Implementation Specialist
PEN-CAL Administrators, Inc.
in CA

409A Plan Administrator
PEN-CAL
in CA

Junior Plan Administrator (409A/NQDC)
PEN-CAL
in CA

Retirement Plan Administrator
Convergence Group
in DE

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[Guidance Overview]

Further Guidance on the ACA's Cadillac Tax
"In order to determine the amount of tax owed for a taxable period, the employer must determine the extent any applicable coverage exceeded the dollar limit in a given month. The employer then must notify both the IRS and the coverage provider, and the coverage provider then must pay the tax. As a result, employers will need to determine the amount of tax soon after the close of the taxable year so that coverage providers may pay the tax in a reasonably timely manner. The IRS anticipates a host of timing issues to arise for different fully insured and self-insured plan structures, and requests comments on any such issues." (McDermott Will & Emery via Lexology)  

[Advert.]

Telehealth & Remote Patient Monitoring Summit – Jan 27-28, 2016 – Atlanta

Incorporating Telehealth and Remote Patient Monitoring practices has been shown to increase access to care, improve outcomes, and decrease health delivery costs. Take $200 off registration -- promo code BLINK2 (not valid on Webcast or Government Rate).

[Guidance Overview]

Frequently Recurring Questions Regarding the Impact of the ACA on Employers (PDF)
Topics include: [1] Permissibility of Offering Employees a Health FSA Without a Major Medical Plan; [2] Permissibility of Offering Employees an HRA Without a Major Medical Plan; [3] Permissibility of Reducing Employees' Hours Below the 30 Hours/Weeks Threshold; and [4] IRS Health Care Coverage Reporting Requirement. (Hinkle Law Firm LLC)  

[Guidance Overview]

Small Business Health Care Tax Credit and the SHOP Marketplace
"The small business health care tax credit benefits employers that: [1] have fewer than 25 full-time equivalent employees; [2] pay an average wage of less than $50,000 a year; [and] [3] pay at least half of employee health insurance premiums. To be eligible for this credit, you must have purchased coverage through the small business health options program, also known as the SHOP marketplace.... How will the credit make a difference for you? ... Can you claim the credit? ... How do you claim the credit?" (Internal Revenue Service [IRS])  

[Guidance Overview]

IRS Health Care Tax Tip 2015-61: Understanding Minimum Essential Coverage
"The Affordable Care Act requires any person or organization that provides minimum essential coverage, including employers that provide self-insured group health plans, to report this coverage to the IRS and furnish statements to the covered individuals." (Internal Revenue Service [IRS])  

Congress Votes to Repeal Small Group Market Expansion
"The PACE legislation would maintain the current definition of a small group market as one to 50 employees and give individual states the flexibility to expand the group size if they feel the market conditions in their state necessitate the change.... [S]mall group market plans must: [1] Cover 10 essential health benefits. [2] Fit into the actuarial value levels (platinum, gold, silver and bronze) defined by the ACA. [3] Participate in the risk adjustment program and be part of a single risk pool for setting premiums. [4] Only consider age, geographic location, family composition and tobacco use in setting rates. Large group plans are not bound by any of these requirements." (Society for Human Resource Management [SHRM])  

Plan Sponsor Hit with $61,380 Penalty for Failing to Provide Plan Documents in Life Insurance Claim
"The Plan provided the insurance policy (SPD), albeit much later and was initially hit with a $12,760 penalty for its failure to provide that document in a timely manner. However, the Plan did not provide the other additional Plan Document until much later in the process. The Plan argued that the other Plan Document did not need to be furnished because it did not mention the insurance policy and because there were conflicting terms between it and the SPD. The court disagreed and found the other Plan Document to be a 'controlling ERISA document' and as such, the Plan 'was under an obligation to furnish a copy of the Plan Document' at the request of the plan participant." [Harris-Frye v. United of Omaha Life Ins. Co., No. 1:14-cv-72 (E.D. Tenn. Sept. 21, 2015)] (AVYM Healthcare Revenue Consultants)  

Court Upholds Employer's Request for Marriage Certificate to Justify Spousal Health Insurance
"While this employee's Title VII claim was dismissed because the employer required marriage certificates of all couples, the outcome may have been different had the employer singled out this couple or required certificates of only certain employees. While this case alleged discrimination based on religion, it would not be a stretch to see this argument made in the context of same-sex marriages. Following the reasoning in this case, employers requiring marriage certificates of all couples, whether same-sex or opposite-sex, would likely face less scrutiny than if they required certificates only of same-sex couples." [Abdus-Shahid v. Mayor and City Council of Baltimore City, No. 15-1972 (D. Md. Sept. 9, 2015)] (Thomson Reuters / EBIA)  

Workplace Wellness Programs: Early Alarm for Workers' Health, or a Recipe for Over-Testing?
"Asking employees about smoking or checking their blood pressure is not controversial among medical experts, but there is less agreement about some of the other tests included in many wellness programs. That's mainly because most require a package that is one size fits all, not stratified based on whether a worker is 25 with no risk factors or 35 with parents who died of heart attacks in their 40s. Testing a broad cross-section of adults every year with a range of screening exams poses some risks, medical and policy experts say." (Kaiser Health News)  

Seven Questions to Ask Your Boss About Wellness Privacy
"[1] What information will my employer see? ... [2] Is the program covered under the HIPAA privacy law? ... [3] Did I give up my HIPAA rights when I filled out my health assessment on the wellness site? ... [4] My employer says it sees only group results. Does that guarantee privacy? ... [5] How many other companies see my wellness data? ... [6] What privacy policies do subcontractors and other third parties have to follow? ... [7] Could somebody try to identify individuals in the group results shared by my wellness plan?" (National Public Radio)  

HHS's Office of Civil Rights to Launch New Round of HIPAA Audits
"OCR has confirmed that its HIPAA audits will target common compliance issues and include both onsite and remote 'desk views.' The audits will include covered entities and their business associates, which often provide data processing and management services to the organization. OCR's HIPAA audits will also review whether organizations have conducted enterprise-wide risk assessments to identify their technical and procedural vulnerabilities, and whether those assessments are then translated into remediation strategies, as well as operational policies and employee training." (The Wagner Law Group)  

NYC Affordable Transit Act: Employers Will Be Required to Offer Tax-Qualified Transportation Benefits in the New Year (PDF)
"Effective January 1, 2016, most employers with 20 or more full-time employees in New York City must offer those full-time employees the opportunity to use pre-tax earnings to purchase qualified transportation fringe benefits in accordance with federal law. Although penalties will not be assessed for noncompliance prior to July 1, 2016, with the new year rapidly approaching, the time for employers to pursue a benefits program that aligns with the new law is now." (Epstein Becker Green)  

Some Insurers Will Take Hit from ACA Risk Corridor Program Shortfall
"While health insurers are owed $2.87 billion through the program for 2014, the government will only be able to pay them about 12.6 percent of what they're owed, CMS says. That's because 'issuers' ... will pay only $362 million into the program.... While not all insurers will take a hit, smaller health plans and those that included risk-corridor payments in their 2014 accounting may face financial strain." (FierceHealthPayer)  

[Opinion]

Selling Health Insurance Across State Lines
"[S]uch a reform has no effect. Back in 2010, Georgia sacrificed its sovereignty to regulate health insurance, but premiums didn't change. The reason is that if a health plan wants to offer coverage in a state, it already can easily do so. Health insurers enter and exit markets all the time.... By far the largest determinant of insurance premiums isn't mandates, it's the provider network tied to a health plan.... [If] we owned our own health insurance, states would quickly harmonize their laws to facilitate a national market. Which brings us to a legitimate recommendation for Congress: Stop the tax code's discrimination against individually owned health insurance." (National Center for Policy Analysis Health Policy Blog)  

Is Your Severance Policy an ERISA Plan?
"[A]n advantage to ERISA coverage is that the employer can reserve to itself discretion to decide claims, which discretion will be respected by a court so long as the decision was not arbitrary and capricious. Disadvantages to ERISA coverage are that a Form 5500 may need to be filed annually, employees can bring a federal court lawsuit alleging a violation of ERISA, and prevailing claimants can recover attorneys' fees. A recent decision by the ... Second Circuit highlights the fact that even where an employer believes it has established a severance policy and has not explicitly characterized that policy as an ERISA plan, the arrangement may in any event be considered a plan subject to ERISA's requirements." [Okun v. Montefiore Medical Center, No. 13-3928 (2d Cir. July 17, 2015)] (Stinson Leonard Street)  

ISS 2015-2016 Policy Survey Summary of Key Items
"ISS appears to be poised to assess the appropriateness of certain adjusted performance metrics as part of its qualitative assessment of a company's incentive plans. This evaluation ultimately may impact ISS's vote recommendation on a company's Say on Pay proposal." (Meridian Compensation Partners, LLC)