Health & Welfare Plans Newsletter

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Employee Benefits Jobs

Defined Contribution Pension Plan Administrator
The Angell Pension Group, Inc.

Financial Sales Specialist-Business Life Products
Nationwide Financial
in OH

Pensions Field Service Rep
Nationwide Financial
in FL

Retirement Planning Consultant
in FL

401(k)/Pension Operations Assistant
Legacy Retirement Solutions
in PA

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Webcasts and Conferences

ACA Reporting…What’s Next???
March 15, 2016 in GA
(ISCEBS - Georgia Chapter)

ESOPs and Loans: Releveraging, Non-Bank Financing, and Working Capital
March 15, 2016 WEBCAST
(National Center for Employee Ownership [NCEO])

401(k) Investment Lineup
April 12, 2016 in IL
(Pensions & Investments)

401(k) Investment Lineup
April 14, 2016 in NY
(Pensions & Investments)

Pension Focus Conference 2016
May 19, 2016 in MO
(Pension Focus)

View All Webcasts and Conferences


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[Official Guidance]

Text of CMS Announcement: Key Priorities for FFM Compliance Reviews for the 2016 Benefit Year (PDF)
7 pages. Unnumbered and undated; published online Feb. 23, 2016. "CMS will review data at both the Issuer and the QHP level.... [A table in this document] lists the regulatory standards governing QHP certification that we anticipate including as part of the FFM compliance reviews for the 2016 benefit year.... [A second table provides] illustrative examples ... of regulatory standards ... that will be monitored for compliance through other review and oversight mechanisms." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


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[Guidance Overview]

IRS Notice 2015-87 Provides Additional Guidance Issued on Health Reimbursement Arrangements (PDF)
"Plan sponsors should review all health premium or cost-sharing reimbursement plan designs during 2016. HRAs cannot reimburse individual market premiums even during the spend-down phase of an HRA. Effective in 2017, HRAs cannot reimburse family members' expenses if these individuals are not also enrolled in non-HRA group coverage." (Segal Consulting)  

The Generic Drug Cost Problem (PDF)
"Employers concerned about the increasing cost of some generic medications should review generic utilization for year-over-year cost increases.... Some employers have instituted two-tier generic copay structures.... Employers could consider coinsurance options on the pharmacy plan." (Marsh & McLennan Agency LLC)  

Telling Coworker of Chest Pains Might Be Sufficient FMLA Notice
"[A] federal district court in Maryland found questions of fact on whether the employee left the job site because of a serious health condition or because he was angry, whether asking his coworker to tell the manager he was leaving due to chest pains constituted sufficient notice of a need for FMLA leave, and whether the employer's reason for the termination (violating notice policy and voluntarily quitting job) was pretextual." [Greene v. YRC, Inc., No. MJG-13-0653 (D. Md. Feb. 19, 2016)] (Wolters Kluwer Law & Business)  

Note to Self: Posting My Beach Vacation Photos on Facebook During FMLA Leave Is Not a Good Idea
"When the employer learned of [the employee's] Facebook posts ... it conducted a complete investigation of the facts at issue.... During [a] meeting [with the employee, his] boss confronted him with the Facebook photos in search of an explanation.... Notably, [the company] maintained a social media policy which stated, in part: 'I understand that Social Media usage that adversely affects job performance of fellow associates, residents, family members, people who work on behalf of [the employer] or violates the HIPAA privacy law may result in disciplinary action up to and including termination.' " (FMLA Insights)  

Aetna Exec: Why We Were Able to Finally Come Up with Core Quality Measures
"[CMS], America's Health Insurance Plans [AHIP] and the National Quality Forum took a unique approach to developing the measures ... The group began the process by creating measures that served as a starting point, then in stages brought in representatives from the provider community, followed by purchasers and consumers, all of which contributed to designing the final sets of measures." (FierceHealthPayer)  

GAO Report: CMS Should Act to Strengthen Marketplace Enrollment Controls and Manage Fraud Risk
"During undercover testing, the federal Marketplace approved subsidized coverage under the act for 11 of 12 fictitious GAO phone or online applicants for 2014.... GAO found CMS relies upon a contractor charged with document processing to report possible instances of fraud, even though CMS does not require the contractor to have any fraud detection capabilities. CMS has not performed a comprehensive fraud risk assessment -- a recommended best practice -- of the PPACA enrollment and eligibility process. Until such an assessment is done, CMS is unlikely to know whether existing control activities are suitably designed and implemented to reduce inherent fraud risk to an acceptable level." (U.S. Government Accountability Office [GAO])  

Appropriate Use of Special Enrollment Periods Is Key to Exchange Stability, Affordability for Consumers (PDF)
"In the employer market and under Medicare, health plans ensure the appropriate use of special enrollment periods by verifying an applicant's eligibility to enroll. In contrast, current rules of the federal Exchange market allow people to enter the marketplace through special enrollment periods without proof of eligibility or evidence of prior coverage. As a result, individuals may purchase health insurance only when they need medical care and then drop coverage after receiving the services they need. This misuse of special enrollment periods threatens the long-term affordability and stability of the Exchange market." (America's Health Insurance Plans [AHIP])  

Most Uninsured Escaped Obamacare Penalty
"Nearly three in four people who lacked health insurance last year were exempt from the penalty under ObamaCare... The two most common exemptions were related to the cost of coverage. Many people without coverage said they couldn't afford healthcare plans in their area or couldn't afford plans through their workplace." (The Hill)  

Benefits in General

ERISA Advisory Council to Meet March 16
"The purpose of the open meeting ... is to welcome the new members, introduce the Council Chair and Vice Chair, receive an update from the Assistant Secretary of Labor for the Employee Benefits Security Administration, and set the topics to be addressed by the Council in 2016." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

Press Releases

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016, 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, 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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