Health & Welfare Plans Newsletter

January 21, 2016

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Webcasts and Conferences

Guide to Target Date Fund Selection and Monitoring
January 27, 2016 WEBCAST
(Multnomah Group)

Health and Welfare Plan Liabilities and Landmines in Corporate Transactions
February 24, 2016 WEBCAST
(Bloomberg BNA)

2016 City Event
May 26, 2016 in CA
(PSCA [Plan Sponsor Council of America])

2016 City Event
September 14, 2016 in IL
(PSCA [Plan Sponsor Council of America])

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[Guidance Overview]

Year End Legislation and Agency Guidance Affects Health and Welfare Plans (PDF)
Topics: [1] Delay in ACA reporting; [2] Final insurance market reforms; [3] Delay in Cadillac Tax and HIF moratorium; [4] IRS 'potluck' guidance on employer group health plans; [5] Taxation of identity protection services; [6] Proposed regulations on disability claims; [7] Other miscellaneous guidance; [8] ADA wellness; [9] 2016 legislative and regulatory outlook. (Groom Law Group)  


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[Guidance Overview]

Form W-2 and 941 Actions May Be Required Immediately for Retroactive Increase in Section 132 Transit Benefits
"To reduce filing and reporting burdens, [Notice 2016-06] clarifies how the increase applies for 2015 and provides a special administrative procedure for employers to use in filing [1] the 2015 fourth quarter Form 941 to reflect changes in the excludable amount for transit benefits provided in all quarters of 2015, and [2] 2015 W-2 wage and tax statement forms. These guidelines are similar to past guidelines addressing retroactive increases in transit benefits." (McDermott Will & Emery)  

[Guidance Overview]

California Expands on ACA's SBC Translation Requirements for Health Plans in 2016
"Thirteen distinct languages qualify as threshold languages ... California residents speak over 100 different languages and more than 40 percent speak a language other than English. Although federal law requires the SBC to be provided in a culturally and linguistically appropriate manner, the federal definition doesn't reach as far as California's.... By July 1, 2016, the state will develop written translations of the template uniform SBC ... Health plans are to adopt these translations by October 1, 2016." (Benefit Revolution)  

Helpful Communication Tools to Explain ACA Form 1095 to Employees
"Self-insured and fully-insured health plans must provide employees with one or both IRS 1095 Forms (1095-B and 1095-C). To help employees understand what IRS Form 1095 means for them, [the authors have] prepared a one-page communication that can be shared with employees." (Findley Davies)  

PEOs: A Remedy for ACA Reporting Requirements?
"One question for businesses that remains to be fully addressed is whether a PEO (certified or not) can take over sole liability for ACA's 'play-or-pay' employer mandate under Section 4980H. Since its enactment in 2010, the ACA has cast uncertainty on its impact with third-party staffing arrangements. Additionally, the final rule and preamble implementing the employer mandate uses the term 'professional employer organization' in a manner that may not be reflective of the IRS-stamp of approval PEOs we now have in 2016." (Benefits Bryan Cave)  

An Employee's 'Hope' That She'll Return to Work Is Not Enough to Require Additional Leave Under the ADA
"One of the most difficult issues an HR professional or in-house employment counsel faces is how to deal with an employee who cannot return to work after FMLA leave expires. Is additional leave beyond 12 weeks required? The answer is almost always 'yes.' But how much leave are we obligated to provide? ... [A]n employer is never required to provide an employee an indefinite leave of absence. Particularly after the employer has already provided a reasonable amount of leave as an accommodation to help the employee return to work." (FMLA Insights)  

Justices Reaffirm Limits on ERISA Plan's Right to Recover Medical Reimbursement Costs
"Writing for all but Justice Ruth Bader Ginsburg, Justice Clarence Thomas's opinion for the Court rejected the plan's argument out of hand. As he explained ... '[e]quitable remedies are, as a general rule, directed against some specific thing ... rather ... than a right to recover a sum of money generally out of the defendant's assets.' A suit for damages is the paradigmatic legal remedy.... [T]he Court's opinion broke no new ground." [Montanile v. Bd. of Trustees of Nat. Elevator Ind. Health Benefit Plan, No. 14-723 (U.S. Jan. 20, 2016)] (SCOTUSblog)  

Which Way Did Our Money Go? Supreme Court Decides ERISA Subrogation Issue
"[In] most cases involving third-party settlements ... the plan fiduciaries will often remain in the dark about settlement negotiations and agreements....[E]ven diligent plan fiduciaries [may] not become aware that a settlement has been reached or amounts paid until well after the fact and, under the reasoning in Montanile, after it is far too late to recover." (Ogletree Deakins)  

Impact of Workplace Wellness Program Participation on Medication Adherence (PDF)
"Biometric screenings led to an average increase in medication adherence for dyslipidemia and depression. Biometric screenings had no impact on medication adherence among individuals with hypertension, congestive heart failure, or asthma/chronic obstructive pulmonary diseases. Participation in health risk assessments (HRAs) had no statistically significant effects on medication adherence for any of the chronic conditions examined." (Employee Benefit Research Institute [EBRI])  

Five Ingredients of a Successful Wellness Program
"[1] A good understanding of the workforce ... [2] The support of senior management ... [3] A detailed plan ... [4] A realistic and comprehensive picture of available resources ... [5] The willingness to evaluate, rework and improve." (Benefitfocus)  

Wellness Plans Get Booster Shot (PDF)
"Because results of the HRA and biometric screenings were reported in the aggregate and used to help set plan terms and costs, the wellness program was considered and determined to be part of the health benefit plan, which allowed the court to conclude that the ADA safe harbor, in fact did apply ... However, the court affirmed that the ADA safe harbor would generally not be appropriate when there is a stand-alone wellness program unrelated to the administration of insurance risks." [EEOC v. Flambeau, Inc., No. 14-cv-638 (W.D. Wis. Dec. 30, 2015)] (Cherry Bekaert Benefits Consulting, LLC)  

Differences in Out-of-Pocket Health Care Expenses of Older Single and Couple Households
"The average per-person out-of-pocket spending for households ages 65 and above during a two-year period on doctor visits, dentist visits, and prescription drugs (referred to collectively as recurring health care services) is roughly $2,500 for both single and couple households. This amount does not change with age. There are large differences in non-recurring health care spending (which includes overnight hospital stays, outpatient surgery, home health care, nursing home stays, and other services) between older singles and older couples, and these differences increase with age. For those 85 and above, singles and couples on average spent $13,355 and $8,530, respectively, on these services during the two-year period of the study." (Employee Benefit Research Institute [EBRI])  

Benefits in General; Executive Compensation

The Supreme Court's Montanile Decision and the Seemingly Random Evolution of Supreme Court ERISA Remedies Jurisprudence
"In the face of a Supreme Court decision that encourages participants to dissipate assets potentially subject to reimbursement obligations, plan sponsors may need to consider taking steps to avoid payment of benefits until potential overpayments are resolved, and fiduciaries should review and enhance their collection efforts." [Montanile v. Bd. of Trustees of Nat. Elevator Ind. Health Benefit Plan, No. 14-723 (U.S. Jan. 20, 2016)] (Seyfarth Shaw LLP)  

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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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