Health & Welfare Plans Newsletter

March 18, 2016

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Webcasts and Conferences

ACA-Driven Litigation: Cases to Watch and What’s Next
March 30, 2016 WEBCAST
(Bloomberg BNA)

Wellness Conference: Emerging Trends in Wellness
April 6, 2016 in MA
(Wellness Workdays)

Half-Day Retirement Plan Symposium
April 14, 2016 in FL
(PSCA [Plan Sponsor Council of America])

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[Official Guidance]

Text of IRS Pub. 5165: Guide for Electronically Filing ACA Information Returns for Software Developers and Transmitters (Processing Year 2016) (PDF)
49 pages; dated Mar. 17, 2016. "[This publication] outlines the communication procedures, transmission formats, business rules and validation procedures for returns transmitted electronically through the AIR system.... The procedures in this publication should be used when the following information returns are transmitted electronically: Form 1094-B, Transmittal of Health Coverage Information Returns; Form 1095-B, Health Coverage; Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns; and Form 1095-C, Employer-Provided Health Insurance Offer and Coverage. This publication does not contain information or procedures for filing Forms 1095-A." (Internal Revenue Service [IRS])  


[Advert.]

ECFC: Championing Choice in Employee Benefits Solutions

Sponsored by ECFC

ECFC is an active voice for tax-advantaged benefit programs and a recognized proponent of flexible compensation. The 35th Annual Conference is the chance to ensure your voice is heard.



[Guidance Overview]

IRS E-File Form Submission Process for Form 8947 and Form 8963 (PDF)
27 presentation slides. Form 8947 is the Report of Branded Prescription Drug Information; Form 8963 is the Report of Health Insurance Provider Information. These forms, and the Form 8453-R Declaration and Signature for Electronic Filing of Forms 8947 and 8963, are the only ACA information reports that can be filed via the ACA Form Acceptance site on irs.gov. (Internal Revenue Service [IRS])  

[Guidance Overview]

DOL Proposes Paid Sick Leave Rules for Federal Contractors (PDF)
"Both the contracts and employees covered under the proposal are nearly identical to those covered under the regulations establishing a minimum wage for federal contractors and subcontractors. Unlike the minimum wage regulations, this proposal also extends coverage to employees who qualify for an exemption under the FLSA including, for example, employees who are employed in a bona fide executive, administrative or professional capacity." (Xerox HR Services)  

[Guidance Overview]

IRS Information Letter Affirms Application of 80/50 Rule to Certain Vanpools
"A previous IRS information letter described the three types of vanpools that may be qualified transportation benefits -- employer-operated, employee-operated, and private or public transit-operated vanpools -- and explained that only employer-operated and employee-operated vanpools must satisfy the 80/50 rule ... [IRS Information Letter 2015-0041] considers these rules in response to an employee's complaint that his employer is imposing the 80/50 requirement on his vanpool even though the vanpool is privately owned." (Thomson Reuters / EBIA)  

Text of Second Circuit Opinion: Human Resource Director Can Be Held Individually Liable for FMLA Interference Claim
28 pages. "[The plaintiff-employee] challenges the district court's conclusion that [the employer's Director of Human Resources] does not constitute an 'employer' under the FMLA and therefore cannot be held individually liable.... [S]everal of our sister circuits ... have observed that the FMLA's definition of 'employer' largely tracks the definition of 'employer' used in the Fair Labor Standards Act and have come to the reasoned conclusion that the standards used to evaluate 'employers' under the FLSA should therefore be applied to govern the FMLA as well....[We] conclude that a rational jury could find, under the totality of the circumstances, that [the Director of Human Resources] exercised sufficient control over [the plaintiff-employee's] employment to be subject to liability under the FMLA." [Graziadio v. Culinary Institute of America, No. 15-888 (2d Cir. Mar. 17, 2016)] (U.S. Court of Appeals for the Second Circuit)  


[Advert.]

Webinar: ACA Potluck Guidance, Understanding IRS Notice 2015-87

Sponsored by ABD Insurance

ABD and Trucker Huss to present new ACA Guidance covering HRA integration, reimbursement, affordability rule clarifications, inflation adjustments, HSA eligibility, COBRA and more. Register Today for ABD Office Hours to be held March 24th, 2016.



Supply Chain Sausage (PDF)
"The simple idea that greater purchasing volume lowers producers' per-unit costs thereby permitting price discounting is the foundation of employer health care group purchasing organizations.... You would think that would mean hospitals would contract with specialized group purchasing organizations (GPOs), pay their annual membership fees and obtain savings from the GPOs' negotiated volume discounts on drugs and supplies for inpatients. But ... it doesn't seem to work that way at all ... [and] hospital GPO practices may be a root cause for the increasing cost our plans pay for the drugs that are administered to inpatients as well as the chronic shortages of inpatient drugs." (Chelko Consulting Group)  

The EEOC's Role In Reshaping Wellness Programs
"Because HRA incentives are pulled under the ADA's ceiling, there will be less room remaining to accommodate health-contingent incentives, such as premium discounts tied to cholesterol levels.... [T]he proposed rule effectively represents a compromise between those who oppose incentives and those who would like to take full advantage of incentives permitted under the ACA.... In light of recent litigation, however, it is unclear how much influence this compromise will have in the long term. What might undermine the compromise? The ADA itself." (Health Affairs)  

Coinsurance Trend Means Seniors Likely to Face Higher Out-of-Pocket Drug Costs
"Medicare beneficiaries may get dinged with higher prescription drug bills this year because more than half of covered drugs in standalone plans require them to pay a percentage of the cost rather than a flat fee ... Fifty-eight percent of covered drugs in Part D drug plans are subject to 'coinsurance' in 2016 rather than flat copayments ... The percentage of drugs requiring coinsurance has climbed steadily, increasing from 35 percent in 2014 to 45 percent last year. That percentage is approaching two-thirds of all covered drugs." (Kaiser Health News)  

How Will the ACA's Cost-Sharing Reductions Affect Consumers' Out-of-Pocket Costs in 2016?
"People with low or moderate incomes who selected a silver plan this year will experience lower deductibles in ... 38 markets ... For [a] hypothetical consumer, the median deductible for the second-lowest-cost silver plan is $2,500 if his income is $25,000, $600 if his income is $20,000, and $125 if he is earning $17,000 ... In contrast, the median deductible for someone earning $35,000 or more, and thus ineligible for a reduction, is $3,500." (The Commonwealth Fund)  


[Advert.]

HIPAA: A Guide to Health Care Privacy and Security Law

Sponsored by Wolters Kluwer

Compliance with HIPAA's exacting standards is a tremendous challenge -- ease the burden with this comprehensive guide. Use code BENEFIT20 for 20% discount.



[Opinion]

Republicans Opt for Budget Savings Over Voters' Health Care
"A GOP budget proposal that cleared the Budget Committee this week is going nowhere. But it is still worth analyzing as a philosophical statement of health policy. It would strip health care coverage from some 35 million people in order to achieve drastic budget savings. Most of these people are low-income." (Morning Consult)  

Benefits in General

[Official Guidance]

Text of IRS Notice 2016-26: Public Comment Invited on Recommendations for 2016-2017 Priority Guidance Plan (PDF)
"The Department of Treasury and [IRS] invite public comment on recommendations for items that should be included on the 2016- 2017 Priority Guidance Plan.... The 2016- 2017 Priority Guidance Plan will identify guidance projects that the Treasury Department and the [IRS] intend to work on as priorities during the period from July 1, 2016, through June 30, 2017.... Please submit recommendations by May 16, 2016, for possible inclusion on the original 2016- 2017 Priority Guidance Plan. Taxpayers may, however, submit recommendations for guidance at any time during the year." (Internal Revenue Service [IRS])  

Executive Compensation and Nonqualified Plans

[Guidance Overview]

IRS Proposal Targets Accrual of Enhanced Executive Benefits Under Qualified Plans
"If the new rules take effect as proposed, they will sound the death knell for QSERPs -- both new QSERPS and future accruals under existing QSERPs.... Instead, the proposal will likely drive benefits currently provided under QSERPs to SERPs and other types of NQDCs, even though these plans pose some insolvency risk to executives and are subject to onerous time and form of payment restrictions." (Morgan Lewis)  

Press Releases

PBGC, Sears Reach Agreement on Financial Protection for Pension Plan
PBGC [Pension Benefit Guaranty Corporation]

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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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