Health & Welfare Plans Newsletter

September 10, 2015

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Employee Benefits Jobs

Retirement Services Consultant
CUNA Mutual Group
in WI

Defined Contribution Practice Manager
Profit Planners, LLC
in IL

Account Manager
Verisight
in CA

Senior Policy Analyst
National Business Group on Health
in DC

Retirement Plan Specialist / Client Service Advisor
Favia Group
in IL

Manager, Plan Services
The Standard
in OR

Experienced Qualified Plan Professional
Compensation & Benefit Solutions, LLC
in CO

Benefits 401 (K) and Compensation Senior Associate
Bayada Home Health Care
in NJ

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Webcasts and Conferences

EBSA Insights on Healthcare Organization’s Employee Benefit Plan Rights and Responsibilities Under ERISA
September 15, 2015 in TX
(North Texas Healthcare Compliance Professionals Association [NTHCPA])

How to Navigate the New IRS Determination Letter Process: What is the Impact on Your Clients
September 24, 2015 WEBCAST
(ABA Joint Committee on Employee Benefits)

Plan Corrections
September 28, 2015 in PA
(ASPPA Benefits Council [ABC] of Western PA)

Full Day Seminar with Ilene Ferenczy
September 29, 2015 in OH
(ASPPA Benefits Council [ABC] of Cleveland)

An Update on the DOL’s Fiduciary Rule Proposal
October 15, 2015 WEBCAST
(fi360)

EBRI Policy Forum
December 10, 2015 in DC
(EBRI [Employee Benefit Research Institute])

View All Webcasts and Conferences


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[Guidance Overview]

ACA Reporting Requirements for Carriers and Employers (Part 8 of 24): Reporting Offers of Coverage 'On Behalf of Another Entity'
"In the vast majority of cases, the offer of coverage will be made to employees under a plan that is established and maintained by the employer or an affiliate of the employer.... But there are instances in which the offer of coverage is not made by the employer or an affiliate. The final regulations under Internal Revenue Code Section 4980H implementing the employer shared responsibility rules recognize and provide separate rules for three such instances: multiemployer or single employer Taft-Hartley plans, multiple employer welfare arrangements (MEWAs), and offers of health coverage made by staffing firms.... These instances are sometimes collectively referred to as 'inadvertent MEWAs.' " (Mintz Levin)  


[Advert.]

State and Local Government Benefits Association (SALGBA)

Sponsored by State and Local Government Benefits Association [SALGBA]

(SALGBA) is the premier organization providing educational and collaborative support for public sector employee benefits professionals, such as national and regional conferences, member directory, and more. For a complete list visit www.salgba.com.



[Guidance Overview]

IRS Health Care Tax Tip 2015-55: What Information Must a Health Coverage Provider Report to the IRS?
"[1] The name, address, and employer identification number of the provider; [2] The responsible individual's name, address, and taxpayer identification number -- or date of birth if a TIN is not available.... [3] The name and TIN, or date of birth if a TIN is not available, of each individual covered under the policy or program and the months for which the individual was enrolled in coverage and entitled to receive benefits; [4] For coverage provided by a health insurance issuer through a group health plan, the name, address, and EIN of the employer sponsoring the plan, and whether the coverage is a qualified health plan enrolled in through the Small Business Health Options Program -- known as SHOP -- and the SHOP's identifier." (Internal Revenue Service [IRS])  

[Guidance Overview]

Executive Order Requires Federal Contractors to Provide Paid Sick Leave
"That the new EO's coverage mirrors EO 13658's coverage suggests that the new EO, like EO 13658, will ultimately apply to contractor personnel beyond those directly performing under covered contracts. The regulations implementing EO 13658 apply the minimum wage to employees directly performing and those indirect-charge employees who spend more than 20% of their time supporting covered contractors. We would encourage contractors to prepare for similarly expansive reaches by implementing regulations for the new EO here." (Wiley Rein LLP)  

2016 Top 10 Compliance-Related Issues for Employers
"[1] Employer shared-responsibility (ESR) strategy.... [2] ESR reporting.... [3] Preventive care.... [4] Other ACA reporting and disclosure requirements.... [5] Midyear changes to cafeteria plan elections.... [6] ACA's out-of-pocket maximum.... [7] Same-sex marriages and domestic partnerships.... [8] Mental health parity.... [9] Wellness.... [10] Fixed-indemnity and supplemental health insurance." (Mercer)  

Maximizing the Value of Consumer-Driven Health Plans (PDF)
"CDHPs have generally been found to be more effective than traditional plans in terms of reducing total medical cost, especially in the short term.... Total Medical Cost correlates more with plan design than plan type (HRA vs. HSA). Lower-income populations in a CDHP don't avoid care. Contributions to an HSA correlate more strongly than household income to better health management. People learn about their new CDHP at varying speeds[.]" (Cigna)  


[Advert.]

Executive Forum on On-Site & Near-Site Employee Health Clinics – Chicago

Sponsored by World Congress

Executive Forum on On-Site & Near-Site Employee Health Clinics – Chicago – Sep 17-18 – HR/Benefits Staff: Attend for $195* – use code BLINK1 – (*valid only for HR/Benefits Staff as defined on event website. Please visit for qualifications)



Preventive Services Tracker
"This tracker presents up-to-date information on the adult preventive services nongrandfathered private plans must cover, by condition, including a summary of the recommendation, the target population, the effective date of coverage, and related federal coverage clarifications." (Henry J. Kaiser Family Foundation)  

Individual Absent Due to Illness on Effective Date of Life Insurance Policy Was 'Actively Employed' on That Date, Says California Court
"The phrase 'actively at work' in a supplemental life insurance policy refers to the employment status of an employee not the employment activities of a covered worker on any given day, a state appeals court in California has ruled.... 'The policy is ambiguous regarding whether [the employee] needed to perform his work responsibilities on New Years' Day or anytime after that in order for his wife to receive benefits ... We therefore interpret the policy in favor of [the employee's] reasonable expectations, which are that he should not have to work on New Year's Day or when he is sick in order to receive coverage that he has paid for,' the court said." [Sequeira v. Lincoln National Life Ins. Co., No. A139639 (Cal. Ct. App. Aug. 31, 2015)] (InsuranceNewsNet.com)  

America's Sick Leave Policies Fail Workers; Here's How Netflix and Google Get It Right
"Tech giants and 'unicorn' startups are in an epic battle for high-skilled labor, one that has created a major influx of foreign workers traveling to the U.S. on rare worker visas known as H-1B's.... It's one of many reasons sick leave has been rightfully heralded as the next frontier in the fight for worker's rights. The Obama administration has promised to push for federal legislation mandating paid sick leave for American workers, not just federal contractors. However, it seems far more likely that industry standards will have to change in order to lure in foreign talent." (The Daily Dot)  

Notice of Cyberattack Affecting Excellus BlueCross BlueShield
"[T]he attackers may have gained unauthorized access to individuals' information, which could include name, date of birth, Social Security number, mailing address, telephone number, member identification number, financial account information and claims information. This incident also affected members of other Blue Cross Blue Shield plans who sought treatment in the 31 county upstate New York service area of Excellus BCBS. Individuals who do business with [Excellus] and provided us with their financial account information or Social Security number are also affected." (Excellus BCBS)  

GAO Report on Private Health Insurance: The Range of Premiums and Plan Availability for Individuals in 2014 and 2015
"The range of premiums available to consumers in 2014 and 2015 varied among the states and counties GAO analyzed.... In the 28 states included in GAO's analysis, from 2014 to 2015 the minimum premiums for silver plans available to a 30-year-old increased in 18 states, decreased in 9 states, and remained unchanged in 1 state.... An interactive graphic reporting by state and county the minimum, median, and maximum premium values for all individual market plans (either on or off the exchange) and for exchange-only plans, is available at http://www.gao.gov/products/GAO-15-687. It includes either data for both years, or partial data (e.g., data for one of the two years) for 49 states." (U.S. Government Accountability Office [GAO])  

Federal District Judge Declines to End House's ACA Lawsuit Against Obama Administration
"U.S. District Judge Rosemary M. Collyer ... concluded that lawmakers had the right under the Constitution to sue Treasury Secretary Jacob Lew and Health and Human Services chief Sylvia Mathews Burwell.... 'The merits of this lawsuit await another day,' Collyer said. The White House decried her decision as 'unprecedented' and said it would appeal." [U.S. House of Representatives v. Burwell, No. 14-1967 (D.D.C. Sept. 9, 2015)] (Bloomberg)  

[Opinion]

Statement of American Academy of Actuaries to House Subcommittee on Potential Implications of the Small Group Definition Expanding to Employers with 51-100 Employees (PDF)
"Among employers offering coverage, employees in groups sized 51-100 comprise roughly 30 percent of employees in groups sized 1-100. Groups sized 51-100 will face more restrictive rating rules, which will increase relative premiums for some groups and reduce them for others. Groups sized 51-100 will face additional benefit and cost-sharing requirements, which could reduce benefit flexibility and increase premiums. The more restrictive rating and benefit requirements could cause more groups sized 51-100 to self-insure." (American Academy of Actuaries)  

[Opinion]

Obama's Free Lunch Fallacy: Paid Sick Days Aren't Free
"Mandating sick pay is a bad idea. If employers are forced to allocate seven paid days off work for illness, they will find other ways to pay for it including adjusting future pay downward.... A better option is to allow workers to decide how many sick days they need, and save for them in an account that can also be used for medical expenses." (National Center for Policy Analysis Health Policy Blog)  

Benefits in General; Executive Compensation

[Guidance Overview]

Form 5500 Deadline Extensions Begin Next Year
"[B]eginning with calendar year 2016 returns to be filed in 2017, the automatically extended due date for the calendar-year return could be as late as November 15, 2017 ... [T]he automatic extensions that are linked to a sponsor's income tax filing deadline should likewise be subject to the extended limitation, and the filing deadline applicable to [a 'direct filing entity,' such as a master trust, pooled separate account, or certain other commingled vehicles,] should be extended by a month ... Until the effective time, however -- including the next filing season, i.e., returns for plan years beginning in 2015, that will be filed for the most part during 2016 -- the maximum extension available will remain at two and one-half months." (Ford & Harrison LLP)  

Government Workers Happier with Retirement Plans, Other Benefits
"Public and private sector workers are similarly satisfied with most of the 13 job aspects Gallup asks them about, but government employees are more likely to be satisfied with their retirement plans, health insurance and vacation benefits." (Gallup)  

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