ERISA Attorney
Kraw Law Group, a Professional Corporation
in CA

Trust Accountant for 401(k)/Defined Contribution Plans
R.J.L. Pension Services, Inc.
in FL

Retirement Plan Administrator
BENETECH, INC.
in CA

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[Guidance Overview]

IRS Provides Guidance on Health Reimbursement Arrangements
"While IRS rules allow an HRA to be integrated with a group health plan not sponsored by the employer sponsoring the HRA, IRS has confirmed that, in general, an HRA cannot be integrated with an individual market plan.... As a result of the documentary compliance requirement for HRAs provided in Notice 2015-87, employers must now carefully review their HRA documentation to ensure that it satisfies the ACA's market reforms. Employers that are considering sponsoring HRAs should proceed with caution[.]" (The Wagner Law Group)  

[Advert.]

Weight Loss at the Workplace: Legal Issues in Reducing Health Care Costs and Promoting Wellness

January 28 webinar - Learn about issues to identify and address when formulating and implementing a corporate wellness program that is aimed at weight loss. BenefitsLink discount.

Employers Can Provide Tax-Free Credit Monitoring and Other Identity Protection Services to Employees Even Before a Breach Happens, IRS Says
"The employer can provide the services without increasing its federal payroll taxes and employees can receive the services without incurring any additional federal tax liability. Employers and employees will still have to consider any potential state and local tax implications ... While these services would not constitute benefits covered under [ERISA], ... employers will want to carefully select the vendors that will provide the services, and take other steps to incorporate this into their overall benefit offerings." (Jackson Lewis via Lexology)  

What Will 2016 Hold for the Affordable Care Act and Employers?
"Employers will enter 2016 with the 'play-or-pay' mandate in full effect and new burdensome reporting obligations. However, a delay of the controversial 'Cadillac' tax on high-cost health plans and the repeal of the ACA's automatic enrollment provision are welcome news to employers. In the upcoming election year, the ACA remains a political punching bag, and additional changes in the future remain possible. Even as uncertainty about the ACA persists, employers should remain diligent in complying with the law and its existing requirements in 2016." (Littler)  

Identifying Insurer Areas of Advantage or Weakness in the Commercial Health Insurance Market
"Mandated risk adjustment and reinsurance programs, as well as the elimination of underwriting, have changed the determination of competitive advantage. Insurers that stay in the old mind-set and market to the healthiest individuals will not be able to thrive in this changing industry. Insurers have the opportunity to attract, enroll, and manage care for individuals with medical conditions that will be appropriately compensated by the market reforms." (Milliman)  

Text of HHS Rate Review Annual Report for Calendar Years 2014 and 2015 (PDF)
"Rate review reduced total premiums for renewed single risk pool plans by an estimated $1.1 billion in the individual market and by $418 million in the small group market, for a total of $1.5 billion.... In the individual market, 30 percent of covered lives were projected to enroll in single risk pool plans with a rate increase that was reduced or denied. In the small group market, the projection percentage was 19.6.... The number of issuers submitting a [Unified Rate Review Template (URRT)] in the individual or small group market grew from 795 in 2014 to 1,195 in 2015, and the number of products included on the URRTs nearly doubled." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

ACA Insurers Sweeten Health Coverage with Free Doctor Visits
"The change is rolling out in a limited number of plans following reports that high copays and deductibles have discouraged many Americans who signed up for private coverage the past two years from using their new insurance under the Affordable Care Act. Insurers say they hope encouraging visits to doctors will benefit members and their bottom lines by catching illnesses early before they become harder and more expensive to treat." (National Public Radio)  

Insurers Paid Close to $500 Million in Health Plan Rebates Last Year
"Health plans reimbursed customers approximately $478 million in 2014, translating to about $129 per family receiving a refund ... MLR premiums and rebate figures were collected for all healthcare providers in all states. California led the nation in MLR rebates with $98 million; Florida came in second, at about $60 million." (Healthcare Payer News)  

Health Insurers to Face Fines for Not Correcting Doctor Directories
"New regulations allow [CMS] to fine insurers up to $25,000 per beneficiary for errors in Medicare Advantage plan directories and up to $100 per beneficiary for errors in plans sold on the federally run insurance exchanges in 37 states. States are imposing their own rules and sanctions.... In November, California fined Anthem Blue Cross $250,000 and Blue Shield of California $350,000, after a survey found that more than 25% of doctors listed in their 2014 state directories weren't at the given location or denied accepting those plans." (The Wall Street Journal; subscription may be required)  

Making Sense of Price and Quantity Variations in U.S. Health Care
"[A recent study finds] that prices paid by insurance companies to providers vary dramatically both across regions, and within regions.... The researchers find a remarkable degree of variation in health care utilization across regions, both in the over-65 and under-65 population.... The study highlights that policy solutions to address variations in health care quantities are very different from policy solutions to fix variations in health care prices." (Health Affairs)  

Health Insurer Mergers Could Affect Credit Ratings
"The three health insurers planning to acquire another insurer -- Anthem, Aetna and Centene -- have each raised a large amount of debt in order to finance their deals with Cigna, Humana and HealthNet, respectively ... S&P could lower Anthem-Cigna's ratings by up to two notches, and it could lower Aetna's ratings by one notch. S&P could raise its ratings on Humana by up to two notches -- capped by its rating on Aetna -- and does not plan any ratings actions on HealthNet or Centene related to their pending merger." (FierceHealthPayer)  

[Opinion]

American Academy of Actuaries Comments to HHS on Notice of Benefit and Payment Parameters for 2017 (PDF)
10 pages. The Academy offers comments related to the risk adjustment, reinsurance, and risk corridor components of the proposed rule for the 2017 benefit and payment parameters, as well as comments on a number of other provisions in the proposed rule, including fair health insurance premiums, student health insurance coverage, the three-month grace period for enrollees, hardship exemptions, and small group considerations. (American Academy of Actuaries)  

Nonqualified Plan Sponsor Settles FICA Taxes Lawsuit for $3.35 Million
"The settlement amount is $3,350,000, and includes attorneys' costs, any award to the lead plaintiff in the case and litigation expenses. The settlement also provides that retirees will receive a 40% gross up of benefit distributions to cover their tax expenses." [Davidson v. Henkel Corp., No. 12-cv-14103 (E.D. Mich. Jan. 6, 2015; settlement approved Dec. 8, 2015)] (PLANSPONSOR)  

ISS's Equity Plan Scorecard: A New Era in Public Company Equity Compensation Plans (PDF)
8 pages. "[The ISS Equity Plan Scorecard] is predicated on detailed guidelines used by ISS when determining if it will recommend that shareholders vote for approval of an equity compensation plan and should be considered by publicly-traded companies when designing or amending their equity compensation plans. The plans subject to the Scorecard include stock option plans, restricted stock plans, omnibus equity plans, and stock-settled stock appreciation rights plans." (Holland & Knight)  

DOL obtains consent judgment restoring more than $50K to money purchase plan of Swedesboro, New Jersey, contractor
U.S. Department of Labor

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