Health & Welfare Plans Newsletter

May 2, 2016

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Best Practices for a Successful Plan Audit
RECORDED
(ASPPA [American Society of Pension Professionals & Actuaries])

QDIAs and Investment 101 for Plan Administrators
May 11, 2016 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

Washington Update: The DOL Fiduciary Rule Package (Is there Anything Else?)
May 19, 2016 in CA
(Western Pension & Benefits Council - Orange County Chapter)

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[Official Guidance]

Official DOL Family and Medical Leave Act (FMLA) Poster
"All covered employers are required to display and keep displayed a poster prepared by the [DOL] summarizing the major provisions of The Family and Medical Leave Act (FMLA) and telling employees how to file a complaint. The poster must be displayed in a conspicuous place where employees and applicants for employment can see it. A poster must be displayed at all locations even if there are no eligible employees." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  


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[Official Guidance]

Text of CMS Submission to OMB: Information Collection for Transparency in Coverage Reporting by Qualified Health Plan Issuers
"This data collection would collect certain information from QHP issuers in Federally-facilitated Exchanges and State-based Exchanges that rely on the federal IT platform (i.e., HealthCare.gov). HHS anticipates that consumers may use this information to inform plan selection.... HHS intends to phase in implementation for other entities over time.... [B]roader implementation ... will continue to be addressed in separate rulemaking ... For State-based Exchanges not addressed in the current proposal, standards will be proposed later." [CMS submission package includes Supporting Statement, Comments and responses, and Data Collection Overview.] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Official Guidance]

Text of CMS Bulletin on Display of Quality Rating System Star Ratings and Qualified Health Plan Enrollee Survey Results for QHPs Offered Through Marketplaces (PDF)
Unnumbered document, dated Apr. 29, 2016. "This guidance announces that there will be an additional year of QRS and QHP Enrollee Survey testing to inform the public display of quality rating information on Marketplace websites.... Although public reporting of QRS results in the FFMs (including FFMs where the State performs plan management functions) and SBM-FPs will now begin with the 2018 open enrollment period, [CMS does] not anticipate major changes to the QRS methodology for the 2018 plan year ... The revised timeframe for the public display will also provide QHP issuers additional time to measure and improve the quality of QHPs offered through Marketplaces using the current QRS measure set and methodology." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

12 Counting Methods Employers Must Know When Sponsoring a Health Plan (PDF)
"Employee counts are used to determine what laws, rules, fees, and penalties apply to a health plan and/or the employer sponsor. But the methods for counting employees are as varied as the laws that affect them.... [This article provides] a synopsis of 12 counting methods that employers must utilize to properly administer their health plans ... [including a summary of] these counting methods in a convenient, easy-to-follow chart." (Compliance Dashboard)  

[Guidance Overview]

DOL Issues Guidance on Interaction Between ACA and Fringe Benefit Requirements Under Service Contract, Davis Bacon and Related Acts
"DOL emphasizes that the [ACA] and the SCA and DBRA are independent laws, and government contractors are expected to comply with each of them. In other words, no provision of either set of laws exempts contractors from the obligations of the other. The DOL then goes on to answer a variety of common questions that have been raised." (Proskauer Rose LLP)  


[Advert.]

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[Guidance Overview]

CMS Releases Revised Transparency Proposal for QHPs
"Insurers may link to existing documents, such as their summaries of benefits and coverage, that provide this information. The general public must be able to access the information, however, without having to log on, create a user ID, or enroll in a plan. This information will be collected on an insurer-level, rather than a plan-level basis, but if policies differ by state or market, insurers must provide 'applicable material.' If policies are changed, the website should be updated within seven days." (Health Affairs)  

[Guidance Overview]

Simplifying Choices in the Marketplace: Simple Choice Plans and Quality Star Ratings
"To improve decision making, Simple Choice plans will display prominently in Plan Compare, with clear visual cues that show consumers the plans that are easy to compare vs. the ones that should be researched for differences. Consumers also will be able to choose to only see these types of plans, if they want to quickly compare them." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

Medicaid Managed Care Final Rule: Examining the Alignment with Qualified Health Plan Requirements
"CMS has rechristened standardized plans as 'simple choice plans.' These are plans with standardized benefit and cost-sharing parameters. Although CMS has not yet decided how exactly these plan options will be displayed or described, the blog post does say that they will be displayed prominently in Plan Compare and that consumers will be able to choose to see only standardized plans if they want to compare only these plans." (Health Affairs)  

Managing Prescription Drug Plan Costs: Pricing Tricks Employers Should Watch For
"Make sure the PBM contract has minimum pricing guarantees. A PBM that passes the pricing it pays the pharmacies on to you (rather than charging you a higher price than the PBM pays the pharmacies for drugs) is a great way to help ensure the best pricing. Carefully review and negotiate virtually every word in the contract to ensure the PBM will actually deliver the pricing promised. Negotiate generous rights to audit the PBM. Even with a carefully negotiated contract, it's not at all uncommon for PBMs to breach the negotiated contract with complete disregard for its provisions." (Marsh Consulting Group)  

Understanding Domestic Partner Health Benefits After Obergefell
"[M]ost domestic partner health benefits plans today rely on some sort of certification by the employee, rather than state action, to determine who is a domestic partner.... In most instances, employers see a domestic partner benefit as being equivalent to a spousal benefit. However, domestic partner health benefits policies raise a variety of concerns not present in spousal benefits.... [1] Compliance with federal and state nondiscrimination statutes. [2] Defining who is a domestic partner. [3] Federal and state tax concerns. [4] COBRA issues." (Calhoun Law Group, P.C.)  

CMS Looks to Simplify Insurance Shopping with 'Simple Choice' Plans, Quality Star Ratings on Exchanges
"The federal insurance exchanges will offer standardized health plans and display a five-star ratings system as pilot program during the fourth open enrollment period, scheduled to open later this year.... The standardized plans, called 'Simple Choice plans' will have a uniform set of features which will allow customers to compare plans on just a few important factors, such as monthly premiums and which providers are part of a plan's network." (Morning Consult)  

Executive Compensation and Nonqualified Plans

[Guidance Overview]

New Incentive Compensation Rules: Implications for Private Equity Firms (PDF)
"[T]he Federal Deposit Insurance Corporation and several other agencies have released revised proposed rules to implement Section 956. The proposals released to date preview what are expected to be substantially similar proposed rules coming from the SEC in the near term. The SEC's version of the proposed rules should provide additional detail that would apply specifically to investment advisers -- including advisers to private equity funds and other private funds -- and to broker-dealers. The proposed rules differ significantly from the original rule proposals issued in 2011." (Debevoise & Plimpton LLP)  

Can You Amend Your Stock Plan to Allow Tax Withholding Up to the Maximum Statutory Rate?
"[B]oth the NYSE and NASDAQ require shareholder approval of a material amendment of a plan that provides for stock awards to directors or executives.... From the perspective of the NYSE and NASDAQ, if the Stock Plan allows the recycling of shares surrendered or withheld to pay tax withholding (that is, puts those shares back in the authorized share pool and allows those shares to be re-used for future awards), then an amendment of that Plan that allows for tax withholding at the maximum rate instead of the minimum rate would be material because it will increase the number of shares available for issuance under the Plan!" (Winston & Strawn LLP)  

Press Releases

DOL, Invesco Trust in Atlanta Reach Settlement to Compensate Investors for Undisclosed Losses
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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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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