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[Guidance Overview]
President Signs PACE Act Changing Small Group Market Definition (PDF)
"On October 7, 2015 President Obama signed the Protecting Affordable Coverage for Employees (PACE) Act that amends the [ACA] definition of a 'small employer' for the purpose of purchasing health insurance coverage.... The PACE Act repeals the mandatory expansion of the small group market to employers with up to 100 employees and reverts to the prior definition of up to 50 employees although the states maintain flexibility to define the small market as up to 100 employees.... Numerous questions surround the passage of this amendment to the ACA given the fact that the change has happened so late in 2015."
(Cherry Bekaert Benefits Consulting, LLC)
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[Guidance Overview]
D.C. Council Introduces Legislation That Would Give D.C. Employees Up to 16 Weeks of Paid Family and Medical Leave
"If the proposed Act becomes law, all companies with at least one 'covered employee' will be required to contribute to a Family and Medical Leave Fund established by the D.C. government. A covered employee is any individual who was employed by a company for some or all of the 52 weeks immediately before a qualifying medical or family leave event and either: (a) spends greater than 50% of work time for the employer in D.C. or (b) works for a company that is a registered business holder in D.C. This means local, regional, and national employers must figure out which, if any, of their employees would qualify for paid leave benefits."
(Mintz Levin)
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[Guidance Overview]
The Leave vs. Compensation Debate (PDF)
15 pages. "This outline is designed to provide a general overview of the following laws pertaining to employee leaves of absence: the federal Family and Medical Leave Act of 1993, the New Jersey Family Leave Act, the New Jersey Workers' Compensation Act, the New Jersey Family Leave Insurance Law and the New Jersey Temporary Disability Benefits Law. This outline will also discuss in broad terms the interplay of these laws with each other and with employer leave of absence policies."
(Fox Rothschild LLP)
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[Guidance Overview]
ACA's Transitional Reinsurance Fee Submissions
"The fees are determined based on the plan's enrollment count during the first nine calendar months of the year, regardless of the plan's actual plan year. Enrollment counts for the first nine months of 2015 will be filed in November 2015 with payment made in 2016.... Plans that are self-insured and self-administered are not required to pay the fees in 2015 or 2016. To be regarded as self-administered, self-insured plans must retain responsibility for claims processing, claims adjudication (including internal appeals) and enrollment."
(Segal Consulting)
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[Guidance Overview]
EEOC Proposes Rule on Application of ADA to Employer Wellness Programs
"The [proposed regulation] requires employers to provide employees with a written notice that clearly explains [1] what medical information will be obtained, [2] how the medical information will be used, [3] who will receive the medical information, [4] restrictions on the medical information's disclosure, and [5] the methods used to prevent improper disclosure of the medical information."
(Morgan Lewis)
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Sixth Circuit: Claimant Could Be Entitled to LTD Benefits, Despite Late Filing of Claim
"[The Court found that, while the plaintiff] did not comply with the notification deadlines outlined in the Plan, in that she did not file her claim for LTD benefits prior to termination, that failure is not surprising given that she was suffering from severe mental illness and was unable to comply due to the very disability for which she sought coverage. Provisions in the Plan contemplate the awarding of LTD benefits to employees who become disabled as long as they are working for Ford at the time of onset, which occurred here." [Waskiewicz v. UniCare Life and Health Ins. Co., No. 14-1479 (6th Cir. Oct. 2, 2015)]
(Cary Kane ERISA Lawyer Blog)
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Can the Cadillac Tax Be Made Less Regressive by Replacing It with an Exclusion Cap?
"One alternative to the Cadillac tax is an 'exclusion cap,' under which individuals enrolled in employer-sponsored plans would be able to exclude premiums from their taxable income only up to a dollar limit (i.e., the cap). This analysis uses RAND's COMPARE microsimulation model to [1] define an exclusion cap scenario that would produce the same amount of federal tax revenues as the Cadillac tax in 2020 and [2] compare the effects of the exclusion cap and the Cadillac tax on families in different income ranges. The analysis shows that there is very little difference in progressivity between the Cadillac tax and a revenue-equivalent exclusion cap."
(RAND Corporation)
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Latest Round of Cadillac Tax Comments Yields More Criticism
"In its comment letter, the OPM said that as the tax currently stands, administering it would likely lead to a reduction or elimination of benefits for employees in the Federal Employees Health Benefits Program.... The question over who should be considered 'the person that administers the plan benefits' was a prominent issue in the comment letters."
(Bloomberg BNA)
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Open Enrollment Tips
"What type of information can help employees make better decisions during Open Enrollment? ... [How should plan sponsors] ensure employees complete their enrollment selections within the open enrollment period? ... [How should they] adapt communication best practices for new hire enrollment?"
(Benefitfocus)
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Why the Cost of Generic Drugs Is Increasing: Regulatory and Legal Reasons
"Oddly, during the past few years many generic drugs that have been on the market for decades have suddenly become expensive. In 2014, the price of more than one-fourth of generic drugs rose 10 percent to 100 percent or more. In other cases, old generic drugs have becomes scarce and hard to procure. [This article describes] some of the regulatory and legal reasons drug prices are rising."
(National Center for Policy Analysis [NCPA])
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Six Economic Facts About Health Care and Health Insurance Markets After the ACA
"Spending on health-care resources varies widely across the country: spending for the average Medicare enrollee in Miami is nearly 70 percent greater than in Minneapolis.... Millions of households with health insurance do not have enough cash on hand to pay out-of-pocket medical expenses in the event of a major health shock.... Over the past three decades the percent of American workers enrolled in conventional health insurance plans has declined from 73 percent to less than 1 percent.... Over the past two decades, there has been a nearly 50 percent increase in the share of private sector workers who are offered a choice of health insurance plans."
(The Brookings Institution)
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Risk Selection Threatens Quality of Care for Certain Patients: Lessons from Europe's Health Insurance Exchanges
"Experience in European health insurance exchanges indicates that even with the best risk-adjustment formulas, insurers have substantial incentives to engage in risk selection.... Recommended improvements to the risk-adjustment process in the United States include considering the adoption of risk adjusters used in Europe, investing in the collection of data, using a permanent form of risk sharing, and replacing the current premium 'band' restrictions with more flexible restrictions."
(Health Affairs)
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Why You Can't Overlook Worksite Wellness
"An increasing number of U.S. employers (over 60%) find value in offering worksite wellness. In response to current business challenges, some employers have cut their wellness programs to save money. But eliminating wellness from an organization's overall health plan strategy ignores the harmful effects unhealthy employees can have on the bottom line -- they can be less productive at work and have higher health care costs."
(Ascende)
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[Opinion]
ACA Excise Tax on Expensive Health Plans Is an Unambiguous Pay Cut
"[E]ven if wages rise in response to cutbacks in employer premium contributions, the level of pre-tax pay (where pay includes both wages as well as other employer-provided benefits) won't increase at all -- instead its composition will simply shift, with employer premium payments falling and wages rising. Further, because wages are taxed and employer premium payments are not, this means that the total tax bill on the worker's overall compensation will have unambiguously increased. So, post-tax compensation is lower with the excise tax, period. It is a take-home-pay cut."
(Economic Policy Institute)
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Benefits in General; Executive Compensation
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Testing Pay for Performance
"There is no silver bullet analysis that will definitively determine whether pay and performance are aligned at every company. However, there are a number of ways companies can test the pay and performance alignment relative to peers or historical results.... By understanding the key drivers of incentive plan outcomes, the compensation committee can discuss an action plan for improvement."
(Meridian Compensation Partners, LLC)
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