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[Guidance Overview]
EEOC Loses Another Wellness Case, Part 2: Beware the ACA Penalties
"If an employee is not permitted to enroll in a plan for failure to complete an HRA or biometric screening, it is not clear that the IRS will treat that employee as having had an offer of coverage for purposes of the 4980H penalties.... If the employee is treated as not qualifying for the incentive -- enrollment -- then if any employee obtains subsidized coverage on the exchange, the employer is likely to be exposed to penalties. If the IRS views the forced HRA and biometric screening as causing coverage not to be 'offered' for ACA purposes, that may result in a failure to offer coverage to at least 95% of the employer's full-time workforce.... Thus, even if the EEOC is unable to require that an employer make HRAs and biometric screenings optional for enrollment, the ACA penalties may discourage employers from adopting that approach[.]"
(Stinson Leonard Street)
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[Guidance Overview]
IRS Notice Provides Additional ACA Employer Shared Responsibility Guidance (PDF)
"Employers should review Notice 2015-87 to confirm that they are properly crediting hours of service for periods when no services are being performed. Governmental entities, particularly those that have delegated shared responsibility reporting to a [designated government entity (DGE)], need to ensure that their employees are reported under the correct EIN. Although the proposed changes to the rules affecting employees who primarily perform services for educational organizations may not become effective for some time, staffing agencies and other third parties that contract with educational organizations should review their staffing models to assess the impact of those changes."
(Xerox HR Consulting)
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[Guidance Overview]
HHS Announces New Health Plan Out-of-Pocket Limits for 2017
"Applicable to non-grandfathered health plans, the OOP limits for plan years beginning on or after January 1, 2017 are $7,150 for single coverage and $14,300 for family coverage, up from $6,850 single/$13,700 family in 2016. The OOP maximum includes the annual deductible and any in-network cost-sharing obligations members have after the deductible is met.... In addition to the new OOP maximum limits ... employers offering high deductible health plans need to be particularly mindful of the embedded OOP maximum requirement."
(Marsh Consulting Group)
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[Guidance Overview]
Agencies Propose Revised SBC Template
"The proposed SBC template adds new questions about deductibles, out-of-pocket limits and network providers, and eliminates certain questions regarding annual limits ... and non-covered services.... The proposed SBC template includes ... new disclosures ... [and] adds a third coverage example ... The instructions for completing the SBC include new information[.]"
(The Wagner Law Group)
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[Guidance Overview]
Overview of GASB Statements 73, 74 and 75 (PDF)
"Many of the provisions of GASB Statements 74 and 75 for OPEB are parallel to the provisions of GASB 67 and 68 for pensions. The current OPEB statements 43 and 45 are very similar to GASB 25 and 27, the former statements for pensions. Pension accounting and financial reporting were overhauled with GASB 67 and 68 and the changes made for OPEB mostly follow the same guidelines."
(Milliman)
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HHS Nondiscrimination Rule Worth Second Look by Employers
"Phyllis C. Borzi, assistant secretary of labor [of EBSA], said the [HHS] rule that was proposed in September is a 'trap for the unwary' because employers sponsoring self-funded plans may be operating under a false assumption that it won't apply to them. Under the proposed rule, individuals can't be denied health care or health coverage based on their sex, including their gender identity. The rule would apply to insurance exchanges, any health program that the HHS itself administers and any health program or activity that receives funding from the HHS.... Because most employer-sponsored plans are administered by TPAs and many of those TPAs are also insurance companies that receive federal funds, it's likely that many more plans will be subject to this rule than were initially thought to be[.]"
(Bloomberg BNA)
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Medicare vs. Group Health Plans: Let's Play the Match Game!
"Employers everywhere are receiving letters from CMS asking them (the employers) to provide eligibility and coverage information, under the employers' group plans, related to certain Medicare-enrolled individuals.... The Data Match game is played when Medicare wants to confirm that claims it is paying on a primary basis should in fact be paid on a primary basis, as opposed paying on a secondary basis, after an employer group plan pays the claim first.... CMS has been doing this for many years. These inquiries of employers are sent out in batches from time to time."
(Lockton)
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What's Keeping Health Care Costs Under Control
"Consumers are now realizing how valuable it is to have access to the data to make more cost-conscious health care decisions. One way employers can empower these smarter decisions is offering personalized decision support.... With web-based decision support tools that integrate employees' actual claims data, national benchmarks and behavioral science, [employees] can evaluate their options based on expected utilization and select the plan that is most cost-effective for their specific situation."
(Benefitfocus)
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Health Insurance Coverage and the ACA, 2010-2016 (PDF)
"This issue brief reviews the most recent survey and administrative information available about gains in health insurance coverage since the enactment of the [ACA] in 2010. We estimate that the provisions of the ACA have resulted in gains in health insurance coverage for 20.0 million adults through early 2016 ... a 2.4 million increase since our previous estimate in September 2015. These estimated health insurance coverage gains are shared broadly across population groups.... Other federal and non-governmental surveys of health insurance status show similar trends over this time period."
(Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])
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Benefits in General
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Supreme Court Preemption Decision Could Reach Beyond Self-Insured Health Plans
"Gobeille's ruling that the Vermont statute was a 'direct regulation of a fundamental ERISA function' might equally be applied to a state-sponsored retirement program for private sector employees where benefits are provided through employer payroll deduction. The rather cursory analysis provided in the preamble to the proposed regulation to support the DOL's rationale for exempting such a program from ERISA, and the recognition that state voluntary payroll decision arrangements might still be pre-empted depending on the specific terms of the applicable state law, would seem to require some re-examination in light of the relatively direct analysis in Gobeille."
(McGuireWoods LLP)
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How to Pay School Loans and Save for Retirement at the Same Time
"CEO Tony Aguilar helped start Student Loan Genius in 2013 ... He's been pushing for Congress to pass a bill that would allow employer matches to student loan payments to be pretax. But in the meantime, his company came up with a way to sync the existing 401(k) program with college loan bills. That way, young people don't lose the opportunity for a tax-deferred match if they've chosen to pay down debt rather than save for retirement."
(Bloomberg)
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Executive Compensation and Nonqualified Plans
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Hot Topics in Executive Compensation: 2016 Proxy Season and Beyond
58 presentation slides. Topics include: [1] Shareholder proposal trends in 2015; [2] Proxy advisor policies for 2016; [3] Addressing the "new" SEC rules: CEO pay ratio, compensation clawbacks, and pay for performance; [4] Focus on performance measures; [5] Post-vest holding restrictions on equity awards; [6] 409A issues; [7] Proxy statement drafting tools and tips; [8] Maximizing "say on pay" support; and [9] Avoiding compensation litigation pitfalls.
(Winston & Strawn LLP, for American Benefits Council)
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Press Releases
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BenefitsLink.com, Inc.
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Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager
BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials
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