Health & Welfare Plans Newsletter

September 14, 2015

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Employee Benefits Jobs

Employee Benefits Attorney
Smith, Gambrell & Russell, LLP
in FL

Regional Sales Consultant, Retirement Plans
United Retirement Plan Consultants
in NJ

Client Relationship Associate
Alliance Benefit Group of Michigan, Inc.
in MI

Implementation Consultant
T. Rowe Price
in CO, MD

Retirement Service Consultants
Ascensus
in NJ, PA

Client Relationship Manager
Goldleaf Partners
in IA, KS, NE

Retirement Plan Administrator
Prime Pensions, Inc.
in NJ

Sr Operations Investment Analyst
T. Rowe Price
in MD

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[Guidance Overview]

HHS Issues Proposed Rule on ACA Section 1557 Nondiscrimination Provisions (PDF)
"[S]ection 1557 is the first law to prohibit sex discrimination in health care programs.... HHS has read the statutory requirements extremely broadly, potentially sweeping entire entities into the scope of section 1557 when even one plan or program receives any federal funds from HHS. The result is that even self-funded plans that utilize health insurance issuers as third-party administrators may be affected." (Groom Law Group)  


[Advert.]

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Proposed Regs Would Extend Health Care Reform's Nondiscrimination Rules to All Health Plans of Exchange Insurers
"Noting that current law is mixed on whether existing federal nondiscrimination laws prohibit discrimination on the basis of sexual orientation as a part of their prohibitions of sex discrimination, HHS has requested comments on the extent to which sexual orientation discrimination should be prohibited by these regulations." (Thomson Reuters / EBIA)  

Third Circuit: Assignments Give Health Care Providers ERISA Standing
"The appeals court rejected Aetna Inc.'s argument that a patient's assignment of benefits must explicitly state that the participant is assigning the right to sue before a provider has standing to bring an [ERISA] action to recover benefits. An assignment of benefits that gives the health-care provider the right to payment of benefits implicitly gives that provider the right to sue under ERISA to recover such benefits, the court said." [North Jersey Brain Spine Ctr. v. Aetna, No. 14-2101 (3d Cir. Sept. 11, 2015)] (Bloomberg BNA)  

Court Strikes Down Restrictions on Sale of Fixed Indemnity Coverage
"Judge Lamberth's decision misses an important point. He seems to believe that excepted benefits are a HIPAA concept, unrelated to the ACA. But excepted benefits are a concept found in the Public Health Services Act, which was amended by HIPAA but more recently extensively amended again by the ACA. Excepted benefits are an ACA concept." [Central United Life, Inc. v. Burwell, No 14-1954 (D.D.C. Sept. 11, 2015)] (Health Affairs)  

Insurers Defeat Obamacare Provision
"As of Jan. 1 ... [c]ompanies faced up to $100 per day in penalties for selling plans to people without other health insurance coverage that meets the [ACA's] minimum requirements.... U.S. District Judge Royce Lamberth sided with the insurers ... calling the government's reasoning 'counterintuitive.' He said it provided 'a recipe for eluding judicial review' in which an agency could issue a rule that puts companies out of business, not enforce it to avoid any challenges and then replace the rule with a new one that still keeps companies out of business." [Central United Life, Inc. v. Burwell, No. 14-1954 (D.D.C. Sept. 11, 2015)] (Courthouse News Service)  


[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)



Doctor Pay Eclipses $240,000 as Value-Based Model Boosts Primary Care
"Compensation of primary care physicians continues to outpace that of their specialist counterparts rising nearly 3.6% last year to $241,273 ... Though specialists make much more than their primary counterparts with their total compensation rising to $411,852 in 2014, the rate of increase was only 2.39% from 2013 ... And since 2012, pay of primary care doctors, which include family physicians, internists and pediatricians has risen more than 9% while specialist total compensation rose just 3.9%." (Forbes)  

Benefits in General; Executive Compensation

[Guidance Overview]

2015 Q&As: IRS Meeting with ABA Joint Committee on Employee Benefits, May 8, 2015 (PDF)
19 pages. Includes questions on plan loans, compensation definition, Form 2848, target benefit plans, rollovers to IRA, hardship definition, safe harbor plans, 401(k) testing, 415 limits, 457 plan deferral of sick leave, VEBA benefit valuation, 4980H measurement methods, and Form 1095-C reporting. (Joint Committee on Employee Benefits [JCEB], American Bar Association)  

Third Circuit: Benefit Denial Notice Must Include Plan-Imposed Deadline for Filing Suit
"Other courts have enforced a plan-imposed limitations period disclosed in a plan's [SPD] even if it was not specified in the denial notice ... [I]including the plan-imposed limitations period in denial notices is easy to do and clearly notifies claimants of the deadline, increasing the likelihood that a reasonable plan-imposed limitations period will be enforced. And doing so now appears to be expressly required in the Third Circuit, as well as the First and Sixth Circuits." (Thomson Reuters / EBIA)  

Include the SOL in Your Benefit Denial Letter (or You'll Be SOL)
"[T]he Third Circuit considered whether a health plan's one-year SOL provision time-barred a lawsuit filed almost 19 months after the claimant exhausted the plan's administrative claims and appeals procedure.... It is a 'trivial burden on plan administrators,' the Mirza court explained, 'to require them to inform claimants of deadlines for judicial review in the documents claimants are most likely to actually read -- adverse benefit determinations.' " (Morgan Lewis)  

IRS Provides Guidance on Non-Qualified Deferred Compensation Plan Audits
"[T]he Audit Guide provides a reminder that a 401(k) plan may not condition, directly or indirectly, any other benefit with the exception of matching contributions, upon the employee's electing to make or not to make 401(k) under the arrangement. For example, the IRS will be looking for provisions in the NQDC Plan that Limits the total amount that can be deferred between the NQDC plan and the Company's 401(k) plan, or States that participation is limited to employees who elect not to participate in the 401(k) plan. In either of these plan provisions are found in the audit, the examiner is instructed to contact the Employee Plans division of the IRS that oversees 401(k) and other qualified plans. The rest, they say, can be history." (The Retirement Plan Blog)  

Press Releases

Ted Godbout Joins DCIIA as Director of Communications
Defined Contribution Institutional Investment Association [DCIIA]

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