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[Guidance Overview]
Proposed Regs on Premium Tax Credits Address Affordability Implications of Opt-Out Payments
"If an employer offers additional compensation to employees who decline coverage under the employer's health plan (the IRS calls these 'opt-out payments'), the amount of the available opt-out payment increases the employee's required contribution when determining the plan's affordability, regardless of whether the employee enrolls in the plan or receives the opt-out payment. The IRS views opt-out payments as economically equivalent to salary reductions (also treated as required employee contributions) because in each case the employee must forgo a specified dollar amount to participate in the plan."
(Thomson Reuters / EBIA)
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[Guidance Overview]
IRS Releases Draft 2016 Versions of Form 1094/1095 Information Returns
"The draft 2016 forms show few changes from 2015.... Form 1095-B: Some headings are modified, and line 9 is now marked as 'reserved.' ... Form 1094-C: The only change is removal of the line 22 box for 'Qualifying Offer Method Transition Relief.' ... Form 1095-C: There are no substantive changes on the form's face, but the Instructions for Recipient indicate that two new line 14 codes will be available to reflect
conditional offers of coverage to an employee's spouse."
(Thomson Reuters / EBIA)
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[Guidance Overview]
IRS Health Care Tax Tip 2016-60: A Mid-Year ACA Refresher for Employers
"Work forces typically fluctuate, so it's important to annually determine the size of your workforce. The number of employees you have during the current year determines whether your business is an applicable large employer for the following year."
(Internal Revenue Service [IRS])
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[Guidance Overview]
San Diego Sick Leave Ordinance Goes Into Effect
"Originally, the ordinance passed by voters prohibited employers from placing any cap on sick leave accrual. However, the amended Ordinance now allows employers to cap an employee's total earned sick leave at 80 hours. This change is important because the cap allows employers who choose to utilize combined PTO policies to meet the sick leave requirements to avoid runaway costs. Since PTO must be paid out on termination (unlike sick leave), the original language forced employers to maintain separate sick and vacation policies or else face uncapped PTO and potentially large payouts at termination."
(Fisher Phillips)
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Does Your HIPAA Compliance Program Adequately Address Portable Electronic Devices?
"Too often business associates fail to ... [address] risks relating to devices (e.g., smartphones, laptops or tablets) that are owned by employees rather than the covered entity or the business associate....[D]oes your organization require that all portable devices be password protected and encrypted? ... Does your organization have the ability to remotely wipe these devices clean? Do you require employees to register their personal devices with your organization? What happens when an individual is no longer employed by your organization? Can e-mail/system access for former employees be removed remotely? Do you have policies that prohibit employees ... from using unsecured, public Wi-Fi networks?"
(Dechert LLP)
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National Health Spending Will Surpass $10,000 per Person This Year
"National health spending will average more than $10,000 a person this year for the first time ... a milestone that heralds somewhat faster growth in health spending after several years of exceptionally low growth. By 2025 ... health care will represent 20 percent of the total economy, up from 17.8 percent last year. By 2025, one of every five Americans will be on Medicare, and the program will spend an average of nearly $18,000 a year for each beneficiary. Medicare spent about $12,000 per beneficiary in 2015."
(The New York Times; subscription may be required)
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National Health Expenditure Projections, 2015-25: Economy, Prices, and Aging Expected to Shape Spending and Enrollment
"Health spending growth in the United States for 2015-25 is projected to average 5.8 percent ... and to represent 20.1 percent of the total economy by 2025.... [G]rowth in health spending is expected to be influenced by changes in economic growth, faster growth in medical prices, and population aging. Projected national health spending growth, though faster than observed in the recent history, is slower than in the two decades before the recent Great Recession, in part because of trends such as increasing cost sharing in private health insurance plans ... [T]he share of total health expenditures paid for by federal, state, and local governments is projected to increase to 47 percent by 2025." [Complete report, with data tables, is available on the CMS website.]
(CMS Office of the Actuary, via Health Affairs)
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Younger Seniors Amass More Costs for End-of-Life Care Than Oldest Americans
"Medicare claims data for 2014 for beneficiaries who died the same year shows that average Medicare spending per person peaked at age 73 -- at $43,353 ... That compared with $33,381 per person for 85-year-olds and among 90-year-olds, $27,779 per person.... researchers said their findings suggest that providers, patients and their families may favor more costly, lifesaving care for younger seniors, and turn to hospice care when patients are older."
(Kaiser Health News)
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Chronic Conditions: Can an Employer Deny FMLA Leave When an Employee Does Not Attend Two Doctor Visits in One Year?
"On Frank's FMLA medical certification, his doctor confirms that he will need to have treatment twice per year for the condition, but he also lists only one occasion within the past year when he treated Frank for the condition.... Why not take the regulation at face value and enforce it -- to obtain FMLA leave, the employee must have visited with a health care provider twice within the year leading up to the certification.... Employers can rely on Lusk v. Virginia Panel Corp., which established that the window you consider for the two visits is the one year period prior to the time the employee needs FMLA leave for the chronic condition."
(FMLA Insights)
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Arbitrator Rules That City's Unilateral Increase in Retiree Health Insurance Premiums Violated Collective Bargaining Agreement (PDF)
"[An arbitrator] recently ruled that the City of Syracuse violated its collective bargaining agreement with the Syracuse Firefighters, Local 280, IAFF, AFL-CIO, when it unilaterally increased the health insurance premium contributions that hundreds of retired firefighters were required to make to maintain coverage.... [T]he City was ordered to restore the lower, negotiated rates and reimburse a class of affected retirees tens of thousands of dollars in overpaid contributions. Additionally, the Arbitrator made clear that the City is strictly prohibited from raising retiree health insurance premium contributions in the future absent agreement with Local 280."
(Blitman & King LLP)
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Seven Remaining Obamacare CO-OPs Prepare Survival Strategies
"There were 23 in 2014.... Eleven are still in business, but four in Oregon, Ohio, Connecticut and Illinois will disappear by fall due to financial insolvency.... For the rest -- which all posted annual losses in 2015 ... survival is job No. 1. Some are diversifying to serve larger employers, no longer limiting themselves to their ACA mandate to offer health plans to individuals and small businesses. A Maryland CO-OP has sued the federal government to avoid paying millions of dollars to other insurers under the ACA's complex formula to keep premiums stable by balancing risks among insurers and helping ailing ones. Other CO-OPs are trying to renegotiate contracts with hospitals and other providers."
(Kaiser Health News)
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Benefits in General
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[Guidance Overview]
Proposed Changes to Form 5500 and Schedules Would Expand Benefit Plan Reporting
"The Departments did not provide mock-ups of the forms, schedules, and structured attachments as they would appear in final.... Some of the instructions are entirely new, while others reflect the elimination of existing line items or schedules that would be deleted under the proposed forms revisions.... The proposed regulations would also add new questions ... on participation, contributions, and asset allocation by age, and participant-level diversification.... [T]he proposed revisions would require all ERISA plans that provide group health benefits to file Form 5500 (including new Schedule J) and applicable schedules, regardless of [the size of the plan, or whether] funded using a trust, unfunded, or an unfunded/insured combination."
(Practical Law Company)
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[Guidance Overview]
Penalties Increase for ERISA Violations
"The new penalty amounts are effective August 1, 2016, and will apply to any penalties assessed after the effective date.... The maximum civil penalties that DOL may assess under ERISA are adjusted as shown in [a detailed chart.]"
(Cheiron)
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Want to Fund Your HSA with Your IRA? Here's How
"A [Qualified HSA Funding Distribution (QHFD)] is done by direct transfer from your IRA to your HSA. This transaction is not taxable or subject to the 10% early distribution penalty. The amount that can be transferred cannot exceed the amount you are eligible to contribute to your HSA for the year.... The amount you can move will be reduced by any HSA contributions you have already made during the year. You may only do one QHFD in your lifetime. There is an exception to this rule if you start out the year with self-only coverage and then later switch to family coverage."
(Slott Report)
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BenefitsLink.com, Inc.
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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 BenefitsLink.com, Inc. All materials
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