Health & Welfare Plans Newsletter

February 1, 2016

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Defined Contribution Practice Manager
Profit Planners LLC
in IL

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Profit Planners LLC
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Ingham Retirement Group
in FL

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The Segal Group
in CA

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Compensation & Benefit Solutions
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in OH

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Webcasts and Conferences

A Focus on Participant Outcomes: Understanding Retirement Readiness, Financial Wellness, and Plan Health
February 18, 2016 WEBCAST
(HANYS Benefit Services)

ACA Reporting: Decoding the Codes
February 18, 2016 in NC
(Hill, Chesson & Woody)

ACA Reporting
February 24, 2016 in CA
(Trucker Huss)

ACA Reporting
February 25, 2016 in CA
(Trucker Huss)

Choosing a Retirement Solution for Your Small Business
February 25, 2016 WEBCAST
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Get Ahead of the Regulatory Curve!
March 21, 2016 in DC
(Retirement Industry Trust Association [RITA])

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[Official Guidance]

Text of IRS Notice 2016-14: Health Insurance Providers Fee; Procedural and Administrative Guidance (PDF)
10 pages. "Because guidance is needed for the 2016 fee year on the definition of expatriate health plan ... for purposes of Section 3(c)(1) of the [Expatriate Health Coverage Clarification Act of 2014 (EHCCA)], which excludes expatriate health plans from the Section 9010 [health insurance provider] fee beginning in 2016, this notice provides that solely for this limited purpose the definition of expatriate health plan will be the same as provided in the MLR final rule definition. No inference is intended regarding the definition of expatriate health plan in Section 3(d)(2) of the EHCCA for any other purpose, nor for purposes of the Section 9010 fee for later years." (Internal Revenue Service [IRS])  


[Advert.]

Forum on Employer Health Care Reform Strategies April 10-12

Sponsored by World Congress

Prepare for the Cadillac Tax | Navigate private exchanges | Hear EEOC updates on employer-sponsored wellness programs | Explore direct-contracting with hospital systems to reduce employee health care costs. Use code BLINK2 to attend for $195.



[Guidance Overview]

CMS Webinar: Qualified Health Plan Updates to the AV Calculator (PDF)
33 presentation slides; dated Jan. 26, 2016.Topics include: [1] AV Calculator Updates: MOOP, Enrollment Data, Algorithms, Claims Data and Trend Factor, and User Interface; [2] AV Calculator Name Fields; [3] Plan and Benefits Template: [4] AV Calculator Macro; [5] Saving AV Calculator Screenshot; and [5] Moving Additional Benefit Design Options. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

IRS Complicates Health Plan Waivers of Coverage
"If an employer is currently using an 'unconditional' waiver of coverage, should it modify that practice to require an employee to show evidence of other coverage? Certainly, doing so will help to insulate the employer from some level of potential tax liability under IRC Section 4980H(b). However, if the actual amount of tax risk is minimal, the employer may want to consider whether it is worthwhile amending its policies and practices to require proof of other coverage." (Squire Patton Boggs)  

[Guidance Overview]

Coding COBRA Coverage on the Form 1095-C: Confusion and Contradictions
"The coding of the Form 1095-C for COBRA rights is extremely complicated. Several oddities exist and an employer is left with too many coding combinations for the various COBRA scenarios. Perhaps the best solution would be a line 14 code specifically for COBRA rights and leaving line 16 blank." (Health Care Attorneys P.C.)  

Consumer Cost-Sharing in Marketplace vs. Employer Health Insurance Plans, 2015
"[C]ost-sharing under marketplace plans remained essentially unchanged from 2014 to 2015.... [F]or people without cost-sharing reductions, average copayments, deductibles, and out-of-pocket limits under catastrophic, bronze, and silver plans are considerably higher than under employer-based plans on average, while cost-sharing under gold plans is similar employer-based plans on average. Marketplace plans are far more likely than employer-based plans to require enrollees to meet deductibles before they receive coverage for prescription drugs." (The Commonwealth Fund)  


[Advert.]

You are invited to Private Exchange FORUM Dallas Feb 23-24, 2016

Sponsored by Institute for Healthcare Consumerism [IHC]

Join us in Dallas Feb. 23-24 at Private Exchange FORUM, the leading event on private exchanges! Learn next steps and best practices in health care consumerism and plan design, as well as ACA compliance and reporting issues for 2016 and beyond!



Obamacare's Premium Hikes Are Much Bigger Than You've Been Told
"Tax credits are determined by an enrollee's income and the benchmark (second-least expensive Silver) plan in his rating region. This introduces a ratchet effect, which can increase the net premium by a significantly higher percentage than the increase in gross premium." (National Center for Policy Analysis Health Policy Blog)  

Behind Fidelity's Move Into Private Exchanges
"Fidelity is taking on the role of insurance broker along with its private health exchange, while Liazon works closely with outside insurance brokers to make sure they have access to a whole host of products and services to offer the small and midsized market.... What makes Fidelity's offering a benefit to clients is that it is integrated with NetBenefits, the 401(k) side of the Fidelity business and what the plan sponsors and their employees already have access to[.]" (Employee Benefit News)  

[Opinion]

Deferring the Cadillac Tax Kills It
"The Cadillac tax is a decidedly modest reform compared to the real solution for the underlying problem -- namely, making all health insurance premiums taxable income to the employees covered by such premiums. Nevertheless, the tax was an initial step in the right direction.... The delay of the Cadillac tax reflects an unfortunate reality: On a bipartisan basis, our elected officials denounce high healthcare costs but are in practice unwilling to take the painful steps necessary to actually control such costs." (Prof. Edward Zelinsky, OUPblog)  

[Opinion]

Health Insurance Shifts Toward Business-to-Consumer Model
"One of the biggest changes [that will be] taking place over the next few years, resulting from dramatic changes in payers' customer base, will be the shift in how payers engage and interact with their customers to protect their market share. Employers and healthcare provider organizations alike should be aware of this shift in payer strategy, as they will be affected by the consequences of those changes." (Daniel Tranotti and Nilesh Chandra, for Healthcare Financial Management Association [HFMA])  

Benefits in General; Executive Compensation

Text of Fourth Circuit Opinion in Marriott 'Top Hat' Case, Dismissing Claim Due to Statute of Limitations (PDF)
"[We] agree with the parties that Maryland's three year statute of limitations for contract actions applies. However ... the question of when the statute begins to run is a matter of federal law.... While the 'formal denial' rule is generally applied in ERISA cases, we [have] recognized ... that in limited circumstances the rule is impractical to use.... [T]he 1978 Prospectus -- in a section entitled 'ERISA' -- plainly stated that the Retirement Awards did not need to comply with ERISA's vesting requirements.... The Appellants then waited more than 30 years to file suit, alleging that the Plan violates ERISA's vesting requirements." [Bond v. Marriott Int'l Inc., No. 15-1160 (4th Cir. Jan. 29, 2016)] (U.S. Court of Appeals for the Fourth Circuit)  

Plan Document Amendments May Be Needed After Montanile Decision
"Part of what the Supreme Court was wading into here was, did Congress use the word 'equitable' as in the traditional courts of equity, or did they use the term in a more benign sense, as a synonym for 'fair?' This is of critical importance for ERISA plans -- the implications are broad. One of the most important is that, in regards to the subrogation provisions in place within many plans (especially large, well-run plans), sponsors will have to be very vigilant and proactive in understanding where they may have the right or even the obligation to pursue recovery of plan assets under the subrogation clause, and where they don't." [Montanile v. Bd. of Trustees of Nat. Elevator Ind. Health Benefit Plan, No. 14-723 (U.S. Jan. 20, 2016)] (PLANSPONSOR)  

Supreme Court Addresses Two ERISA Cases in One Week
"[F]rom the viewpoint of plan sponsors and fiduciaries, the recent rulings in [Montanile] and [Amgen] appear to confirm the Court's ongoing awareness that ERISA balances the competing interests of participants, on one hand, and employers or plan sponsors, on the other. It is well settled that ERISA was intended, in part, to promote an environment that encourages employers to offer employee benefits programs voluntarily. 'In these two cases, the Supreme Court is curtailing the trend towards a litigation free-for-all that we've seen elsewhere, such as in mass-tort litigation,' [said Charles Seemann of Jackson Lewis P.C.]." (Bloomberg BNA)  

The Impact of Lower Stock Prices on 2016 Say-on-Pay
"[T]he market decline will cause an increased number of energy companies to trip a key ISS test in 2016. Fortunately, it's easy to spot now so companies can anticipate the issue and address it in their CD&A." (Meridian Compensation Partners, LLC)  

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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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