Health & Welfare Plans Newsletter

March 31, 2016

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[Guidance Overview]

2015 San Francisco HCSO Annual Reporting Form Released; April 30 Filing Deadline
"The San Francisco Office of Labor Standards Enforcement (OLSE) has just released the 2015 Health Care Security Ordinance (HCSO) Annual Reporting Form. HCSO-covered employers are required to complete and submit this form by April 30, 2016 to report on the 2015 calendar year.... The San Francisco [HCSO] generally requires employers with a valid San Francisco business registration and with 20 or more employees ... to make a minimum level of hourly health care expenditures for employees performing at least eight hours of work per week in San Francisco." (ABD Insurance & Financial Services)  


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Supreme Court Reaffirms ERISA's Preemptive Effect
"Although the larger effect of Gobeille is not yet known, there are a few immediately clear new rules of law. First ... any state mandate that creates novel, redundant or inconsistent administration requirements [is] preempted unless [it qualifies] for an exemption, even if the state is acting in pursuance of a policy goal within the scope of the ACA. Second, information relating to ERISA claims is exempt from the 'all-payer databases' established by at least 18 states. In fact, additional disclosures beyond those required by the [DOL] may violate the sponsor or administrator's fiduciary duty to plan participants." (Pillsbury Winthrop Shaw Pittman LLP)  

What If the Doctor Refuses to Use the Employer's FMLA Medical Certification Form? And Wants to Charge for It?
"Generally speaking, it doesn't matter whether a medical certification is written on your preferred form or on the back of a bar napkin. So long as the document is signed by a health care provider, and is 'complete' and 'sufficient' in the sense that it provides the employer with all of the information needed to determine if the leave is covered by the FMLA, then the certification should be accepted.... because the employee is responsible for providing the employer with complete and sufficient medical certification supporting the need for FMLA leave, the employee also is on the hook to pay the fee ... Not the employer." (FMLA Insights)  

Number of Employers Offering Fully-Paid Health Care Plummets
"The share of Fortune's best companies that still pay for 100% of employee's healthcare has dropped to 9% this year from a peak of 34% in 2001.... That big drop represents a broader workplace trend -- employees are covering more of their health insurance premiums than in previous years. Workers with employer-sponsored health plans now contribute an average of 18% of the premium for single coverage and 29% of the premium for family coverage[.]" (Fortune)  

Inviolable -- or Not: The Legal Status of Retiree Medical Benefits for State and Local Employees
"Of the ten states reviewed herein, three -- Illinois, New York, and Pennsylvania -- provide significant protection for retiree medical benefits, either through explicit statutory provisions or through case law suggesting that retiree benefits vest for life in the absence of explicit language to the contrary; five states -- California, Connecticut, Michigan, New Jersey, and Texas -- provide a moderate level of protection, with the specifics varying significantly from case to case; and two states -- Alabama and Ohio -- lack sufficient legal precedent to make any generalizations regarding the legal approach typically used." (Manhattan Institute for Policy Research)  


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President's Task Force Aims to Help End Discrimination in Mental Health Coverage
"Tucked in remarks the president made Tuesday on the opioid epidemic was his announcement of a new task force on mental health parity -- aimed at ensuring that people with mental illnesses and substance abuse problems don't face discrimination in the health care system.... Advocates say parity has long been an 'empty phrase' and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them." (Kaiser Health News)  

First Medical Loss Ratio Audits Suggest Need for Clearer Standards
"[CMS has] posted the results of the first audits it has conducted of insurers under the [ACA] medical loss ratio (MLR) program.... The audits covered four insurance companies for the 2013 reporting year, which included 2011, 2012, and 2013 data.... One of the audited companies ... passed with flying colors -- no concerns were noted in the audit. Another company ... was found to have overstated its claims by double counting capitation payments to a particular provider. [A third company] was also found to have overstated its claims through errors in recording capitation expenses.... The audit of a fourth company ... found more serious and pervasive problems." (Health Affairs)  

House Committees Subpoena HHS for Information on $1.3 Billion in Payments for Basic Health Program
"As part of a nearly yearlong effort to obtain information regarding unlawful spending, the House Committee on Ways and Means and the House Energy and Commerce Committee [have] issued subpoenas to [HHS]. The committees have been seeking to understand ... the Administration's decision to fund the Basic Health Program without a congressional appropriation. Instead of seeking an appropriation, as required by the law, the Administration has redirected taxpayer dollars that were appropriated to fund a different Obamacare program. HHS has failed to comply with the committees' targeted requests for information." (Committee on Ways and Means, U.S. House of Representatives)  

CO-OPs Are Doing Well, Even If They Are Disappearing
"Performance and CMS oversight of the [CO-OPs] ... has improved over time, despite the fact that the number of CO-OPs is shrinking. Additionally, according to a GAO report ... the issuers are averaging lower premiums for 2015 than they were in 2014 and generally have lower premiums than competing issuers. The GAO also found that combined enrollment for the 22 CO-OPs that offered plans in 2015 was more than double the enrollment of the prior year[.]" (Wolters Kluwer Law & Business)  

American Academy of Actuaries Comments to CMS on 2017 Unified Rate Review Template Instructions (PDF)
"On behalf of the American Academy of Actuaries' Premium Review Work Group, [the author] would like to offer a number of comments related to the 2017 Unified Rate Review Template (URRT) instructions.... Version 3.3 of the URRT includes wider tolerances than previous versions; however, there are two places in which the overall tolerances may not be appropriate." (American Academy of Actuaries)  

Executive Compensation and Nonqualified Plans

[Official Guidance]

Text of FASB Update 2016-09: Stock Compensation (Topic 718) -- Improvements to Employee Share-Based Payment Accounting
127 pages. "The areas for simplification in this Update involve several aspects of the accounting for share-based payment transactions, including the income tax consequences, classification of awards as either equity or liabilities, and classification on the statement of cash flows. Some of the areas for simplification apply only to nonpublic entities." (Financial Accounting Standards Board [FASB])  

FASB Issues Standard to Simplify Share-Based Payment Accounting
"In addition to rules that affect all organizations that issue share-based payments, the ASU contains provisions that simplify two areas specific to private companies:... [1] [P]rivate companies will be able to apply a practical expedient to estimate the expected term for all awards with performance or service conditions that have certain characteristics. [2] Private companies will be able to make a one-time election to switch from measuring all liability-classified awards at fair value to measuring them at intrinsic value." (Journal of Accountancy)  

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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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