Billing and Eligibility Specialist
Zenith American Solutions
in MN

Retirement Plan Administrator
Plan Design Consultants, Inc.
in CA

Operations Supervisor (Claims)
Zenith American Solutions
in CA

Claims Processor 3
Zenith American Solutions
in CA

Retirement Plan Specialist
Arista Wealth Management
in NV

Billing and Eligibility Supervisor
Zenith American Solutions
in WI

Consulting Actuary
TPA Firm
in ANY STATE

Trust Accountant for 401(k)/Defined Contribution Plans
R.J.L. Pension Services, Inc.
in FL

DC Retirement Plan Administrator
RetireWell Administrators, LLC
in NJ

ERISA/Labor Attorney
Spear Wilderman, P.C.
in PA

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Employer Shared Responsibility and the ACA
November 4, 2015 in CA
(Western Pension & Benefits Council - San Diego Chapter)

Next-Generation Affordable Care Act
November 11, 2015 WEBCAST
(Benefitfocus)

What the Healthcare Law Means for your Small Business
November 12, 2015 WEBCAST
(U.S. Small Business Administration [SBA])

Missing and Non-Responsive Participants: The Impact of Terminated Employees
November 17, 2015 in CA
(Western Pension & Benefits Council - San Diego Chapter)

2016 Retirement Industry Conference: Advancing Retirement Readiness
May 4, 2016 in MA
(LIMRA)

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[Guidance Overview]

ACA Reporting Requirements for Carriers and Employers (Part 15 of 24): Coding Form 1095-C, Part II for Offers of COBRA Coverage
"[T]he recently issued final 2015 Instructions for Forms 1094-C and 1095-C changed certain of the rules relating to the reporting for offers of COBRA coverage where the COBRA qualifying event occurs in the reporting year. This post explains these changes in detail and also covers the reporting of COBRA in years subsequent to the year in which the qualifying event occurs." (Mintz Levin)  

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[Guidance Overview]

ACA Information Returns (AIR) Working Group Meeting: General Program Topics (PDF)
30 presentation slides, dated Oct. 27, 2015. "This is the tenth AIR working group webinar; previous sessions have provided an overview of the ACA Information Returns program, electronic filing requirements (e.g. forms, schemas, and business rules), Publications 5164 and 5165, Employer Information Reporting Scenarios, and indicator standardization. This session will focus on reviewing topics that address recent questions and issues as well as a Tax Year 2014 recap and a review of the [Transmission Control Code (TCC)] application process." (Internal Revenue Service [IRS])  

[Guidance Overview]

New York City's Pre-Tax Transportation Benefit Mandate
"While many employers already provide pre-tax transportation benefits as a matter of company policy ... effective January 1, 2016, unless otherwise exempted, New York City employers with at least 20 full-time employees in the city of New York must offer full-time employees the opportunity to purchase pre-tax qualified transportation fringe benefits. For purposes of the legislation, a full-time employee is any employee who works an average of 30 hours or more per week for an employer." (Jackson Lewis P.C.)  

Justices Trying Once Again to Define 'Legal' and 'Equitable' Remedies Under ERISA
"Whatever the Justices bring to the case in their conception of 'liens,' they presumably will regard the case as weighing the significance of Montanile's plainly maleficent behavior against the statutory language that the Court has interpreted so narrowly. Skeptics might expect Montanile's 'unclean hands' to carry the day for the plan; purists might expect the Court to follow its precedents. One very real possibility is that the appearance of the Solicitor General on Montanile's behalf will carry significant weight: if the government discounts the risks to plan solvency of a decision in Montanile's favor, and if the Solicitor of Labor (who signed the government's brief) can stomach Montanile's behavior, then the Justices might find it much easier to follow the lead of Great-West and Sereboff and rule for Montanile." [Bd. of Trustees of the National Elevator Industry Health Benefit Plan v. Montanile, No. 14-11678 (11th Cir. Nov. 25, 2014; cert. pet. granted Mar. 30, 2015; oral arg. sched. Nov. 9, 2015)] (SCOTUSblog)  

What Happens to an Award of Attorney Fees When the Plan and the Insurer Don't Agree on the Benefit Denial?
"[W]hat happens when the ERISA plan and the insurer are defendants, and the plan disagrees with the insurer's denial of ERISA-governed disability benefits? Can the ERISA plan, a nominal defendant, recover attorney fees against the insurer? ... Yes for fees incurred during the litigation on the merits; no for fees incurred on the appeal." [Micha v. Sun Life Assurance Co. of Canada, No. 09cv2753 (S.D. Cal. Sept. 30, 2015)] (Lane Powell PC)  

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Recognizing and Addressing COBRA

November 11 -- Failure to provide required notices have cost employers thousands of dollars in courts all across the country. Don't be a statistic - learn about your responsibilities. BenefitsLink discount.

Tentative Budget Deal Would Avert Rise in Medicare Part B Premiums
"The package would prevent a 52 percent Medicare premium increase that will affect more than 8 million Part B enrollees in 2016 ... Congressional leaders have yet to include full details of how the spending increases would be offset, but if premiums are frozen for all recipients it will cost the government about $12 billion[.]" (FierceHealthPayer)  

Private Health Insurance Exchanges for Employers: Issues for Regulators and Public Policy (PDF)
12 pages. "Private exchanges, so far, have not degraded employer sponsorship of health benefits ... Instead, there is good reason to believe that private exchanges might enhance employers' willingness to continue offering health benefits.... Views were more divided on whether useful regulatory measures could be taken to facilitate or promote private exchanges ... The strongest accelerant would be if tax law were changed to allow workers to use pre-tax employer contributions to purchase individual insurance." (Mark A. Hall, for the Robert Wood Johnson Foundation)  

Can Telemedicine Be the Future of Health Care?
"Telemedicine has been praised as a cost-effective way to link doctors and patients, enabling physicians to monitor their medical conditions and consult with specialists in a way that overcomes time and distance. But despite a half-century of technological advances, the ready availability of interactive devices, and the full-throated encouragement of the Obama administration, advocates say telemedicine has failed to reach its full potential, due largely to policies in some states that make it difficult to practice, and pay for, such care." (Stateline, via The Huffington Post)  

Study Raises Questions About Mail Order Pharmacy Patient Adherence (PDF)
"Nearly 58% of the medications returned from mail order had 80% or more of the medication left, compared to 37% from community pharmacy. Additionally, the returns of brand medications were proportionally higher from mail order pharmacy.... [A] general benchmark indicator of adherence is completion of 80% or more of therapy within a given timeframe." (Community Pharmacy Foundation)  

Anthem Blue Cross to End Mid-Year Policy Changes, Refund $8.3 Million to California Consumers
"Under a class action settlement announced [Oct. 27], Anthem Blue Cross in California will no longer make mid-year changes to individual customers' annual deductibles, co-pays, or other out-of-pocket costs and will refund $8.3 million to consumers. The settlement resolves two lawsuits challenging mid-year changes Anthem made to individual California policies in 2011.... The lawsuits alleged that Anthem illegally increased 'annual deductibles' and other 'annual' and 'yearly' out-of-pocket costs, thereby reducing the benefits available under consumers' health plan contracts, in the middle of the year." (Consumer Watchdog)  

Utah Shuts Down the State's Nonprofit Insurance CO-OP
"Arches Health Plan, a membership cooperative that was born out of the Affordable Care Act and insures 66,000 Utahns, has been ordered out of the insurance market for 2016. Arches insures more low-income Utahns on the federal exchange, healthcare.gov, than any other company besides SelectHealth. But it also has customers who get their insurance on their jobs and individuals who buy plans through insurance agents or brokers. Those 35,000 people who bought Arches plans via the exchange or from insurance brokers or agents will now have to find new health insurance for 2016." (The Salt Lake Tribune)  

CMS Head Says ACA Consumers May Drive Market Change
"[A]cting CMS administrator Andy Slavitt said that during the second ACA marketplace enrollment period for 2015 plans, more than half of consumers shopped to decide whether to pick new plans and more than a quarter did so, which is 'three or four times the number that do this in employer settings.' As consumers get educated about health care, he said, they 'can really drive change.' " (Bloomberg BNA)  

[Opinion]

Aetna Accidentally Invalidates the Wellness Industry's 'Savings' Model
"Aetna studied Aetna employees who, by Aetna's own admission, didn't have anything wrong with them, other than being at risk for developing metabolic syndrome, defined as 'a cluster of conditions that increase your risk for heart attack, stroke and diabetes.' In other words ... the subjects' 'diagnosis' was being at risk for being at risk. Not only did they not have diabetes or heart disease, but they didn't even have a syndrome that put them at risk for developing diabetes or heart disease. You and I should be so healthy.... And yet, Aetna reported savings of $1464/participant in the first year." (Al Lewis and Vik Khanna)  

Last Minute Budget Deal Contains Changes Affecting Employee Benefit Plans (PDF)
"Among the fiscal provisions are several changes to pension and healthcare benefits, which were largely included to generate revenue to offset the cost of the legislation.... PBGC premium increases ... Extension of DB funding stabilization rates ... Accelerate 2025 PBGC premium due date ... Expanded options for plan-specific mortality tables ... Repeal of ACA automatic enrollment." (Groom Law Group)  

Equity and Phantom Equity Based Compensation for LLCs
"LLCs taxed as partnerships can issue: Restricted or Performance Units ... Capital Interests ... Profits Interests ... Phantom Unit Rights or Unit Rights ... Phantom Unit Appreciation Rights." (Jackson Lewis P.C.)  

Blue Cross Blue Shield Association Announces Largest National Network of Patient-Focused Care Programs
Blue Cross and Blue Shield Association

Kyla M. Keck of SageView Advisory Group Elected to At-Large Seat on the American Retirement Association’s Board of Directors
SageView Advisory Group

PSCA Non-Qualified Plan Survey -- Participation Request
PSCA [Plan Sponsor Council of America]

Fidelity to Offer Envestnet Retirement Solutions’ Integrated Workstation to Retirement Advisors
Fidelity Investments

New Financial Finesse Study Uncovers Emerging Solution to America's Retirement Crisis
Financial Finesse

Qualifying FBi Clients can Secure Significantly Reduced Premiums on their Fiduciary Liability Insurance
Fiduciary Benchmarks, Inc.

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