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[Guidance Overview]
DOL Proposes New Regs for Disability Benefit Claims
"One of the key additions to the regulations is a requirement giving the claimant the 'last word' in the appeal process.... The regulations require 'automatic' timely disclosure of the new evidence and an opportunity for the claimant to respond before the appeal decision deadline expires; and that if the response triggers another round of point/counterpoint, the claimant must be furnished with new evidence and given an opportunity to respond even if it means tolling the time to decide the appeal until the claimant responds."
(DeBofsky & Associates, P.C.)
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[Guidance Overview]
DOL Issues Proposed Revisions to Disability Plan Claims Regulations
"Failure to establish or follow claims procedures consistent with the new (and existing) requirements will result in the claimant being deemed to have exhausted the administrative remedies under the Plan and entitled to pursue any available remedies under ERISA Section 502(a), unless the violation is de minimis. The claim or appeal will be deemed to have been denied on review without the exercise of discretion by an appropriate fiduciary."
(Seyfarth Shaw LLP)
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[Guidance Overview]
Interim No More, ACA Insurance Reforms Promoted
"[D]etermination of grandfather status applies separately with respect to each benefit package ... [T]he prohibition [on lifetime limits on coverage and annual limits on coverage for essential health benefits (EHB)] does not bar a plan or insurer from excluding all benefits for a condition if it does so regardless of when the condition arose, although other provisions of the ACA like the essential health benefits requirements may preclude such exclusion.... The Final rule allows plans and insurers not subject to EHB requirements to pick among any of the EHB benchmarks that apply in any of the 50 states or the District of Columbia or the three largest federal employee health benefit program plans available nationally."
(Wolters Kluwer Law & Business)
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[Guidance Overview]
Proposed Benefits and Payment Rule Includes Standardized Plans, New Network Adequacy Standards
"The proposed rule would create six standard option plans ... at the 73 percent, 87 percent, and 94 percent actuarial-value levels -- available for individuals eligible for cost sharing reduction payments.... [S]tates in which the FFM is operating would be asked to select from a set of network adequacy metrics ... [I]nsurers offering QHPs in any marketplace would have to provide enrollees at least 10 days' notice prior to a procedure in an in-network facility if the enrollee might receive out-of-network services, for example from an out-of-network anesthesiologist or pathologist.... For 2017, the [premium adjustment] percentage would increase 5.1 percent over 2016, 13.3 percent over 2014. The annual maximum out-of-pocket limit would increase from $6,350 in 2014 to $7,150 for an individual for 2017." [A related article by the author addresses the proposed rule in more detail.]
(Timothy Jost, in Health Affairs)
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[Guidance Overview]
IRS Releases 2015 Form 8889 and Instructions for HSA Reporting
"Although Form 8889 is filed by HSA holders as an attachment to Form 1040, employers and advisors working with HSAs should have a basic understanding of its scope. The similarity between this year's and last year's versions was expected, as the rules for HSAs have remained relatively stable since last year."
(Thomson Reuters / EBIA)
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Paid Family Leave, Fathers' Leave-Taking, and Leave-Sharing in Dual-Earner Households
"[The authors] study California's Paid Family Leave (CA-PFL) program, which is the first source of government-provided paid parental leave available to fathers in the United States.... [F]athers in California are 0.9 percentage points ... more likely to take leave in the first year of their children's lives when CA-PFL is available.... CA-PFL increases father-only leave-taking (i.e., father on leave while mother is at work) by 50 percent and joint leave-taking (i.e., both parents on leave at the same time) by 28 percent. These effects are much larger for fathers of sons than for fathers of daughters, and almost entirely driven by fathers of first-born children and fathers in occupations with a high share of female workers."
(National Bureau of Economic Research [NBER])
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Health Plans Should Learn Rules Against Balance Billing
"Regulators are especially concerned when balance billing occurs in connection with emergency services, because then patients are not in control of which providers are treating them and can't necessarily stay in-network ... Because of concerns with consumer protection, regulatory authorities at the federal and state level have responded with preventive rules."
(Thompson SmartHR Manager)
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Midwest Employers Are Actually Spending Less on Health Benefits
"In the first two quarters of this year, Midwest employers reduced their spending on health benefits compared with the same two quarters in 2014 ... The reduction was modest -- just 0.8 percent from the second quarter of 2014 to the second-quarter of 2015. But that's the first time benefits spending has gone down since the BLS started tracking these data in 2004."
(Indianapolis Business Journal)
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[Opinion]
House Hearing Shines Some Light on Secretive PBM Practices But More Answers Needed
"This hearing was an important step in investigating important and sometimes troubling aspects of the relationship between PBM corporations and community pharmacies, and the impact this relationship has on patients and payers. However, several questions remain. For example, [Amy Bricker of Express Scripts, and Natalie Pons of CVS Health] alluded to robust audit rights their health plan clients have. But they did not address which party selects the auditor; what information do auditors have access to and what information does the PBM corporation deem proprietary; and how the information affects the outcome of the audit."
(National Community Pharmacists Association [NCPA])
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Benefits in General; Executive Compensation
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[Guidance Overview]
IRS Issues Guidance on Applicability of Section 162(m) to CFO Compensation
"[A recent IRS Chief Council advice memorandum] leaves open several questions, including [1] whether a smaller reporting company need only be eligible to rely on the scaled-back disclosure rules or whether it must actually rely on them, in order for Section 162(m) to apply to compensation paid to the company's principal financial officer; [2] whether compensation paid to the principal financial officers of emerging growth companies, which are also eligible to rely on the same scaled-back disclosure rules, will also be subject to Section 162(m); and [3] how the IRS will treat deductions already claimed for compensation paid in excess of the $1 million limitation to CFOs of smaller reporting companies or emerging
growth companies since 2008."
(Wilmer Hale)
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ISS and Glass Lewis Issue 2016 Policy Updates
"Glass Lewis now indicates that if it identifies egregious compensation practices, it may not only recommend against the Say-on-Pay vote but also recommend against the compensation committee based on the practices or actions of the committee during the year.... ISS will generally recommend against the Say-on-Pay proposal where there is an external management structure in place and there is insufficient detail in the company's disclosures for ISS to perform a comprehensive pay-for-performance analysis."
(EdwardHauder.com)
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SEC Official Unveils Ambitious Executive Compensation Proxy Disclosure Review Project
"Keith Higgins, Director of the SEC's Division of Corporation Finance, announced ... that the Commission is expanding its comprehensive review of corporate disclosures to include an examination of the descriptions of executive compensation in the proxy and the accompanying tables.... The Project was started by the SEC two years ago and initially focused on a review of business and financial reporting of annual and quarterly reports. However, Mr. Higgins stated that the next priority would be executive compensation and governance information."
(HR Policy Association)
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Press Releases
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David Rhett Baker, J.D., Editor and Publisher
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