Health & Welfare Plans Newsletter

January 6, 2016

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Employee Benefits Jobs

Defined Benefit Administrator
TPA firm in sunny Phoenix, Arizona
in AZ

Sr. Relationship Manager
AIG
in AZ, CO, IL, MO, NM, TX

5500 and Trust Specialist
Kravitz, Inc.
in CA

ERISA Compliance Specialist
Milliman
in TX

Director for Retirement Programs and Services
Board of Regents of the University System of Georgia
in GA

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Webcasts and Conferences

Cyber Risk and the Actuary
January 14, 2016 WEBCAST
(Society of Actuaries)

2016 ABA Midyear Meeting
February 3, 2016 in CA
(ABA Joint Committee on Employee Benefits [JCEB])

Interaction of Employer-Provided Group Health Plans with Marketplace Coverage, COBRA, and Medicare
February 4, 2016 WEBCAST
(ABA Joint Committee on Employee Benefits [JCEB])

Certificate Series
February 15, 2016 in CA
(International Foundation of Employee Benefit Plans [IFEBP])

Telemedicine Adoption: Developments and Barriers to the Public and Private Sectors
February 18, 2016 WEBCAST
(International Foundation of Employee Benefit Plans [IFEBP])

Public Sector Plan Headlines
July 13, 2016 WEBCAST
(Conference of Consulting Actuaries)

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Discussions


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[Official Guidance]

Text of IRS AIR Submission Composition and Reference Guide for Tax Year 2015, version 2.6 (PDF)
112 pages, dated January 2016. "This document covers details on composing and submitting Form 1094/1095-Bs and Form 1094/1095-Cs by transmitters to IRS. The scope of the document addresses the Application to Application interface (A2A -- application based via SOAP messages exchanged between client and exposed Web Service endpoints) and the Web User Interface (Web UI-browser-based requiring human initiation)." (Internal Revenue Service [IRS])  


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[Official Guidance]

Text of 2015 Instructions for IRS Form 8965: Health Coverage Exemptions (And Instructions for Figuring Your Shared Responsibility Payment) (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])  

Group Health Plan Action Items and Reminders for the New Year
"While plan sponsors of group health plans breathed a little easier this year-end, there are still important action items and reminders to consider as we look to 2016.... 2016 Applicable Large Employer status ... 2015 Transitional Reinsurance fee ... 2015 Patient-Centered Outcome Research Institute (PCORI) fee ... 'Cadillac Tax' delay ... Housekeeping for 2016 changes to health and welfare plans." (Morgan Lewis)  

Recent Trends in Employer-Sponsored Health Insurance Premiums
"Between 1999 and 2015, premiums increased by 203%, outpacing both inflation and workers' earnings. However, growth of premiums for family coverage slowed toward the end of that time period, from an average of 11% per year between 1999 and 2005 to 5% per year between 2005 and 2015. Between 2014 and 2015, the average premium for single and family coverage increased 4%, and over the past 5 years, deductibles increased faster than both premiums and wages." (JAMA)  

CDHP Enrollees More Cost Conscious Than Traditional Plan Enrollees
"Those in a CDHP or HDHP were more likely than those with traditional coverage to say that they had checked whether the plan would cover care; asked for a generic drug instead of a brand name; talked to their doctors about prescription options and costs; asked a doctor to recommend a less costly drug; talked to their doctors about other treatment options and costs; developed a budget to manage health care expenses; and used an online cost-tracking tool provided by the health plan." (Wolters Kluwer Law & Business)  

Wellness Shock-and-Awe: Federal Court OKs 100% Non-Participation Fines
"Because the decision only applies to participatory programs and not outcomes-based programs, many companies will either not switch to outcomes-based programs or else maybe switch back. It also puts pressure on the EEOC to put the kibosh on this end-run around the ACA and Americans with Disabilities Act, which was also artificially ignored in this decision. Note that the decision can and should be appealed. Otherwise it is a de facto repeal of a big chunk of the Affordable Care Act." [EEOC v. Flambeau, Inc., No. 14-cv-638 (W.D. Wis. Dec. 30, 2015)] (Al Lewis and Vik Khanna)  

District Court: ADA Allows Wellness Exams as Condition of Health Plan Enrollment
"The court rejected the EEOC's argument that a separate exception under the ADA involving voluntary tests or inquiries that are part of 'employee health programs' would be rendered irrelevant by applying the ADA safe harbor to the employer's wellness program.... This decision, another litigation defeat for the EEOC in the wellness context, appears to make available a fairly significant work-around to the EEOC's regulatory position that for health programs with disability-related inquiries or medical exams to be voluntary, an employer may not deny access to health coverage for non-participation." [EEOC v. Flambeau, Inc., No. 14-cv-638 (W.D. Wis. Dec. 30, 2015)] (Practical Law Company)  

Can Workplace Wellness Signal Superior Stock Performance?
"Do healthy employees deliver a healthy bottom line for corporate America? ... [A] new study ... demonstrates a distinct correlation between comprehensive, best practice wellness programs and corporate stock performance.... Findings indicate that effectively run companies share the common practice of investing in workplace health and well-being." (Mercer)  

Time to Set Limits on Wellness Screenings?
"While screenings for high blood pressure, blood glucose level and high cholesterol are often seen as routine, they may not be necessary for all employees every year. Whether wellness programs should perform additional diagnostic tests, such as those for prostate cancer and thyroid disorders, is even more questionable." (Society for Human Resource Management [SHRM])  


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Lack of Paid Sick Leave Places Huge Financial Burden on Patients with Cancer
"A survey of more than 1300 patients with stage 3 colorectal cancer found that only 55% who were employed at the time of diagnosis retained their jobs after cancer treatment. Patients who had paid sick leave were nearly twice as likely to retain their jobs as patients without paid sick leave ... After adjusting for factors such as income, education, and health insurance, 59% of patients with paid sick leave retained their jobs, whereas only 33% of those without paid sick leave did." (American Journal of Managed Care)  

Aetna Leaving Insurance Industry Lobbying Group AHIP
"Another top-five health insurance company is ditching the industry lobbying group... Aetna, which is in the process of buying competitor Humana, is not renewing its membership in America's Health Insurance Plans for 2016 ... This comes several months after UnitedHealth Group, the nation's largest insurer, made the same announcement and said its interests 'are no longer best represented by AHIP.' " (Modern Healthcare Online; free registration required)  

CMS Standardized Plan Option Could Reduce Discrimination
"In their recently proposed rule, [CMS] created a 'standardized option' for plans at the bronze, silver, and gold metal levels. Insurers could elect -- but are not required -- to create a standardized option for sale on the exchange.... While simplifying the vast array of plan options for consumers is an important goal in and of itself, there may be other important reasons to support plan standardization. Namely, plan standardization may be a solution to another emerging issue: the manipulation of benefit designs to discourage enrollment by those with chronic health conditions." (Health Affairs)  

CMS Could Not Effectively Ensure That ACA Advance Premium Tax Credit Payments Were Made Only for Enrollees Who Paid Their Premiums
"[The HHS Inspector General] found that CMS [1] did not have a process in place to ensure that APTC payments were made only for enrollees who had paid their monthly premiums; instead, CMS relied on each QHP issuer to verify that enrollees paid their monthly premiums and to attest that APTC payment information that the issuer reported to CMS was accurate; and [2] had sole responsibility for ensuring that APTC payments were made only for enrollees who had paid their premiums and did not share these data for enrollees with the IRS when making payments." (Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS])  

Feds Funding Effort to Refer Patients to Social Services
"The federal government has announced a $157 million project to help hospitals and doctors link Medicare and Medicaid patients to needed social services that sometimes have a bigger impact on their health than medical interventions.... The goal of the 'Accountable Health Communities' project is to find better ways to identify patients' non-medical needs and connect them to available services in their communities.... The project will fund up to 44 separate experiments over five years." (Kaiser Health News)  

Accountable Health Communities: Addressing Social Needs through Medicare and Medicaid
"By some estimates, more than 95% of the trillion dollars spent on health care in the United States each year funds direct medical services, even though 60% of preventable deaths are rooted in modifiable behaviors and exposures that occur in the community.... CMS recently announced a 5-year, $157 million program to test a model called Accountable Health Communities (AHC).... [T]he test will assess whether systematically identifying and addressing health-related social needs can reduce health care costs and utilization among community-dwelling Medicare and Medicaid beneficiaries." (New England Journal of Medicine)  

[Opinion]

2016 Obamacare Outlook
"According to early CMS data, 38% of exchange enrollees are under age 35. Is the risk pool beginning to stabilize? ... If rates increase too much in 2017, will those young people jump ship? ... Will the higher tax penalty for not having coverage prompt more young and healthy people to enroll? ... Will other carriers get out of Obamacare? ... Will provider-based plans continue to grow? ... Will the small business SHOP exchanges continue to struggle?" (Bob Laszewski's Health Care Policy and Marketplace Review)  

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

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