Health & Welfare Plans Newsletter

January 28, 2016 logo logo LinkedIn logo Twitter logo Facebook logo
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Employee Benefits Jobs

Account Manager
National Retirement Services, Inc.
in NC

ERISA Attorney
Kraw Law Group, a Professional Corporation
in CA

Retirement Administration and Benefits Technology Manager
BAE Systems
in VA

Benefits Department Manager
IUPAT Industry Pension Fund
in MD

Director of Retirement Plan Services
Sikich LLP
in WI

Senior Benefits Consultant (Non-Qualified Plans)
in TX

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Webcasts and Conferences

Securities Law for ERISA Professionals
February 18, 2016 WEBCAST
(American Law Institute Continuing Legal Education Group [ALI CLE])

Plan Benchmarking. Why is it Important to Evaluate your Plan?
February 25, 2016 WEBCAST

Employee Benefits Law Academy Spring 2016: Section 125 / Cafeteria Plans in the Age of the Affordable Care Act
March 8, 2016 in NY
(Bond, Schoeneck & King, PLLC)

Employee Benefits Law Academy Spring 2016: HIPAA Privacy Requirements for Your Group Health Plan
April 12, 2016 in NY
(Bond, Schoeneck & King, PLLC)

Employee Benefits Law Academy Spring 2016: Understanding Your Retirement Plan: Challenges and Choices
May 10, 2016 in NY
(Bond, Schoeneck & King, PLLC)

View All Webcasts and Conferences


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[Official Guidance]

Text of CMS CLAS County Data, January 2016 (PDF)
"PHS Act section 2719 requires non-grandfathered group health plans and health insurance issuers offering non-grandfathered health insurance coverage to provide relevant notices in a culturally and linguistically appropriate manner.... [T]hese plans and issuers [are required] to make certain accommodations for notices sent to an address in a county meeting a threshold percentage of people who are literate only in the same non-English language.... The list below includes all counties which meet or exceed the 10 percent threshold (rounded to the nearest percent) for the 2010-2014 ACS data and is applicable until the next edition." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


Still time to attend Trustees and Administrators Institutes

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Immerse yourself in a comprehensive educational experience to learn, discuss and understand plan design, legal requirements, regulatory obligations, and share solutions with your peers. Register today!

[Official Guidance]

Text of IRS AIR Submission Composition and Reference Guide, v. 4.0 (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])  

[Guidance Overview]

A Big Yawner? DOL Issues FMLA Fact Sheet Regarding Joint Employers But Here are Safety Tips
"[T]he DOL outlines the FMLA responsibilities for both primary and secondary employers ... Analyze your worker arrangements that are not straight-up employer-employee relationships. Inquire about the FMLA practices/procedures of any staffing or labor agency you use to ensure it is fulfilling its FMLA obligations. Coordinate FMLA compliance with any other employer with which you share workers. Do it now so that you're not deciding as on the fly Joint employer obligations extend beyond FMLA obligations[.]" (FMLA Insights)  

[Guidance Overview]

IRS Health Care Tax Tip 2016-11: Why Size of Your Workforce Matters
"The number of employees you had during the prior year determines whether your organization is an applicable large employer for the current year.... [T]wo provisions of the [ACA] apply only to applicable large employers.... The vast majority of employers fall below the workforce size threshold on which ALE status is based and therefore are not subject to these provisions." (Internal Revenue Service [IRS])  

[Guidance Overview]

New York State Now Requires PBM Contracts to Include a Mechanism for Appealing Disputes Related to Generic Drug Pricing
"Under the new law, contracts between PBMs and pharmacies (or pharmacies' contracting agents) will be required to include a process by which a pharmacy can appeal a [maximum allowable cost (MAC)] price that is below its cost, with a reasonable timeline for both the pharmacy to appeal and for the PBM to respond to the appeal." (Epstein Becker Green)  

Employers Getting Pushed for 1095s Despite Deadline Extension
"[E]mployees are now realizing that, in order to fill out their tax returns -- and get their refunds -- they need the information from Form 1095. IRS and Treasury officials ... [have] posted Q&As directed to individuals explaining the Form 1095 delay implications and gave limited relief, under certain conditions, which would permit employees to go ahead and file their individual tax returns without the Form 1095.... Since the requirements are complicated, employers would be well advised to direct employee questions/demands concerning the Form 1095 to the IRS website or the employee's tax advisor." (Barrett McNagny LLP)  

Recent Supreme Court Decision Limits ERISA Plans' Ability to Recover Benefits Paid to Injured Employees Who Later Receive Third-Party Settlements
"While plans typically include notice provisions with respect to third-party litigation and settlements, subrogation clauses requiring an employee to reimburse the plan for medical expenses the plan has paid and other safeguards to prevent participants from evading their reimbursement obligations, Montanile suggests that such provisions, by themselves, may be insufficient to preserve the plan's right to settlement funds if the plan does not assert that right quickly and the employee spends those funds." (K&L Gates LLP)  

Understanding Recent Trends in Generic Drug Prices
"[G]eneric drug prices are not an important part of the drug cost problem facing the nation.... [A]bout two-thirds of generic products appear to have experienced price declines in 2014.... [S]ome segments of the market have experienced large price increases.... Some explanations for these occurrences include: small markets with limited entry; the impact of mergers, acquisitions, and market exits; the ability to obtain new market exclusivities; and distribution activities. These problems apply to relatively small segments of the market and, while they lead to increased costs in certain therapeutic areas, they have little influence on overall spending increases." (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])  

Most Obamacare Enrollees Will Pay More in 2016
"[If] every single enrollee who chose the second-lowest cost Silver plan in 2015 shopped around and found the (usually different) second-lowest cost Silver plan in 2016, the average gross premium hike would be 7.5 percent. However, ... [only] 23 percent of 2014 beneficiaries who re-enrolled in 2015 switched plans.... If these enrollees did shop around perfectly and switched, they would be largely immunized from a premium hike.... [F]or the majority who do not shop around the tax credits introduce leverage that can result in a higher percentage increase in net premiums than gross premiums." (National Center for Policy Analysis [NCPA])  


Fidelity Enters the Benefits Business: Why Many Others Will Follow
"Employer desire to simplify.... Demand for more and better outsourced services.... Advance of Defined Contribution Plans (aka Private Exchanges) ... Financial wellness in the workplace ... The broker commission is in play." (Joe Markland)  

Press Releases

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016, 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, 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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