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Keeping Your Mind on Money While Listening to Matters of the Heart: Fiduciary Heuristics for ESG Investing
February 2, 2016 WEBCAST
(fi360)

DOL’s Retirement Income Initiative - DC Plan Lifetime Income Products
February 18, 2016 in CA
(Western Pension & Benefits Council - Orange County Chapter)

Wellness Certification Level 1 Training
February 23, 2016 in MI
(Chapman Institute)

Social Security and Why We Truly May Be Facing a Retirement Crisis
February 25, 2016 WEBCAST
(fi360)

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[Official Guidance]

Text of CMS Final 2017 Actuarial Value Calculator Methodology (PDF)
29 pages. "This document is meant to detail the specific methodologies used in the [actuarial value (AV)] calculation.... The first part of this document provides background that includes an overview of the regulation that allows HHS to make updates to the AV Calculator as well as the updates that are incorporated into the 2017 AV Calculator. For the second part of the document, we provide a detailed description of the development of the standard population and the AV Calculator methodology." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

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[Guidance Overview]

IRS Clarifies FSA Carryover and HRA Coverage Issues
"Notice 2015-87 gives employers two tools to address concerns over keeping an employee on the FSA plan books when that employee isn't otherwise an active FSA participant ... [1] Employers can limit the carryover feature to only those employees who elect to make their own contributions for the following plan year. [2] The employer can limit the carryover to only one plan year." (Society for Human Resource Management [SHRM])  

Five Important Highlights from the Last IRS Notice of 2015
"[1] The IRS has reaffirmed that employers don't have a way to pay for individual medical plans on behalf of employees using tax-advantaged dollars.... [2] Dollars offered through a health reimbursement arrangement (HRA) are disallowed from the medical plan's affordability calculations if the funds can also be allocated to non-medical plans ... [3] Employers that offer a cash incentive to employees who waive health coverage ... [may be required to add] the incentive ... to the employee cost when figuring affordability.... [4] Employees can apply now for tax credits in the public exchange ... even though the employer is held harmless from the employer mandate excise tax until final regulations are published.... [5] Employers with HRA plans that are integrated with their medical plan must restrict payments for dependents' health expenses only to those covered by the medical plan." (bswift)  

Seven Questions Employees Will Ask About the ACA Form 1095
"[1] What is this form I'm receiving? ... [2] Who is sending it to me, when, and how? ... [3] Why are you sending it to me? ... [4] What am I supposed to do with this form? ... [5] What if I get more than one 1095 form? ... [6] What if I did not get a Form 1095-B or a 1095-C? ... [7] I have more questions -- who do I contact?" (International Foundation of Employee Benefit Plans [IFEBP])  

What Practitioners Should Know About the Cadillac Tax Delay
"Given the current corporate income tax rate of 35 percent, making the Cadillac tax deductible effectively changes it from a 40 percent excise tax to a 26 percent excise tax for those businesses that pay corporate income taxes.... [R]ules on the age and gender adjustment will likely not come until after the comptroller general and the NAIC report their findings to the Senate Finance Committee." (AccountingWEB.com)  

Employers Push Limit of Obamacare by Excluding Outpatient Surgery in Plans
"For 2016, insurance lacking outpatient surgery benefits has been marketed primarily to staffing companies, hoteliers and other lower-wage employers that had historically never provided major medical coverage. Those are the same firms that were sponsoring skinny coverage a year ago ... It's unclear how many companies said yes for this year[.]" (The Washington Post; subscription may be required)  

Designing an Accountable and Integrated Value-Based Health Plan
"Providers are generally very suspicious of being paid based on value. They are not used to it. Most will have to change their business models and practice patterns.... Since facilities are generally better able to manage the transition than smaller provider practices, some plans are focusing value based reimbursement initiatives on facilities first, thus leaving physicians on a fee for service schedule for now." (Arlington Healthcare Group)  

Text of Sixth Circuit Opinion Remanding Retiree Health Benefit Case for Determination of Vesting in Accordance with Supreme Court Decision (PDF)
"[W]hile the Supreme Court's decision prevents us from presuming that 'absent specific durational language referring to retiree benefits themselves, a general durational clause says nothing about the vesting of retiree benefits,' we also cannot presume that the absence of such specific language, by itself, evidences an intent not to vest benefits or that a general durational clause says everything about the intent to vest ... [We] remand so the district court can decide, among other things, outside the 'shadow of Yard-Man,' [1] what documents make up the parties' Agreements; [2] whether reference to extrinsic evidence is appropriate; and [3] whether the Agreements, and any extrinsic evidence that may be considered, vests with Retirees lifetime contribution-free health care benefits. The district court should use ordinary principles of contract law to answer these questions, without a 'thumb on the scale' in favor of either party." [Tackett v. M&G Polymers, No. 12-3329 (6th Cir. Jan. 21, 2016)] (U.S. Court of Appeals for the Sixth Circuit)  

Supreme Court: ERISA Plan Cannot Recover Settlement Funds That Have Been Spent
"SPDs should include language that puts participants on notice of the plan's reimbursement rights in the case of a tort recovery and the obligation of participants to guard and not spend any medical expense funds received in a tort recovery that may be subject to the plan's claim for reimbursement.... [P]lan fiduciaries must anticipate the need to enforce and monitor the plan's subrogation rights when plan assets are paid related to personal injury scenarios and should establish administrative procedures to carry out such enforcement and monitoring." [Montanile v. Bd. of Trustees of Nat. Elevator Ind. Health Benefit Plan, No. 14-723 (U.S. Jan. 20, 2016)] (Jackson Lewis P.C.)  

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Designing Your Wellness Plan to Avoid Enforcement Action and Litigation Risks

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

Supreme Court Limits ERISA Plan Reimbursement Rights: ERISA Fiduciaries Need to be Diligent
"The plan should not only provide for subrogation and reimbursement, but also require participants to notify plan fiduciaries of claims against third parties and otherwise to cooperate. The plan should provide that not cooperating has consequences, such as offsets against future benefits or terminating plan coverage for misconduct ... Once a plan fiduciary has notice of a potential claim worth pursuing, the fiduciary needs to take steps to avoid having the funds dissipated." [Montanile v. Bd. of Trustees of Nat. Elevator Ind. Health Benefit Plan, No. 14-723 (U.S. Jan. 20, 2016)] (Bradley Arant Boult Cummings LLP)  

U.S. Government Suspends Enrollment in Cigna Medicare Advantage, Drug Plans
"The government said Cigna had deficiencies in its appeals and grievances processes in both Medicare Advantage and the Medicare prescription drug program, according to a copy of a letter it sent to Cigna on Jan. 21. Officials also found problems with the administration of its covered drug plans and compliance program, such as not properly handling prior authorization and exception requests. Cigna said in a regulatory filing the suspension, effective immediately, does not affect members currently enrolled in the plans. It said it is working to resolve the issues as quickly as possible." (Reuters)  

Mega Health Insurance Mergers: Is Bigger Really Better?
"[M]any benefits of megamergers put forward by these companies will not materialize, and there will be few benefits for consumers.... Three broad reasons have been proposed by the insurers for these acquisitions: scale economies, negotiating leverage in hospital and physician contracting, and diversification. But scale economies, where fixed assets and overhead decrease with firm size, are very uncertain in health insurance mergers. Some deals create leverage with providers, and some won't. Some mergers will add or create 'best in class' capabilities, and some won't." (Health Affairs)  

CMS to Issue Guidance to Help Remaining CO-OPs
"CMS and the Justice Department are working to figure out how much of the taxpayer money funneled to the failed co-ops can be recovered.... [CMS Acting Director Andy Slavitt] told Chairman Orrin Hatch (R-Utah) that the agency has a 'fiduciary responsibility' to use any tools necessary to re-collect the taxpayer money. Some audit and legal actions would be appropriate in some cases, he said, outlining ways the agency could collect the money." (Morning Consult)  

Proposed Exchange Standardized Benefit Designs Could Lower Out-of-Pocket Costs for Many Consumers
"[T]he federal government proposes establishing 'standardized' benefit designs wherein all cost-sharing features (i.e. deductibles, out-of-pocket limits, etc.) are the same for plans within a metal level. While these benefit designs would be optional for plans, the government is strongly encouraging plans to sell at least one standard silver plan.... [T]hese new, optional plan designs would provide first-dollar coverage for physician visits, and all tiers of prescription drugs in silver and gold plans." (Avalere Health)  

Health Insurance Marketplaces 2016: Average Premiums After Advance Premium Tax Credits (PDF)
18 pages. "This report focuses on the health plan choices made by returning consumers and the premiums for the plans they selected. The analysis uses data on the number of reenrollees who actively reenrolled and/or changed plans; and data on several metrics related to the impact of the advance premium tax credit on net premium costs in the 38 states using the HealthCare.gov eligibility and enrollment platform. The appendix to this report also provides data on plan selections by premium amount and average premium savings at the state level for the 38 states using the HealthCare.gov eligibility and enrollment platform." (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])  

[Opinion]

Is Healthcare Ripe for Disintermediation?
"More than consolidation and the Affordable Care Act, disintermediation is the single greatest catalyst for change in the health system. Conditions are ripe: Why? Our costs are not sustainable.... Our value proposition is in question. Our system is fragmented and complex.... Consumers are open to alternatives. Millennials want more control of their own health." (Paul Keckley)  

Employee Stock Plans: Year-End 2015 International Reporting Requirements
"This Commentary highlights some of the principal calendar and year-end reporting requirements for employee stock plans that U.S. companies most commonly encounter when offering these programs to their employees in selected jurisdictions worldwide. Please note that this Commentary does not address routine, year-end tax reporting obligations. A chart summarizing these items [is included]." (Jones Day)  

New Year's Executive Compensation To-Do List
"Although the rules do not mandate a specific hedging policy, companies will want to consider adding or amending a policy given heightened shareholder interest. Communicating the CEO pay ratio will be important -- the ratio will be out there for all to see. A primary concern should be implementing the clawback policy in a way that does not trigger shareholder lawsuits." (Towers Watson)  

IRS Announces Six New Members for Information Reporting Program Advisory Committee
IRS [Internal Revenue Service]

DCIIA Membership Elects New Leaders and Members to Executive Committee
Defined Contribution Institutional Investment Association [DCIIA]

Ted Goldman Named Senior Pension Fellow at the American Academy of Actuaries
American Academy of Actuaries

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