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TAG Employer Services, LLC
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1199SEIU Funds
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Associated Pension Consultants
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Pen-Cal Administrators, Inc.
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T. Rowe Price
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16th Annual Employee Health Care Conference - The Changing Health Care Agenda: Pace, Process, Performance
March 10, 2016 WEBCAST
(Conference Board, The)

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[Official Guidance]

Text of 2016 Instructions for IRS Form 1099-H: Health Coverage Tax Credit (HCTC) Advance Payments (PDF)
"What's New: Truncating recipient's identification number on paper recipient statements.... HCTC extended and modified through 2019 ... Online fillable form ... Section 6050T requires that if you are a provider of qualified health insurance coverage (defined in section 35(e)) and you receive advance payments from the Department of the Treasury on behalf of eligible recipients pursuant to section 7527, you must file Forms 1099-H to report those advance payments. You must also furnish a statement reporting that information to the eligible recipient." (Internal Revenue Service [IRS])  

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[Official Guidance]

Text of 2015 Instructions for IRS Form 8965: Health Coverage Exemptions and Shared Responsibility Payment Calculation (PDF)
19 pages. "What's New: ... Several changes have been made to the types of coverage exemptions available for 2015. Some coverage exemptions have been added, clarified, or are no longer available.... A flowchart has been added to help you figure your shared responsibility payment." (Internal Revenue Service [IRS])  

[Guidance Overview]

ACA Numbers and Limits: Reference Guide (PDF)
One-page chart lists numerous dollar limits for 2014-2016, including: [1] 4980H Large Employer Shared Responsibility Penalty; [2] 5000A Individual Shared Responsibility Penalty; [3] 36B Marketplace Subsidies/Premium Tax Credits (PTC); [4] Health Insurance Reforms; and [5] Health Savings Accounts. (Kaufman & Canoles, P.C.)  

[Guidance Overview]

IRS Confirms Penalty Amounts for Pay or Play Penalties for 2015 and 2016
"With a mere two weeks to go in 2015, the IRS finally confirmed in a Notice that the penalty amounts for 2015 would be increased to $2,080 ($173.33/month) and $3,120 ($260/month).... A large employer who does not offer coverage to substantially all of its full-time employees in 2016 will be subject to an annual penalty of $2,160 ($180/month) multiplied by all of its full-time employees less 30 in 2016. An employer who does not offer minimum value, affordable coverage to a full-time employee who goes to the exchange and receives financial assistance will receive an annual penalty of $3,240 ($270/month) per full-time employee that goes to the exchange and receives financial assistance." (Graydon Head & Ritchey LLP)  

[Guidance Overview]

Eliminating Some of the 200 Possible Outcomes for Part II of the Form 1095-C
"[T]he Form 1095-C instructions make it clear that line 15 should only be completed if 1B, 1C, 1D, or 1E is entered on line 14. Taking the inverse of that statement line 15 should not be completed if 1A, 1F, 1G, 1H, or 1I is entered on line 14. Applying these two rules eliminates 110 of the 200 possible combinations for line 14, 15 and 16. Of the remaining 90 possible outcomes only 48 are true outcomes and some of these 48 are only theoretically possible and could only be expected to be seen in the most bizarre circumstances." (Health Care Attorneys P.C.)  

[Guidance Overview]

Departments Release Series of Final Rules Under the ACA
"Going forward, annual or lifetime dollar limits are prohibited whether the benefit is provided in network or out of network. Plan sponsors gain new flexibility to suspend Health Reimbursement Arrangement (HRA) balances rather than providing for permanent forfeiture. Plan sponsors cannot require children under 26 to live or work in the service area of a health maintenance organization (HMO) or other network." (Segal Consulting)  

[Guidance Overview]

New Guidance on the Mental Health Parity and Addiction Equity Act
"A plan administrator or health insurer cannot refuse to provide the plan's medical necessity criteria on the basis that the information is proprietary or has commercial value. A plan administrator or health insurer may provide an understandable summary of the plan's medical necessity criteria, but this not a substitute for providing the actual criteria when requested. Some determinations made by non-grandfathered plans are subject to external review." (Segal Consulting)  

Best Practices for Improving Health Plan Cost Recoveries
"This article suggests tactics plan fiduciaries can use to make recoveries in the event of a worst-case Montanile ruling, which would result in a world where dissipated funds (regardless of the reason) mean no recovery for the plan.... Identify the disputed funds ... Condition payment on signed subrogation agreements ... Seek refunds ... Impose offsets ... Use ethical considerations." (Roy Harmon III, in Thompson SmartHR Manager)  

Cadillac Tax Likely to be Delayed
"The bill would delay implementation of the Cadillac tax until 2020 -- two years past its original 2018 effective date. Many commentators will soon question whether the tax will ever actually take effect.... A separate 200+ page tax extender bill ... titled the Protecting Americans from Tax Hikes Act of 2015, includes a provision to restore parity to the tax exclusion for parking and mass transit benefits." (ABD Insurance & Financial Services)  

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Spending Deal's Adjustments to Health Law Seen as Step to Permanent Change
"A two-year delay to the law's 'Cadillac tax' on high-value health plans means the government will miss out on about $3 billion in revenue in 2018, and $6 billion in 2019 ... Industry groups trying to repeal the Cadillac tax as well as supporters who are working to preserve it say they see the two-year delay as a step toward axing the tax." (The Wall Street Journal; subscription may be required)  

Key Proposals to Strengthen the ACA (PDF)
"[The authors] propose nineteen steps that could help fix recognized flaws in the ACA as well as build on its accomplishments. Taken together, these proposals would further improve the access and affordability of health care under the ACA, create more robust provider networks, enhance competition among insurers, improve the consumer experience, and strengthen the Medicaid program.... This report identifies problems and suggests potential solutions." (Timothy Jost and Harold Pollack, for The Century Foundation)  

NAIC Updates Model Network Adequacy Law to Address Narrow Networks and Surprise Bills
"The Network Adequacy Model Act looks to state insurance commissioners to determine the adequacy of an insurer's network, using criteria such as geographic population dispersion and new health care delivery options like telemedicine. Insurers are now required to have a process in place to ensure that covered persons can access covered benefits at the in-network level (including for cost sharing) from a non-participating provider." (Epstein Becker Green)  

Access to Care and Affordability Have Improved Following ACA Implementation But Problems Remain
"This study used data from the Health Reform Monitoring Survey to describe changes in access and affordability for nonelderly adults from September 2013, just prior to the first open enrollment period in the Marketplace, to March 2015, after the end of the second open enrollment period. [The study] found strong improvements in access to care for all nonelderly adults and across income and state Medicaid expansion groups ... [and] improvements in the affordability of care for all adults and for low- and moderate-income adults. Despite this progress, there were still large gaps in access and affordability in March 2015, particularly for low-income adults." (Health Affairs)  

Two Years In, ACA's Impact on Health Insurer Ratings Remains Limited
"In 2014, with few exceptions, ACA business proved to be unprofitable for health insurers, and [S&P expects] the same when full-year 2015 results are reported. The significant downsizing of risk-corridor payments for 2014 and the questionable sources of funding for those payments for 2015 and beyond further hurt profitability.... Although ... most health insurers can withstand a period of moderate strain,... there could be pressure on the creditworthiness of insurers with a meaningful proportion of ACA business." (Standard & Poors)  

Insurers Finding It Too Difficult to Gain Market Share in Mandated Multi-State Plans
"The law required that at least two multi-state plans be available to consumers in 31 states by 2014 and in all states by 2017. However, the law doesn't require insurers to offer the plans and most so far have opted not to. Federal officials and insurance experts say it is unlikely that the 2017 goal will be met.... The multi-state plan program's halting start threatens to undermine one of the key tenets of the health law: that boosting competition in the individual market will lead to lower premiums and better coverage." (Healthcare Payer News)  

[Official Guidance]

Text of IRS Notice 2016-01: Standard Mileage Rates (PDF)
"The standard mileage rate for transportation or travel expenses is 54 cents per mile for all miles of business use (business standard mileage rate).... The standard mileage rate is 14 cents per mile for use of an automobile in rendering gratuitous services to a charitable organization under Section 170.... The standard mileage rate is 19 cents per mile for use of an automobile [1] for medical care described in Section 213, or [2] as part of a move for which the expenses are deductible under Section 217." (Internal Revenue Service [IRS])  

[Guidance Overview]

2015 Q&As: EEOC Meeting with ABA Joint Committee on Employee Benefits, May 7, 2015 (PDF)
4 pages. Includes questions on ADA and exclusion of prescription drugs from a group health plan's formulary; wellness plan design; ADA and GINA issues relating to a spouse's disability; wellness programs provided by a third-party vendor; and ADEA and retirement planning advice. (Joint Committee on Employee Benefits [JCEB], American Bar Association)  

Worker Opinions About Employee Benefits: Differences Among Millennials, Baby Boomers, and Generation X Have Implications for Plan Sponsors
"Millennials are less likely than Baby Boomers and Gen Xers to report health insurance as the most important benefit they receive at work. Millennials are more likely than Baby Boomers or Gen Xers to report that they value life insurance and paid time off as the most important benefit. Millennials are less likely than Baby Boomers and Gen Xers to report that the benefits a potential employer offers are extremely important in their decision to accept or reject a job.... Millennials are more likely than other workers to respond that they do not know about their benefits. Participation in various employee benefit programs is generally lower among Millennials than among Baby Boomers and Gen Xers." (Employee Benefit Research Institute [EBRI])  

Think Automatic Vesting on a Change in Control Is Not Important? Ask This Former Employee
"[T]he court found that the language of the [long-term incentive plan (LTIP)] was clear; there could be no legal dispute that [the employee's] employment with the company had terminated, even though she continued to sit at the same desk and perform the same job functions on the day after the sale of OCD as she did on the day before the sale. The LTIP did not provide for accelerated vesting of [this employee's] RSUs. The provisions of the LTIP on change in control simply did not apply to the sale of a division of the company." [Timian v. Johnson & Johnson, No. 6:15-cv-06125 (W.D.N.Y. Oct. 26, 2015)] (Winston & Strawn LLP)  

Executive Incentives in the Natural Resources Industry Include Safety Metrics
"At the executive level ... [i]n almost half (45%) of the companies surveyed, safety metrics represent a percentage of the annual incentive opportunity, typically between 10% and 20% of the overall opportunity. In about a quarter (22%) of the survey participants, the compensation committee considers safety when applying discretion to annual incentive plan outcomes, while another 12% use safety goals as a hurdle in their annual incentive plans." (Towers Watson)  

Executive Compensation Compliance Matters to Consider in 2016
"[I]ssues companies will need to address in the months ahead [include]: ... Hedging Policy Disclosure ... CEO Pay Ratio ... Pay-for-Performance Disclosure ... [and] Clawback Policy Disclosure ... [for which the] following steps should be on company calendars in advance of the rules being finalized: [1] Inventory existing compensation arrangements ... to determine what forms of pay are and aren't subject to clawbacks.... [2] Determine the extent to which current grant agreements and plan documents need to be updated to become subject to the clawback policy.... [3] Understand how the recoupment process (and stock value declines) would affect executives under different clawback scenarios.... [4] Instruct your legal counsel to report to you the extent to which imposing clawbacks is permitted or feasible under state and foreign laws.... [5] [R]eview the process by which pay decisions are documented so it's clear which payouts are based on financial metrics and which are not[.]" (Towers Watson)