Health & Welfare Plans Newsletter

March 2, 2016

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Employee Benefits Jobs

Corporate Benefits Attorney
Navia Benefit Solutions
in WA

Retirement Plans Manager
ESCO Corporation
in OR

Retirement Plan Administrative Assistant
PACE TPA
in CA

Director of Contributions & Plan Management
State of Delaware - Office of the State Treasurer
in DE

Account Manager
LT Trust
in CO

Relationship Manager
LT Trust
in CO

Employee Benefits/ERISA Group Attorney
Hill Ward Henderson
in FL

Sr Retirement Plans Consultant
People's United Bank
in CT

Retirement Relationship Manager
Alerus
in MI, MN, NH

Retirement Account Administrator
Alerus
in NH

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Webcasts and Conferences

ESOP Accounting: By the ESOP
March 8, 2016 WEBCAST
(National Center for Employee Ownership [NCEO])

Would you Survive a HIPAA Audit?
March 31, 2016 WEBCAST
(International Foundation of Employee Benefit Plans [IFEBP])

Health Benefits Laws Compliance Assistance Seminar
April 5, 2016 in ME
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

2016 Benefits Selling Expo
April 18, 2016 in FL
(Summit Professional Networks)

2016 ASPPA Spring Virtual Conference
April 21, 2016 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

Will ACOs Go the Way of HMOs and What Is the Difference Anyway?
April 24, 2016 WEBCAST
(International Foundation of Employee Benefit Plans [IFEBP])

Legislative Update: Retirement Plans
May 25, 2016 WEBCAST
(TRI-AD)

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Discussions


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[Official Guidance]

Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act
"On Feb. 10, 2014, the IRS and Treasury issued final regulations on the Employer Shared Responsibility provisions under section 4980H of the Internal Revenue Code.... The following questions and answers provide helpful information about the guidance:

  • Basics of the Employer Shared Responsibility Provisions: Questions 1-3
  • Which Employers are Subject to the Employer Shared Responsibility Provisions: Questions 4-14
  • Identification of Full-Time Employees: Questions 15-17
  • Liability for the Employer Shared Responsibility Payment: Questions 18-23
  • Calculation of the Employer Shared Responsibility Payment: Questions 24-26
  • Making an Employer Shared Responsibility Payment: Questions 27-28
  • Transition Relief: Questions 29-39
  • Basics for Small Employers: Questions 40-42
  • Related Provisions: Questions 43-47
  • Additional Information: Questions 48-56"
(Internal Revenue Service [IRS])  


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[Official Guidance]

AIR Composition and Reference Guide, Version 4.2 (PDF)
117 pages, dated Feb. 2016. "The purpose of this document is to provide guidance to all types of external transmitters about composing and successfully transmitting compliant submissions to IRS.... This document covers details on composing and submitting Form 1094/1095-Bs and Form 1094/1095-Cs by transmitters to IRS. The scope of the document addresses the Application to Application interface ... and the Web User Interface[.]" (Internal Revenue Service [IRS])  

[Official Guidance]

Federal Employees Health Benefits Program Carrier Letter for 2017 Contracts (PDF)
"The annual call for benefit and rate proposals sets forth the policy goals and initiatives for the FEHB Program for 2017 and beyond. We encourage all carriers to thoroughly evaluate their health plan options to find ways to improve affordability, reduce costs, and improve the quality of care and the health of the enrolled population. Except where noted, benefit enhancements must be offset by proposed reductions so that premiums are not increased due to benefit changes." (U.S. Office of Personnel Management [OPM])  

[Guidance Overview]

The 2017 Benefit and Payment Parameters Final Rule: Drilling Down (Part 1)
"The final rule, therefore, generally defines the geographic rating area of a small business as the rating area where the greatest number of employees work or reside. The SHOP marketplace will use the place of business address used to qualify the employer for SHOP coverage for rating purposes.... The final rule makes a number of changes in the '3R' premium stabilization programs: risk adjustment, reinsurance, and risk corridors.... Under the final rule, HHS will spend all remaining reinsurance program funds in 2016.... HHS has concluded that it needs all rate filings to reasonably evaluate rate increases. Insurers seeking rate increases must also file an actuarial memorandum, and insurers seeking increases above the threshold must additionally file a written justification." (Health Affairs)  

Do You Have Your Ducks in a Row for the Employer Mandate?
"Your auditors ... will likely want assurances that you have policies and procedures in place to protect your organization from the excise taxes that can apply by failure to meet the employer mandate.... Examples of internal controls may include: [1] Monitoring compliance with the employer mandate on a monthly basis to ensure the 95 percent threshold is achieved. [2] Properly tracking hours of variable hour and part-time employees to ensure they are offered coverage if they average 30+ hours over their designated measurement period.... [3] For employers that intend to offer affordable coverage, ensuring the cost of single coverage meets one of the safe harbors ... Employers that rely on a contingent workforce are likely to face special scrutiny." (Lockton)  

Supreme Court Restores ERISA Express Preemption's Superpower
"Here, the Court found that reporting, disclosure and recordkeeping are central to, and an essential part of the uniform system of plan administration contemplated by ERISA. The Court held that the Vermont law was preempted because it both intrudes on a central matter of plan administration, and interferes with nationally uniform plan administration. In taking this direct path rather than applying the twists and turns imposed by the Travelers line of cases, the Court restored ERISA express preemption's superpower." [Gobeille v. Liberty Mutual Ins. Co., No. 14-181 (U.S. Mar. 1, 2016)] (Tucker Ellis LLP)  

Justices Kill State Effort to Get Data From ERISA Plans
"While the court's decision doesn't entirely put an end to all-payer claims databases (APCDs) -- they may still seek information from non-ERISA entities that pay for medical care, such as insurance companies -- this decision is likely to render APCDs significantly less effective. The databases will now miss out on data concerning the large segment of the population that receives health insurance from an employer." [Gobeille v. Liberty Mutual Ins. Co., No. 14-181 (U.S. Mar. 1, 2016)] (Bloomberg BNA)  

Supreme Court Sends Vermont All-Payer Database Back to the Drawing Board
"On the one hand, Gobeille offers a fairly straightforward preemption analysis under ERISA and is significant for that reason if no other. However, Justice Thomas's concurrence in the result and Justice Ginsburg's dissent both indicate some degree of continuing skepticism about the Court's approach to ERISA preemption[.]" [Gobeille v. Liberty Mutual Ins. Co., No. 14-181 (U.S. Mar. 1, 2016)] (Ogletree Deakins)  

The Demise of ERISA Preemption Has Been Exaggerated
"Laws similar to Vermont's law are on the books of many other states as well. This decision also calls into question the validity of these other similar state laws as they apply to self-insured health plans under ERISA. Nevertheless, it is possible that, in light of this decision, the [DOL] may collaborate with states to require more detailed reporting in the future that can be used for these purposes, as suggested by Justice Breyer in his concurring opinion." [Gobeille v. Liberty Mutual Ins. Co., No. 14-181 (U.S. Mar. 1, 2016)] (Kilpatrick Townsend)  

Text of Comments on IRS Notice 2015-87: Further Guidance on the Group Health Plan Market Reform Provisions of the ACA to Employer-Provided Health Coverage and on Certain Other ACA Provisions
BenefitsLink has obtained the 60 comments to the IRS that were filed by the February 18 deadline, about IRS Notice 2015-87, which addressed "among other health care arrangements: [1] health reimbursement arrangements (HRAs), including HRAs integrated with a group health plan ... and [2] group health plans under which an employer reimburses an employee for some or all of the premium expenses incurred for an individual health insurance policy." It also "clarifies certain aspects of the employer shared responsibility provisions of Section 4980H, including the identification of employee contributions when employers offer HRAs, flex credits, opt-out payments, or fringe benefit payments required under the McNamara-O'Hara Service Contract Act or other similar laws, the application of the adjusted 9.5 percent affordability threshold ... to the safe harbor provisions under Section 4980H, and the employer status of certain entities for Section 4980H purposes." (BenefitsLink)  

Creating a Culture of Health at Work
"[Six] factors make for successful workplace wellness programs: [1] Organizational commitment; [2] Incentives for employees to participate; [3] Effective screening and triage; [4] State-of-the-art theory and evidence-based interventions; [5] Effective implementation; and [6] Ongoing program evaluation." (America's Health Insurance Plans [AHIP])  

HealthCare.gov to Offer Standardized Health Plans in 2017
"The standardized option will have a specific cost-sharing structure for each of the bronze, silver and gold tiers in the federal exchange markets, which are being used in 38 states in 2016. The policy doesn't restrict issuers' ability to offer nonstandardized options[.]" (Bloomberg BNA)  

Only 15 Percent Say They Have Benefited from Obamacare
"Just 15 percent of people say they have personally benefited from ObamaCare, although more than one-third believe it has helped the people of their state ... Most Americans -- a total of 56 percent -- say they haven't felt directly affected by the Affordable Care Act.... Twenty-six percent of U.S. adults say they have been personally harmed by the healthcare law since its passage -- a fraction that likely reflects those in the poll who said they have noticed rising healthcare costs in the last several years." (The Hill)  

Six Health Insurers, Medicaid Join Colorado State Innovation Model
"Each insurer agreed to offer payments to primary care practices based on how well those doctors met goals centered around the quality of their care. In doing so, they moved another step away from the traditional fee-for-service model that has long dominated the health care industry ... The insurers also made several other agreements, including sharing pricing data with primary care practices." (The Gazette)  

Benefits in General

Supreme Court Says Plan Fiduciaries Cannot Seek Recoupment Under ERISA Section 502(a)(3) from a Participant's General Assets (PDF)
"The Supreme Court's decision narrows the timeframe within which plan fiduciaries can enforce their right to recoupment and limits the enforcement of such rights under ERISA section 502(a)(3), making their duty to recover plan assets more cumbersome.... [P]lan sponsors should revisit plan operations to ensure that rights to subrogation and recoupment are asserted promptly. This may require closer monitoring of payment information and potential settlements." [Montanile v. Bd. of Trustees of Nat. Elevator Ind. Health Benefit Plan, No. 14-723 (U.S. Jan. 20, 2016)] (Groom Law Group)  

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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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