Health & Welfare Plans Newsletter

January 26, 2016

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ERISA Service Desk Specialist
John Hancock Retirement Plan Services
in MA

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Transamerica
in MA

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Charles Schwab
in AZ, CO

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Ascensus
in PA

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Webcasts and Conferences

Controlled Groups & Affiliated Service Groups: What Employers Need to Know
February 9, 2016 WEBCAST
(Cowden Associates, Inc.)

ACA Reporting: Decoding the Codes
February 11, 2016 in NC
(Hill, Chesson & Woody)

5 Steps to Conducting a Successful Recordkeeper Search
February 11, 2016 WEBCAST
(ProCourse Fiduciary Advisors, LLC)

Roth Conversions: Understanding the Rules and When They Make Sense
March 16, 2016 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

2016 City Event
November 10, 2016 in KS
(PSCA [Plan Sponsor Council of America])

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Discussions


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[Guidance Overview]

IRS Publication 5215: Understanding Reporting Requirements of the Health Care Law -- Form 1095-B (PDF)
2-page booklet, revised January 2016. "The general rule is that whoever provides the minimum essential coverage is responsible for reporting. However, there are exceptions, which reduce the reporting burden on entities that must report coverage of enrolled individuals through a different section of ACA. These exceptions include: [1] Individual market qualified health plans enrolled in through the Marketplace -- the Marketplace must report on this coverage rather than the provider. [2] Supplemental coverage to other MEC, if the same entity provides both primary and supplemental coverage. [3] Supplements to government-sponsored coverage, like Medicare." (Internal Revenue Service [IRS])  


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[Guidance Overview]

Happy Affordable Care Act New Year
"The extension of reporting deadlines is good news especially for Applicable Large Employers (ALEs) with fewer than 100 full-time employees plus FTEs. Remember to use 2014 employee information for this purpose, and for 2014 only, employers can select any period of six consecutive months to determine this average number of full-time employees and FTEs. But get started on compiling the necessary historical information because payroll services will not be able to provide all of the data required to complete IRS Forms 1094-C and 1095-C (1094-B and 1095-B for self-insured plans)." (The Retirement Plan Blog)  

Supreme Court Limits ERISA Healthcare Plan's Reimbursement Rights: What Montanile Really Means
"By reaffirming that a plan can assert a lien against a participant's recovery from a third party, Montanile reiterates that ERISA plans can have claims to settlement or judgment proceeds held by a lawyer representing the participant in a personal injury claim against such a party. Montanile does not relieve these attorneys of their duties when holding funds subject to valid liens. Counsel for an ERISA plan should carefully check applicable state law as to the process by which the plan's lien rights can be asserted against funds held in a plaintiff lawyer's trust account." [Montanile v. Bd. of Trustees of Nat. Elevator Ind. Health Benefit Plan, No. 14-723 (U.S. Jan. 20, 2016)] (McGuireWoods LLP)  

Montanile: The World's Simplest ERISA Decision
"[T]he practical impact of this decision is simple: if you are a plan administrator, never sit on your hands and instead pursue reimbursement before the participant can squander the settlement fund.... in dissent, Justice Ginsburg pointed out that the decision was correct but, in layman's terms, silly. (She didn't actually say it was silly, and instead used fancy legal terminology to make the same point)." [Montanile v. Bd. of Trustees of Nat. Elevator Ind. Health Benefit Plan, No. 14-723 (U.S. Jan. 20, 2016)] (Stephen Rosenberg, The Wagner Law Group)  

As Out-of-Network Provider Litigation Continues, 2015 Court Opinions Offer Guidance to Insurers
"Certain issues arise frequently in these lawsuits over whether the payers had properly paid claims. This article discusses several published decisions from 2015 that illustrate how courts across the country are handling some of these common issues." (Manatt Phelps & Phillips LLP, via Lexology)  


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Sponsored by Institute for Healthcare Consumerism [IHC]

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The Prescription Drug Supply Chain 'Black Box': How It Works and Why You Should Care (PDF)
23 pages. "[S]elf-insured employers who want to hold their pharmacy benefit cost trend flat will need to either [1] shift more of their prescription drug costs to their employees, or [2] take a different approach to contracting with their prescription drug supply chain.... This paper ... suggests a new prescription drug supply chain model designed to better align pharmacy industry stakeholder interests with those of the plan sponsor and its employees." (American Health Policy Institute)  

Don't Miss Insider Threats to Wellness Program Information
"[A recent survey] of more than 1,100 organizations ... showed internal actors were responsible for 43 percent of information loss.... There are two types of insider threats: [1] The disgruntled employee who tries to do something with company data to harm the company and [2] The employee who inadvertently does something with data that comes back to harm the company.... Or, it can be when employees/contractors use their personal devices for work, regardless of policy." (HealthFitness)  

Health Insurer Says Data Drives Missing, Contain Client Information
"Health insurer Centene Corp said on Monday it is missing six hard drives containing the personal and health information of about 950,000 people. The hard drives do not include any financial or payment details of customers, the company said. It said it was conducting an internal search for the hard drives and believed the information has not been used inappropriately." (Reuters)  

Senators Vent Frustration with ACA CO-OP Program
" 'Taxpayers have been forced to foot the bill for the co-op experiment, to the tune of $2.4 billion in federal loans for 23 co-ops around the country,' said [Senate Finance Committee] chair Orrin Hatch (R-Utah). 'And, to date, more than half of the co-ops have failed, while the vast majority of the others are in poor financial shape. ' ... Hatch blamed the co-op program's problems largely on CMS, which, he said, 'apparently encouraged the co-ops to cook their books with some creative accounting.' " (MedPage Today)  

CBO: Federal Spending on Health Programs to Jump 11%
"[S]pending on federal health programs will make up 5.5 percent of the country's gross domestic product this year, and reach 6.6 percent by the end of 2026.... [F]ederal spending on major health programs, such as Medicare and Medicaid, make up more than 60 percent of the projected growth in mandatory spending in 2016." (Morning Consult)  

Insurer Participation in State-Based Marketplaces in 2016: A Closer Look
"Despite the struggles of many consumer operated and oriented plans (CO-OPs) and persistent market challenges, most state-based marketplaces have an equal or greater number of insurers competing for business this year." (The Commonwealth Fund)  

Consumers Cut Costs by Combining Limited Coverage Health Plans, Despite Penalty Risks
"In 2014, when the provisions of the health law took effect, the number of people applying for short-term plans rose 130 percent, to 147,383, at online health insurance vendor eHealth.... Sales of critical illness policies on the individual market grew to $311 million in 2014, a 24 percent increase over five years ... Non-group accident policy sales reached $430 million in 2014, a 13 percent rise over five years." (Kaiser Health News)  

[Opinion]

ERISA Industry Committee Engages EEOC on Proposed GINA Regs
"ERIC appreciates and supports the Commission's efforts to clarify how its rules will affect employer-sponsored wellness programs and is especially encouraged by its attempts to align the GINA Title II permissible reward limits with those of the Affordable Care Act (ACA). However, ERIC members continue to have serious concerns with respect to where these rules diverge." (The ERISA Industry Committee [ERIC])  

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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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