Health & Welfare Plans Newsletter

June 1, 2016

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Hot Topics in Employee Benefits: What We're Seeing
June 8, 2016 WEBCAST
(Morgan Lewis & Bockius LLP)

Preventive Health Programs: 5 Ways You May Be at Compliance Risk
June 14, 2016 WEBCAST
(EHE International)

Employment and Benefits Law Update
June 16, 2016 in TN
(Bass, Berry & Sims)

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[Official Guidance]

Text of 2015 IRS Instructions for Form 8962: Premium Tax Credit (PDF)
19 pages; revised June 1, 2016. "If you or a member of your family enrolled in health insurance coverage for 2015 through a Health Insurance Marketplace (Marketplace, also known as an Exchange), APTC may have been paid to your insurance company to help cover your monthly premium, and you may be eligible for the PTC. If APTC was paid on your behalf or, if APTC was not paid on your behalf but you wish to take the PTC, you must file Form 8962 and attach it to your tax return (Form 1040, 1040A, or 1040NR)." (Internal Revenue Service [IRS])  


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[Guidance Overview]

The DOL's New FMLA Poster -- Does It Impact Your FMLA Policy?
"[At] a minimum, all of the information that is in the poster must be included [in the employer's FMLA policy]. Note that 'all' means 'all'; your policy must include, for example, not only information about the employee's rights and responsibilities, but also the information in the poster regarding the employer's responsibilities, along with enforcement information such as the employee's right to file a complaint with the [DOL] and the DOL's contact information." (Benefits Bryan Cave)  

[Guidance Overview]

ACA's Affordability Contribution Percentages Increased for 2017
"Several [ACA] provisions measure the 'affordability' of employer-sponsored health coverage. 'Affordability' is defined differently depending on the specific ACA provision. Employers subject to the ACA's employer shared responsibility provisions may be subject to penalties if the coverage offered to full-time employees is unaffordable. The different measurements of affordability are summarized and compared in this article." (Ascende)  

The Ins and Outs of Provider-Sponsored Health Plans
"Provider ownership in health plans has been increasing steadily, from 94 in 2010, to 106 in 2014 ... Most of the enrollment growth has occurred in the Medicaid, Medicare Advantage, and individual markets.... [S]ince 2014, the number of provider-run plans has more than doubled, from 107 two years ago to 270 currently in operation today.... [E]xpectations are that half of health systems will be applying or will consider applying for an insurance license." (Healthcare Finance News)  

The Importance of Hearing Aid Coverage
"Medicare excludes hearing aid coverage and only two-thirds of states cover adult hearing aids through Medicaid. On top of that, no state mandates that private health insurance plans cover hearing devices for adults and only seven have such a mandate for children. These statistics leave those without coverage to pay out-of-pocket an average of $4,500 per pair for these necessary therapeutic aids." (Morning Consult)  


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State Officials Say CMS Inflexible on Risk Adjustment Changes
"Without more flexibility from the HHS in administering an ACA program intended to help insurers covering sick enrollees, more nonprofit CO-OPs and other small, new entrants into the health insurance marketplaces may go out of business. State insurance officials and insurance company executives [said] that steps taken by the HHS to help states mitigate problems from the [ACA] risk adjustment program appear to be of little use." (Bloomberg BNA)  

Share of Total Spending on Healthcare Increased from 1984 to 2014
"In 2014, consumers spent 8.0 percent of total spending on healthcare, compared with 4.8 percent in 1984. Consumers spent 5.4 percent of total spending on health insurance in 2014, compared with 1.7 percent in 1984." (U.S. Bureau of Labor Statistics [BLS])  

How to Pay for Medicare
"Over the next 75 years ... Medicare is projected to grow from 3.53 percent to 6.02 percent of gross domestic product... One of the goals of the [ACA] and of the majority of Medicare reform proposals has been to reduce or eliminate excess cost growth as it applies to federal spending. Without significant changes in the current program, it is not realistic to think that federal Medicare spending per capita can be constrained to grow at the same rate as per capita GDP." (National Center for Policy Analysis [NCPA])  

Insurers File for ACA Rate Increases for 2017 in North Carolina
"Blue Cross and Blue Shield of North Carolina has filed for an average increase of 18.8 percent in its individual [ACA] plans for 2017 as the company continues to experiences losses in that segment.... BCBSNC paid out $1.29 billion in claims for the sickest five percent of its ACA segment last year, which accounted for 70 percent of the company's overall ACA revenue. Over the past two years, BCBSNC has lost more than $400 million on its ACA business." (InsuranceNewsNet.com)  

UnitedHealth to Exit California's Obamacare Market
"UnitedHealth Group Inc. is leaving California's insurance exchange at the end of this year, state officials confirmed ... UnitedHealth's pullout also affects individual policies sold outside the Covered California exchange, which will remain in effect until the end of December.... It's expected that UnitedHealth will continue offering coverage to employers in California and to government workers and their families through [CalPERS]." (Kaiser Health News)  

House Republicans Say Administration Is Evading Questions of Illegal Obamacare Funding
"Earlier this month, Republican lawmakers were emboldened by federal court ruling that said the administration is unlawfully paying insurers who are required to reduce costs for poorer customers on Obamacare's exchanges. But they also want to know if the administration is going around the [ACA]'s text to fund the Basic Health Program, a second, lesser-known part of the 2010 health care law that allows states to set up a coverage program for low-income people who are ineligible for Medicaid and would otherwise enter Obamacare's subsidized health care exchanges." (Washington Times)  

Benefits in General

[Guidance Overview]

June and July 2016 Filing and Notice Deadlines for Qualified Retirement and Health & Welfare Plans
"The filing and notice deadline table [in this article] provides key filing and notice deadlines common to calendar year plans for the next two months." (King & Spalding)  

Executive Compensation and Nonqualified Plans

Broad-Based Stock Grants and Employee Ownership Are Expanding
"[B]road-based grants of equity awards to all [employees] ... show that stock compensation and share ownership are not just for executives and directors but are also practical, commonsense ways in which companies can reward rank-and-file employees above and beyond salary and encourage a commitment to workplace excellence through a culture of employee ownership. From an economic perspective, corporate profit-sharing through stock options and restricted stock/RSUs has the potential to reduce income inequality by giving employees potentially substantial investment upside via the familiar, trustworthy channel of their own companies." (myStockOptions.com)  

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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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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