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[Official Guidance]
Text of IRS Notice 2016-17: Application of the Market Reforms and Other Provisions of the ACA to Student Health Coverage (PDF)
"[T]he Departments recognize that schools may need additional time to adopt a suitable alternative or make other arrangements to come into compliance. Accordingly, the Departments will not assert that a premium reduction arrangement fails to satisfy PHS Act section 2711 or 2713 if the arrangement is offered in connection with other student health coverage (insured or self-insured) for a plan year or policy year beginning before January 1, 2017 (therefore including, for example, plan years or policy years that are roughly coterminous with academic years beginning in the summer or fall of 2016 and ending in 2017)." [Also issued as EBSA Technical Release 2016-01 and as an unnumbered CMS insurance standards bulletin.]
(Internal Revenue Service [IRS])
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[Guidance Overview]
Health and Welfare Plans: Big Compliance Burdens, Big Penalty Exposures
"This post examines the compliance environment of health and welfare plans generally and group health plans in particular. An employer who offers benefits must also meet the requirements of a number of laws including the Affordable Care Act, ERISA, the Internal Revenue Code, HIPAA, the Public Health Service Act, and state insurance laws. These laws vary depending on the type and size of plan and may require governmental reporting, disclosures and notices to participants, administrative practices (such as claims processes) and mandated coverages.... [W]hat if an employer fails to meet its health and welfare plan legal requirements? Here are some of the key penalties[.]"
(Mintz Levin)
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[Guidance Overview]
DOL Issues 2015 Form M-1; No Significant Changes
"Although there were no significant changes to Form M-1 this year, administrators of MEWAs and ECEs should review the instructions carefully to ensure familiarity with all applicable requirements, as major changes were made a few years ago ... Also, remember that the copy of Form M-1 on the DOL website is only an information copy -- Form M-1 must be filed electronically through the Form M-1 Online Filing System."
(Thomson Reuters / EBIA)
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Takeaways from the U.S. Supreme Court's Montanile Decision on ERISA Plan Reimbursement/Subrogation Claims
"The Supreme Court thought the plan was wrong for not objecting to the 14-day letter, rather than concluding that the lawyer was wrong for sending the 14-day letter that created an artificial 'deadline' for resolving a dispute that was also artificial -- because the participant had originally promised to repay the funds.... The response from ERISA plans will have to be ... aggressively intervening in personal injury claims, or filing separate causes of action to seek a temporary restraining order to prevent the disbursement of funds until the reimbursement claim has been litigated."
(Tucker Ellis LLP)
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High-Deductible Health Plans: Effects and Alternatives
"A number of studies have shown that increasing consumers' share of costs reduces their care use.... At least some of the research so far seems to indicate that high deductibles and out-of-pocket expenses reduce use of necessary as well as unnecessary care, particularly in specific populations.... With an increased health system focus on value, one policy to more specifically target unnecessary care use may be value-based insurance design."
(Robert Wood Johnson Foundation)
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Federal Employees Health Benefits (FEHB) Program: An Overview (PDF)
25 pages. "This report provides a general overview of FEHB. It describes the structure of FEHB, including eligibility for the program and coverage options available to enrollees, as well as premiums, benefits and cost sharing, and general financing of FEHB. The report also describes the role of the Office of Personnel Management (OPM) in administering the program." [Report No. R43922, dated Feb. 3, 2016.]
(Congressional Research Service [CRS])
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[Opinion]
Ohamacare's Robin Hood Scheme and the Socioeconomics of Health
"Although they are loath to blame lifestyles, liberal health policy folks worry about health disparities. But the reality is most health disparities are due to behavior, not lack of health coverage. Indeed, about 60 percent of medical spending is on conditions linked to lifestyle. This includes diabetes, hypertension and high cholesterol.... People who probably had not spent their own money on medical care in the past decade now have encouragement to get a decade's worth of care the first year or two they are enrolled. As a result, everyone's premiums are skyrocketing and the state and federal exchanges are descending into an adverse selection death spiral."
(National Center for Policy Analysis Health Policy Blog)
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Benefits in General; Executive Compensation
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[Guidance Overview]
IRS Private Letter Ruling Addresses Elections to Contribute Unused Vacation to Retiree HRA or 401(k) Plan
"Prior IRS rulings have looked favorably on the automatic and mandatory contribution of unused vacation into another plan -- and a recent ruling allowed employees to choose which of two retiree medical plans would get the contribution ... However, the choice between an HRA and a 401(k) plan is a new twist.... The nondiscrimination rules could be an obstacle in other situations and for other plans (including HRAs), depending on the design."
(Thomson Reuters / EBIA)
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[Guidance Overview]
409A Rules Cast a Very Wide Net in Defining What Constitutes a Nonqualified Deferred Comp Plan
"Because 409A applies to all 'service providers' ... and 'service recipients' ... its regulatory reach is not limited to just arrangements between 'employers' and 'employees'.... Arrangements covering rank-and-file employees, directors, partners, independent contractors, consultants, and even other organizations potentially bear the risk of being subject to 409A.... 409A applies to any arrangement that provides for a 'deferral' of compensation. Such deferral arrangements may be elective or non-elective. It could be a paragraph in an employment agreement for just one individual or a 50-page document for a group. Even if it is informal (e.g., communicated through an internal memo) or even oral (i.e., the classic 'handshake agreement'), 409A could come into play if a deferral is recognized."
(Milliman Retirement Town Hall)
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BenefitsLink.com, Inc.
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Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager
BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials
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