Territory Sales Manager
Milliman
in TX

Internal Sales/Support Specialist
TPA Firm
in CO

Relationship Manager
National Qualified Plan Provider
in CT, GA, MO

ESOP and 401(k) Administrator
Primark Benefits
in CA

Pension Administrator
Primark Benefits
in CA

Benefits Compliance Associate
The National Rural Electric Cooperative Association [NRECA]
in VA

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What the Healthcare Law Means for your Small Business
October 15, 2015 WEBCAST
(U.S. Small Business Administration [SBA])

Hot Buttons in Executive Compensation and Dodd-Frank: A Roundup of Recent Developments
October 20, 2015 in NY
(Worldwide Employee Benefits Network [WEB] - New York Chapter)

Benefit Plan Vendor Agreements From the Employer’s Perspective: Better Know What’s in the Fine Print!
October 22, 2015 in CA
(Western Pension & Benefits Council - Orange County Chapter)

IRA Reporting
December 3, 2015 WEBCAST
(Ascensus)

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[Guidance Overview]

ACA Reporting Requirements for Carriers and Employers (Part 10 of 24): Final Instructions for 2015 Reporting -- Good News for HRAs, Changes to COBRA Reporting, Clarifications for Multiemployer Plans, and More
"The 2015 Instructions for Forms 1094-B and 1095-B implement a suggestion ... relating to the reporting of Health Reimbursement Arrangements (HRAs) that are integrated with other group health plan coverage. The 2015 Instructions for Forms 1094-C and 1095-C make a substantive change in the manner in which offers of COBRA coverage are reported and clarify the reporting of multiemployer plan coverage. The Treasury Department and IRS also issued Notice 2015-68, which announces their intent to propose regulations to reflect recent changes in the law ... and to clarify existing regulations (e.g., the reporting of coverage under integrated HRAs)[.]" (Mintz Levin)  

[Advert.]

Grow your business at the 25th Annual Health Benefits Conference & Expo

Reach nearly 400 employee health benefits and wellness professionals with buying power authority by exhibiting at or sponsoring the 25th Annual Health Benefits Conference & Expo. Premier opportunities are still available. Contact us today!

Deductibles Have Increased Six Times Faster Than Wages Since 2010
"Despite the reported slowdown in healthcare spending, consumers are unlikely to have noticed such a change because of the sharp increase in deductibles.... Currently 81% of workers are in plans with a general annual deductible. Workers at smaller firms face average deductibles of $1836, which is 66% more than the $1105 average paid by workers in large firms. Meanwhile, premiums continued to grow moderately, rising an average of 4% this year, compared with an average growth of 5% each year since 2005 and 11% annually between 1999 and 2005." (American Journal of Managed Care)  

2015 Employer Health Benefits Survey
"Annual premiums for employer-sponsored family health coverage reached $17,545 this year, up 4 percent from last year, with workers on average paying $4,955 towards the cost of their coverage ... The 2015 survey includes information on the use of incentive for employer wellness programs, plan cost-sharing as well as firm offer rate. Survey results are released here in a variety of ways, including a full report with downloadable tables on a variety of topics, summary of findings, and an article published in the journal Health Affairs." (Henry J. Kaiser Family Foundation)  

Fitness Wearables: A Shiny Penny for Employee Wellness?
"While it's clear that wearables have sparked an interest in employee health and wellness, do fitness trackers and wearables result in long-term behavior change for the individuals that wear them? ... How long does interest in fitness wearables typically last? Just six months, according to a [recent] report ... [which] states that after six months of use, one-third of U.S. consumers stop using their fitness wearable devices. And more than half of Americans who have owned a wearable activity tracker no longer use it." (HealthFitness)  

Recent HIPAA Enforcement Actions Signal More to Come in Phase 2 Audits
"HHS OCR will likely be looking for whether organizations have conducted enterprise-wide risk assessments to identify their core technical and procedural vulnerabilities, and whether those assessments then translated into remediation strategies, as well as operational policies and employee training. In particular, HHS OCR is sure to examine the preparedness of organizations to detect, response, and recover from security incidents and data breaches." (Orrick)  

[Advert.]

American Conference Institute's Employee Benefit Plans Conference

Our faculty of leading in-house counsel & top law firms will break down the latest concerns impacting employee benefit plans & illustrate the steps you can take to remain compliant. Join us on November 17-18, 2015 in New York, NY.

Report from HHS: Health Insurance Coverage and the ACA, September 2015
"This factsheet highlights the changes in health insurance coverage after the ACA's enactment in March 2010, for young adults who were able to gain coverage through their parents' health insurance plan, as well as adults who gained coverage after the start of open enrollment for the Health Insurance Marketplaces in October 2013 through September, 2015. Details on people who gained health insurance coverage include race and ethnicity, state Medicaid expansion status, gender, and young adults." (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])  

Keeping Healthcare Costs Sustainable: Efforts Continue (PDF)
"Provider consolidation is on the rise ... The weakness is variability in provider price and quality. The strategy to capitalize on provider variability is to get plan members to seek care from those providers with the least cost and highest quality. Plan management techniques that promote value-seeking by plan members are transparency and reference-based pricing.... To make a dent in total plan expense, we have to match up the primary source of plan costs, our plan members with expensive, complicated conditions, with expert, value-oriented providers. We need to identify those limited groups of providers who have validated quality (not just skill, but who also work in a value-oriented practice model) and are willing to agree to bundled pricing." (Chelko Consulting Group)  

How an Obscure Drug's 4,000% Price Increase Might Finally Spur Action on Soaring Healthcare Costs
"Spectacularly high drug prices have become a political punching bag, especially since Turing Pharmaceuticals struck a nerve by increasing the price of a 62-year-old drug by more than 4,000 percent -- a mind-boggling increase similar to waking up one day and finding out a gallon of gas costs nearly $100.... The details do indeed turn out to be as insane as they sound. But behind them lurks a real lesson about the way drugs are priced in the United States and what role they actually play in the trillion-dollar fight over controlling health-care costs." (The Washington Post; subscription may be required)  

Prescription Drug Costs Are Rising as a Campaign Issue
"Per capita drug spending increased by more than $100 last year, a big jump. At the same time, a growing share of Americans are being asked to foot the bill for their medicines, even if they're insured. The Affordable Care Act, which has expanded insurance coverage, didn't do much to counteract those trends." (The New York Times; subscription may be required)  

Attention Shoppers: New California Website Details Costs, Quality of Medical Procedures
"Having a baby in California? Your average out-of-pocket costs for an uncomplicated birth could cost a lot less in San Mateo County ($920) than in Alameda County ($1,300), Santa Clara County ($1,500) or Orange County ($1,800). Thinking about a knee replacement? You'll find a surprisingly wide variation in quality ratings among Bay Area hospitals for the procedure. These are among the insights from a new consumer website unveiled Monday by the California Department of Insurance to help Californians better shop for health care based on both quality and price." (Kaiser Health News)  

Colorado Employers Face Significant Change In Vacation Pay Law
"The division's new position will prohibit any vacation pay policy in which an employee loses earned vacation time if it is not used by a certain time. In other words, once vacation pay has been earned, it cannot be 'unearned.' Earned and determinable vacation pay cannot be lost during employment or upon separation from employment." (Fisher & Phillips LLP)  

Reforming Medicare with Personal Accounts, Incentives and Better Plan Design
"An actuarial analysis ... found that prefunding personal accounts and coupling them with high-deductible plans would save Medicare an estimated $2.4 trillion annually by 2053 compared to the status quo. Of this amount: An estimated one-fifth ($434 billion) would come from better incentives that reduce the rate of health care inflation (that is, the medical trend rate). An estimated one-third of the savings ($787 billion) would come from reduced use of benefits by seniors. An estimated one-quarter ($651 billion) would come from increased cost-sharing by seniors." (National Center for Policy Analysis [NCPA])  

2016 Premium Tax Credit Quick Reference Chart (Based on 2015 Federal Poverty Lines) (PDF)
"[1] Locate line where estimated 2016 household income & household size intersect. [2] First column shows household percentage of Federal Poverty Line -- if between 100% and 400% continue. [3] Second column shows percentage of household income required [to] purchase 2nd lowest cost Silver coverage in Marketplace. [4] 'CSR AV' column shows resulting Actuarial Value after Cost Sharing Reductions applied (otherwise standard 70%). [5] 'Monthly contribution' = contribution percentage x household income divided by 12." (Kaufman & Canoles, P.C.)  

CMS Did Not Identify All Federal Marketplace Contract Costs and Did Not Properly Validate the Amount to Withhold for Defect Resolution on the Principal Federal Marketplace Contract (PDF)
32 pages. "CMS did not accurately identify all obligations and expenditures related to the Federal marketplace. For 6 of the 62 contracts, CMS recorded $24,336,404 of obligations and $22,885,725 of expenditures in the Healthcare Integrated General Ledger Accounting System (HIGLAS) but did not identify them as being related to the Federal marketplace. Specifically, CMS either recorded some transactions in HIGLAS without the necessary project codes or recorded transactions related to Federal marketplace work using project codes that CMS did not identify in HIGLAS as being related to the Federal marketplace. Consequently, CMS is unable to accurately account for and report to interested stakeholders the amount spent on the development, implementation, and operation of the Federal marketplace." (Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS])  

[Opinion]

Health Insurance Exchanges: Old Wine in an Old Bottle
"Health insurance exchanges are old wine in an old bottle, albeit they have just come out of the closet into the open. Hence, the furor currently around them. If someone tells you that they are a new concept, an innovation and disruption as to how health insurance is distributed, it's because they do not know. Disruption in health insurance distribution as a result of exchanges can be debated to a certain extent since it sure has brought benefits to the center stage.... What the Affordable Care Act of 2010 has done is brought Web-based open enrollment out of the closets of these benefits administrators into the open for everyone to access and benefit. ACA has made individual enrollment more popular than ever before." (The Institute for HealthCare Consumerism [IHCC])  

[Opinion]

The Section 1557 Regulation: What's Missing, and How We Can Include It
"[T]he rule is conspicuously silent about discrimination on the basis of health status.... The reticence to address 'price-based' discrimination likely stems from insurers historically charging different prices for medications and services. Insurers argue that this pricing structure allows them to encourage the use of more low-cost services and medications. However, this omission even has the potential to undermine the very forms of discrimination that the proposed Section 1557 regulation aims to protect against." (Health Affairs)  

Fifth Circuit Severance Pay Decision Emphasizes the Need for a Strong Administrative Record
"[T]he court found that the severance plan administrator acted arbitrarily and capriciously because the administrative record contained no specific evidence supporting the determination that the plaintiff was fired for a violation of the employer's policies.... The court found that a mere citation to a policy, absent any specific evidence indicating how the policy was violated, was not substantial evidence that the plaintiff was actually fired for having violated the policy. Importantly, the court also found that the plan administrator failed to provide the plaintiff with a full and fair review of the claim because the plan administrator did not describe the specific reasons for the denial of benefits as required by [DOL] regulations" [Napoli v. Johnson & Johnson, Inc. No. 14-31000, (5th Cir. Sept. 8, 2015; unpublished)] (Winston & Strawn LLP)  

When Does ERISA Govern a Severance Plan?
"The court first observed that ERISA's definition of employee welfare benefit plan was expansive, including 'any plan, fund, or program,' and explained: '[u]se of the word "any" and inclusion of three undefined, overlapping descriptors (plans, funds, and programs) suggests that Congress intended the definition of "employee welfare benefit plan" to be broad and independent of the specific form of the plan.' ... The court noted that ERISA did not require long-term commitments or discretionary determinations, but stated that 'these factors are useful analytic tools to the extent that they help us decide the ultimate question of whether a particular undertaking or obligation is a "plan, fund, or program" '." [Okun v. Montefiore Medical Center, No. 13-3928 (2d Cir. July 17, 2015)] (Begos Brown & Green LLP)  

Alliance Benefit Group has added Professional Capital Services to its National Network
Alliance Benefit Group

ECFC Announces the Appointment of Robert L. Natt to Board of Directors
ECFC [Employers Council on Flexible Compensation]

Beacon Benefits, Inc. is Certified to Industry Best Practices
Centre for Fiduciary Excellence [CEFEX]

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