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ACCG
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Transamerica
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The Standard
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CUNA Mutual Group
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Three Bell Capital
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Vision, Dental, But No Hearing? Why Do Employers Need a Hearing Benefit?
RECORDED
(University Conference Services)

Strategies to Control Specialty Drug Costs
RECORDED
(University Conference Services)

Implementing the DOL's Fiduciary Rule
May 11, 2016 in NY
(SIFMA [Securities Industry and Financial Markets Association])

Implementing the DOL's Fiduciary Rule
May 11, 2016 WEBCAST
(SIFMA [Securities Industry and Financial Markets Association])

ACFC Exam Preparation Session 7: Preparing for DOL Audits
July 6, 2016 WEBCAST
(ECFC [Employers Council on Flexible Compensation])

ACFC Exam Preparation Session 8: Employer Reporting and Compliance Calendar
July 20, 2016 WEBCAST
(ECFC [Employers Council on Flexible Compensation])

Getting It Right - Know Your Fiduciary Responsibilities
July 20, 2016 in WI
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

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[Official Guidance]

Text of DOL ACA FAQs, Part 31: Certain Preventive Services, Mental Health Parity, and Women's Health
12 questions and answers covering: [1] Coverage of Food and Drug Administration (FDA)-approved contraceptives; [2] Rescissions; [3] Out-of-network emergency services; [4] Coverage for individuals participating in approved clinical trials; [5] Limitations on cost-sharing under the [ACA]; [6] Mental Health Parity and Addiction Equity Act of 2008; and [7] The Women's Health and Cancer Rights Act. (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

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[Guidance Overview]

Final SBC Guidance: The Sequel to the Sequel
"Based on the quick turnaround, it is not surprising to note that the final version of the template is very similar to the proposed version. Here are highlights of the changes: [1] In the coverage examples on the template, the cost-sharing language is more specific when copayments and coinsurance are applied to coverage. [2] The description of an embedded deductible has been clarified. [3] Each of the terms in the uniform glossary of terms has an independent web link so the key terms in electronic versions of the SBC can be linked directly to their definitions. [4] Coverage example calculators and their instructions have been updated." (International Foundation of Employee Benefit Plans [IFEBP])  

[Guidance Overview]

New Guidance on SHOP Online Enrollment Requirements
"Four states ... have not yet offered online enrollment in their state-based SHOP marketplace. In these states the employer continues to apply for an eligibility determination through the state-based SHOP, but employers and employees enroll directly with an insurer in a SHOP qualified health plan.... CMS [recently] released a guidance extending the option of direct enrollment for these states for two more years, 2017 and 2018. The guidance encourages direct enrollment states ... to offer employees horizontal and vertical choice and also to continue allowing employers to apply for small business health care tax credits through the state-based SHOP. The guidance also clearly requires, however, that states must make online enrollment available for 2019." (Health Affairs)  

Value-Based Reimbursement: The New Normal
"The traditional fee-for-service health care reimbursement system is falling out of fashion, largely due to its undeniable role in driving up health care costs.... The idea is to break (or weaken) the connection between quantity of services and reimbursement dollars. If providers are paid based on their cost savings or the effectiveness of the care they provide, the impulse to provide more, more, and more care will wane." (Wolters Kluwer Law & Business)  

Is On-Site Health Care Right for Employers?
"These nine questions will help you determine whether an onsite health center is the right 'stretching' strategy to propose.... A high-quality onsite health provider can be much more than a vendor -- they can be a true partner in helping an organization improve the health of their workforce and the performance of their business." (InsuranceNewsNet.com)  

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Supreme Court Limits ERISA Reimbursement Rights: Insurers Will Need to be Diligent
"The result in Montanile will embolden some insureds to avoid reimbursing plans. For insurers, the dollars lost might be big. What should an insurer do? A first step should be to make sure the plan documents, which probably means the insurance policy and the certificate ... not only provide for subrogation and reimbursement, but also require insureds to notify plan fiduciaries of claims against third parties and otherwise to cooperate. The plan documents should provide that not cooperating has consequences, such as offsets against future benefits or terminating coverage for misconduct, but imposing these consequences might raise other issues. The plan documents might specify that the participant and his lawyer are plan fiduciaries as to any recovery (i.e., plan assets) that should be returned to the plan." [Montanile v. Bd. of Trustees of Nat. Elevator Ind. Health Benefit Plan, No. 14-723 (U.S. Jan. 20, 2016)] (Bradley Arant Boult Cummings LLP)  

Watch Your Co-Pays: Your Pharmacy May Be Overcharging You.
"When drugstores join a Part D plan, they agree to charge consumers the plan's designated co-pay for each drug and to accept the plan's reimbursement amount. In return, they get customers seeking low-cost drugs, customers who will buy additional items once inside the store. Apparently, though, some smaller stores can't afford to take these low co-pays and reimbursements, and they try to recoup their costs by charging more or try to avoid losing money by refusing to fill the prescription." (The Washington Post; subscription may be required)  

Express Scripts Countersues Anthem in Contract Dispute
"Express Scripts said it made five separate proposals to Anthem between June 2015 and March 2016 that would have reduced Anthem's costs by a range of $2 billion to $2.8 billion during the remainder of the contract. Express Scripts said its proposals included 'billions of dollars in additional value' if Anthem agreed to implement more restrictive prescription drug benefits, such as narrower drug formularies and pharmacy networks, to gain better rebates from drugmakers and pricing from pharmacies." (The Wall Street Journal; subscription may be required)  

Comments Show Sharp Divide on Contractor Paid Sick Leave Rule
"The business community urged the [DOL] to scale back and clarify a proposal to provide paid sick leave for federal contractor employees, while progressive groups have chimed in with support but also called for language tweaks.... Many employer groups ... wrote to recommend revisions they said would make the final regulation less of a hassle, for instance by exempting employers from the record-keeping provisions if they already offer paid leave. Unions and worker advocacy organizations that focus on work-family balance hailed the DOL for expanding paid sick leave protections." [Comments are available online.] (Bloomberg BNA)  

[Opinion]

Five Things ACA Supporters Don't Want You To Know About UnitedHealth's Withdrawal from Obamacare
"Obamacare hasn't yet collapsed in a ball of flames. But UnitedHealth's withdrawal from Obamacare's Exchanges is more ominous than the administration wants you to know. [1] UnitedHealth's departure shows Obamacare is suffering from self-induced adverse selection.... [2] UnitedHealth's departure is bad news for other carriers.... [3] UnitedHealth's departure shows Obamacare premiums will continue to rise.... [4] There will be more exits.... [5] UnitedHealth's departure shows quality of coverage under Obamacare will continue to fall." (Forbes)  

District Court: Claim of Intentional Infliction of Emotional Distress is Narrow Enough to Avoid ERISA Preemption
"The governing rule is that so long as the claim could result in relief irrespective of the outcome of the ERISA claim, the plaintiff states a viable cause of action and is able to survive a motion to dismiss. However, if the claim is linked to or intertwined with the underlying ERISA claim such that the success or failure of the claim would depend on a favorable decision on the benefit claim, it will be pre-empted.... Here, the court ... [concluded] that the intentional infliction of emotional distress claim was not preempted. However, if [the participant] had alleged an entitlement to emotional distress damages solely on account of the claim denial or alleged consequential damages on account of a delay in processing his claim, such as asserting an eviction from his home due to the delay, such a claim would easily have been found pre-empted." [Kresich v. Metropolitan Life Ins. Co., No. 15-cv-05801 (N.D. Cal. Apr. 4, 2016)] (DeBofsky & Associates, P.C.)  

Rationalizing the Dodd-Frank Clawback
69 pages. "[T]he SEC's proposed Dodd-Frank clawback, while reducing executives' incentives to misreport, is overbroad. The economy and investors would be better served by a more narrowly targeted 'smart' excess-pay clawback that focuses on fewer issuers, executives, and compensation arrangements." (Jesse M. Fried, Harvard Law School, via SSRN)  

Digital Insurance Shakes up Employee Benefits Marketplace with Investment in Tech Company GoCo
Digital Insurance

Manning & Napier, Inc. Announces the Retirement of Patrick Cunningham, CEO
Manning & Napier, Inc.

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