Health & Welfare Plans Newsletter

May 16, 2016

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Pension De-Risking Market Update -- Decision 2016: Which Path will you Elect to Go?
May 25, 2016 WEBCAST
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What's New with 403(b) and 457(b) Plans?
May 26, 2016 WEBCAST
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403(b) and 457(b) Plan Documents
May 31, 2016 WEBCAST
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HCEs: Digging Deeper
June 7, 2016 WEBCAST
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[Official Guidance]

Text of EEOC Final Regs: The ADA and Workplace Wellness Programs
73 pages. "The [EEOC] is issuing its final rule ... to provide guidance on the extent to which employers may use incentives to encourage employees to participate in wellness programs that ask them to respond to disability-related inquiries and/or undergo medical examinations. This rule applies to all wellness programs that include disability-related inquiries and/or medical examinations whether they are offered only to employees enrolled in an employer-sponsored group health plan, offered to all employees regardless of whether they are enrolled in such a plan, or offered as a benefit of employment by employers that do not sponsor a group health plan or group health insurance." (U.S. Equal Employment Opportunity Commission [EEOC])  


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[Official Guidance]

Text of EEOC Final Regs: GINA and Workplace Wellness Programs
69 pages. "This rule addresses the extent to which an employer may offer an inducement to an employee for the employee's spouse to provide information about the spouse's manifestation of disease or disorder as part of a health risk assessment (HRA) administered in connection with an employer-sponsored wellness program. Several technical changes to the existing regulations are included." (U.S. Equal Employment Opportunity Commission [EEOC])  

[Guidance Overview]

Text of EEOC FAQs: The ADA and Workplace Wellness Programs
23 questions and answers. Topics: [1] Background; [2] ADA protections; [3] Purpose of the Rule; [4] ADA "Safe Harbor" applicable to insurance; [5] "Reasonably Designed" employee health programs; [6] Incentives permitted; [7] Confidentiality; [8] Coordination with other federal agencies; [9] Applicability date; [10] Other EEOC guidance on wellness programs. (U.S. Equal Employment Opportunity Commission [EEOC])  

[Guidance Overview]

EEOC Fact Sheet: The ADA and Workplace Wellness Programs
"Incentives to an employee who answers disability-related questions or undergoes medical examinations as part of a wellness program in order to earn a reward or avoid a penalty, are limited ... The provisions of this rule requiring a notice and establishing incentive limits apply only prospectively to wellness programs as of the first day of the first plan year that begins on or after January 1, 2017, for the health plan used to determine the level of incentives permitted under the rule." (U.S. Equal Employment Opportunity Commission [EEOC])  

[Guidance Overview]

Text of EEOC FAQs: GINA and Workplace Wellness Programs
22 questions and answers. Topics: [1] Background; [2] Purpose of the Rule; [3] "Reasonably Designed" program; [4] Inducements permitted; [5] Confidentiality; [6] Other revisions to the GINA regulations; [7] Coordination with other federal agencies; [8] Applicability date; and [9] Other EEOC guidance on wellness programs. (U.S. Equal Employment Opportunity Commission [EEOC])  


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[Guidance Overview]

EEOC Fact Sheet: GINA and Workplace Wellness Programs
"[A]n employer can offer a limited inducement to an employee whose spouse provides current or past health status information as part of a wellness program. Inducements may be financial or in-kind ... Employers may offer children the opportunity to participate in wellness programs, but may not offer inducements in exchange for current or past health status information about children.... [An] employer that offers health or genetic services and requests current or past health status information of an employee's spouse must obtain prior, knowing, written, and voluntary authorization from the spouse before the spouse completes a health risk assessment.... The provisions of this rule establishing inducement limits apply only prospectively to wellness programs as of the first day of the first plan year that begins on or after January 1, 2017, for the health plan used to determine the level of inducement permitted under the rule." (U.S. Equal Employment Opportunity Commission [EEOC])  

[Guidance Overview]

HHS Issues Final ACA Nondiscrimination Regs
"Covered entities that are principally or primarily engaged in providing or administering health services or health insurance coverage may not discriminate in the operation of their employee health benefit programs. The nondiscrimination provision also applies to employers that receive federal financial assistance to fund their employee health benefit programs and health service or coverage operations of employers that are not primarily engaged in health care.... Employee health benefit programs include insured and self-insured plans, employer- provided or employer-sponsored wellness programs, employer-provided health clinics, and long-term care coverage provided or administered by an employer, group health plan, third party administrator, or health insurer. Wellness programs are covered as an employee health benefit program whether or not they are part of the employer's health benefit plan." (Timothy Jost, in Health Affairs)  

[Guidance Overview]

Be an Organ Donor in Wisconsin, and Qualify for Unpaid Leave
"Effective July 1, 2016, Wisconsin law will require covered employers to provide eligible employees with up to 6 weeks of unpaid leave in a 12-month period to undergo and recover from bone marrow or organ donation procedures.... The new law ... borrows heavily from the Wisconsin Family and Medical Leave Act (WFMLA), including its employer scope, employee eligibility requirements, benefit continuation and reinstatement requirements, substitution rules, and enforcement standards and procedures." (Ogletree Deakins)  

Text of Supreme Court Per Curiam Opinion Remanding Religious Non-Profit Contraceptive Cases (PDF)
"Following oral argument, the Court requested supplemental briefing from the parties addressing 'whether contraceptive coverage could be provided to petitioners' employees, through petitioners' insurance companies, without any such notice from petitioners.' Both petitioners and the Government now confirm that such an option is feasible.... In light of the positions asserted by the parties in their supplemental briefs, the Court vacates the judgments below and remands to the respective United States Courts of Appeals ... Given the gravity of the dispute and the substantial clarification and refinement in the positions of the parties, the parties on remand should be afforded an opportunity to arrive at an approach going forward that accommodates petitioners' religious exercise while at the same time ensuring that women covered by petitioners' health plans 'receive full and equal health coverage, including contraceptive coverage.' ... Although there may still be areas of disagreement between the parties on issues of implementation, the importance of those areas of potential concern is uncertain, as is the necessity of this Court's involvement at this point to resolve them." [Zubik v. Burwell, No. 14-1418 (S.Ct. May 16, 2016)] (Supreme Court of the United States)  

Why a Logical Approach to Health Plan Design Can Be Financially Disastrous
"[O]ur premium rating software was creating a tantalizing 25% reduction in premium by introducing a modest $250 deductible with 90% coinsurance as compared to a zero-deductible, 100% coinsurance plan.... This decrement was actuarially wrong -- very wrong. However, from the insurance company's perspective, the premiums were 100% correct and approved for sale.... While sometimes these irregularities are underwriting mistakes, most often, they are intentional financial incentives geared to move employers away from historic plan designs, networks and platforms." (CBIZ, via Employee Benefit News)  

District Court Just Dealt a Blow to the ACA, But Employers Shouldn't Get Too Excited
"This case does not affect an individual's ability to go to the exchange and get a tax credit or cost-sharing reduction. It only affects an insurer's ability to get reimbursed for providing a cost-sharing reduction. So, if one your employees goes to the exchange and gets a tax credit or cost-sharing reduction, your company will still be on the hook for penalties." [U.S. House of Representatives v. Burwell, No. 14-1967 (D.D.C. May 12, 2016)] (Jackson Lewis P.C.)  

Supreme Court Ruling Calls Into Question Validity of State APCD Statutes and Claims Taxes with Respect to ERISA-Governed Plans (PDF)
"The Gobeille decision is noteworthy in that it may effectively block a growing trend of states enacting strict reporting regimes applicable, in part, to ERISA-governed insured and self-insured plans. Furthermore, the opinion may undermine other state laws that necessitate gathering health care data -- for example, state taxes levied on paid medical claims.... [T]he scope of the Court's decision in Gobeille is not entirely clear and future litigation at the federal district and circuit court level should be expected regarding the permissibility of states' specific rules." (Groom Law Group)  

Some Cost-Sharing Measures Rise Significantly in ACA Marketplace Plans
"Out-of-pocket limits rose by 7 percent, general annual deductibles climbed 10 percent and copayments for nonpreferred drugs rose 14 percent [from 2015 to 2016 among the 40 million Americans who aren't eligible for cost-sharing reductions]. In contrast, copayments for generic drugs decreased by 3 percent. Deductibles ... increased by 10 percent for bronze plans and by 5 percent for silver and gold plans, while platinum plans had a 16 percent decrease in deductibles[.]" (FierceHealthPayer)  

Insights from the 2016 Survey of U.S. Health Care Consumers
"Exchange consumers say they are satisfied with their coverage at the same rate as people with employer coverage.... More than twice as many exchange consumers report using online information sources to shop for a policy than the average consumer, including those with employer coverage. More exchange consumers say they understand their costs than consumers with employer coverage, and when they used their coverage, few had surprise out-of-pocket costs." (Deloitte Center for Health Solutions)  

[Opinion]

Interstate Health Insurance Would Undermine State Law Consumer Protections for Sicker-Than-Average People
"Selling health insurance 'across state lines,' supporters say, would reduce premiums and give consumers substantially more options. The handful of states that tried to open their markets to out-of-state insurers before health reform, however, had little to show for it." (Center on Budget and Policy Priorities)  

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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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