Health & Welfare Plans Newsletter

July 19, 2016

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Benefits Manager
Kraft Group LLC
in MA

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T. Rowe Price
in CO, MD

Compliance Specialist
Guidant Financial
in WA

Retirement Plan Services Specialist
Meeder Investment Management
in OH

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Boulay PLLP
in MN

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Webcasts and Conferences

Employee Plans - Examinations Update Fall 2015
RECORDED
(IRS [Internal Revenue Service])

Highlights of the 2015 Cumulative List of Changes for Retirement Plans
RECORDED
(IRS [Internal Revenue Service])

DOL's Conflicts of Interest Rule: the Impact on Plan Sponsors
July 26, 2016 WEBCAST
(Multnomah Group)

Break Out of Commodity Thinking - For Good!
July 27, 2016 WEBCAST
(TPA Resources, LLC)

Affordable Care Act Risk Adjustment, Reinsurance and Cost-sharing Reduction Reconciliation Payment and Charge Collection Process
July 27, 2016 WEBCAST
(Centers for Medicare & Medicaid Services [CMS])

All About the ACA: Manage Compliance so it Doesn't Manage You
August 16, 2016 in WI
(The Alliance)

Mental Health Parity and Addiction Equity Act: Does Your Plan Comply?
August 18, 2016 WEBCAST
(International Foundation of Employee Benefit Plans [IFEBP])

VISION: IRI Annual Meeting 2016
September 25, 2016 in CO
(Insured Retirement Institute [IRI])

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[Guidance Overview]

ACA Information Returns (AIR) Working Group Meeting, July 19, 2016 (PDF)
50 presentation slides. Topics include: [1] General AIR information; [2] AIR successful transmission tips and lessons learned; [3] Post deadline reminders; [4] Common portal issues and resolutions; [5] Tax Year 2016/Processing Year 2017 AATS testing requirements changes. (Internal Revenue Service [IRS])  


[Advert.]

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Sponsored by Wolters Kluwer

Earn CE credits while learning about the latest news and industry trends and your ftwilliam.com software!



[Guidance Overview]

Final Nondiscrimination Rules in Health Programs and Activities (PDF)
"If you are not a direct covered entity and your medical plan is fully insured, you may be indirectly subject to these rules because of your health insurance carrier. Many carriers sponsor health plan coverage in the Marketplace. If you are unsure whether your insurance carrier receives some form of federal financial assistance, ask.... If you are not a direct covered entity and your medical plan is self-funded, you may be tangentially subject to these rules because of your third-party administrator (TPA).... Action steps will differ depending on the type of entity." (Marsh & McLennan Agency LLC)  

[Guidance Overview]

Treatment of Opt-Out Bonuses When Determining Affordability (PDF)
"If your organization maintains a non-conditional opt-out bonus, it must be included in affordability testing for your first plan year beginning on or after January 1, 2017.... Eligible opt-out arrangements need to meet specific requirements (beyond a general conditional opt-out) in order for the opt-out amount to be excluded.... The amount of the opt-out bonus can be excluded from the affordability calculation as long as reasonable evidence is provided for the entire plan year, even if the alternative coverage terminates at some point during the year." (Marsh & McLennan Agency LLC)  

IRS Releases Draft 2016 Forms 1095 and 1094
"While the 'good faith effort' standard may limit the impact of these errors for 2015 forms, the good faith effort standard and extended deadlines will not apply for 2016 forms. Now that the 2016 draft forms have been released, it may be time to begin validating payroll, HRIS and vendor systems to ensure that they will be ready to accurately report on the health coverage offered to full-time employees." (Mazursky Constantine LLC)  

Eight Ways Plan Sponsors Can Fight the Opioid Epidemic
"[1] Use data analytics to identify and manage fraudulent drug use. [2] Require prior authorization for opioid prescriptions of more than 15 days for all outpatient pain management prescriptions. [3] Monitor hospital discharges and conduct patient oversight to look for prior drug-abuse events (e.g., overdoses or substance abuse treatment).... [4] Develop plan strategies to cover abuse-deterrent opioids ... [5] Work with the pharmacy benefits manager to establish a fraud tip hotline. [6] Offer alternative treatment for pain management. [7] Train and educate prescribing physicians. [8] Communicate and educate participants about the addiction aspects of opioids." (International Foundation of Employee Benefit Plans [IFEBP])  


[Advert.]

Register for NBCH's 21st Annual Conference, Sept. 26-28 in Orlando

Sponsored by National Business Coalition on Health [NBCH]

This must-attend event convenes employers, health plans, providers, business health coalitions and other key stakeholders focused on the future of health care and benefits. Free admission for employers that are members of an NBCH coalition. Join us.



Consumer-Driven Plan Enrollment Still Elusive in the Middle Market
"High-deductible plan enrollment continues to grow across the country, but the enrollment is coming from the small group and exchange arena where most other traditional products have all but evaporated.... The middle-market employer is slow to embrace these plans because an overwhelming majority of human resources professionals and employees simply do not like them. While they are an 'efficient' mechanism to procure care, users find them a challenge to understand and they can often lead to substantial out-of-pocket expenses for higher users of care." (Frenkel Benefits)  

Why Student Loan Repayment May Soon Be a Standard Employee Benefit
"Because student loan debt is so important to younger employees, companies that offer relief in this area will have a big leg up on the competition and likely be able to bolster dwindling retention rates. What's more, student loan debt isn't only an issue for Millennials. Thirty-five percent of all student loan debt is held by individuals over the age of 39. Many people also have Federal Parent PLUS Loans, loans for parents to help finance their children's college education." (HR Benefits Alert)  

Widespread HIPAA Vulnerabilities Result in $2.7 Million Settlement
"OCR's investigation uncovered evidence of widespread vulnerabilities within [Oregon Health and Science University's] HIPAA compliance program, including the storage of the electronic protected health information (ePHI) of over 3,000 individuals on a cloud-based server without a business associate agreement. OCR found significant risk of harm to 1,361 of these individuals due to the sensitive nature of their diagnoses. The server stored a variety of ePHI including credit card and payment information, diagnoses, procedures, photos, driver's license numbers and Social Security numbers." (U.S. Department of Health and Human Services [HHS])  

Despite Six Risk Analyses, University Must Pay $2.7 Million in HIPAA Settlement
"Though multi-million dollar HHS settlements involving HIPAA compliance have become surprisingly routine, this one [is notable] because of what it suggests regarding HHS's position on cloud vendors as HIPAA business associates. In the past, it could be argued that at least some cloud providers fell within a 'conduit exception' to the BAA requirement that HHS had recognized regarding entities that merely transported information but generally did not access it ... More recently, however, HHS has taken the view that an entity that maintains PHI on a covered entity's behalf is a business associate and not a conduit -- even if the entity does not view the PHI." (Practical Law Company)  

UnitedHealth's Profit Surges But ACA Sales Drag
"UnitedHealth's second-quarter earnings jumped 11 percent to trump expectations even though the nation's largest health insurer took a bigger hit than expected from coverage linked to the [ACA]. The Minnetonka, Minnesota, company said Tuesday that losses from its ACA-compliant individual business came in $200 million above projections, which means the company now expects to lose around $850 million this year from what is essentially a small slice of its total operation." (ABC News)  

[Opinion]

Losing the 'All' in All-Payer Claims Databases
"[The Supreme Court's decision in Gobeille v. Liberty Mutual Ins. Co.] may be not fatal to policy-relevant research. Some or many ERISA plans may continue to voluntarily share their data with states, which is the best case scenario from a research perspective -- more data is preferable to less. The Court's decision should only be fatal to APCDs if the ERISA data are fundamentally different from the non-ERISA data and the data available to APCDs cannot be used to approximate the ERISA data. If the ERISA populations are identical (or nearly identical) to the non-ERISA populations, the loss of the ERISA data is inconsequential since the non-ERISA data can substitute for the ERISA data." (Health Affairs)  

[Opinion]

ERIC Expands Efforts to Increase Access to Telehealth
"ERIC urged both Delaware and Maine to consider the benefits of telehealth and adopt flexible rules that permit the practice of telemedicine without burdensome restrictions, while maintaining a high standard of care.... ERIC agreed with the Delaware Board of Clinical Social Work Examiners that the standards governing in-person visits, that ensure patient safety and a high-standard of care, should also apply, in the same manner, to telehealth visits." (The ERISA Industry Committee [ERIC])  

Benefits in General

[Guidance Overview]

Proposed Changes to the Form 5500 (PDF)
"The Proposed Revisions make clear that, due to resource an d other constraints, the Agencies are increasingly relying on the Form 5500 as a key component of their enforcement efforts.... The Agencies are seeking more information related to investments.... The Agencies are attempting to harmonize the fee disclosure requirements (Schedule C) with the disclosure regime under ERISA section 408(b)(2) that applies to ERISA pension plans.... The Agencies want more information about health and welfare plans." (Groom Law Group)  

[Guidance Overview]

DOL Increases Penalties for ERISA Violations (PDF)
"The catch-up inflation adjustments will apply to penalties DOL assesses after August 1, 2016, if the associated violation occurred after November 2, 2015. (Violations that occurred on or before November 2, 2015, and assessments made on or before August 1, 2016, will be subject to the old penalty amounts in effect prior to the inflation catch-up adjustment.)" [Includes a 2-page chart listing penalties with old and new amounts.] (Xerox HR Services)  

Stock Options In Startup Companies Could Become More Popular Than Ever Under Proposed Tax Code Change
"[R]ecently proposed bipartisan legislation could provide a new optional tax treatment (pun intended) and make stock options more appealing than ever at startups and other pre-IPO companies.... [T]he Empowering Employees Through Stock Ownership Act seeks to give employees in privately held companies extra time to pay taxes on the income they recognize at exercise.... Instead of paying taxes at exercise with nonqualified options (or at RSU vesting when settled in stock), this legislation would allow tax deferral for up to seven years." (myStockOptions.com)  

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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