Plan Administrator, Compliance
Verisight
in IL

Senior Plan Analyst
Retirement Horizons Inc.
in TX

Plan Document Specialist
Campbell Albrecht
in CA

Manager, Reporting & Analytics and Consulting Support Services
Northwestern Benefit Corporation of Georgia
in GA

Pension Administrator / Consultant
Boyce & Associates, Inc.
in AZ

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Market Volatility: Answering Your Questions
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[Guidance Overview]

ACA Reporting Requirements for Carriers and Employers (Part 12 of 24): Deconstructing Form 1095-C, Parts II and III
"While the mechanics of the Code Sections 6055 and 6056 reporting scheme mirror the reporting rules for wages and withholding on IRS Forms W-2 and W-3, they are far more complicated. To comply, employers need to access and collate information from a number of disparate sources such as payroll, HRIS, and other employment records. The IRS also has designed Form 1095-C to elicit information needed to enforce the individual mandate and the administration of premium tax credits available to low- and moderate-income individuals through public insurance exchanges, thereby adding to the complexity." (Mintz Levin)  

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[Guidance Overview]

Health Care Reform: Employer Reporting and Other Upcoming Key Dates
"[This list] is based upon dates for plans that are operated on a calendar-year basis. Certain dates listed will be different for non-calendar-year plans." [The list contains action items from October 2015 through July 2016.] (Vedder Price)  

[Guidance Overview]

CCIIO Explains What Employee Premium Assistance Notices You Will and Won't Receive in 2016
"Employers should be aware ... that in the spring of 2016, the first notices they receive, if any, will be from the IRS, not from the exchanges. Assessable payment liability notices from the IRS will, at that time, indicate that at least one of an employer's employees received an advance premium tax credit in 2015. Therefore, employers will not be getting a heads-up in the coming year with regard to whether or not they could be subject to penalties because one of their employees received an APTC." (Wolters Kluwer Law & Business)  

[Guidance Overview]

The Long Arm of the ACA Nondiscrimination Rules
"The proposed rule does not offer any specific guidance on how a covered health insurance issuer's required compliance would apply to its services as a third party administrator for a self-funded group health plan.... This means that insurers participating in the ACA Marketplaces that also offer coverage to employers in the group market, and those who act as TPAs for self-funded plans, may need to apply these rules to their group insurance coverages and even to the plans for which they serve as TPAs. This is a potentially very broad-sweeping rule that could change what employer plans have to cover." (Benefits Bryan Cave)  

[Guidance Overview]

New Law Restores the Health Coverage Tax Credit But Effect of COBRA Unclear (PDF)
"Under the previous version of HCTC, individuals who had dropped or not elected continued health coverage under [COBRA] would, under limited circumstances, have a 60-day special enrollment right triggered by becoming eligible for [Trade Adjustment Assistance (TAA)]. The [DOL] has not yet issued guidance as to the application of COBRA to the new extension of HCTC. Moreover, the DOL has not yet provided guidance on whether COBRA notices should include information about the HCTC extension." (Segal Consulting)  

Federal Courts Consider Viability of State-Law Claims Arising from Anthem Data Breach
"Anthem, Inc.'s February 2015 announcement of a massive breach of HIPAA electronic protected health information has prompted several class-action lawsuits by participants in health plans insured or administered by Anthem subsidiaries. In the cases [discussed in this article], participants sued in state court, but the Anthem entities moved the cases to federal court. These federal court rulings address requests by the participants to return the cases to state court.... Individuals seeking compensation in connection with large-scale data breaches may prefer to sue in state court because of the greater remedies typically available under state law." (Thomson Reuters / EBIA)  

Not All Plans Can Establish a Shortened Limitations Period for Filing a Lawsuit
"[A federal district court] prohibited a fully insured plan from establishing a deadline shorter than the state imposed deadline. The plan was a long term disability plan that was insured under Wisconsin law [which] attempted to impose a shorter deadline for bringing claims than the three year period allowed under Wisconsin insurance law. The court held that because Wisconsin law precluded an insurance company from using a shorter limitations period, the three year time limit applied." [Lundsten v. Creative Commun. Living Services, Inc. LTD Plan, No. 13-C-108 (E.D. Wis. Aug. 20, 2015)] (Stinson Leonard Street)  

D.C.'s 16-Week Paid Family Leave Plan Would Be Most Generous in U.S.
"The District would become the most generous place in the country for a worker to take time off after giving birth or to care for a dying parent under a measure supported by a majority of the D.C. Council.... [A]lmost every part-time and full-time employee in the nation's capital would be entitled to 16 weeks of paid family leave to bond with an infant or an adopted child, recover from an illness, recuperate from a military deployment or tend to an ill family member. The broad new worker benefit ... would be paid from a fund created by a new tax on D.C. employers." (The Washington Post; subscription may be required)  

House Approves Bill Redefining Small Group Plans
"[A recent CBO analysis said] H.R. 1624 would result in a net reduction in premiums for health insurance purchased by some firms with between 51 and 100 employees in the near term. Premiums would be lower because some firms would choose to offer insurance that does not meet the standards required under current law, the CBO said.... The American Academy of Actuaries has estimated that expanding the definition of small employer to include companies with as many as 100 employees could affect more than 150,000 establishments with more than 3 million workers, and would likely lead to decreased plan design flexibility, adverse selection and higher premiums." (Bloomberg BNA)  

What State Policies Best Foster Insurance Market Competition?
"[It] is important to better understand how different regulatory environments may affect the functioning and competitiveness of insurance markets. In the case of rate review, a recent study suggests that pre-ACA premiums were lower in states that took a more active regulatory approach.... On the other hand, an NBER working paper argues that state regulatory backlash against managed care during the late 1990s increased health spending by a non-trivial amount. State regulatory action, therefore, has the potential to both increase and decrease costs for consumers." (Health Affairs)  

The Bigger Questions about Health Insurance
"[As] regulators assess the big deals, the bigger questions about the insurance industry will likely come into focus ... What is the purpose for health insurance? ... Should it cover everything or only the most costly episodes? And should employers play a role at all? Should health insurers be required to make their data accessible and transparent to the providers, pharmacists, and hospitals they contract, and to the members, employers, and government agencies they serve? ... Should their decisions to suspend a plan, raise premiums, eliminate providers from networks for causes other than safety or quality, be subject to tighter scrutiny by state departments of insurance to which they're accountable?" (Paul Keckley)  

How Has the Review of Rates by States Affected Health Insurance Premiums? (PDF)
"[A]djusted premiums in the individual market in states with prior approval authority combined with loss ratio requirements were lower in 2010-2013 ($3,489) than premiums in states that had no rate review authority or that had only file-and-use regulations, preventing the states from blocking rate increases ($3,617). Adjusted premiums declined modestly in prior approval states with an anticipated loss ratio requirement, from $3,526 in 2010 to $3,452 in 2013, while premiums increased from $3,422 to $3,683 in states with no rate review authority or file-and-use regulations only. Adjusted premiums experienced a similar decline in prior approval states without an anticipated loss ratio requirement." (Robert Wood Johnson Foundation)  

SEC Filing Details Tumultuous Negotiations in Anthem-Cigna Deal
"Anthem announced in late July that it planned to acquire Cigna in a $54.2 billion deal -- but not before the two companies sparred publicly over a previous takeover bid that Cigna rejected. The [406-page SEC filing by Anthem], part of the regulatory process to complete the deal, reveals more about how it all transpired." (FierceHealthPayer)  

[Opinion]

Cadillac Tax Could Cut Care Along with Costs
"Evidence shows that making health care more expensive does induce people to consume less of it. But the same evidence shows that people do not cut back only on care that is ineffective or somehow luxurious; instead, they cut back across the board. Expecting sick Americans to decide on the fly in an opaque and uncompetitive marketplace what health care is cost-effective-and what is not-is an unrealistic and unfair approach to containing costs.... The excise tax is a shotgun blast. But what's needed for cost containment is a scalpel." (Economic Policy Institute)  

[Opinion]

Risk Corridor Stabilization Fund: Another ACA Failure
"[T]he stabilization fund is able to cover only about 13% of of the losses above the upper margin of the corridor.... Congress has created barriers to using funds other than the user fees authorized by the risk corridor stabilization program.... Risk corridors, risk adjustment, and reinsurance are not for the benefit of patients, rather they are to protect the insurers. Not only do they add to our profound administrative waste, they also open up opportunities for insurers to profit even more through chicanery and gamesmanship." (Physicians for a National Health Program [PNHP])  

[Guidance Overview]

IRS Proposes Eliminating Requirement That Section 83(b) Elections Be Filed with Federal Income Tax Returns
"The IRS makes a notable observation in the preamble to the proposed regulations about the service provider's obligation to maintain documents, stating that taxpayers have a duty to maintain sufficient documents to establish the tax basis in property, and that this duty extends until the expiration of the period of limitations following the date of the disposition of the property (i.e., the taxable disposition of the property subject to the 83(b) election, which could occur years after the date of the 83(b) election itself). Current recordkeeping practice may not correspond to the IRS' view." (Morgan Lewis)  

SEC Clawback Rules Have Executive Tax Consequences
"The first issue arises if a company's recovery policy were to provide for clawback from nonqualified deferred compensation before it becomes payable, which could result in a significant tax penalty on an affected executive under Section 409A of the Internal Revenue Code. The second issue arises when an executive has already paid taxes on the IBC, as the rule requires the clawback be equal to the bonus amount pre-tax, not the amount that the executive netted from the bonus." (Husch Blackwell)  

TRA Welcomes New Regional Sales Consultant
The Retirement Advantage [TRA]

T. Rowe Price Expands Retirement Plan Offerings With New I Share Class
T. Rowe Price

Stadion Money Management to Add Support for 401(k) Industry’s Most Underserved Segment – Micro- and Small-Plan Participants – with Launch of Small Business Retirement Planning Solution
Stadion Money Management

MassMutual Introduces Integrated Employee Benefits Exchange Combining Retirement Savings, Healthcare and Insurance Coverages
MassMutual

New Ninth Edition of ‘The Complete HSA Guidebook’ from HealthEquity Founder and Vice Chairman Unlocks Keys to Winning with a Health Savings Account
HealthEquity

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