Health & Welfare Plans Newsletter

May 26, 2016

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Senior Pension Benefits Analyst
Willis Towers Watson
in CO, MA, MI, PA, TX

Pension Consultant
Willis Towers Watson
in CO, MA, MI, PA, TX

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SuperiorUSA Benefits
in IA, MN

Retirement Plan Manager
Aspire Public Schools
in CA

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Insperity
in TX

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Actuarial Consultants, Inc.
in CA

Director for Retirement Programs and Services
Board of Regents of the University System of Georgia
in GA

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Webcasts and Conferences

ACA: A Never-Ending Story
June 14, 2016 WEBCAST
(Cowden Associates, Inc.)

PBM Trends
June 21, 2016 in MA
(Employers Health)

2016 Annual Employer Symposia: Building a Thriving Workforce through Benefits
June 23, 2016 in OH
(Employers Health)

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[Official Guidance]

Text of CMS FAQ on Waiting Periods for Essential Health Benefits (PDF)
Unnumbered document, dated May 26, 2016. "For plans that must provide coverage of the essential health benefit package under section 1302(a) of the [ACA], if an issuer imposes a waiting period before an enrollee can access a covered benefit, is that a violation of the EHB requirements? Yes.... After further consideration of whether pediatric orthodontia should be excepted from this prohibition on waiting periods, we are revising our policy to no longer allow waiting periods for pediatric orthodontia, as we have determined that the same concerns we previously noted also apply to these benefits." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


[Advert.]

Innovations in Wellness and Population Health Management - July 25-26, 2016 - Boston, MA

Sponsored by World Congress

Health plans discuss implementation/sustainability of wellness programs, engaging consumers, incentives, & privacy. Promo Code BLINK2 takes $200 off your registration (May not combine w any other offer. Invalid twd Govt Rate/Workshop Only/Webcast



[Guidance Overview]

HHS Issues Final ACA Nondiscrimination in Health Programs and Activities Regulation
"The nondiscrimination provision extends to employers who as plan sponsors receive federal financial assistance to fund their employee health benefit programs; however, an employer that otherwise receives federal financial assistance does not become subject to the rule simply by offering employee health benefits.... Third-party administrators are only liable for their own discriminatory actions based on decisions that are within the scope of their authority, such as discriminatory claims denials. A discriminatory plan design would be the liability of the self-insured group health plan, with OCR reviewing whether the third-party administrator and the self-insured group health plan are legally separate on a case-by-case basis." (McDermott Will & Emery)  

IRS Doubted Legality of Obamacare Payments, Former Official Says
"David Fisher, who was the IRS's chief risk officer, told the House Ways and Means Committee that agency officials questioned whether the [ACA] provided the authority to make certain payments to insurers without an appropriation from Congress. Most senior IRS officials ended up concluding that the payments were legal after a meeting with the White House to hear its legal justification, and the administration eventually went ahead with disbursing the funds." (The Hill)  

New Health Benefits Survey Shows Continued Employer Focus on Containing Costs (PDF)
"Of employers who do offer spousal coverage, 27 percent required a surcharge to cover the spouse, compared to 16 percent in 2014. The average surcharge in 2015 was $2,288, which increased from $1,730 in 2014....The average percentage of the medical premium that employees paid for single coverage in 2015 was 15 percent, which has remained relatively constant over the past several years. The average premium share for family coverage was 20 percent in 2015.... 50 percent of employers offer a plan with either an HSA or an HRA account option. This is up significantly from last year at 41 percent." (Conrad Siegel Actuaries)  

The Cost/Benefit Analysis of Self-Funding Employee Health Benefits
"Large self-funded employers ... have the deep pockets to hire major, brand name administrators. Smaller employers sometimes end up with smaller, less sophisticated administrators, either because of cost or because they simply don't know what to look for in picking an administrator. These operational risks place a smaller employer with a self-funded plan at risk of losses, and need to be accounted for by smaller companies in, first, deciding whether to self-fund health benefits and, second, in planning how to do so." (Stephen Rosenberg, The Wagner Law Group)  


[Advert.]

ECFC's 29th Annual Administration Symposium Coming This August Ė Sign Up Now!

Sponsored by ECFC [Employers Council on Flexible Compensation]

ECFC's Flexible Benefit Administrators' Symposium is the premier networking and professional development event for the consumer-directed benefits industry: get advice, technical education, and Congressional and regulatory updates from industry leaders.



Understanding How Payment and Benefit Designs Work Together in Health Care
"Many of those experimenting with or interested in implementing reforms don't understand the nuances of the payment methods and or benefit designs involved: their strengths and weaknesses; how to combat potential weaknesses; what performance measures should be used to counter possible unintended consequences; and how these incentives may affect provider pricing. Having a greater understanding of the nuances inherent in provider and consumer incentives can help implementers determine where their reforms fall short and how they can address those challenges." (Health Affairs)  

The ACA's Section 1332: Escape Hatch or Straightjacket for Reform?
"In state capitols across the country, health care lobbyists and consultants are pushing a relatively unknown provision of the [ACA] (ACA): Section 1332. According to some proponents, these waivers will 'turbocharge state innovation' and will provide states with an 'exit strategy' from the ACA. But is the hype true? Will Section 1332 waivers be as truly transformative to our health care system as suggested? ... A serious, objective examination of the new Section 1332 federal guidance sparks far more questions than answers for policymakers." (Health Affairs)  

Missouri Says Aetna-Humana Merger Is Anti-Competitive
"Missouri insurance officials have issued a preliminary order against the merger of Aetna and Humana, the first state to find serious antitrust problems with the massive transaction. However, Aetna and Humana have 30 days to 'submit a plan to remedy the anti-competitive impact of the acquisition.' ... But some antitrust experts aren't convinced selling off assets to another insurer will solve all concerns.... Aetna has received approval for the Humana deal in 15 out of a necessary 20 states." (Modern Healthcare Online; free registration required)  

Missouri to Ban Small-Group Products of Resulting Firm If Aetna and Humana Merge
"In a preliminary order, Missouri Department of Insurance Director John Huff writes that if Aetna and Humana's deal eventually closes, the company and its subsidiaries must 'cease and desist' from doing business throughout the state in the comprehensive individual, comprehensive small-group and group Medicare Advantage markets. In the individual MA market, Aetna-Humana would have to stop doing business in certain counties in Missouri that the state has determined would be adversely affected by competition." (FierceHealthPayer)  

[Opinion]

CFOs and HR Execs Face Millions in Personal Liability Due to Unmanaged Health Plans
"Employers typically have extremely rigorous oversight of retirement benefits with independent investment committees, regular audits and more. Though the same fiduciary responsibility exists for health benefits, evidence suggests that the vast majority of employers have fallen short." (Forbes)  

[Opinion]

Taxes, Fees, and Your Health Insurance Premiums
"What determines how much you pay in health insurance premiums? That's a complicated question that involves a number of factors ... [One] factor that receives less attention is the total amount of various taxes and fees paid by health insurance companies. We must understand these costs and aim to reduce or end these taxes and fees if we are to address the affordability of coverage." (America's Health Insurance Plans [AHIP])  

[Opinion]

Will You Ever Understand Your Medical Bill?
"It is hard not to get carried away on a wave of outrage when reading stories of patients faced with ridiculous bills, which (even if they can understand them) they might never be prepared to pay. A new crop of entrepreneurs is hoping to solve this problem.... The Obama Administration itself is getting into the act, having just announced a competition to design 'A Bill You Can Understand,' which will give prizes of $5,000 each to two designers who meet the challenges of making bills comprehensible and improving the workflow that generates them." (National Center for Policy Analysis Health Policy Blog)  

Executive Compensation and Nonqualified Plans

Court Boots Executive's $21 Million ERISA Claim Under Stock Rights Plan
"In affirming a federal district court's decision, the U.S. Court of Appeals for the Ninth Circuit held ... that the Booz Allen stock rights plan wasn't covered by [ERISA] because it wasn't designed or intended to provide retirement or deferred income. With this ruling, the Ninth Circuit joins the Third, Fifth and Eighth circuits in holding that to qualify as an employee pension benefit plan subject to ERISA, 'the paramount consideration is whether the primary purpose of the plan is to provide deferred compensation or other retirement benefits.' " [Rich v. Shrader, et al., No. 14-55484 (9th Cir. May 24, 2016)] (Bloomberg BNA)  

Press Releases

TRA Expands Western Sales Staff
The Retirement Advantage [TRA]

DOLís Actions Recover $7.1M for Workers in AIT Laboratories Employee Stock Ownership Plan
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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