Retirement Plan Administrator
NestEggs, Inc.
in FL

5500 Specialist
Plante Moran
in MI

Plan Implementation Manager
Aspire Financial Services LLC
in FL

Valuation Analyst
United Retirement Plan Consultants
in RI

Senior Financial Consultant
Arthur J. Gallagher & Co.
in TX

Retirement Services Associate
The Benefit Practice
in CT, FL

Benefit Administrator I
GuideStone Financial Resources
in TX

Retirement Account Representative
GuideStone Financial Resources
in TX

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2015 ASPPA Virtual Conference
RECORDED
(ASPPA [American Society of Pension Professionals & Actuaries])

Saving: America’s Challenge and Opportunity in The Twenty-First Century
November 3, 2015 in IL
(WISER [Women’s Institute for a Secure Retirement])

Current Pension Risk Management Strategies
November 19, 2015 in NY
(Worldwide Employee Benefits Network [WEB] - New York Chapter)

View All Webcasts and Conferences

[Official Guidance]

Text of CMS FAQ on Impact of PACE Act on State Small Group Expansion (PDF)
"What constitutes a State election to extend the definition of small employer? ... [M]ay States allow carriers to modify their rate filings for small group coverage for 2016? ... Does the enactment of the PACE Act affect the counting methodologies to be used by the SHOPs... and for purposes of the medical loss ratio (MLR), risk adjustment, and risk corridors programs? ... How does the PACE Act impact employer size for MLR, risk corridors, and risk adjustment reporting purposes? ... If a State with a SHOP that uses HealthCare.gov elects to extend the definition of small employer to 1-100 employees, when will CMS make the applicable changes to the employer eligibility screens on HealthCare.gov?" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Advert.]

An Essential New Guide for Self-Funded Health Plans

Self-Funding Health Benefit Plans provides a comprehensive look at the advantages of self-funded plans and offers plan sponsors, attorneys and other professionals practical guidance concerning plan design and administration. Order Now!

[Official Guidance]

Text of 2015 Benefit Year Risk Adjustment: HHS-Developed Risk Adjustment Model Algorithm 'Do It Yourself' Software (PDF)
"This document provides instructions for the HHS risk adjustment models for the 2015 benefit year, with revisions from the software instructions posted on the CCIIO website on June 2, 2014.... The risk adjustment methodology consists of concurrent risk adjustment models, one for each combination of metal level (platinum, gold, silver, bronze, and catastrophic) and age group (adult, child, infant). This document provides the detailed information needed to calculate risk scores given individual diagnoses." [Also available: Technical Details (Excel spreadsheet) and 2015 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (SASsoftware.zip)] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Official Guidance]

Text of DOL Advisory Opinion 2015-02A: Stop-Loss Insurance Policies Purchased for Self-Contributory Plan Do Not Constitute Plan Assets
"The Plan Sponsors wish to purchase one or more stop-loss insurance policies for the purpose of managing the risk associated with their liabilities under the medical benefit portions of the Plans.... You describe certain accounting procedures that were put in place by the Plan Sponsors to ensure that no monies attributable to employee contributions are used for paying premiums on the Policies.... Except for the use of participant contributions to partly fund the medical benefit portions of the Plans, you represent that the facts surrounding the purchase of the Policies will be identical in all material respects to the facts surrounding the purchase of the stop-loss insurance policy described in Advisory Opinion 92-02A.... It is the view of the Department, based on the facts and representations contained in your submission, that the Policies would not constitute assets of the Plans." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

[Official Guidance]

Text of DOL Advisory Opinion 2015-01A: Long-Term Disability Program Sponsored by the California Law Enforcement Association Is Not an 'Employee Welfare Benefit Plan'
"[Y]ou have not shown that the individuals who participate in the CLEA LTD program are all employees of one such employer, i.e., the State of California. Instead, you suggest that the CLEA LTD program participants have a similar commonality to that shared by federal employees because they are covered by a state-mandated benefit package and participate in the CLEA program as a supplement to that state-mandated benefit package. However, even if state law entitles a diverse group of employees to specified benefits, that fact alone would be insufficient to satisfy the commonality requirement.... We do not view this commonality requirement as satisfied where the association's membership extends to individuals belonging to a variety of associations, unions or clubs." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

[Official Guidance]

Text of 2015 IRS Draft Instructions for Form 8962: Premium Tax Credit (PDF)
19 pages. "Use Form 8962 to figure the amount of your premium tax credit (PTC) and reconcile it with advance payment of the premium tax credit (APTC). If you or a member of your family enrolled in health insurance coverage for 2015 through a Health Insurance Marketplace ... APTC may have been paid to your insurance company to help cover your monthly premium, and you may be eligible for the PTC. If APTC was paid on your behalf or, if APTC was not paid on your behalf but you wish to take the PTC, you must file Form 8962 and attach it to your tax return....What's New: Information reporting about employer offer of coverage (Form 1095-C).... Health coverage tax credit (HCTC)." (Internal Revenue Service [IRS])  

Transitional Reinsurance Submission Due by November 16
"Annual enrollment counts and other required information (including supporting documentation, if applicable) must be submitted on the prescribed form by Monday, November 16, 2015. The Transitional Reinsurance Fee, which is equal to $44 per covered life, is due either [1] in a single payment made on or before January 15, 2016, or [2] in two installments due by January 15, 2016 and November 15, 2016, respectively." (Haynes and Boone, LLP)  

HSAs to Be Included in Cadillac Tax Calculations, IRS Official Says
"When asked whether it might be possible to exclude HSAs from the cost of coverage for purposes of the 40 percent excise tax on higher-cost health plans that takes effect in 2018, Kevin P. Knopf, senior technical reviewer for the Internal Revenue Service's Office of Chief Counsel, Health and Welfare Branch of the Tax Exempt and Government Entities Division, quickly shut down that line of thinking. 'I personally continue to believe that HSA contributions' that are excluded under tax code Section 106 are still going to be included in calculating the cost of coverage for the tax 'for the foreseeable future,' he said[.]" (Bloomberg BNA; free registration may be required)  

IRS Rule Could Force Health Coverage Plans Overseas
"An IRS rule that could limit health plan coverage for expatriates working in the U.S. to one year would put domestic insurers at a disadvantage to foreign competitors ... Multinationals and foreign governments prefer to make large purchasing decisions on a multiyear basis and would be more likely, if the rules were to be implemented, to buy from overseas plan providers that are able to offer coverage for 'unlimited' periods of time, Cigna said." (Bloomberg BNA)  

Humana, Aetna Shareholders Approve Acquisition
"Louisville health care giant Humana took one step closer to changing hands on Monday. Aetna and Humana shareholders resoundingly ratified the proposed $37 billion acquisition of Humana, the Louisville-based health care company, by Aetna. The acquisition was put to separate votes of both companies' shareholders at special meetings Monday afternoon." (The Courier-Journal)  

Health Care Consumerism: Lessons My 401(k) Plan Taught Me (PDF)
"As we think about how individuals will pay for health care -- while actively employed and while retired -- our experiences with 401(k) plans provide some valuable lessons. In order to support employees in this new health care world -- a challenge arguably more daunting than the 401(k) challenge we faced 20 years ago -- some very different types of support are needed. Employers should consider providing their employees with the resources to manage health care changes." (Allen T. Steinberg, in Benefits Quarterly, published by the International Society of Certified Employee Benefit Specialists [ISCEBS])  

After He Allegedly Showed Up Drunk to Practice, Should Former USC Football Coach Have Been Placed on FMLA Leave Instead of Being Terminated?
"In a word, no.... Insights for Employers: Hold your employee to reasonable performance standards.... [If] an employee is not being disciplined for violating a substance abuse policy but simply advises the employer that he intends to take time off for substance abuse treatment, this is a legitimate basis for FMLA leave.... [An] employee's absence or performance issues due to his abuse of a substance is not afforded any protection under the FMLA.... Even the EEOC supports an employer's right to take action where the employee violates a workplace policy prohibiting the use of alcohol." (FMLA Insights)  

Changes in Claims, Premiums, and Medical Loss Ratios Across and Within States' Individual Markets Between 2010 and 2014
"[The authors] compare average net MLRs by state and examine the distribution of net MLRs across insurers in each state. In the individual market, [they] find: average net MLRs rose because of rising net claims relative to net premiums, almost all states had average net MLRs higher than 80 percent by 2014, and average net MLRs varied from 83 percent at the 25th percentile to 99 percent at the 75th percentile." (Urban Institute)  

Judge Rejects Early Appeal In House Challenge to Reimbursement of ACA Cost-Sharing Reduction Payments
"In denying the government's request for an expedited 'interlocutory' appeal, Judge Collyer held that ... an immediate appeal to the D.C. Circuit would not materially advance the ultimate termination of the litigation.... The judge concluded that the case would move more quickly if she decided the merits first, so that the appellate court could simultaneously decide whether her decision on the merits was right and whether she had any authority to decide the question in the first place. She set the case for a briefing schedule under which final briefs will be filed by January 18 and an oral argument scheduled thereafter." (Health Affairs)  

[Opinion]

On Dynamic Pricing of Health Care (PDF)
"Using customer value as an element to set the price for a good or a service has been around forever. But rarely has it been a component in the design of our healthcare plans. Our healthcare plans are essentially mechanisms that reimburse providers' charges, which are a function of many factors, like expertise, procedure complexity and overhead ... minus some form of agreed-upon discount. Cost-effective value to the patient is not an explicit consideration in determining how much our plans will pay." (Chelko Consulting Group)  

Costly Penalties Emphasize Importance of Providing Plan Documents Upon Request
"The court imposed the maximum penalty of $110 per day (for 674 days) ... The court specifically rejected the plan administrator's arguments that: [1] The plan document was unnecessary because the SPD contained all of the relevant terms; [2] The penalty should not apply because the plaintiff was not prejudiced by the plan's failure to provide the documents; [3] The penalty should not apply because the plan administrator acted in good faith; and [4] The penalty for not providing the insurance policy should have stopped accruing when the plaintiff obtained a copy of the policy from the insurance company." [Harris-Frye v. United of Omaha Life Ins. Co., No. 1:14-cv-72 (E.D. Tenn. Sept. 21, 2015)] (Mazursky Constantine LLC)  

Six in 10 Workers Say Health Insurance Costs Directly Affect How Much They Save for Retirement
"59 percent of workers agree or strongly agree that what they pay for medical/health insurance benefits directly affects how much they will put aside for retirement.... While 95 percent of employees say financial literacy is important, only 28 percent are very confident in their ability to make important financial decisions." (LIMRA)  

SageView Advisory Group Continues to Expand in Honolulu with Industry Veteran David Lum
SageView Advisory Group

ERISA Compliant Electronic Document Distribution and Tracking System Introduced
Virtual Management Systems

vWise Announces Retirement Plan Engagement Platform
vWise Inc.

Enrollment Advisors Acquires HighRoads Division
Enrollment Advisors

Clearwater Compliance Designated as the United States Air Force’s Sole Provider of Risk Analysis Software
Clearwater Compliance

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