Health & Welfare Plans Newsletter

January 29, 2016

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Employee Benefits Jobs

Retirement Plan 401(k) / Pension Administrator
QBI, LLC
in CA

Plan Services Consultant - Retirement
OneAmerica Financial Partners
in IN

Director, Plan Consulting & Legislative Compliance
OneAmerica Financial Partners
in IN, WI

Staff Accountant
Professional Capital Services
in PA

Retirement Plan Services Senior
CliftonLarsonAllen
in IL

Retirement Plans Specialist
Benefit Plans Plus, LLC
in ANY STATE, IL, IN, MO

Employee Benefits Associate
Akerman LLP
in FL

TPA Account Manager
MidAmerica
in FL

Sr. Relationship Management Specialist
Securian Financial Group
in MN

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Webcasts and Conferences

Current Trends in ERISA Litigation and Best Practices to Avoid the Courtroom
February 4, 2016 in IL
(ASPPA Benefits Council [ABC] of Chicago)

Highlights of the 2015 Cumulative List of Changes for Retirement Plans
February 18, 2016 WEBCAST
(IRS [Internal Revenue Service])

Transfers and Rollovers
March 29, 2016 WEBCAST
(Ascensus)

View All Webcasts and Conferences


Discussions


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[Guidance Overview]

ACA Requires 'Effective' Internal Claims Appeals Process
"The appeals process must include, at a minimum... [1] an established internal claims appeal process; [2] a notice to participants, in a 'culturally and linguistically appropriate manner,' of available internal and external appeals processes, including the availability of assistance with the appeals processes; and [3] a provision allowing an enrollee to review his or her file, to present evidence and testimony as part of the appeals process, and to receive continued coverage during the appeals process." (Wolters Kluwer Law & Business)  


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[Guidance Overview]

New Proposed Claim Procedures for Disability Plans (PDF)
"[This article] [1] Reviews the current ERISA claim and appeal procedures for disability plans; [2] Reviews changes proposed by the new regulations; [3] Clarifies the difference between pay practices and ERISA plans; [4] Provides action steps for employers." (Marsh & McLennan Agency LLC)  

Do You Have Compliance Anxiety? Understanding 'Wellness Law' Can Help
"It's crucial for an employer to know whether their wellness plan is part of a group health plan.... HIPAA nondiscrimination rules prohibit discrimination by group health plans based on 'health factors,' but make an exception for wellness programs if they follow specific rules.... [T]he issues and rules involved in wellness law are wide-ranging and still evolving." (The Alliance)  

Employers Are Sticking with Health Plans
"In 2013, 21% of employers with 50-499 employees said they were likely to drop their plans within the next five years; this number fell to 15% in 2014 and to just 7% this past year. Among employers with 500 or more employees, just 5% say they are likely to drop their plans, essentially unchanged from 4% in 2014." (Mercer/Signal)  

U.S. Health Spending Tops $3 Trillion
"[H]ealth-related spending in the U.S. topped the $3 trillion mark in 2014. This equates to $9,500 for every man, woman and child in America. To put the spending into further perspective, total government spending in 2014 was $3.5 trillion. Health-related spending increased by 5.3% in 2013, reversing the historically low increase of 2.9% in 2013. It equaled 17.5% of America's gross domestic product (GDP) for the year." (Fox Business)  

Health Law Insurance Will Probably Cost More in 2017, Top Insurer Says
"Anthem Inc., the second-largest U.S. health insurer by membership, said premiums for Affordable Care Act insurance probably will go up next year.... Premiums for mid-level silver Obamacare plans increased 11 percent on average for this year, after climbing 7 percent for 2015[.]" (Chicago Tribune; subscription may be required)  

Obamacare's Cost Per Beneficiary Explodes with Shrinking Enrollment
"[T]he January update [from CBO] still estimates tax credits, which subsidize insurers participating in exchanges, will cost taxpayers $56 billion this year. That amounts to about $4,308 per enrollee (although not all are subsidized). Back in March 2010, CBO estimated that 21 million people would be covered in exchanges in 2016, for a total cost of $59 billion in tax credits (pp. 20-23). That would amount to about $2,810 per enrollee." (National Center for Policy Analysis Health Policy Blog)  

Does Medicare Advantage Cost Less Than Traditional Medicare?
"In the 25 counties where the cost differences between MA plans and traditional Medicare are largest, MA plans spent a total of $5.2 billion less than what traditional Medicare would have been expected to spend on the same beneficiaries, with health maintenance organizations (HMOs) accounting for all of that difference. In the rest of the country, MA plans spent $4.8 billion above the expected costs under traditional Medicare. Broad determinations about the relative efficiency of MA plans and traditional Medicare can therefore be misleading, as they fail to take into account local conditions and individual plans' performance." (The Commonwealth Fund)  

Benefits in General; Executive Compensation

You've (Still) Got to Be Kidding: Supreme Court Holds ERISA Plan Participants May Ignore Reimbursement Provisions If They Spend the Money Fast Enough
"The case adds nothing to the Court's earlier guidance on what makes a reimbursement provision enforceable. And since its earliest decisions in this area the Court has recognized the loophole allowing an industrious (or spendthrift) participant to flout a reimbursement provision by spending the plan's money on non-traceable items. But several federal circuit courts of appeals either overlooked this wrinkle or could not believe the Court meant it, and instead held that ERISA plans may seek reimbursement from a recalcitrant participant's general assets. The Court agreed to hear Montanile to set them straight." [Montanile v. Bd. of Trustees of Nat. Elevator Ind. Health Benefit Plan, No. 14-723 (U.S. Jan. 20, 2016)] (Spencer Fane)  

Study Finds 'Mortality Gap' Among Middle-Aged Whites
"From 1999 to 2014, death rates in the U.S. rose for non-Hispanic white adults between the ages of 22 and 56, peaking at about age 30 and age 50 ... Deaths from suicide and substance abuse explain about 40 percent of the 'mortality gap,' while 60 percent is tied to death rates failing to drop as expected for nearly all of the top-ranked causes of death of middle-aged whites ... 'For working-age whites -- especially 45-to-54-year-olds -- we are witnessing regression that has little precedent in the industrialized world over the past half century,' the report said." (Kaiser Health News)  

Employment Cost Index, December 2015
"Compensation costs for civilian workers increased 0.6 percent, seasonally adjusted, for the 3-month period ending in December 2015 ... [B]enefits (which make up ... 30 percent of compensation) increased 0.7 percent.... The increase in the cost of benefits [for private industry] was 1.3 percent for the 12-month period ending in December 2015, lower than December 2014 when the increase was 2.5 percent. Employer costs for health benefits increased 3.0 percent over the year. In December 2014, the increase was 2.4 percent." (U.S. Bureau of Labor Statistics [BLS])  

Proposed Section 83(b) Regs May Benefit Nonresidents (PDF)
"A nonresident who expects to become a U.S. tax resident in the future may not be required to file a return. Failure to do so could, however, invalidate a Section 83(b) election. By eliminating the return filing requirement, the proposed regulations would facilitate Section 83(b) elections by nonresidents." (Holland & Knight)  

Press Releases

CMS Announces Proposed Improvements to Medicare Shared Savings Program
Centers for Medicare & Medicaid Services [CMS]

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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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