Health & Welfare Plans Newsletter

July 22, 2016

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Webcasts and Conferences

Election 2016: What's at Stake for Group Health Plans?
August 11, 2016 in NC
(Hill, Chesson & Woody)

401(k) Beyond the Basics 03: Eligibility and Vesting Design Considerations
August 15, 2016 WEBCAST
(FIS Relius Education)

CCA Public Plans Community White Paper on Public Pension Funding Policies
August 18, 2016 WEBCAST
(Society of Actuaries)

Regional Conference
September 7, 2016 in CO
(State and Local Government Benefits Association [SALGBA])

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[Guidance Overview]

An Action Plan for Employers Who Receive Exchange Notices (PDF)
"[N]otifications are sent to all employers of individuals who are found to be APTC-eligible -- including those employers that are not subject to employer shared responsibility because they have less than 50 full-time employees (including full-time equivalents).... Employers should also keep in mind that different Exchanges may be sending different notification forms, may have marginally different processes for employer appeals, and may provide different levels of detail regarding the employee.... [This article describes] several alternative action items for Employers who receive an Exchange Notice -- along with the pros and cons of using each approach[.]" (Groom Law Group)  


[Advert.]

ECFC's 29th Annual Administration Symposium Coming This August Sign Up Now!

Sponsored by ECFC [Employers Council on Flexible Compensation]

ECFC's Flexible Benefit Administrators' Symposium is the premier networking and professional development event for the consumer-directed benefits industry: get advice, technical education, and Congressional and regulatory updates from industry leaders.



[Guidance Overview]

Why Am I Getting This Marketplace Notice?
"The Marketplace is using employment information provided by the individual. That employment information may be old (resulting in Marketplace Notices for individuals who terminated employment before January 1, 2016) and/or may be addressed to a local workplace (resulting in Marketplace Notices going to locations not prepared to respond to them)." (Vorys, Sater, Seymour and Pease LLP)  

[Guidance Overview]

Significantly More Information to Be Collected Under the Proposed Form 5500
"With respect to group health plans, the main changes would include: [1] Eliminating the exemption for unfunded welfare plans with under 100 participants ... [2] Expanded use of Schedule C for certain small plans; [3] Adding a new Schedule J[.]" (Kilpatrick Townsend)  

[Guidance Overview]

Proposed Regs Provide Permanent Relief for Expatriate Health Plans (PDF)
"Under ACA regulations, hours of service worked outside of the 50 U.S. states and the District of Columbia (i.e., where compensation for services constitutes income from sources outside of the U.S.) are not counted, regardless of the individual's residency or citizenship. This means that these employees likely will not have the requisite hours of service to be considered full-time employees and, therefore, would not have to be taken into account in determining whether an employer has offered coverage to substantially all of its full-time employees or in determining the amount of any assessment." (Xerox HR Services)  

[Guidance Overview]

Agencies Request Input on Potential Contraceptive Coverage Compromises
"The RFI requests a response from entities that object to the current accommodation; it also asks other stakeholders who are not parties to the litigation, such as insurers, third-party administrators, and women who need contraceptives, how possible accommodations would affect them." (Health Affairs)  


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2016 Health Savings Accounts Facts - answers at your fingertips

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Turn to the new 2016 Health Savings Accounts Facts to obtain vital HSA questions and answers right at your fingertips. Updated to include current fiduciary standards; impact of Obergefell v. Hodges; and recent IRS releases on the Cadillac Tax and HSAs.



Health Care Cost Hikes Are 'Eating Into Employer Revenue' Faster Than Inflation.
"Since the most recent recession, the annual increase in health care costs has eased from 11.6 percent in 2010 to 8 percent through the first half of 2016. During the same period, the United States Bureau of Labor Statistics stated inflation rate in the U.S. has been 1.4 percent. The rising expense of health care is causing employers to shift more costs to employees, resulting in consumers weighing price into their decisions of where and when to seek health care, with some even delaying treatment due to cost." (Xerox HR Insights)  

OCR Fines HIPAA Covered Entity Over Multiple Noncompliance
"OCR opened its investigation after receiving multiple breach reports ... including two reports involving unencrypted laptops and a large breach involving an unencrypted thumb drive ... OCR reported that OHSU had performed at least six Security Rule risk analyses, but they were not enterprise-wide in scope -- that is, the risk analyses did not address all of the ePHI maintained or transmitted within the organization." (Ice Miller LLP)  

Federal Judge Finds ACA Contraception Mandate Violates RFRA
"U.S. District Judge Jean C. Hamilton said Thursday that HHS may not compel Republican state lawmaker Paul Joseph Wieland, his wife Teresa Jane Wieland or their insurer to include contraception coverage in their health plan.... [T]he government had argued that requiring the Wielands to subscribe to a group health plan that covers services, such as contraception, that the family won't use because of religious reasons, isn't a substantial burden on the family. The court, however, disagreed." [Wieland v. HHS, No. 13-1577 (E.D. Mo. July 21, 2016)] (Modern Healthcare Online; free registration required)  

Fight or Run Is Choice for Health Insurers After DOJ Suit
"Within minutes of the Justice Department filing its case in federal court, Aetna Inc. and Humana Inc. issued a joint statement, promising they'd fight in lockstep and 'vigorously defend the companies' pending merger.' ... Cigna Corp. seemed to use a related lawsuit also filed Thursday as a potential escape from Anthem Inc.'s $48 billion takeover of the company.... Anthem declined to comment on Cigna's comments Thursday, other than to say it was ready to challenge the department. If the deal falls apart under antitrust scrutiny, Cigna is owed a breakup fee of $1.85 billion, according to the companies' agreement." (Bloomberg)  

Small New Insurers Making Big Payments to Blues Plans Under ACA
"The risk adjustment program is critical to ensuring that health plans are able to cover people with pre-existing conditions as required by the health-care law. But implementing the program has proved difficult as small new plans ... say the low-cost plans they sell attract younger, healthier enrollees needed to keep the ACA marketplaces more affordable and thus they are stuck footing a larger bill." (Standard & Poors)  

Humana to Significantly Reduce Marketplace Offerings in 2017
"Humana will stop marketing Obamacare exchange plans in several states next year and will exit many off-exchange individual markets as well ... The decision means the company will only offer individual plans in 156 counties in 11 states, down from 1,351 counties across 19 states this year. It had sold plans on [ACA] exchanges in 15 states this year." (Politico)  

Obamacare Premiums Are Lower Than You Think
"[A]verage premiums for the second-lowest cost silver-level marketplace plan in 2014, which serves as a benchmark for ACA subsidies, were between 10 and 21 percent lower than average individual market premiums in 2013, before the ACA, even while providing enrollees with significantly richer coverage and a broader set of benefits.... [L]ocal conditions can vary significantly because premiums are determined separately for each local marketplace. Similarly, due to its community rating provisions, the impacts of the ACA on individuals' premiums may vary significantly based on health status -- the ACA is more likely to increase premiums for healthier enrollees and decrease them for sicker enrollees." (Health Affairs)  

[Opinion]

Jonathan Gruber: What We Didn't See Coming with the ACA
"More people are in Medicaid than anticipated; fewer bought health plans through the exchanges. The reasons why this has happened ... include some surprises, even for those of us who have tracked the law closely and rooted for its success.... CBO projected more than 20 million people would be enrolled in these new online markets by this year. In fact, only about half that many are covered. One big reason is yet another ACA surprise, and a fortunate one: The employer insurance market is much more stable than expected." (Jonathan Gruber, in Politico)  

[Opinion]

Medicare Is Not 'Bankrupt'
"Although Medicare faces financing challenges, the program is not on the verge of bankruptcy or ceasing to operate. Such charges represent misunderstanding (or misrepresentation) of Medicare's finances.... Health reform, along with other factors, has significantly improved Medicare's financial outlook, boosting revenues and making the program more efficient." (Center on Budget and Policy Priorities)  

Benefits in General

Employee Benefit Participation Rates, March 2016
"The participation rate for employer-sponsored medical care benefits for civilian workers was 52 percent in March 2016 ... The participation rate was 49 percent for private industry workers and 73 percent for state and local government workers.... The participation rate for employer-sponsored retirement benefits, which include defined benefit and defined contribution plans, was 54 percent for civilian workers. The participation rate was 49 percent for private industry workers and 81 percent for state and local government workers." (U.S. Bureau of Labor Statistics [BLS])  

DOL Holds Modest Sway With Courts on Benefits Issues
"Of the 77 cases that led to clear decisions on the questions raised by the DOL, the department has scored 44 victories and suffered 33 losses. That's a win rate of about 57 percent -- only modestly better odds than a coin flip. Although the department has filed ERISA-related briefs in all the federal circuit courts and several district and state courts, its win-loss record doesn't vary significantly by court. In most courts, the department has won about as many cases as it's lost." (Bloomberg BNA)  

[Opinion]

DOL's Proposed Form 5500 Changes Could Improve Plan Design
"Eric Ryles, Managing Director of Judy Diamond Associates [said,] 'Right now, information on the small group health market is essentially nonexistent. By requiring companies with fewer than 100 participants to file a 5500, the DOL has opened the door to increased competition resulting in better, cheaper plans for the covered employees.' Continues Ryles, 'Transparency of fees and coverage is always a good thing, and we will be ready to incorporate each and every proposed change as soon as they are incorporated into the form.' " (Judy Diamond Associates)  

Press Releases

Burnham Benefits Welcomes New Senior Account Manager
Burnham Benefits Insurance Services Inc.

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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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