Health & Welfare Plans Newsletter

July 1, 2016

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[Official Guidance]

IRS Announcement: ACA Information Returns May Continue To Be Filed After June 30, 2016
"The ACA Information Returns (AIR) system will remain up and running after the [June 30] deadline. If you are not able to submit all required ACA information returns by June 30, 2016, please complete the filing of your returns after the deadline.... [F]ilers of Forms 1094-B, 1095-B, 1094-C and 1095-C that miss the June 30, 2016, due date will not generally be assessed late filing penalties under section 6721 if the reporting entity has made legitimate efforts to register with the AIR system and to file its information returns, and it continues to make such efforts and completes the process as soon as possible." (Internal Revenue Service [IRS])  


[Advert.]

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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



[Official Guidance]

Text of CMS Final Regs: Expanding Uses of Medicare Data by Qualified Entities
111 pages. "This final rule implements requirements under Section 105 of the Medicare Access and CHIP Reauthorization Act of 2015 [MACRA] that expand how qualified entities may use and disclose data under the qualified entity program to the extent consistent with applicable program requirements and other applicable laws, including information, privacy, security and disclosure laws. This rule also explains how qualified entities may create non-public analyses and provide or sell such analyses to authorized users, as well as how qualified entities may provide or sell combined data, or provide Medicare claims data alone at no cost, to certain authorized users. In addition, this rule implements certain privacy and security requirements, and imposes assessments on qualified entities if the qualified entity or the authorized user violates the terms of a data use agreement required by the qualified entity program." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

CMS Finalizes Rule Giving Providers and Employers Improved Access to Information for Better Patient Care
"The new rules, as required by the Medicare Access and CHIP Reauthorization Act (MACRA), allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups who can use the data to support improved care.... The rule also includes strict privacy and security requirements for all entities receiving patient identifiable and beneficiary de-identified analyses or data, as well as expanded annual reporting requirements." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

EEOC Issues Guidance on Notice Requirements for Wellness Programs That Solicit Medical Information
"The EEOC has warned that it will vigorously investigate notice complaints received from employees. Accordingly, employers that sponsor wellness programs that make health-related inquiries or involve medical examinations must be sure that they review the new notice requirements and understand how their wellness program procedures are impacted." (The Wagner Law Group)  

[Guidance Overview]

Chart: California State and City Paid Sick Leave Laws
This 9-page chart compares the principal provisions of the California paid sick leave law and similar laws in six California cities. (Fox Rothschild LLP)  


[Advert.]

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[Guidance Overview]

Oh HSA Can You See ... a $2,600 Minimum HDHP Deductible
"As a result of a California law taking full effect in 2017, the minimum HDHP individual deductible will be $2,600.... California AB 1305 generally requires fully insured California policies to have an embedded individual deductible on a family plan that is no greater than the policy's individual deductible for coverage starting in 2017.... [T]he HDHP rules prevent including an embedded individual deductible that is lower than the minimum required deductible for family HDHP coverage ($2,600 in 2016/2017).... For fully insured 2017 California HDHP policies, the individual deductible will need to be increased to at least $2,600 to maintain HDHP status." (ABD Insurance & Financial Services)  

Text of Draft CMS Letter for Issuers Who Request Alternative Schedule of Payment of CSR Portion of Advance Payments (2014 and 2015 Benefit Years) (PDF)
Marked as "Draft"; undated and unnumbered document. "If you fail to make timely payment in accordance with the installment payment schedule or enter into insolvency, rehabilitation, early pre-liquidation, or fail to make the initial 10 percent payment, the full balance of the charge will become immediately due. You are permitted to make an early payment toward your outstanding debt. We note that early payments will be applied to interest first and the remaining portion will reduce the principal balance. Please return this letter with the information on page three completed to provide your written agreement and approval no later than no later than 11:59 p.m. ET on Tuesday, July 12, 2016." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

What to Do If Your Company Receives a Marketplace Notice
"If you offered minimum value, affordable coverage to the employee(s) listed on the notice or if the employee is enrolled in your health plan (regardless of whether it is minimum value or affordable), you should not be subject to a shared responsibility penalty. Further, if these employee(s) were not offered coverage due to not being full-time, the employee is entitled to financial assistance and no penalty will be issued as a result of this employee qualifying for financial assistance." (Graydon Head & Ritchey LLP)  

Large Employers' Response Strategies to ACA Mandates Are Keeping Health Insurance Costs Stable
"Total health premium cost per employee rose 5.0% from 2014 to 2016.... [W]hile total plan cost increased by 2.8% for 2014-2015 and 2.1% for 2015-2016, the amount of premiums that employers paid also increased, by 3.1% and 2.5% for the same periods, respectively.... [E]mployer contribution share increased slightly in most age groups and decreased only slightly for those 55 and older." (Wolters Kluwer Law & Business)  

TPA's Alleged Incentive to Deny Claims Does Not Trigger Nondeferential Review
"[M]any plan sponsors seek to avoid a conflict by delegating full discretionary authority to a TPA that has no financial interest in the claims decision. But claimants often question whether TPAs are truly independent, since they are hired by a party who is financially liable for approved claims. This decision represents an important acknowledgement of the professionalism of TPAs -- whose reputation is on the line each time they decide a claim." [Jones v. PepsiCo, Inc., No. 15-0426 (S.D.N.Y. May 6, 2016)] (Thomson Reuters / EBIA)  

The Next Big Debate in Health Care
"With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage. That particularly means rising payments for deductibles and their impact on family budgets and access to care.... [P]ayments toward deductibles by consumers who have insurance through large employers rose 256% from 2004 to 2014; over the same period, wages increased 32%." (The Wall Street Journal; subscription may be required)  

State 1332 Waiver Update: Vermont and Hawaii
"Vermont wants to waive the requirement to maintain a website where people can enroll in the SHOP ... Instead, Vermont Health Connect's website (the state marketplace where individuals enroll in coverage) would include educational and online tools to allow employees to compare plan choices, but insurers would directly enroll small businesses and their employees into plans.... Hawaii wants to waive SHOP requirements, which do not mesh well with its Prepaid Health Plan -- a 40-year old state law that requires Hawaii employers to cover their employees." (Families USA)  

Insurers Suffer Large Losses in Individual Market
"Despite receiving huge subsidies, insurers suffered larger losses selling qualified health plans in the individual market than they did selling nearly identical policies in the small group market ... Lower-than-expected enrollment in the new insurance exchanges, and significant insurer losses, have resulted in substantial premium increases and insurer withdrawals from state markets ... Researchers say this casts doubt on the long-term sustainability of certain aspects of the ACA." (Healthcare Finance News)  

Benefits in General

[Guidance Overview]

Text of EBSA Fact Sheet: Interim Final Rule Adjusting ERISA Civil Monetary Penalties for Inflation (PDF)
"Beginning in 2017, the Department will adjust the new ERISA Title I penalty amounts annually for inflation no later than January 15 of each year.... EBSA will post any changes to ERISA Title I penalty amounts on its website. Annual inflation adjustments are not subject to notice and rulemaking.... The table [in this fact sheet] shows the current penalty amounts enforceable by EBSA and the inflation adjusted penalty that will go into effect for penalties assessed after August 1, 2016." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

Executive Compensation and Nonqualified Plans

[Guidance Overview]

409A Deferral Election Results: A Mixed Bag
"As with many of 409A's rules, the restrictions on deferral elections require tight timing. This blog will highlight the differences between permissible 401(k) and NDCP deferral elections while also describing some of the plan design options available to provide participants with at least some flexibility when making their NDCP deferral elections with respect to salary and bonuses." (Milliman Retirement Town Hall)  

[Guidance Overview]

IRS Issues Supplemental 409A Guidance on Deferred Compensation Plans
"[T]he proposed regulations modify current rules under Section 409A, including with respect to: [1] the short-term deferral rule ... [2] the definition of 'eligible issuer of service recipient stock' ... [3] recurring part-year compensation; [4] amounts payable following the death of service providers and their beneficiaries; [5] the conflict of interest exception to the prohibition on the acceleration of payments[.]" (Holland & Knight)  

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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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