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[Official Guidance]
Text of CMS Guidance: Risk Corridors Payment Commitments for the 2014 Benefit Year (PDF)
"[A]ssuming full collections of risk corridors charges for the 2014 benefit year, insurers will be paid an amount that reflects a proration rate of 12.6% of their 2014 benefit year risk corridors payment requests. The remaining 2014 risk corridors payments will be made from 2015 risk corridors collections, and if necessary, 2016 collections. In the event of a shortfall for the 2016 program year, [HHS] will explore other sources of funding for risk corridors payments ... This includes working with Congress on the necessary funding for outstanding risk corridors payments.... HHS is recording those amounts that remain unpaid following our 12.6% payment this winter as fiscal year 2015 obligation of the United States Government for which full payment is required."
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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[Guidance Overview]
HHS Regulatory Agenda, Fall 2015
A CMS item in the Final Rule stage is "Omnibus Group & Individual Insurance Market Reforms." An OCR item in the Prerule Stage is "HIPAA Enforcement: Distribution of a Percentage of Civil Money Penalties or Monetary Settlements to Harmed Individuals." An OCR item in the Proposed Rule stage is "Nondiscrimination Under the Patient Protection and Affordable Care Act."
(U.S. Department of Health and Human Services [HHS])
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[Guidance Overview]
ACA Reporting Requirements for Carriers and Employers (Part 18 of 24): Terminations, Changes in Status and Service Breaks Under the Monthly Measurement Method
"The final regulations under Code Section 4980H establish two -- and only two -- methods for determining an employee's status as full-time: the monthly measurement method and the look-back measurement method.... The monthly measurement method is particularly well-suited to employers and industries with stable workforces and low turnover. In most instances, the reporting burdens for these employers will be relatively manageable. But even in this environment, employees will from time-to-time terminate, change status, or incur service breaks. This [article] explores the reporting challenges associated with employee terminations, changes in status, and breaks in service under the monthly measurement method."
(Mintz Levin)
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[Guidance Overview]
EEOC Releases Proposed GINA Rule on Wellness Programs (PDF)
"[T]he Proposed Rule only provides guidance under Title II of GINA, which relates to employers. The Proposed Rule does not provide guidance under Title I of GINA, which relates to group health plans and is under the jurisdiction of the Departments of the Treasury, Labor, and Health and Human Services. There continues to be uncertainty regarding the level of inducements, if any, that may be provided with respect to spousal HRAs under Title I of GINA."
(Groom Law Group)
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CMS Report of 2014 Medical Loss Ratio Results (PDF)
"Since the [MLR] rule was enacted in 2011, more than $2.4 billion in total refunds will have been paid to consumers, including refunds for 2014.... For 2014, 3.7 million families representing a total of over 5.5 million consumers, are receiving approximately $470 million in refunds this year. The average refund per family is $139 in the individual market, $134 in the small group market, and $102 in the large group market." [An accompanying chart details MLR refunds by state.]
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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Discretionary Clauses and Choice of Law in ERISA Cases
"[E]ven if [Firestone Tire and Rubber Co. v. Bruch] discretion-granting language is present, that does not necessarily end the discussion, as illustrated by a recent ruling from a federal court in California.... [T]he court was presented with insurance policy documentation that clearly reserved discretionary authority to the insurer, Principal. Yet the court found the grant of discretion was negated and applied the de novo standard of judicial review[.] The court's rationale involved a choice of law determination." [Hirschkron v. Principal Life Ins. Co., No. 15-cv-00664 (N.D. Cal. Oct. 29, 2015)]
(DeBofsky & Associates, PC)
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State Law Claims Under Group Life Insurance Policy Were Preempted by ERISA
"On ERISA preemption grounds, a federal court has ruled against state law claims asserted by the beneficiary of a former school teacher who sought benefits from a group life insurance policy.... [A recent case] illustrates how a governmental employee's life insurance benefits may fall within the scope of ERISA when sponsored by a non-governmental 'employee organization' and be subject to the full weight of ERISA." [Woods v. American United Life Ins. Company, No. 1:15-cv-859 (N.D. Ala. Nov. 13, 2015)]
(Williams Mullen)
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New Oregon Paid Sick Leave Law Has Some Stakeholders Feeling Ill
"Oregon's new law applies to all employers, and to nearly Oregon's entire workforce -- full-time, part-time, seasonal and temporary employees. It's intended to cover many types of employee leave, from mental health to a care for a sick family member. The law goes into effect Jan. 1, 2016, but the government agency tasked with enforcing it -- the Bureau of Labor and Industries -- is still in the rulemaking phase. Of particular to concern to construction groups in the weeks ahead will be ensuring that contractors' existing sick leave policies, and collective bargaining agreements that provide sick leave, are covered under the law."
(DJC Oregon)
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How High Is America's Health Care Cost Burden? Health Care Affordability Tracking Survey, July-August 2015
"In the 12-month period ending in July-August 2015, 25 percent of privately insured adults had unaffordable health care costs as measured by the Affordability Index.... More than half (53%) of privately insured adults with incomes under 200 percent of poverty ($23,340 for an individual or $47,700 for a family of four) had unaffordable health care costs. Three of 10 (30%) adults with moderate incomes (up to $46,680 for an individual or $95,400 for a family of four) had unaffordable costs, which was double the rate of higher-income adults."
(The Commonwealth Fund)
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An HSA Portal May Not Be the Right Hub for You
"Perhaps you have spent significant time, effort and resources to create an employer portal that focuses more broadly on areas like health, wealth and career. You view this as your employees' hub and there is no reason to direct your employees away from it. Why not include links to your favorite HSA/consumerism tools, calculators and educational materials right on your portal?"
(Xerox HR Insights)
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Employers Struggle to Engage Employees in Health Programs
"Driven by ongoing concerns over worker stress (75%), obesity (70%) and sedentary lifestyles (61%) ... a large majority (84%) of U.S. employers identify health and productivity improvement as essential or moderately important to their health strategies.... [O]ver three-quarters (77%) of U.S. employers expect their organization's commitment to increase or significantly increase over the next three years.... Only one-third [of employees] said the well-being initiatives offered by their employers encouraged them to live healthier lifestyles.... [N]early one-third (32%) said the initiatives offered by their employers don't meet their needs. Nearly half (46%) don't want their employers to have access to their personal health information ... and close to one-third (30%) don't trust their employers to be involved in their health and well-being."
(Towers Watson)
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Obamacare's Fate May Rest on Patience of Insurers Aetna, Anthem
"While UnitedHealth has a small share of that market, Anthem and Aetna are two of the biggest players. Like UnitedHealth, neither has had financial success there -- Aetna has said it's losing money, while Anthem is making less than it would like. They're both working to widen profit margins and have said their strategy is based on the expectation that covering people under the law will become more profitable."
(Bloomberg)
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Health Care Law Results in $2.4 Billion in Consumer Rebates on Premiums Since 2011
"Today's results show that an increasing number of consumers are in plans where they are receiving more value for their premium dollars up front because their premium rates were set to reasonably reflect insurers' spending on medical care and quality improvement activities. The number of consumers in plans that owe refunds decreased by more than one million in 2014, from approximately 6.8 in 2013 to 5.5 million in 2014."
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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[Opinion]
The Feds Are Wrong: Lots of Wellness Programs Violate the ADA
"Workplace wellness programs discriminate. That's what they do.... The Affordable Care Act makes an exception, however, for wellness-based discrimination.... At the same time, the Americans with Disabilities Act ... says that employers can't conduct medical examinations, including medical histories, unless they're 'voluntary.' ... The question thus boils down to whether the EEOC can reasonably say that a health assessment is still 'voluntary' if there's a substantial financial penalty for refusing to take it. Notice that the ACA has no bearing on that inquiry. It's purely a question of the meaning of the ADA."
(The Incidental Economist)
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Benefits in General; Executive Compensation
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[Guidance Overview]
SEC Regulatory Agenda, Fall 2015
Items in the Proposed Rule stage include (but are not limited to): [1] Investment Company Advertising, Target Date Retirement Fund Name and Marketing; [2] Personalized Investment Advice Standard of Conduct; and [3] Rules Regarding Incentive Compensation. Items in the Final Rule stage include (but are not limited to): [1] Listing Standards for Recovery of Erroneously Awarded Compensation; [2] Pay Versus Performance; and [3] Reporting of Proxy Votes on Executive Compensation and Other Matters.
(Securities and Exchange Commission [SEC])
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[Guidance Overview]
DOL Regulatory Agenda, Fall 2015
EBSA items in the Proposed Rule stage are: [1] Conflict of Interest Rule -- Investment Advice; [2] Amendment to Claims Procedure Regulation; [3] Revision of the Form 5500 Series, including Implementing Related Regulations Under ERISA; and [4] Savings Arrangements Established by States for Non-Governmental Employees. EBSA items in the Final Rule stage are: [1] Amendment of Abandoned Plan Program; [2] Electronic Filing of Apprenticeship & Training Notices, and Top Hat Plan Statements; [3] Adoption of Amended and Restated Voluntary Fiduciary Correction Program; and [4] Final Rules under the Affordable Care Act for Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections. A Wage and Hour Division item in the Proposed Rule stage is: Establishing Paid
Sick Leave for Contractors, Executive Order 13706.
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
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[Guidance Overview]
IRS Regulatory Agenda, Fall 2015
IRS items in the Proposed Rule stage include: [1] Determination of Governmental Plan Status; [2] Deferred Compensation Plans of State and Local Governments and Tax-Exempt Entities; [3] Indian Tribal Governmental Plans; [4] Additional Rules Regarding Pension Plan Funding and Benefit Restrictions; [5] Requirements Relating to Pickup Arrangements Under Section 414(h)(2); [6] Eligible Combined Plan (under Code section 414(x) as added by the Pension Protection Act of 2006); [7] Section 280A Deduction Limitation Regulations; [8] Update to Minimum Present Value Requirements for Defined Benefit Plan Distributions; [9] Contributions of an Employer Under a Plan That Does Not Meet the Requirements of Section 401(a), including Application of Section 404(a)(5); [10] Guidance With Respect to FATCA Coordination; [11] Application of Section 409A to
Nonqualified Deferred Compensation Plans; [12] Collectively Bargained Welfare Benefit Funds; [13] Guidance Under Section 125; [14] Spousal IRAs, SEPs and IRA Technical Changes; [15] Implementation of Windsor; [16] Reporting and Notice Requirements for Deferred Vested Benefits Under Section 6057; [17] Application of Normal Retirement Age Regulations to Governmental Plans; [18] Requirements for Employee Stock Ownership Plans; [19] Extension of Time to File Certain Information Returns; [20] Nondiscrimination Relief for Closed Defined Benefit Plans; [21] Election to Include in Income in Year of Transfer; [22] Updated Mortality Tables for Determining Present Value; [23] Minimum Value of Eligible Employer-Sponsored Health Plans; [24] Administration of Multiemployer Plan Participant Vote on an Approved Suspension of Benefits Under MPRA; and [25] Section 72(t) 10% Additional Tax
Regulations. IRS items in the Final Rule state include: [1] Accrual Rules for Defined Benefit Plans; [2] Determination of Minimum Required Pension Contributions; [3] Notice to Participants of Consequences of Failing to Defer Receipt of Qualified Retirement Plan Distributions, including Expansions of Applicable Election Period and Period for Notices; [4] Reporting and Notice Requirements for Deferred Vested Benefits Under Section 6057; [5] Modifications to Minimum Present Value Requirements for Defined Benefit Plan Distributions; [6] Regulations Explaining How to Compute Unrelated Business Taxable Income (UBTI) of Voluntary Employees' Beneficiary Associations (VEBAs); [7] Removal of Rollover Allocation Rule From Designated ROTH Regulations; [8] Minimum Value of Employer Sponsored Coverage; [9] Transition Rules Relating to the Market Rate of
Return Requirements for Statutory Hybrid Plans; [10] Health Insurance Premium Tax Credit Additional Issues; [11] Health Insurance Provider's Fee; [12] Summary of Benefits and Coverage; [13] Suspensions of Benefits Under the Multiemployer Pension Reform Act of 2014; [14] Suspensions of Benefits Under the Multiemployer Pension Reform Act of 2014 (Temporary); and [15] Regulations Governing Organization of the Joint Board for the Enrollment of Actuaries. An OCC item in the Proposed Rule stage is: "Incentive-Based Compensation Arrangements."
(Internal Revenue Service [IRS])
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Press Releases
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David Rhett Baker, J.D., Editor and Publisher
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