Health & Welfare Plans Newsletter

March 1, 2016

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Defined Contribution Plan Administrator
Profit Planners LLC
in IL

Sr. Retirement Plan ERISA Consultant
Benefit Consultants Group
in NJ

Advisor Services Consultant
Benefit Consultant Group
in NJ

Retirement Consultant
Buck Consultants a Xerox Company
in NY

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Webcasts and Conferences

Fundamentals of Qualified Plans Web Series: 04- Coverage Test
March 3, 2016 WEBCAST
(FIS Relius Education)

MEPs, IRAs, and More: DOL Guidance on State Plans
March 8, 2016 WEBCAST
(FIS Relius Education)

Impact of EEOC Regulations on Wellness Programs
March 10, 2016 WEBCAST
(International Foundation of Employee Benefit Plans [IFEBP])

Fundamentals 05: Elective Deferrals
March 10, 2016 WEBCAST
(FIS Relius Education)

Everything You Wanted to Know About Pensions – But Were Afraid to Ask!
March 15, 2016 WEBCAST
(International Foundation of Employee Benefit Plans [IFEBP])

Church Plans: The Retirement Benefits Are Better Than Ever
March 15, 2016 WEBCAST
(FIS Relius Education)

Getting It Right - Know Your Fiduciary Responsibilities: Retirement and Health Plan Sponsors – Day 1
March 15, 2016 WEBCAST
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Getting It Right - Know Your Fiduciary Responsibilities: Retirement and Health Plan Sponsors – Day 2
March 17, 2016 WEBCAST
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Getting It Right - Know Your Fiduciary Responsibilities: Retirement and Health Plan Sponsors – Day 3
March 22, 2016 WEBCAST
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

ACA & Benefits Compliance Update
March 24, 2016 WEBCAST
(Frenkel Benefits, LLC)

ACA Potluck (IRS Notice 2015-87): IRS Provides Full Serving of New ACA Guidance
March 24, 2016 WEBCAST
(ABD Insurance & Financial Services)

Legislative Update: Health & Welfare Benefit Plans
March 30, 2016 WEBCAST
(TRI-AD)

Nonqualified Plans
April 19, 2016 in MN
(ASPPA Benefits Council [ABC] of Greater Twin Cities)

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Discussions


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Text of Supreme Court Opinion: ERISA Preempts Vermont Claims Reporting Law (PDF)
39 pages. "ERISA's extensive reporting, disclosure, and recordkeeping requirements are central to, and an essential part of, this uniform plan administration system. Vermont's law and regulation, however, also govern plan reporting, disclosure, and recordkeeping. Pre-emption is necessary in order to prevent multiple jurisdictions from imposing differing, or even parallel, regulations, creating wasteful administrative costs and threatening to subject plans to wide-ranging liability." [Gobeille v. Liberty Mutual Ins. Co., No. 14-181 (U.S. Mar. 1, 2016)] (Supreme Court of the United States)  


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[Official Guidance]

Text of HHS Final Notice of Benefit and Payment Parameters for 2017
539 pages (!). "This final rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional amendments regarding the annual open enrollment period for the individual market for the 2017 and 2018 benefit years; essential health benefits; cost sharing; qualified health plans; Exchange consumer assistance programs; network adequacy; patient safety; the Small Business Health Options Program [SHOP]; stand-alone dental plans; third-party payments to qualified health plans; the definitions of large employer and small employer; fair health insurance premiums; student health insurance coverage; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions and appeals; and other related topics." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Official Guidance]

Text of CMS 2017 Letter to Issuers in the Federally-Facilitated Exchange (PDF)
87 pages. "This Letter provides issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Marketplaces (FFMs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs) with operational and technical guidance to help them successfully participate in any such Marketplace(sm) in 2017. Throughout this Letter, CMS identifies the areas in which States performing plan management functions in the FFMs have flexibility to follow an approach different from that articulated in this guidance. CMS also describes how parts of this Letter apply to issuers in State-based Marketplaces on the Federal Platform. CMS notes that the policies articulated in this Letter apply to the certification process for plan years beginning in 2017." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Official Guidance]

Text of CMS Insurance Standards Bulletin: Extended Transition to ACA-Compliant Policies (PDF)
"States may permit issuers that have renewed policies under the transitional policy continually since 2014 to renew such coverage for a policy year starting on or before October 1, 2017; however, any policies renewed under this transitional policy must not extend past December 31, 2017. We will work with issuers and States to implement this policy, including options such as allowing policy years that are shorter than 12 months or early renewals with a January 1, 2017 start date." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Official Guidance]

Text of CMS Insurance Standards Bulletin: Timing of Submission and Posting of Rate Filing Justifications for the 2016 Filing Year for Single Risk Pool Coverage (PDF)
"[T]his bulletin establishes the uniform deadline ... for health insurance issuers to submit the Rate Filing Justification for proposed rates for single risk pool coverage in the individual and small group markets. It also establishes the uniform posting deadline ... for a State with an Effective Rate Review Program to provide public access to information regarding proposed rate increases that are subject to review. The bulletin also identifies the uniform deadline for a State with an Effective Rate Review Program to post final rate increases (including those not subject to review)[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


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[Official Guidance]

Key Dates for Calendar Year 2016: QHP Certification in the Federally-Facilitated Marketplaces; Rate Review; Risk Adjustment and Reinsurance (PDF)
Three-page chart. Excerpt: "This document summarizes key dates for calendar year 2016 regarding some activities and policies that are outlined in other documents -- 2017 Letter to Issuers in the Federally-facilitated Marketplaces (February 29, 2016); the Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017; (February 29, 2016), and the Bulletin: Timing of Submission and Posting of Rate Filing Justifications for the 2016 Filing Year for Single Risk Pool Coverage Effective on or after January 1, 2017 (February 29, 2016)." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Official Guidance]

Text of CMS FAQ on the 2017 Moratorium on Health Insurance Provider Fee (PDF)
"Does the 2017 moratorium apply to the 2017 fee year or the 2017 data year? ... What is the 2017 fee amount that would have been collected but for the moratorium? ... Will the 2017 moratorium affect the fee amount for the 2018 fee year? ... What is the expected impact on 2017 plan year rate changes as a result of the moratorium?" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

CMS Finalizes Improvements for the 2017 Health Insurance Marketplace
"The rule finalizes provisions to: [1] help consumers with surprise out-of-network costs at in-network facilities, [2] provide consumers with notifications when a provider network changes, [3] give insurance companies the option to offer plans with standardized cost-sharing structures, [and] [4] provide a rating on HealthCare.gov of each QHP's relative network breadth ... to support more informed consumer decision-making, and improve the risk adjustment formula." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

CMS Issues 2017 Benefit and Payment Parameters Rule and Letter to Issuers in the Federally Facilitated Marketplaces
"[T]he final rule and letter adopt with a few changes proposals regarding standardized plans ... The final rule and letter adopt some, but not all of the network adequacy requirements that were proposed, and delay some until 2018.... The final rule backs off this requirement but provides that the FFM will itself generally apply quantitative time and distance standards in determining network adequacy for qualified health plans.... CMS is not finalizing until 2018 a requirement the insurers apply to the in-network cost sharing limit the cost of services provided by out-of-network providers at an in-network facility; the agency is also weakening this already weak requirement." (Health Affairs)  

[Guidance Overview]

Obama Administration Backs Off on ACA Rules for 2017 Health Plans
"The agency [had] proposed tight network adequacy provisions and standardized health plan options in late November, which fueled antipathy from the health insurance industry. Monday's rule relaxes those aggressive proposals, a move that likely will raise the ire of consumer groups ... The federal government ... will now have to publish all changes to premium rates, not just increases that are subject to review. The rule addresses several other issues, including surprise medical bills and the 2017 open-enrollment period." (Modern Healthcare Online; free registration required)  

[Guidance Overview]

The Use of Modified Adjusted Gross Income (MAGI) in Federal Health Programs (PDF)
20 pages. "Although the different health programs use the word 'household,' they do not necessarily refer to the same groupings of people. For example, married couples living together are counted as the same Medicaid household regardless of whether they file a joint tax return. By contrast, married couples must file a joint tax return to be eligible for premium credits. This report explores the different MAGI definitions across health programs, including Medicare, the health insurance exchanges under the ACA, and Medicaid. It also addresses why MAGI is used, and how it is applied, specific to each program." [Report R43861, dated Feb. 25, 2016.] (Congressional Research Service [CRS])  

[Guidance Overview]

Wading Through the Changing Tide of Paid Sick Leave Laws in Washington State
"Two months into the new year we have already seen significant changes to the Seattle sick and safe time law, a new paid leave ordinance taking effect in Tacoma, and a new ordinance enacted in Spokane. At the state level, legislators are considering a bill to mandate paid sick leave statewide. Even if this legislative effort is unsuccessful, voters may be presented with a statewide sick leave ballot initiative this November. [This article] will discuss important developments at the local and state levels in 2015 and 2016, provide an overview of ongoing enforcement efforts, and highlight compliance challenges and strategies for employers." (Littler)  

[Guidance Overview]

Text of CMS Fact Sheet on Final HHS Notice of Benefit and Payment Parameters for 2017 (PDF)
5 pages."The 2017 maximum annual limitation on cost sharing is $7,150 for individual coverage and $14,300 for family coverage ... [I]ssuers of student health insurance plans may establish one or more separate risk pools for each college or university, but the risk pools must be based on a bona fide school-related classification and not on health status.... We are adding a third employee choice option [to SHOP] under which employers will have the option of offering all plans across all actuarial value levels from one issuer (vertical choice)." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

Equitable Liens by Agreement Do Not Obviate 'Res' Requirement
"The Court should never have had to decide this case. The plan's argument was patently wrong under prior Supreme Court precedent. Nonetheless, careless reading of those prior cases by lower courts required the correction administered in Montanile which is very simple to understand." (Health Plan Law)  

Affordability: The Most Urgent Health Reform Issue for Ordinary Americans
"While the Affordable Care Act (ACA) has made health insurance more affordable for the uninsured, premiums and cost-sharing are still too high for many Americans. And cost-sharing has been edging ever higher for the majority of Americans who have coverage through employer-based plans. This post examines the affordability problem and offers suggestions for tackling it that combine approaches in the ACA with proposals by the law's detractors." (Timothy Jost, in Health Affairs)  

Benefits in General

March and April 2016 Filing and Notice Deadlines for Qualified Retirement and Health & Welfare Plans
"The filing and notice deadline table [in this article] provides key filing and notice deadlines common to calendar year plans for the next two months. If the due date falls on a Saturday, Sunday, or legal holiday, the due date is generally delayed until the next business day. Please note that the deadlines will generally be different if your plan year is not the calendar year." (King & Spalding, LLP, via Lexology)  

Executive Compensation and Nonqualified Plans

Severance, ERISA, and Rum Punch
"If your severance benefit is more than two years' pay or if payments extend over more than two years, the plan likely is beyond the ERISA severance pay exception. If the plan involves more than one check which is easily calculated, don't look back. Get help. You likely have an administrative scheme and, accordingly, ERISA provisions -- including plan document, reporting and disclosure requirements -- could be sneaking up on you." (Jackson Lewis)  

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Lois Baker, J.D., President <loisbaker@benefitslink.com>
David Rhett Baker, J.D., Editor and Publisher <davebaker@benefitslink.com>
Holly Horton, Business Manager <hollyhorton@benefitslink.com>

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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