Health & Welfare Plans Newsletter

June 6, 2016

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401(k) Pension Administrator
Nicholas Pension Consultants
in CA

International Benefits Project Manager
Skadden, Arps, Slate, Meagher & Flom LLP and Affiliates
in NY

Director of H&W Policy Planning and Program Design
University of California Office of the President
in CA

Retirement Service Associates/Consultants (Financial or Insurance Bkgd.)
Ascensus
in MN

Strategic Account Manager
Ascensus
in PA

Pension Plan Administrator
Growing Retirement Plan Administration Firm
in NY

Retirement Account Analyst
Alerus
in NH

Compliance Analyst
Alerus
in MN

Retirement Education Consultant
Alerus
in MI

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[Guidance Overview]

It's That Time of Year Again: PCORI Filing Due to IRS by August 1 (PDF)
"The PCORI fee is $2.17 per covered life for plan years ending on or after Oct. 1, 2015, and must be reported on (and remitted with) IRS Form 720 by Aug. 1, 2016 ... For self-funded plans, the employer/plan sponsor will be responsible for submitting the fee and accompanying paperwork to the IRS.... The process for remitting payment by sponsors of self-funded plans is described in more detail [in this article]." (Lockton)  


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[Guidance Overview]

The Modern Workplace: Paid Sick Leave Arrives in the Mill City
"The [Minneapolis] ordinance permits employees to use accrued sick time for a wide variety of reasons, including their own medical appointments or sickness, sick family members, absences due to domestic violence, sexual abuse or sexual assault, and unexpected childcare needs.... [E]mployers based outside of Minneapolis will need to provide sick leave to their employees who work at least 80 hours per year in Minneapolis." (Gray Plant Mooty)  

ERISA Claims for Alleged Overpayments to Hospital Fail to Qualify as 'Equitable Relief'
"[A]fter CIGNA 'discovered' the billing pattern that caused this situation, it sued the provider basing its case in part upon ERISA.... CIGNA knows it could use some 'lien' language at this point to shore up its claim.... The closest thing CIGNA can find is the typical 'overpayment' clause in the plan documents.... The Court found this provision inadequate ... So what about tracing the funds paid to the provider? This claim fails as well[.]" [Connecticut General Life Ins. Co. v. Humble Surgical Hospital, No. 4:13-cv-3291 (S.D. Tex. June 1, 2016)] (Health Plan Law)  

Another Supreme Court Subrogation Decision, and Another Deep Dive Into Equity Treatises
"Putting Knudson, Sereboff and Montanile together, there are at least three elements to a successful claim for reimbursement by an ERISA plan: [1] the plan must contain language giving the plan rights to a specifically identifiable fund; [2] that specific fund must come into the participant's possession or control at some point in time; [3] the fund, or identifiable items purchased with the fund, must remain in the participant's possession or control when the plan sues." (Begos Brown & Green LLP)  

Another UnitedHealthcare-Administered ERISA Health Plan Sued
"[O]verpayment recoveries initiated by the large carriers have reached into the billions of dollars over the past 5 to 7 years. Yet, self-insured health plans have not reaped the benefits of successful overpayment recoupments. Consequently, recoupment through offsetting, when used as an anti-fraud initiative, has become an increasingly popular source of revenue for insurers." (AVYM Healthcare Revenue Consultants)  


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What to Know About OCR Pre-Audit Questionnaires
"Unlike the Phase 1 audits, gone are the days of OCR simply 'inquiring' whether a policy and procedure is in place.... [T]he current audit protocol takes a more granular look at the regulations and is comprised of further in-depth inquiries and documentation review." (Clearwater Compliance)  

Insurer-Driven Price Negotiation Makes Dent in Cancer Care Cost Growth
"The concept of paying for value in the cancer care space has gained steam of late with health insurers, as major companies including Anthem, UnitedHealth, Aetna and Highmark have all debuted value-based oncology payment models aimed at reducing costs and improving quality. And when it comes to paying for all types of drugs, insurers are increasingly pushing manufacturers toward outcomes-based pricing deals." (FierceHealthPayer)  

Universal Health Care Bill Passes New York State Assembly
"A bill to provide health-care coverage to every New Yorker has passed in the state Assembly by an overwhelming majority. Health-care costs continue to rise despite the federal [ACA], and almost 2 million New Yorkers still lack health insurance. The New York Health Act would provide complete health care without deductibles, co-pays or provider networks." (Public News Service)  

Benefits in General

ERISA and Cybersecurity
"[If] a plan fiduciary's duties under Section 404(a) include securing plan data against cyberattacks, a data breach may not necessarily be a breach of fiduciary responsibility. If the fiduciary could demonstrate that it had taken appropriate steps to secure such data, this might be an adequate defense, given that there is no absolute shield against such an attack. The question, of course, is what steps would be 'appropriate.' " (McGuireWoods LLP)  

DOL's Final Overtime Rule May Affect Retirement, Other Benefit Programs (PDF)
"Although the final rule focuses on paying time-and-a-half for hours worked in excess of 40 per week, it includes other new requirements that could have implications for sponsors of retirement plans ... [that depend] on the inclusion or exclusion of overtime pay and/or bonuses in the plan's formula for employer contributions. The final rule also might affect a retirement or other benefit plan's participation base, if salaried (exempt) employees are treated differently from hourly (nonexempt) employees, or it could raise concerns if the programs shift toward favoring the highly compensated." (Milliman)  

Executive Compensation and Nonqualified Plans

Pay for the Top Executive at New York-Based Non-Profit Organizations
"The highest total compensation was observed among Arts, Culture & Humanities organizations, which paid a median of $498,888, approximately $100,000 more that the next highest paid sectors, International (with median pay of $398,212) and Education & Research (with median pay of $397,150). The lowest pay was observed among the Human Services sector, where median total compensation for the top executive was $257,698." (Steven Hall & Partners)  

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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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