Health & Welfare Plans Newsletter

February 10, 2016

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Webcasts and Conferences

Are You At Risk? Staying on Top of Your Fiduciary Responsibilities Within Your 401(k) Plan
March 6, 2016 WEBCAST
(Dorsey & Whitney LLP)

ASPPA Philadelphia Regional Conference
May 19, 2016 in PA
(ASPPA [American Society of Pension Professionals & Actuaries])

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[Guidance Overview]

It's That Time Yet Again: Creditable Coverage Disclosures to CMS Due by February 29 (PDF)
"Each year, group health plan sponsors that provide prescription drug coverage to individuals eligible for Medicare Part D must disclose to [CMS] whether that coverage is 'creditable' or 'non-creditable.' The disclosure obligation applies to all plan sponsors that provide prescription drug coverage, even those that do not offer prescription drug coverage to retirees. Calendar year plans must submit this year's disclosure to CMS by February 29, 2016." (Xerox HR Services)  


[Advert.]

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[Guidance Overview]

Parity of Mental Health and Substance Use Benefits with Other Benefits: Using Your Employer-Sponsored Health Plan to Cover Services (PDF)
"If you are someone who is trying to figure out how to use your health coverage provided by your employer to pay for your mental health or substance use [MH/SU] services -- this sheet is for you.... In this document, we explain MH/SU parity, answer questions about the parity law, and provide ways to learn more. We hope you use this information to get the mental health and substance use services you and your family need paid for (either fully or partially) by your health plan." (Substance Abuse and Mental Health Services Administration [SAMHSA], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

Subsidizing Student Health Insurance with Stipends: New Agency Guidance and Relief
"The guidance does not say which subsidy type arrangements create [employer payment plans (EPPs)] and which do not. All we know is that not all arrangements whereby a school subsidizes coverage under student health plans will be EPPs. It appears that, if the student is an employee, and the amounts are paid towards student health insurance coverage, then the subsidy is an EPP. If the student not an employee, then a stipend towards student health insurance coverage will not be an EPP because there is no employer-employee relationship with which to create an EPP." (Mintz Levin)  

HIPAA Phase 2 Audits Include Business Associates
"Here's a closer look at Phase 1 and Phase 2 audits and the background information you'll need to prepare for a possible audit." (International Foundation of Employee Benefit Plans [IFEBP])  

The Proposed Budget and Health Care: A Quick Rundown
"One proposal would attempt to curb surprise balance bills by out-of-network providers by requiring hospitals to take steps to match patients with in-network providers and requiring physicians who regularly provide services in a hospital to accept an appropriate in-network rate as payment in full. Another proposal would allow HHS to develop uniform definitions and principles for standardizing medical billing and making it more transparent. Self-insured non-federal governmental plans would be prohibited from opting out of various federal consumer protection laws, such as the Mental Health Parity Law.... The Internal Revenue Service budget request includes $402 million in ACA funding, including $105 million for taxpayer services, $20 million for enforcement, and $277 million for operations support." (Health Affairs)  

Feds Want Healthcare.gov to Become an Active Purchaser
"The proposed reforms, tucked into the 2017 Notice of Benefit and Payment Parameters released by [CMS] late last year, suggest that CMS wants to trade a wide array of plan choices on the federal exchange for more tailored options.... These standardized options for bronze, silver and gold plans would include a single provider tier, a fixed in-network deductible, a fixed annual limitation on cost sharing, and standardized copayments and coinsurance for a key set of essential health benefits ... Insurers would not be required to offer standardize options in 2017 and 'would retain flexibility to offer non-standardized plans.' " (FierceHealthPayer)  

Benefits in General; Executive Compensation

[Official Guidance]

Text of IRS Disaster Relief Announcement ARK-2016-04, for Victims of Severe Storms, Tornadoes, Straight-line Winds and Flooding in Arkansas
"Victims of the severe storms, tornadoes, straight-line winds and flooding that took place beginning on Dec. 26, 2015, in parts of Arkansas may qualify for tax relief ... Individuals who reside or have a business in Benton, Carroll, Crawford, Faulkner, Jackson, Jefferson, Lee, Little River, Perry, Sebastian, and Sevier Counties may qualify for tax relief.... [C]ertain deadlines falling on or after Dec. 26, and on or before May 16, 2016, have been postponed to May 16, 2016. This includes 2015 income tax returns normally due on April 18." (Internal Revenue Service [IRS])  

[Guidance Overview]

Pension and Health Plans: 2015 Year End Review (PDF)
Topics include: [1] The 'Cadillac Tax'; [2] Delayed ACA reporting; [3] Legal challenges to the ACA; [4] Repeal of automatic enrollment; [5] Expanded preventive care services; [6] Substantial hospital inpatient services and minimum value; [7] Pace Act; [8] ACA fees and penalties; [9] Nondiscrimination for fully insured health plans; [10] IRS determination letter program; [11] Form 5500 filing deadlines remain the same; and [12] NYC Commuter Benefits Law. (Schulte Roth & Zabel LLP)  

2015 in Review: ERISA Civil Enforcement Recoveries Remain Low, Criminal Investigations Continue to Rise
"The DOL reported total monetary recoveries of $696.3 million in FY 2015, an increase of $96.6 million over FY 2014. While this was a significant increase ... the total monetary results for FY 2015 still lagged behind the 15-year average of approximately $1.3 billion in annual recoveries.... In FY 2015, almost half of the $96.6 million improvement -- $46.7 million -- came from the Informal Complaint Resolution System, which has been steadily replacing Prohibited Transactions Corrected and Plan Assets Protected as the largest source of recovery." (Sutherland Asbill & Brennan LLP)  

U.S. Supreme Court Ruling: ERISA Equitable Relief Not So Equitable?
"The moral of the story is that self-insured plans that wish to enforce their subrogation and ... recovery rights must act quickly before the proceeds from any law suit against a third party to recover the medical expenses have been commingled with the plan participant's other assets.... [It] remains to be seen if the same tracing requirement that applies to third party settlements in the subrogation context extends to overpayments from pension and disability plans. Lastly, the Court's ruling could spur legislative initiatives to expand the ERISA remedies available to plan fiduciaries." [Montanile v. Bd. of Trustees of Nat. Elevator Ind. Health Benefit Plan, No. 14-723 (U.S. Jan. 20, 2016)] (Troutman Sanders)  

[Opinion]

ERIC Report Card for Health Care and Retirement Provisions in the President's Proposed 2017 Budget: Needs Improvement
"The ERISA Industry Committee (ERIC) is disappointed President Obama did not use his 2017 fiscal year budget to promote important proposals that would allow the employer-provided health and retirement benefits system to grow. 'The budget is an ideal time to propose measures that improve and support the employer-sponsored retirement and health care system, like full repeal of the 40 percent excise tax and taking PBGC premiums "off-budget",' said Annette Guarisco Fildes, president and CEO, ERIC." (The ERISA Industry Committee [ERIC])  

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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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