding members of the need to continue medical and drug treatments: free in-home health exams. Aetna has begun offering these exams -- conducted by a doctor or nurse practitioner -- to members of individual and small group health plans in 2015." (Frenkel Benefits)  

CMS Begins Implementation of ACA Transparency Standards
"For 2016 at least, the data collection and resulting data display is modest. While the transparency standards will ultimately apply to nearly all health insurers, this initial data collection is limited only to insurers with products on exchanges that use www.healthcare.gov." (Faegre Baker Daniels LLP)  

Home Confinement Provisions of City Sick Leave Policy Survive Constitutional Challenge
"The home confinement provisions of a newly adopted sick leave policy survived [federal] constitutional challenges asserted by police officers for the City of Shreveport. The Fifth Circuit determined that the provisions rationally served the police department's legitimate interests in safety and morale, and rejected the officers' contention that the provisions were unconstitutional because they gave government officials too much discretion to decide whether and when an ill or injured officer may leave his or her house." [The plaintiffs asserted a violation of their rights to travel and associate with others under the Substantive Due Process clause of the U.S. Constitution.] (Wolters Kluwer Law & Business)  

Is King v. Burwell the Last Piece of the Obamacare Puzzle?
"Setting aside some of Justice Scalia's histrionics, the case itself isn't all that interesting for its legal reasoning and conclusions. But its consequences are far-reaching.... There are signs that the business sector is becoming skeptical about the replace-and-repeal campaign speeches and is ready to get to work.... And then there are some of those fixes needed by the ACA.... Employer mandate.... Employer reporting.... Automatic enrollment.... Tax on rich plans.... Defined contribution health plans." (Dorsey & Whitney, via Bench & Bar of Minnesota)  

Vermont to Dish Out $1.6 Million to Blue Cross Blue Shield of Vermont
"Vermont plans to pay $1.6 million to Blue Cross Blue Shield of Vermont to cover past-due premiums and incorrectly paid claims that resulted from the state's disastrously run health insurance exchange.... The technical issues began back in 2013, after the launch of Vermont Health Connect. The exchange lacked a key function, which led to workers manually processing customers' changes to their personal information, which in turn caused a backlog. Yet many insurers weren't notified they should stop billing customers." (FierceHealthPayer)  

Benefits in General; Executive Compensation

Union Rallies Outside Patriot Coal Over Pension and Retiree Health Benefits
"The company wants permission from a federal bankruptcy judge in Virginia to reject the company's collective bargaining agreement with union miners and change retirees' health care benefits. Patriot wrote that it would otherwise run out of cash and have to liquidate.... For union mine retirees, a cut to their pensions and health benefits would snap an essential pact that they rely on for their livelihood. This is the second time in two years those benefits have been threatened for Patriot union miners and retirees." (ABC News)  

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