Health & Welfare Plans Newsletter

July 25, 2016

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Webcasts and Conferences

Why Health Care in America is BROKE-N and What Self-Funded Health Plans Can Do About It!
August 12, 2016 WEBCAST
Ault International Medical Management [AIMM]

Documented Confusion 2016: IRS rewrites rules on plan amendments
August 17, 2016 WEBCAST
FIS Relius Education

Attract, Retain, and Retire the Workforce of Tomorrow
September 14, 2016 WEBCAST
ASPPA [American Society of Pension Professionals & Actuaries]

Regional Conference
September 20, 2016 in PA
State and Local Government Benefits Association [SALGBA]

2016 Executive Compensation Conference
November 1, 2016 in NY
Conference Board, The

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[Guidance Overview]

IRS Proposes Additional Regs Clarifying Handling of 'Opt-Out' or 'Cash-In-Lieu' Programs Under ACA
"You must now not only verify that the person has other coverage; but you must verify that it is group (not just individual) coverage. That is not necessarily easy to do. Often times insurers will still assign a 'group' number to an individual card so as to align the insured's internal records with other records the insurer keeps. This effectively turns your HR staff into the 'cash in lieu police' while angering employees who don't understand why they are not getting an award for an individual plan[.]"  Benefit Revolution


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

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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]

Opt-Out Payment Arrangements and Employer Impact
"The proposed regulations clarify that if an individual declines to enroll in employer-sponsored coverage for a plan year and does not have the opportunity to enroll in coverage for one or more succeeding plan years, the individual is treated as ineligible for those succeeding years. Subsequently, this ineligibility for the plan could render that employee eligible for premium tax credits. Said another way, if employees are not given an opportunity to enroll at least annually, they are not considered eligible for the plan which could cause ALEs to be liable for Section 4980H penalties."  Compliance Dashboard

[Guidance Overview]

IRS Provides Helpful Guidance Regarding Opt-Out Payments Under the ACA
"An eligible opt-out arrangement is an arrangement under which an employee's right to receive the opt-out payment is conditioned on the employee providing reasonable evidence that the employee, spouse and dependents ... have alternative minimum essential coverage ... Reasonable evidence of alternative coverage includes an employee's 'attestation' that the employee, spouse and dependents, if any, have alternative minimum essential coverage other than through the individual market -- whether obtained on- or off-the-Marketplace ... [E]mployers are permitted -- but not obligated -- to require the employee to provide evidence of alternative coverage."  Miller Johnson

[Guidance Overview]

Health Insurance Marketplace Subsidy Notices
"A non-full-time employee cannot trigger a pay or play penalty.... If an ALE offered a non-full-time employee affordable, minimum value coverage ... the ALE may want to appeal the Subsidy Notice to limit the amount of the APTC that the employee must repay.... Non-ALEs (generally employers with less than 50 full-time and full-time equivalent employees) are not subject to the pay or play penalty.... But a non-ALE may consider appealing a Subsidy Notice on behalf of an employee who was offered affordable, minimum value coverage, to limit the amount of the APTC that the employee must repay."  Miller Johnson

[Guidance Overview]

Nondiscrimination Rule Expands Administrative Practices, Notice/Language Requirements and Coverage for Certain Plans
"Employers and plan sponsors should determine whether they are subject to the regulation. If so, many requirements are already effective. However, they have until October 16, 2016 ... to comply with the notice requirements and until the first plan year beginning on or after January 1, 2017 to make coverage changes to health insurance or group health plan benefit design."  Cheiron


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Competing Wellness Rules Pose Compliance Challenges
"New workplace wellness regulations that address participation incentive limits under disability and genetic anti-discrimination laws are inconsistent with overlapping federal laws, so employers must scrutinize their programs closely to ensure compliance."  Bloomberg BNA

Testimony of American Academy of Actuaries to House Ways and Means Committee Hearing: 'Rising Health Insurance Premiums Under the ACA' (PDF)
"[H]ow 2017 premiums differ from those in 2016 will depend on many factors. Key drivers include the underlying growth in health costs and the sunset of the reinsurance program, each of which will increase premiums relative to 2017.... Insurers have more information than they did previously regarding the risk profile of the enrollee population ... However, some uncertainty remains, as a market equilibrium in terms of enrollment levels and risk profiles likely has not yet been reached."  American Academy of Actuaries

1.5M Workers Gained Employer-Sponsored Healthcare Coverage in 2015
"[T]he number of consumers enrolled in employer-sponsored healthcare coverage rose from 55.8 million in 2014 to 57.3 million in 2015. In fact, at large firms, the number of employees covered under employer-sponsored insurance rose by 1.6 million people. However ... at smaller companies with less than 50 employees, the enrollment rate in this type of coverage was reduced from 28.3 percent to 27.1 percent between 2014 and 2015."  HealthPayer Intelligence

Exploring Single-Payer Alternatives for Health Care Reform
"Single-payer proposals are wide-ranging reform efforts spanning financing and delivery, but vary in the provisions. [The author] modeled two sets of national scenarios -- one labeled comprehensive and the other catastrophic -- and compared insurance coverage and spending relative to the ACA in 2017.... [T]he comprehensive scenario increased national health care expenditures by $435 billion and federal expenditures by $1 trillion relative to the ACA."  RAND Corporation

What to Consider Before Launching a Provider-Sponsored Health Plan
"Today's New Health Economy demands that providers shoulder greater risk. In response, health systems and physician groups contemplate taking full control of the healthcare dollar by launching their own health plans.... Measure your investment needs.... Take stock of the environment.... Define your purpose, and then execute on it.... Tout your unique advantage -- trusted brand, niche offerings and community presence.... Deepen relationships with other insurers."  PricewaterhouseCoopers

[Opinion]

Consumers Often Lose When Health Insurers Merge
"There are clearly benefits to better-coordinated care, but that does not justify all of these mergers. Coordination can often take place without concentrating so much market power in the hands of a few companies. And rather than making the system more efficient, recent research has found that increased concentration has driven up the cost of health care."  The New York Times; subscription may be required

Benefits in General

GOP Nominates Trump, Releases Platform (PDF)
"Stating that the 'greatest asset of the American economy is the hard-working American,' the platform deems getting people back to work by fostering job creation to be its 'first priority' and 'overarching goal.' As such, the platform reflects the party's outlook on reforming current laws affecting healthcare, employment, labor and retirement. Many provisions in the platform are quite general in nature and echo policy positions previously outlined by Republicans. Highlights that will resonate with employers [are listed and described]."  Xerox HR

Executive Compensation and Nonqualified Plans

SEC Proposal: The End of Equity Compensation Plan Disclosure?
"[T]he SEC proposes to eliminate the now obsolete disclosure requirements regarding equity compensation plans.... The SEC explained that the information required under Item 201(d) can be found in other financial statements and that the listing standards by the national exchanges now require that almost all equity plans be approved by shareholders."  Bloomberg BNA

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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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