Health & Welfare Plans Newsletter

February 25, 2016

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[Official Guidance]

Text of DOL Proposed Regs: Establishing Paid Sick Leave for Federal Contractors
"This document proposes regulations to implement Executive Order 13706 ... which requires certain parties that contract with the Federal Government to provide their employees with up to 7 days of paid sick leave annually, including paid leave allowing for family care... This proposed rule ... describes the categories of contracts and employees the Order covers and excludes from coverage, sets forth requirements and restrictions governing the accrual and use of paid sick leave, and prohibits interference with or discrimination for the exercise of rights under the Executive Order. It also ... establishes the standards and procedures for complaints, investigations, remedies, and administrative enforcement proceedings related to alleged violations of the Order." (U.S. Department of Labor [DOL])  


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[Official Guidance]

Text of IRS Comment Request on Final Regs for ACA Summary of Benefits and Coverage Disclosures
"[T]he IRS is soliciting comments regarding the burden estimate or any other aspect of this collection of information entitled 'Affordable Care Act -- Summary of Benefits and Coverage Disclosures'.... A proposed rule, and proposed templates, instructions and related materials were published in the Federal Register on December 30, 2014. A final rule was published on June 16, 2015. The Departments are proposing to finalize, as of April 1, 2016, the templates, instructions and related materials and this ICR relates to them." (Internal Revenue Service [IRS])  

[Guidance Overview]

Trouble on the Horizon for Employers Who Do Not Document Eligibility Conditions
"[An] employer who elects to use the look back measurement method will have to include the details of the initial measurement period and standard measurement period, including dates, in order to satisfy the SPD requirements if the health plan's eligibility conditions are properly synchronized.... [T]here is frequently one set of eligibility standards that apply for the purposes of the look back measurement method and a separate set of standards applied to the actual health plan. Furthermore, sometimes the health plan's SPD is not providing any eligibility conditions. This lack of synchronization is a problem." (Health Care Attorneys P.C.)  

[Guidance Overview]

IRS Health Care Tax Tip 2016-22 -- Form 1095-B: What You Need to Do with This Form
"Form 1095-B, Health Coverage, provides you with information about your health care coverage if you, your spouse or your dependents enrolled in coverage through an insurance provider or self-insured employer last year.... You might not receive a Form 1095-B by the time you are ready to file your 2015 tax return, and it is not necessary to wait for it to file. The information on these forms may assist in preparing a return, and you, however you can prepare and file your return using other information about your health insurance." (Internal Revenue Service [IRS])  

[Guidance Overview]

IRS Health Care Tax Tip 2016-23: Here's What You Need to Do with Your Form 1095-C
"This form provides you with information about the health coverage offered by your employer and, in some cases, about whether you enrolled in this coverage. If you enrolled in a health plan through the Marketplace, the information in Part II of Form 1095-C could help determine if you're eligible for the premium tax credit.... If there are months you did not have coverage, you should determine if you qualify for an exemption from the requirement to have coverage. If not, you must make an individual shared responsibility payment." (Internal Revenue Service [IRS])  


[Advert.]

Master Health Reform Guide, 2016 Edition

Sponsored by Wolters Kluwer

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[Guidance Overview]

CMS Announces New Requirements to Enroll in Special Enrollment Periods
"CMS said that it would require documentary verification for the most common SEPs: loss of minimum essential coverage; permanent move; birth; adoption, placement for adoption, placement for foster care or child support, or other court order; or, marriage. These SEPs account for three quarters of special enrollments." (Health Affairs)  

[Guidance Overview]

Enforcing Attendance Standards in the New World of California Sick Leave
"When California's sick leave law went into effect in 2015, many employers -- especially national employers -- did not change their pre-existing sick leave or paid-time-off (PTO) policies because those policies exceeded the requirements of the law. The accrual and usage limits permitted by the law were seen as too draconian or too cumbersome to be attractive, so employers left well enough alone. Now, these employers are facing an unintended consequence of this decision: the inability to hold employees accountable for the excessive use or abuse of their sick leave entitlement." (Davis Wright Tremaine LLP)  

Five Ways the ACA May Be Contributing to Limited Healthcare Cost Growth
"[1] Minimum essential benefits ... [2] Medical loss ratio ... [3] Higher coverage rates ... [4] Competition and transparency ... [5] The Cadillac Tax." (Benefitfocus)  

This MIT Professor Thinks Wall Street Can Fix High Health Care Costs
"As much as 'financial innovation' has become a dirty phrase since Wall Street brought down the economy, its fingerprints are everywhere. Health insurance, after all, is a type of financial innovation that spreads the cost of health care over a large pool of people. Maybe the way to fix health care costs is smarter financial engineering." (WIRED)  

Oregon Insurer Files $5 Billion Class-Action Suit Against Feds Over Subsidies
"Health Republic Insurance Company of Oregon... [has] filed a $5 billion class action lawsuit on behalf of insurers it says were shorted by the federal government under ... a program that was intended to offset insurer losses in the early years of the implementation of the [ACA]. Instead, payments to insurers under the 'risk corridor' program amounted to 12.6 percent of the amount expected for 2014, and are expected to be similarly low for 2015.... Health Republic was one of 23 federally backed startups set up to increase competition in selected markets. Last fall it announced that as a result of not receiving the federal funds expected, it would wind down operation[.]" (Portland Tribune)  

Six States Sue Obama Administration Over ACA Health Insurance Providers Fee
"The complaint that Texas, Wisconsin, Kansas, Louisiana, Indiana and Nebraska filed in the Northern District of Texas takes issue with the Health Insurance Providers Fee assessed to health insurers to cover federal subsidies.... The suit seeks an injunction against the federal rules that say states are responsible for the fee. It also asks that states be refunded for what they've already paid." (ABC News)  

Texas Telemedicine 2015 Year in Review
"[A]mendments to the telemedicine rules ... [would have] required 'establishing a diagnosis through the use of acceptable medical practices, including documenting and performing patient history, mental status examination, and physical examination that must be performed as part of a face-to-face or in-person evaluation' ... Medicare, Medicaid and other payors continue to add aspects of telemedicine that qualify as reimbursable services ... Several other states, including Arizona, Colorado, Connecticut, Florida, Kentucky, Maine, Montana, Nebraska, New Hampshire, New Mexico, Oklahoma and Tennessee, have enacted legislation to regulate a variety of telemedicine activities." (Haynes and Boone, LLP)  

Benefits in General

[Official Guidance]

Text of IRS Instructions for 2015 Form 5500: Annual Return/Report of Employee Benefit Plan (PDF)
82 pages. Revised Feb. 2016 to reflect the new IRS announcement regarding certain questions. "New Lines 4o, 4p 6c, and 6d were added to Schedules H and I. The IRS has decided not to require plan sponsors to complete these questions for the 2015 plan year and plan sponsors should skip these questions when completing the form." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; Internal Revenue Service [IRS]; Pension Benefit Guaranty Corporation [PBGC])  

Spotlight Is on Employee Benefits Communication for Many Organizations
"[D]espite prioritizing benefits communication, only 19% of employers say their employees have a high level of understanding their benefits.... The reason employers say benefits understanding is so low is because most participants do not open/read materials (80% of organizations reported this), almost half don't understand the materials, and participants do not perceive value in their benefits (31%)." (International Foundation of Employee Benefit Plans [IFEBP])  

Managing Benefits in an M&A or IPO Deal
"The top strategic questions companies face during an M&A transaction include how rich benefits should be for the combined entity and whether one company's benefits prevail over the other's.... Before and after an IPO, a newly public company may want to expand its employee benefit offerings to be more competitive in the market and to meet long-term employee retention goals.... Bringing all employees onto a single benefits system or platform usually eases administrative cost and complexity. It also has implications for workforce management." (Society for Human Resource Management [SHRM])  

FASB Proposed Changes to Accounting for Pension and Other Postretirement Plan Expenses
"One exposure draft, 'Improving the Presentation of Net Periodic Pension Cost and Net Periodic Postretirement Benefit Cost' ... would change the presentation of net periodic costs, so that the service cost must be shown separately from other components and provide that only the service cost can be capitalized. The other exposure draft, 'Changes to the Disclosure Requirements for Defined Benefit Plans' ... would change the disclosure of costs and expense in the financial statements of employers that sponsor defined benefit plans (pension plans and other postretirement benefit plans). FASB has requested responses to a series of questions posed in each of the exposure drafts." (Cheiron)  

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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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