Health & Welfare Plans Newsletter

August 20, 2015

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Employee Benefits Jobs

ESOP and 401(k) Administrator
Primark Benefits
in CA

Pension Administrator
Primark Benefits
in CA

Corporate 401K Administrator
Lockheed Martin
in MD

Retirement Account Administrator
Alerus Financial
in MN

Retirement Plan Consultant
Loren D. Stark Company
in TX

Sr. Employer Benefits Financial Analyst
Arthur J. Gallagher & Co.
in LA

Area President / Branch Manager
Arthur J. Gallagher & Co.
in IA

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Webcasts and Conferences

Legal Updates with Marcia Wagner
August 25, 2015 WEBCAST
(401k Coach Program)

Distributions, Taxation & After-Tax Contributions
August 27, 2015 WEBCAST
(SunGard Relius)

Private Exchange FORUM
September 1, 2015 in MD
(Institute for HealthCare Consumerism)

The Deadline For Filing Forms 1094-C And 1095-C Is Approaching. Are You Prepared?
September 3, 2015 WEBCAST
(Tucker Ellis LLP)

Strategies to Increase Participants
September 11, 2015 WEBCAST
(SunGard Relius)

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[Guidance Overview]

Rules for QHP Transparency Soon Will Apply to Employers
"Insurers and plan sponsors soon will have to report to the government (and list on a web page) their policies on: out-of-network liability and balance billing; enrollee claim submission; claims and denials; recoupment of overpayments; medical necessity; prior authorization; drug exception timeframes; explanations of benefits; and coordination of benefits.... Although the QHP requirements take effect for 2016 policies, very similar rules soon (after an official rulemaking process) will apply to employer plan sponsors and group policy issuers selling outside of exchanges." (Thompson SmartHR Manager)  


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[Guidance Overview]

New Law Increases Penalties for IRS Reporting Failures Including ACA (PDF)
"Penalties could provide a one-two punch under the ACA for employers and other responsible entities. For example, under the Section 6056 shared responsibility provisions, applicable large employers (ALE) must file information returns to the IRS (the 1094-B and/or 1094-C) as well as furnish statements to employees (the 1095-B or 1095-C). So, incorrect information shared on those forms could result in a double penalty -- one associated with the information return to the IRS and the other associated with individual statements to employees." (Buck Consultants at Xerox)  

ACA Compliance: Some Common Questions and Answers
"What effect does smoking status have on affordability standards for the employer? ... Should a taxpayer receive a Form 1095 if he or she is not covered? ... If an employer is fully insured, what documents do part-time employees covered on health plans need to receive? ... Do large employers that qualify for transition relief in 2015 (50-99 employees) need to send out Form 1095-C to employees even though they are not subject to penalties?" (bswift)  

Controversial Narrow Networks May Help Lower Healthcare Costs
"With the health insurance industry shifting toward a more consumer-centric mindset, providing shoppers with choices is imperative so they can make informed decisions about their care. And while narrow networks may impede consumer choice, they could also provide benefits[.]" (FierceHealthPayer)  

Do Provider-Owned Health Plans Produce the Cheapest Insurance Premiums?
"The integration of insurer and provider within these provider-owned health plans holds the promise to deliver more appropriate care to patients and lower insurance costs by eliminating unnecessary tests, surgeries, and other healthcare that inflate overall costs.... Although provider-owned plans cover less than 10% of the entire privately insured market, their membership increased 4% between 2012 and 2013, a higher rate of growth than other plan types.... Contrary to expectations, the cheapest provider-owned health plans were more expensive on average than the cheapest plans not owned by providers." (HealthPocket)  

Cadillac Tax Is Key in Union Worker Lockout by Steel Producer
"A provision of the Affordable Care Act, which is one reason Allegheny Technologies locked out more than 2,000 union workers last week at 12 plants in six states, also could be a stumbling block in negotiations involving two other major steel producers whose contracts covering about 30,000 union workers expire in less than two weeks.... Allegheny Technologies' final contract proposal was a four-year deal that included a provision requiring new negotiations during the life of the agreement if the company projected escalating premiums would trigger the tax." (Pittsburgh Post-Gazette)  

How Health Care Reform Adds to Wal-Mart's Pharmacy Woes
"It's one of the dirty secrets of the pharmacy industry that uninsured people frequently pay more for drugs than those with insurance, [said Adam Fein, president of Pembroke Consulting]. That's because the prescription drug plans can use their clout and scale to negotiate lower reimbursement rates with the pharmacies, while uninsured people pay more.... '[Wal-Mart has] many more cash-paying customers than the average pharmacies, and as those people got insurance, the insurance companies decided in some cases they would pay less than what Wal-Mart was getting from the cash-paying customers,' Fein said." (The Washington Post; subscription may be required)  

[Opinion]

ERIC Urges Flexibility as Colorado Medical Board Considers Telehealth Policies
"ERIC recommends the Board adopt regulations that take into account a wide variety of technological solutions, minimize additional requirements on providers, allow enough flexibility so that patients can access medical services without having to visit specific locations, and make rules patient-centric, giving patients expanded access to care through telehealth visits and remote monitoring of their health conditions." (The ERISA Industry Committee [ERIC])  

Benefits in General; Executive Compensation

SEC Adopts CEO Pay Ratio Disclosure Rule (PDF)
14 pages. "[T]he three-year provision regarding the frequency of median employee identification does not apply to the frequency of computing the compensation of the median employee for purposes of pay ratio disclosure. A Subject Company that uses the same median employee for two or three years would still be required to calculate that employee's total annual compensation and disclose the pay ratio each year." (Morgan Lewis)  

Press Releases

Harry Conaway Named CEO of the Employee Benefit Research Institute
EBRI [Employee Benefit Research Institute]

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