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The Segal Group
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Verisight
in IL

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PenSys, Inc.
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SunGard Relius
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Hooker & Holcombe
in CT

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USI Consulting Group
in CT, NY

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Consulting Actuaries Incorporated
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What Every Employer Needs to Know About the Affordable Care Act
November 12, 2015 WEBCAST
(Wagner Law Group P.C.)

Advanced Pension Conference 2016
February 10, 2016 in FL
(SunGard Relius)

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Today's Discussions on the BenefitsLink Message Boards

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Employee Out-of-Pocket Health Plan Costs Skyrocketing, Deductibles Doubled in Five Years
"The survey finds median in-network deductibles for singles jumped 33 percent from $1,500 in 2014 to $2,000 in 2015, while deductibles for families remained unchanged at $4,000. When out-of-network, families are hit hardest: their median deductible increased 16.7 percent from $6,000 in 2014 to $7,000 in 2015, while the costs for singles remained unchanged at $3,000. Both singles and families are seeing large increases in median in-network out-of-pocket maximums (up 14.3 percent and 8.8 percent, respectively, to $4,000 and $8,700). However, again for out-of-network costs, families are bearing larger dollar increases ($2,000) versus singles ($1,000)." (United Benefit Advisors)  

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Will Cheaper Health Insurance Really Raise Wages? The Evidence Is Thin
"Economists have convincing arguments about why, in theory, the Cadillac tax should raise wages. But when it comes to actual data -- real-life examples that show the wage-premium trade-off is happening -- evidence is sparse." (Vox)  

Microsimulation of Demand for Health Insurance (PDF)
7 presentation slides. Topics: [1] CBO's Health Insurance Simulation Model (HISIM); [2] CBO Data Used in HISIM; [3] Major Outcomes Modeled by CBO's HISIM; [4] Advantages of Microsimulation Modeling of Health Insurance Coverage Versus Other Approaches; [5] Value of MEPS Household Component Data to HISIM; and [6] Value of MEPS Insurance Component Data to HISIM. (Congressional Budget Office [CBO])  

IRS Health Care Tax Tip 2015-70: Understanding Your Form 1095-B, Health Coverage
"Form 1095-B, Health Coverage, is used to report certain information to the IRS and to taxpayers about individuals who are covered by minimum essential coverage and therefore aren't liable for the individual shared responsibility payment.... By January 31, 2016, health coverage providers should furnish a copy of Form 1095-B, to you if you are identified as the 'responsible individual' on the form." (Internal Revenue Service [IRS])  

CMS Statement to House Ways and Means Health Subcommittee on Consumer Operated and Oriented Plan (CO-OP) Program (PDF)
"New entrants to any market, especially the insurance market, can face pressures, particularly in early stages. CO-OPs entered the health insurance market with a number of challenges, including building a provider network and customer support, no previous claims experience on which to base pricing, and competition from larger, experienced issuers. As with any new set of business ventures, some CO-OPs have succeeded while others have encountered more challenges." (Committee on Ways and Means, U.S. House of Representatives)  

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Join us in Las Vegas Nov. 16-18 at IHC FORUM West! Learn next steps and best practices in health care consumerism and plan design, as well as ACA compliance and reporting issues for 2015 and beyond!

With Michigan Closure, More Than Half of ACA CO-OPs Now Out of Insurance Marketplaces
"On [Nov. 3], two days after the start of the new enrollment season in insurance exchanges created under the health-care law, the Web site of Michigan's Consumers Mutual Insurance posted notice that it will not sell coverage for 2016. That co-op becomes the 12th plan to fail in the past year -- and the ninth this fall -- out of the 23 that opened at the start of 2014.... The dozen collapses will disrupt insurance for 740,000 individuals and small-business employees[.]" (The Washington Post; subscription may be required)  

A Tale of Two Deliveries, or an Out-Of-Network Problem
"[S]electing an 'in network' hospital is only part of the puzzle for consumers negotiating the health care system.... Who would have the presence of mind during labor to ask whether the anesthesiologist on call is part of her insurance network? While providing patients with information regarding which physicians are in network is an important part of health insurance transparency, it is meaningless in situations where the patient has no choice." (Health Affairs)  

California Fines Top Health Insurers for Overstating Obamacare Networks
"The state's Department of Managed Health Care levied fines of $350,000 against Blue Shield of California and $250,000 for Anthem Blue Cross. At issue were the companies' error-riddled provider directories that frustrated many consumers statewide as they tried to find doctors during the rollout of the Affordable Care Act in 2014. As a result, some patients incurred big unforeseen medical bills because they unwittingly went out of network for care. In addition to the state's enforcement action, consumer lawsuits are still pending against both insurers." (Los Angeles Times)  

Committee Votes to Raise Health Care Premium for New Hampshire Retirees Under 65
"Roughly 3,000 state retirees will pay an additional $46 a month for health care under a plan lawmakers approved Tuesday. The Joint Legislative Fiscal Committee voted 6-4 to raise premium contributions from 12.5 to 17.5 percent for state retirees under age 65. The change will take effect Jan. 1 and save about $2.8 million, helping lawmakers close a $10.6 million deficit in the state retiree health plan that has been driven by rising pharmaceutical costs." (Concord Monitor)  

PPOs Decline in Marketplace Plans
"Only 33 percent of 2015 silver plan PPO offerings remain available in 2016. In 22 states, all of the PPO offerings for 2015 were either dropped or reduced, with only 11 states keeping their offerings unchanged. The dropping of PPO plans occurred either because carriers exited the market, or because they discontinued their PPO plans." (Robert Wood Johnson Foundation)  

[Opinion]

Unaffordable Care Act's Third Open Enrollment Nothing to Celebrate
"[P]remiums for coverage in Alaska, Colorado, Hawaii, Idaho, Minnesota, Montana, Oklahoma and Tennessee, for example, will rise by about one-third in 2016. Rates in Arizona, Delaware, Nebraska, North Carolina, Oregon, South Dakota and West Virginia will increase by 20 percent to 25 percent. Residents in Iowa, Kansas, Louisiana, Nevada, North Dakota, South Carolina and Utah will see increases of above 10 percent or more." (National Center for Policy Analysis Health Policy Blog)  

[Opinion]

Risk Selection Threatens Quality of Care for Certain Patients: Lessons from Europe's Health Insurance Exchanges
"The best strategy for reducing incentives for risk selection is to improve risk adjustment so that insurers' reimbursement is aligned with predicted medical expenses.... [T]ying reimbursement to a patient's health care expenses in the previous year reduces the risk of losses but discourages efficiency among insurers. Dutch officials mitigated this risk by, among other things, relying on expenditures from multiple prior years. The U.S. also might consider factoring disability, pharmaceutical costs, and previous use of durable medical equipment into risk adjustment formulas that determine payment." (The Commonwealth Fund)  

[Guidance Overview]

November and December 2015 Filing and Notice Deadlines for Qualified Retirement and Health & Welfare Plans
"The filing and notice deadline table below provides key filing and notice deadlines for the next two months. If the due date falls on a Saturday, Sunday, or legal holiday, the due date is delayed until the next business day. Please note that the deadlines will generally be different if your plan year is not the calendar year. Please also note that the table is not a complete list of all applicable filing and notice deadlines (including any available exceptions and/or extensions), just the most common ones." (King & Spalding)  

Reply Brief for Petitioner Montanile to Supreme Court on Tracing Requirement for ERISA Overpayments (PDF)
"An agreement can define the scope of property to which a lienholder is entitled. But no agreement can create a lien that is enforceable against something other than specific property. That is simply not a lien... Similarly situated litigants said precisely the same thing nearly fifteen years ago in Great-West. Since then, the world has not crumbled, and Congress has not rushed in to correct this Court's alleged error. As this Court and ERISA litigants well know, Congress' decision to limit 29 U.S.C. Section 1132(a)(3) to 'equitable relief' has its pluses and minuses. But it is up to Congress, and Congress only, to change that equation." [Bd. of Trustees of the National Elevator Industry Health Benefit Plan v. Montanile, No. 14-11678 (11th Cir. Nov. 25, 2014; oral arg. sched. Nov. 9, 2015)] (Robert Montanile, petitioner)  

Wellness Programs Add Financial Advice to Improve Employee Health
"About half of all U.S. employers now offer financial wellness programs, although how they define them varies. Many companies have long offered lectures on topics like retirement. But increasingly, say analysts tracking the trend, employers are tailoring their programs to the worker -- more like a personal trainer who works on your budget rather than your waistline." (National Public Radio)  

iJoin Solutions and Alliance Benefit Group Announce Strategic Partnership
iJoin Solutions

US Labor Department Sues DC-area Government Contractor and Employee Benefit Plan Service Providers
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

HealthCare.gov Pilots New Doctor Lookup Feature
Centers for Medicare & Medicaid Services [CMS]

John Hancock to Acquire Assets of Transamerica Broker Dealer Unit
John Hancock Financial Network

Mercer Announces US Leadership Changes in Support of Accelerated Growth in Defined Contribution and Financial Wellness
Mercer

InterOcean Capital, LLC is Certified for Fiduciary Excellence
Centre for Fiduciary Excellence [CEFEX]

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