Health & Welfare Plans Newsletter

January 19, 2016 logo logo LinkedIn logo Twitter logo Facebook logo
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Webcasts and Conferences

Legislative Outlook for 2016
January 28, 2016 WEBCAST
(Xerox Corporation)

2016 City Event
April 4, 2016 in FL
(PSCA [Plan Sponsor Council of America])

2016 City Event
April 5, 2016 in MA
(PSCA [Plan Sponsor Council of America])

35th Annual ISCEBS Employee Benefits Symposium
September 18, 2016 in MD
(ISCEBS [International Society of Certified Employee Benefit Specialists])

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[Guidance Overview]

Reconciliation of Advance Payment of Cost-Sharing Reductions
"In early 2015, CMS announced that it would delay the 2014 reconciliation process until April of 2016. Insurers are now supposed to reconcile payments both for 2014 and for 2015 (subject to later adjustments) in April of 2016.... The Draft Manual provides for several different methods that insurers may use for CSR reconciliation." (Health Affairs)  


You are invited to Private Exchange FORUM Dallas Feb 23-24, 2016

Sponsored by Institute for Healthcare Consumerism [IHC]

Join us in Dallas Feb. 23-24 at Private Exchange FORUM, the leading event on private exchanges! Learn next steps and best practices in health care consumerism and plan design, as well as ACA compliance and reporting issues for 2016 and beyond!

[Guidance Overview]

Puerto Rico's Qualifying Employees May Use Paid Sick Leave to Care for Others
"Effective December 31, 2015, all employers in Puerto Rico with at least 16 employees must allow eligible employees to use up to 5 paid sick leave days to care for an ill spouse, parent, or child. Eligible employees are those covered by the Puerto Rico Minimum Wage, Vacation, and Sick Leave Act (i.e., nonexempt employees and outside salespersons). This new leave is also available to care for the following ill individuals who are under the caregiver's legal custody or guardianship: minors, persons who are 60 years of age or older, and disabled individuals." (Ogletree Deakins)  

HRA Access for Spouses and Dependents: A New Wrinkle for Form 1095-C
"If the HRA can be used to pay for copayments and deductibles incurred by the employee's spouse and dependents, should the spouse and dependents be listed in Part III as covered individuals (even though they are 'covered' only under the HRA)? ... Can an HRA satisfy the market reform requirements of the [ACA] if it reimburses copayments and deductibles incurred by the employee's spouse and dependents despite the employee's enrollment for self-only coverage under the group health plan of which the HRA is a component part? Both of these questions are important because they may increase (or lighten) your reporting burdens or reveal a latent compliance problem with your HRA." (Ogletree Deakins)  

Managing FMLA Fraud: Investigate, Don't Assume
"While the legal standard for demonstrating an 'honest belief' of FMLA fraud to defeat an FMLA claim varies by jurisdiction, it is always a good idea to avoid acting rashly or based on assumptions. To greatly increase chances of prevailing, employers should ensure that they conduct a reasonable investigation that includes gathering information from the employee and/or the employee's provider as appropriate, before taking adverse action." (Benefits Bryan Cave)  

Some Pointers on 'Reasonable Accommodation' Where ADA and FMLA Overlap
"If employers engage in the interactive process early on in an employee's FMLA leave -- and determine whether additional leave may be a reasonable accommodation -- chances are they'll be able to avoid a problem after the employee's leave is exhausted.... [B]usinesses can assess whether additional leave will present an 'undue hardship' on 'day one' of an employee's FMLA leave. And to present a solid case for undue hardship, they should probably be doing just that." (HRMorning)  


Designing Your Wellness Plan to Avoid Enforcement Action and Litigation Risks

Sponsored by Lorman and BenefitsLink

February 8 webinar - Make sure you are up to speed and fully compliant on the latest issues surrounding wellness plans. BenefitsLink discount.

Identity Theft Protection: Don't Worry About Taxability
"In contrast to earlier guidance, the IRS won't assert the taxability of identity theft protection even if the employer provides it before any data breach occurs.... Many states follow the IRS's lead in determining taxable income for state income tax purposes. But that doesn't mean a state can't take a contrary position ... Identity theft protection is not a 'qualified benefit' for purposes of cafeteria plans under section 125 of the federal tax code, so employees cannot purchase this protection on a pretax basis." (Lockton)  

HHS Report Shows Rate Increases in Individual and Small Group Plans Are Moderate
"An HHS annual report claims that in 2015, the Department's Rate Review Program reduced total health care insurance 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.... The report's data also indicates that health insurance premium rate increases in the individual and small group market have remained moderate since 2013, with an average rate increase in the individual market of 2.4 percent in 2014 and 6.9 percent in 2015, and an increase of 3.6 percent in 2014 and 4.3 percent in 2015 for the small group market." (Wolters Kluwer Law & Business)  

Health Costs Soar for Employers Outside the U.S.
"Corporations outside the U.S. are generally seeing double-digit percentage rate increases between 9 and 20 percent in part because government coverage doesn't pay for all a patient's healthcare needs and workers turn to their employer to pick up the remaining tab ... [A new report] shows the average cost increases for employer sponsored medical plans are projected at 9.1 percent for this year. That's almost double the rate increase of U.S. employers and more than three percentage points higher than the 5.8 percent medical trend the report shows for North America." (Forbes)  

Lifesaving Flights Can Come With Life-Changing Bills
"When a patient needs an air ambulance, the first priority is getting them needed care as fast as possible. Patients don't always know who is going to pick them up or if the ambulance is an in-network provider. That can make a huge difference -- and lead to huge bills." (National Public Radio)  

Benefits in General; Executive Compensation

Tax Reporting for Stock Compensation: Understanding Form W-2, Form 3922, and Form 3921
"The vesting of restricted stock, the share delivery from restricted stock units (RSUs), and the vesting of performance shares all prompt W-2 reporting of the income received. The treatment on the W-2 is essentially the same for all three grant types.... If you exercised nonqualified stock options last year, the income you recognized at exercise will be reported on your W-2.... The W-2 reporting for ESPP income depends on whether your company's ESPP is tax-qualified or not and, if it is tax-qualified, how long you hold the shares.... If you sold shares from stock compensation or an ESPP last year, you will need guidance to report the sale proceeds on your tax return." (  

Press Releases

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