Health & Welfare Plans Newsletter

February 22, 2016

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Heartland Financial, USA
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Webcasts and Conferences

Multiple Employer Plans: How MEPs Work for Private Employers
March 1, 2016 WEBCAST
(FIS Relius Education)

Settling Down Lessons Learned from Recent Class-Action ERISA Settlements
March 17, 2016 in CA
(Western Pension & Benefits Council - Orange County Chapter)

How to Make the Most of Your Firm's Qualified High Deductible Health Plan
April 8, 2016 WEBCAST
(Lorman Education Services)

10th Executive Forum on On-site and Near-Site Employee Health Clinics
April 10, 2016 in DC
(World Congress)

Interaction of Health Care Reform with Other Laws in 2016 and 2017
April 19, 2016 WEBCAST
(Lorman Education Services)

2016 Annual Employee Benefits Summit - Navigating the Total Health Revolution
June 10, 2016 in MA
(New England Employee Benefits Council)

NAPA Connect
June 26, 2016 in MA
(National Association of Plan Advisors [NAPA])

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Discussions


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[Guidance Overview]

ACA Final Rule Confirms Retirees Have Options Not Available to Active Employees (PDF)
"A retiree may decline retiree coverage under a group health plan and still qualify for a federal subsidy (if otherwise eligible). Some retirees may find the premiums for Exchange/Marketplace coverage attractive because the Affordable Care Act limits the amount that older individuals may be charged for coverage. Plan sponsors may want to tell retirees about their additional coverage options, particularly if the retirees pay all or a significant portion of the monthly cost for group coverage." (Segal Consulting)  


[Advert.]

Family and Medical Leave Guide

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[Guidance Overview]

Health Apps and HIPAA: OCR Publishes New Privacy Guidance for Health App Developers
"OCR's Health App Guidance details six scenarios in which Health Apps collect, store and/or transmit health information directly from consumers ... The Health App Guidance also clarifies that a health app that is downloaded and used solely by individual consumers does not result in the app developer's becoming subject to HIPAA ... However, a developer who contracts directly with a CE to collect, maintain or transmit PHI through a particular health app is deemed to be a BA under HIPAA, and accordingly will be subject to HIPAA requirements ... A developer who contracts with a BA on behalf of a CE to do the same thing likewise will be subject to HIPAA." (Ropes & Gray LLP)  

[Guidance Overview]

February 2016: The Month of Groundhog Day, Super Bowl 50, Valentine's Day -- and HIPAA Breach Notifications
"While HIPAA requires covered entities to provide breach notification to affected individuals without unreasonable delay (and no later than 60 days after discovery), covered entities must report small breaches to OCR no later than 60 days after the calendar year in which the small breaches were discovered -- for this year, no later than Feb. 29, 2016. Business associates of covered entities should not be affected by this deadline, as their reporting obligation is to the covered entity and not to OCR, unless the covered entity has delegated its breach reporting obligations to the business associate." (Davis Wright Tremaine LLP)  

TPA of Self-Insured Health Plan Not Subject to Texas Prompt-Pay Law
"In contrast with the Fifth Circuit's ruling, earlier cases have concluded that the Texas prompt-pay law applies to TPAs of self-insured plans and is enforceable because it is not preempted by ERISA ... However, in this case, the Fifth Circuit did not have to rule on the preemption issue because of its determination that the law does not even apply to the TPA." [Health Care Service Corp. v. Methodist Hospitals of Dallas, No. 15-10154 (5th Cir. Feb. 10, 2016)] (Thomson Reuters / EBIA)  

Under 'Ordinary Principles of Contract Law,' Sixth Circuit Holds That Retirees Have No Vested Right to Lifetime Benefits
"[Gallo v. Moen Inc.] shows how far the law has moved since Tackett. The days of granting 'nudges' in favor of vested benefits have come to a close. As a result, many companies that have previously deferred the modernization of their legacy benefits obligations will want to reevaluate the applicable agreements, as now may be the right time to press ahead with long-overdue changes." (Mayer Brown)  


[Advert.]

Forum on Employer Health Care Reform Strategies April 10-12

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Eleventh Circuit Upholds Religious Accommodation for Contraceptive Coverage
"On February 18, 2016, the Eleventh Circuit joined the Second, Third, Fifth, Sixth, Seventh, Tenth, and District of Columbia Circuits in upholding the accommodation that the federal agencies have offered to religious organizations that object to covering contraceptives in their employee benefit plans. (The Eighth Circuit held the accommodation invalid.) The court reversed the district court's decision in a case brought by the Atlanta Archdiocese and other Catholic organizations, which had ruled against the government below[.]" [Eternal Word Television Network v. Burwell, No. 14-12696 (11th Cir. Feb. 18, 2016)] (Health Affairs)  

Reducing Employees' Hours Could Lead to Discrimination Claims Under ERISA
"[Marin v. Dave & Buster's, Inc.] is the first case to address whether a workforce realignment allegedly done for the purpose of avoiding the Employer Mandate constitutes a violation of Section 510. The case was commenced as a putative class action alleging that Dave & Buster's reduced its number of full-time employees to avoid costs associated with providing ACA-compliant healthcare coverage." (Andrews Kurth LLP)  

Firing Someone Returning from FMLA
"Taking action against an employee after they return from a Family and Medical Leave Act absence can expose an employer to claims of FMLA retaliation. But sometimes it takes an employee's absence to learn about that employee's performance issues. So how should an employer handle disciplining someone who is returning from protected leave when the misconduct was discovered during their absence?" [Montoya v. Hunter Douglas Window Fashions, Inc., No. 14-1491 (10th Cir. Jan. 25, 2016)] (McAfee & Taft)  

Employers: Be Prepared to Respond to Exchange Notices of ACA-Subsidized Employees
"Beginning in Spring 2016, the Affordable Care Act (ACA) Exchanges will begin to send notices to employers whose employees have received government-subsidized health insurance through the Exchanges.... Although CMS has provided these guidelines to apply only to the Federal Exchange, it is likely that the state-based Exchanges will have similar notification programs. Employers should be prepared in advance by developing a process for handling the Exchange notices, including appealing any incorrect information that an employee may have provided to the Exchange. Advance preparation will enable you to respond to the notice promptly and help to avoid potential employer penalties." (Marsh Consulting Group)  

'Where's My 1095?' -- Addressing Tax Filing Confusion
"[M]any employees had been told that they would need these forms to prepare their 2015 income taxes. Many even believed, incorrectly, that Form 1095s were to be filed with their tax returns, along with their Form W-2s.... Employers, therefore, should inform workers to expect these forms by March 31, and assure them they may go ahead and file their taxes -- and collect any refunds that may be coming their way -- without waiting until the form is in their hands." (Society for Human Resource Management [SHRM])  

Federal Health Officials, Insurers Agree on How to Rate Doctors' Quality
"For the first time, the Medicare program and the health insurance industry have agreed on a set of ratings to gauge how well doctors do their jobs.... The ratings will not be used immediately but are intended to have a big effect within a few years on U.S. health care. They will serve as building blocks on which both private health plans and Medicare ... rely in shifting how doctors are paid." (The Washington Post; subscription may be required)  

Large Companies Form Alliance to Rein in Health Costs
"[The Health Transformation Alliance (HTA)] said its alliance was not a multiple employer welfare arrangement since it didn't assume any financial or performance risk in the delivery of benefits. Instead, the alliance would facilitate contracting opportunities between the alliance members and service providers. And in response to a question on the Affordable Care Act, the HTA said its group was a private sector response to the issue of health-care costs." (Bloomberg BNA)  

Executive Compensation and Nonqualified Plans

[Opinion]

What If the Compensation for All S&P 500 CEOs Were Confiscated and Redistributed to Rank-and-File Workers?
"The AFL-CIO reports that CEOs of companies in the S&P 500 received $13.5 million in average total compensation in 2014, and those 500 CEOs as a group would have therefore generated $6.75 billion in compensation. If that total amount of almost $7 billion was confiscated and redistributed equally to the 97,734 million workers that the AFL-CIO uses for its 'average worker pay' calculation, each of those rank-and-file hourly workers would have received $69.07 in extra annual pre-tax income in 2014, or about 3.5 cents per hour for a 40-hour workweek and about 4.2 cents per hour for a 33.7-hour workweek[.]" (American Enterprise Institute)  

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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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