Health & Welfare Plans Newsletter

November 9, 2015

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DC/401(k) Administrator
Gelman Pension Consulting, Inc.
in NY

Benefit Consultant
Unified Trust Company, N.A.
in ANY STATE, KY

Retirement Plan Administrator
Matthews Benefit Group, Inc.
in FL

Pension Plan Administrator
Growing Retirement Plan Administration Firm
in NY

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Webcasts and Conferences

ERISA Cyber Security – The Next Frontier
November 18, 2015 WEBCAST
(Wagner Law Group P.C.)

Best Behavioral Practices to Solve the DC Outcomes Crisis
November 19, 2015 in CA
(Western Pension & Benefits Council)

FMLA Update: Hot Topics and Avoiding Pitfalls
January 28, 2016 WEBCAST
(International Foundation of Employee Benefit Plans [IFEBP])

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[Official Guidance]

Text of 2015 Instructions for IRS Form 8889: Health Savings Accounts (HSAs) (PDF)
"Use Form 8889 to: [1] Report health savings account (HSA) contributions (including those made on your behalf and employer contributions), [2] Figure your HSA deduction, [3] Report distributions from HSAs, and [4] Figure amounts you must include in income and additional tax you may owe if you fail to be an eligible individual." [Also available: 2015 IRS Form 8889.] (Internal Revenue Service [IRS])  


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[Official Guidance]

Text of CMS Web-Broker Public List, November 2015 (PDF)
"CMS regulations establish additional requirements that apply when an agent or broker uses their own website, or that of another agent or broker, to facilitate enrollment in a qualified health plan through the FFM ['web-brokers'].... This list contains the names of web-brokers who have completed FFM registration (including execution of the required agreements) for the 2016 plan year. This list is current as of November 4, 2015 and CMS anticipates updating the information on a monthly basis." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

After-Tax Purchases of Optional Group Term Life Insurance Avoid Imputed Income
"Even when premiums are paid entirely by employees with after-tax dollars, optional life insurance can result in imputed income if the insurance is treated as provided under a policy carried by the employer. This may happen if the after-tax coverage is sold in conjunction with other coverage that is employer-paid. But it may also happen for separate coverage if the employer arranges for payment of the premiums by employees, and those rates 'straddle' the Table I rates -- that is, the rate for at least one employee is lower than the Table I rate and the rate for at least one other employee is higher than the Table I rate. Here the employer avoided aggregation of its basic and optional policies, and avoided imputed income on the optional policies because there was no straddle: all of the rates were less than or equal to the Table I rates." [PLR 2015 42003 (Oct. 16, 2015)] (Thomson Reuters / EBIA)  

[Guidance Overview]

DOL Advisory Opinion Addresses Whether Stop-Loss Insurance Policy Is ERISA Plan Asset
"Because an advisory opinion addresses only the fact pattern presented, we cannot tell whether the DOL considers all of these factors necessary to avoid plan-asset status for a stop-loss policy purchased in connection with a contributory plan. Indeed, it's not clear from the opinion how the fourth factor would be applied, making it hard to reconcile how the DOL's description of the employer's special accounting system, under which all claims would be paid from the account to which participant contributions are deposited, could ensure that the employer never received reimbursements from the insurer for claims paid with participant contributions." [DOL Advisory Opinion 2015-02A (Oct. 19, 2015)] (Thomson Reuters / EBIA)  

[Guidance Overview]

EEOC Proposed Regs Address Genetic Information in Wellness Programs
"Because information about the current or past health status of an employee's spouse is considered to be genetic information about an employee ... employers face uncertainty as to whether providing incentives in exchange for information on an HRA about the spouse's current or past health status will subject them to liability under Title II of GINA. The proposed rule would clarify that offering limited incentives in these circumstances is permitted under the stated conditions. The guidance also aligns GINA with the EEOC's proposed wellness program regulations issued under the Americans with Disabilities Act (ADA) in April 2015[.]" (Thomson Reuters / EBIA)  


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Five Ways ACA Can Drive Innovation in Your Benefits Program
"Think of the ACA disruption as an opportunity for you to redefine what a benefits program can be.... Here are just five of the emerging trends that could make a huge difference for your employees as they enter a new era of healthcare consumerism: [1] Retail Clinics ... [2] Telemedicine ... [3] Digital Rx ... [4] Wearables ... [5] Transparency Tools." (Benefitfocus)  

'Carving Out' Spousal Benefits: Cost-Cutting, with Repercussions
"There are several ways to carve out spousal health care benefits: [1] Restricting health care coverage only to spouses who do not have health insurance available elsewhere, such as through the spouse's own employer. [2] Imposing a surcharge on coverage for spouses who have health insurance available elsewhere. [3] Eliminating premium subsidies for spouses who have health insurance available elsewhere. [4] Offering a monetary reward to employees who do not enroll their spouses in the health plan. Taking any one of these approaches can lead to significant cost-savings." (Society for Human Resource Management [SHRM])  

The Maze of Mental Health Parity Enforcement
"Compliance with the parity law is monitored by a patchwork of regulatory authorities, depending on how and where an individual is insured. Individuals who purchase insurance on their own -- either through the Marketplace or on the individual market -- or who have insurance through an employer that is fully insured file complaints with their state department of insurance.... Officials in Alabama, Oklahoma, Missouri, Texas, and Wyoming have determined that they lack authority under state law to enforce the MHPAEA, so individuals in those states must file complaints with HHS. Individuals who have employer-based insurance in which the employer is self-insured file complaints with the federal Department of Labor. Individuals covered by Medicaid go to the state Medicaid agency, while those who work for a state or local government that self-insures must turn to HHS." (Health Affairs)  

Responding to HIPAA Breaches
"[1] Stop the breach.... [2] Notify the privacy officer.... [3] Respond promptly.... [4] Investigate appropriately.... [5] Mitigate the effects of the breach.... [6] Correct the breach.... [7] Impose sanctions.... [8] Determine if the breach is reportable to the individual and HHS.... [9] If required, report the breach to the individual and HHS.... [10] Log the breach in accounting log." (Holland & Hart LLP)  

Supreme Court to Hear ACA Birth-Control Challenges
"On [Nov. 6], for the fourth time in three years, the Supreme Court agreed to rule on challenges to the new federal health care law -- this time, religious non-profit institutions' objection to the Affordable Care Act's birth-control mandate, which requires employers to provide their female employees with health insurance that includes no-cost access to certain forms of birth control. The Court accepted parts of all seven cases on that issue filed with it under the ACA. It has not yet spelled out how those will be consolidated for a hearing -- planned for late March." (SCOTUSblog)  

New Yorkers Face Hard Decisions After Collapse of Health Republic Insurance
"Health Republic has now become a cautionary tale and a warning to other struggling insurers.... Problems arose in September when state regulators said they were closing the co-op and instructed policy holders to seek new insurance plans on the federal exchange. Initially, Health Republic plans were to stay in effect until the end of the year. But last week, the State Department of Financial Services said it had moved the date to Nov. 30." (The New York Times; subscription may be required)  

[Opinion]

The Future of Health Insurance in the United States
"In the Affordable Care Act, and in regulation implemented by Medicare (CMS) this year, financial risk is be shifted to doctors and hospitals from payers. Through a variety of alternative payment programs (accountable care organizations, bundled payments, value-based purchasing programs, avoidable readmissions, patient centered medical homes et al.), doctors and hospitals will be paid based on their management of cost and quality. And capitated payments from insurers, employers, Medicaid and Medicare are likely to follow as payers shift their financial risk to providers." (Paul Keckley, Ph.D., Navigant Healthcare)  

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