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[Official Guidance]

Text of Agency FAQs on ACA Implementation, Part 32: Notice of Coverage Options -- COBRA and Health Insurance Marketplace Coverage (PDF)
"[P]lan administrators may include with the COBRA election notice other information about the Marketplaces, such as: how to obtain assistance with enrollment ... the availability of financial assistance, information about Marketplace websites ... general information regarding particular products offered in the Marketplaces, and other information that may help qualified beneficiaries choose between COBRA and other coverage options.... COBRA election notices may be tailored to particular groups like young adults aging out of dependent coverage on their parents' health plan. In all cases, they are required to be 'easily understood by the average plan participant' and, therefore, information should not be too lengthy or difficult to understand." (U.S. Department of Labor [DOL], U.S. Department of Health and Human Services [HHS], and U.S. Treasury Department)  


SALGBA Regional Conferences: vital information for public sector benefits professionals

Sponsored by SALGBA

Upcoming 2016 Events: Sept. 7 - Regional Conference, Denver, CO; Sept. 20 - Regional Conference, King of Prussia, PA; November 3-4 - State Roundtable, Oklahoma City, OK. For more information, please visit

[Official Guidance]

Text of IRS Final Regs: Modification of Treatment of Certain Health Organizations
14 pages. "This document contains final regulations that provide guidance to Blue Cross and Blue Shield organizations, and certain other organizations, on computing and applying the medical loss ratio an d the consequences for not meeting the medical loss ratio threshold. The final regulations reflect the enactment of a technical correction to section 833(c)(5) of the Internal Revenue Code by the Consolidated and Further Continuing Appropriations Act of 2015. The final regulations affect Blue Cross and Blue Shield organizations, and certain other organizations involved in providing health insurance." (Internal Revenue Service [IRS])  

[Official Guidance]

Text of CMS Announcement: Pro Rata Adjustment to the National Coinsurance Rate for 2015 Benefit Year (PDF)
Unnumbered document, dated June 17, 2016. "[T]he national coinsurance rate for the 2015 benefit year transitional reinsurance program will be an estimated 55.1 percent for non-grandfathered reinsurance-eligible individual market plans' covered claims costs between the attachment point of $45,000 and the reinsurance cap of $250,000. HHS will remit payments to issuers available contributions and this initial, estimated coinsurance rate starting in August 2016." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

From the EEOC, Another Notice Requirement for Wellness Programs
"[E]mployers that already provide a wellness notice (for example, under [HIPAA]) need not furnish a separate notice to satisfy the notice requirement under the ADA final regulations, provided that the other notice informs employees of the required information[.]" (Practical Law Company)  

Your Doctor Will See You in This Telemedicine Kiosk
"In the past several years, a growing number of employers have provided insurance coverage for telemedicine services enabling employees to connect with a doctor by phone using both voice and video. One limitation of such phone-based services is physicians cannot always obtain basic vital signs such as blood pressure and heart rate. That's where telemedicine kiosks offer an advantage. Hundreds of employers -- often supported by their health insurers -- now have them installed in the workplace[.]" (Kaiser Health News)  


Don't miss Private Exchange FORUM Baltimore Sept. 8-9

Sponsored by Institute for Healthcare Consumerism [IHC]

Learn the latest compliance and regulatory issues around the private exchange market at the IHC's Private Exchange FORUM Baltimore. PEX Baltimore will be held at the Renaissance Harborplace hotel in Baltimore, MD Sept. 8-9. Register here for free.

Court Allows Offset for Social Security Benefits Received by Children of Long Term Disability Claimant
"Is it wrong to take an offset for Social Security benefits received by the children of a long term disability claimant? No, says a new decision.... [T]he court noted: '[t]he plan defines Social Security benefits as including family benefits' and the dependent benefits are awarded here because of plaintiff's disability. Also, the SSDI 'family award notices' expressly designate Jones as the payee and authorize her to use the funds" [Jones v. Life Insurance of North America, No. 08-03971 (N.D. Cal. June 14, 2016)] (Lane Powell PC)  

Employers Fight Against High Prescription Drug Costs
"The most popular cost-controlling methods for organizations are tiered pricing and a mail-order drug service, with 89% and 82% of employers currently implementing these initiatives. As for drug formulary lists, 71% of organizations have this tool in place, and 63% are using a pharmacy benefit manager (PBM)." (International Foundation of Employee Benefit Plans [IFEBP])  

Employers Cut Down on Wellness Benefits
"As employers begin to analyze return-on-investment and participation data, they 'may be taking a step back' ... Just 37% of the employers studied offered health coaching ... Last year, nearly half of them offered that benefit. Fewer employers are making seasonal flu vaccinations available at work, with 54% doing so, down from 61% last year." (The Wall Street Journal; subscription may be required)  

States Fight Back Against PBM Attempts to Skirt Around Transparency Laws
"Over the past three years 32[states] have enacted laws that require PBM corporations to be more forthcoming about how they determine the cost of multi-source generic drugs. These laws also reform the process of how PBMs update their price lists.... [M]any states have had to revisit their respective laws to strengthen the relevant provisions to ensure PBM corporate compliance." (National Community Pharmacists Association [NCPA])  

Health Care Costs to Grow 6.5% as Employers Shift Cost to Workers
"While costs are expected to go up by 6.5% next year, employers anticipate that they will only have to swallow a nearly 4% cost gain thanks to some realignments, says Gniewek. This can include moves like higher deductibles, switching to high-performing providers, narrower drug options, or higher co-pays. That means that more and more of rising health care costs are going to be shouldered by everyday workers." (Fortune)  

Healthcare Spending Trend $2.6 Trillion Below Original Projections
"[A recent] study concluded that the U.S. could spend $2.6 trillion less on healthcare services for much of this decade than originally projected prior to the passage of the ACA....But the ACA is not entirely the source for the slowdown.... The report noted that the annual spending increase averaged 3.6 percent from 2010 to 2013, down from the 5.4 percent that originally had been forecast." (FierceHealthcare)  

California Department of Managed Health Care Approves Aetna's Acquisition of Humana (PDF)
"The Department's conditions on this merger will help control health care costs, increase access to care and improve quality of care. Aetna also has committed to help improve California's health care infrastructure, and invest in programs that will serve the vulnerable populations enrolled in these plans." (California Department of Managed Health Care)  


House Shouldn't Repeal Limits on Tax-Advantaged Health Accounts
"The House is expected to consider legislation this week ... to repeal health reform's limit on ... [FSAs and HSAs] to buy over-the-counter medicines. The limit, in effect now for more than five years, is both sound tax and health policy and should be retained." (Center on Budget and Policy Priorities)  


Employers Outsmart the Government with Health Plan Design
"[A]lthough employers have actually expanded coverage with a 0.5% increase in employees offered coverage, there has been a decrease of 1.5% in employees actually taking their employers' plans. Apparently, employers have found ways to improve their 'offering' numbers while actually reducing the take-up rates and their resulting net costs.... Minimum value plans, dependent buy-ups, managing hours, and banding contributions by class or income are just some of the strategies ... employed." (Frenkel Benefits)  

Executive Compensation and Nonqualified Plans

[Official Guidance]

Text of IRS Proposed Regs: Application of Section 409A to Nonqualified Deferred Compensation Plans
65 pages. "These proposed regulations address certain specific provisions of the final regulations and the proposed income inclusion regulations and are not intended to propose a general revision of, or broad changes to, the final regulations or the proposed income inclusion regulations. The narrow and specific purpose of these proposed regulations should be taken into account when submitting comments on these proposed regulations.... [T]axpayers may rely upon these proposed regulations immediately." (Internal Revenue Service [IRS])  

Linkedin, Microsoft and 'Stock-Based Compensation'
"Silicon Valley Pre and Post-IPO companies used stock options almost exclusively until the last six or seven years.... LinkedIn was an early and enthusiastic member of the companies who moved to RSUs.... If LinkedIn had used exclusively stock options over the past 3 years, most of those options would have little or no readily ascertainable value in the Microsoft transaction. This would have been demotivational for LinkedIn staff and executives. It would have also been costly to Microsoft[.]" (Performensation)  

Press Releases

TRA Hires Tri-State Regional Sales Consultant
The Retirement Advantage [TRA]

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(407) 644-4146

Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016, 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, 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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