Health & Welfare Plans Newsletter

February 2, 2016

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[Guidance Overview]

Integrated Health Reimbursement Accounts, Coordination with Family Coverage, and Notice 2015-87 -- Something's Missing
"According to Notice 2015-87, Q&A 4, an HRA is integrated with an employer's group health plan coverage for purposes of the application of the ACA insurance market reforms 'only as to the individuals who are enrolled in both the HRA and the employer's other group health plan.'... While the concept seems simple enough, the text of the notice is less than clear as to which group health plan the HRA must be integrated with and the timing of the integration of spouse and/or dependent coverage." (Mintz Levin)  


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[Guidance Overview]

Under the ACA, Are Employees Receiving Short-Term or Long-Term Disability Benefits Still Considered Full-Time Employees?
"For purposes of calculating hours of service, an individual receiving payments from a short-term disability (STD) or long-term disability (LTD) arrangement might be treated as a full-time employee. Two of the determining factors are whether the recipient of disability payments retains his or her status as an employee and who paid for the disability arrangement. However, hours of service will only result from disability payments made to a person who has not terminated employment with the employer." (Graydon Head & Ritchey LLP)  

[Guidance Overview]

Staffing Agency Workers and ACA Offers of Coverage
"In determining who is a full-time employee of an employer under the ACA rules, the IRS has indicated that it intends to use a fact-based 'common law' definition of employee.... Where an employer uses a staffing agency to supply workers, making the determination as to who is a common law employee becomes potentially more complex. However, the final rules allow for some relief for an employer who might otherwise incur the 'pay-or-play' penalties with respect to workers hired through staffing agencies that are reclassified by the IRS as common law employees of the client employer." (Thompson Coburn)  

[Guidance Overview]

New CMS Guidance Regarding CO-OPs and CLAS Data
"CMS is taking corrective action in an attempt to secure the remaining CO-OPs.... [A CMS FAQ dated January 27, 2016] clarifies that CO-OPs are not limited to selling qualified health plans in the individual and small group market in the marketplaces. As long as two thirds of their policies are sold through the marketplaces, they can also sell large group, Medicaid managed care, Medicare Advantage, dental or vision care, or other products.... The CLAS guidance notes that the language tagline addendum will not count toward the eight-page SBC maximum page limit. [HHS] has been taking a hard line that SBCs may not exceed eight pages, so this is a curious development." (Health Affairs)  

ERISA Does Not Stand for 'Equitable Relief In Swollen Assets'
"The court thus rejected all of the respondent's arguments asserting a right to enforce its lien on Montanile's general assets, including its claim that it could enforce its lien under the 'swollen assets doctrine,' which ostensibly allows an equitable recovery from an individual whose assets had swollen due to receipt of the funds claimed to be subject to restitution.... Montanile will afford injured tort claimants greater leverage in negotiating liens, particularly in situations where liability insurance is limited and the claimant's recovery falls far short of make whole relief. Otherwise, overly aggressive demands for full reimbursement will backfire on the benefit plans because putative plaintiffs will forgo seeking recompense for personal injuries if the recovery ends up entirely or mostly in the hands of the health benefit provider." (DeBofsky & Associates, P.C.)  


[Advert.]

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Sponsored by Institute for Healthcare Consumerism [IHC]

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Talk to Your Participants About Using HSAs to Fund Their Retirement
"HSA contributions made pre-tax and when balances are used to pay qualified health care expenses, they come out of HSA accounts tax-free. There are no other employee benefits that work this way.... The key to building an account balance that can carry over into retirement is maxing out contributions each year and investing unused contributions so account balances can grow. If your HSAs don't offer investment funds, think about adding them in 2016." (Lawton Retirement Plan Consultants)  

Healthcare Transparency: What Is It and How Do You Get It?
"It's critical that your transparency vendor provides robust pricing data across multiple markets that will offer participants a true representation of what they'll actually pay, regardless of where they live.... Look for a vendor with a simple interface ... An independent transparency tool can help eliminate consumer distrust.... Avoid transparency tools that push the concept of doctor shopping.... The only path to effective patient care is credible, risk-adjusted, measurable quality metrics sourced from a large data set ... Look for a vendor that can support your communications needs[.]" (Benefitfocus)  

Small Groups Have Options: Professional Employer Organizations
"Professional Employer Organizations (PEOs) are a potent weapon for small groups facing costly premiums, limited networks, very high deductibles and plans with no out-of-network benefits.... Employers will soon be able to move in and out of the PEO market and change PEOs mid-year without duplicating FICA and unemployment taxes which would have had to be reset with every payroll change." (Frenkel Benefits)  

Healthcare -- For Here or To Go? Rising Investment in On-Demand Health Services Reflects an Appetite for Change (PDF)
"Health represents the second fastest growing on-demand segment. The number of on-demand health service companies has spiked from four in 2010, to 42 in 2014 ... Imagine the clinical benefits when diabetics or heart disease patients have low-sodium, low-fat or vitamin-rich foods delivered to their door. By combining Auto & Transportation and Household Chores, consumers can successfully 'age in place.' Even more, those in urban settings can take advantage of convenient Health services, such as in-home visits delivered to patients at home or at the office." (Accenture)  


[Advert.]

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Google Wants to Be a Payer
"[T]here's a huge amount of interplay between patients, providers and payers. That, coupled with Google's multiple data-generating partnerships with the life sciences industry, and it's not a far cry to imagine Google having all the moving pieces under its purview to take on the role of payer." (MedCity News)  

Blue Cross and Blue Shield of North Carolina Projects Major ACA Exchange Losses
"Blue Cross and Blue Shield of North Carolina (BCBSNC) is projecting a loss of more than $400 million on its ACA policies for 2014 and 2015 ... As a result of those significant losses ... BCBSNC will eliminate sales commissions for agents, stop accepting applications for ACA policies online and terminate its advertising of ACA policies." (FierceHealthPayer)  

ACA Delivers Mixed Financial Results for Health Insurers
"United Healthcare, the nation's largest health insurer by enrollment, has suggested it could pull out of the exchanges ... The company, which expects to lose about $500 million selling individual plans this year, 'is not pursuing membership growth,' and has taken other steps to cut costs, including eliminating certain products, scrapping broker commissions and cutting its marketing budget.... Anthem, the second-largest health insurer in the country, signed up 30 percent fewer customers through the marketplaces than it expected and is facing pressure to keep health plan prices at what it called unsustainably low rates[.]" (InsuranceNewsNet.com)  

The Affordable Care Act and the U.S. Economy
"This report provides a five-year perspective on the impact the Affordable Care Act (ACA) has had on the U.S. economy since the law's enactment. It discusses trends in economic growth, employment, and health care costs since 2010, as well as the national experience prior to that time, and compares the recovery in the United States with that in other high-income countries.... To date, there is no evidence that the ACA has had a negative impact on economic growth or jobs or that its reforms have undermined full-time employment ... [E]vidence indicates that the ACA has likely acted as an economic stimulus, in part by freeing up private and public resources for investment in jobs and production capacity." (The Commonwealth Fund)  

[Opinion]

Skyrocketing Health Costs, Obamacare, and the Special Interests
"The higher cost of living longer is one important variable that cannot be attributed to the expensive Obamacare jig saw puzzle. But what about the role of the health care industry itself? Are there forces within the industry that-in order to preserve their own profitability -- [to] actively attempt [to] restrain competition from alternative procedures that will lower costs?" (Morning Consult)  

[Opinion]

Why the 2016 Open Enrollment Stalled: How Unaffordable Obamacare Is for the Working and Middle Class
"Most insurance companies are losing money today under Obamacare because not enough healthy people have signed up. They were hoping that the 2016 enrollment would change that. It has not. This can't continue." (Bob Laszewski's Health Care Policy and Marketplace Review)  

Benefits in General; Executive Compensation

Venue Selection Clauses Live to Fight Another Day
"Although it did not explicitly bless venue-selection clauses, the U.S. Supreme Court has denied review of a Sixth Circuit case, Smith v. Aegon Companies Pension Plan, which upheld a venue-selection clause in a retirement plan.... The Solicitor General did argue, however, that the Sixth Circuit's ruling is inconsistent with ERISA's broad objective of granting plan participants ready access to federal courts in order to enforce their rights under the statute, and that eliminating jurisdictional and procedural obstacles that would otherwise keep participants from enforcing their rights is one of the key principles underlying ERISA." (Nixon Peabody LLP)  

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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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