Health & Welfare Plans Newsletter

August 4, 2016

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Webcasts and Conferences

The Impact of Consumerism on Benefits Strategy & Selection
August 9, 2016 WEBCAST
Liazon Corporation

Blast from the Past - What 401ks Can Teach Us About How to Drive HSA Growth
August 11, 2016 WEBCAST
Alegeus Technologies, LLC

Cyber Security
August 23, 2016 in FL
ASPPA Benefits Council [ABC] of Central Florida

Cybersecurity: What advisors need to know about protecting data
August 23, 2016 WEBCAST
fi360

Employment and Affordable Care Act Update
August 25, 2016 WEBCAST
Jackson Lewis LLP

The Basics of Benefit Claims
September 13, 2016 WEBCAST
ABA Joint Committee on Employee Benefits [JCEB]

West Coast Defined Contribution Conference
October 23, 2016 in CA
Pensions & Investments

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[Guidance Overview]

Substantial Changes to Form 5500 Reporting Proposed
"The extensive scope of information required under new Schedule J will require additional recordkeeping by ERISA-covered group health plans and likely increase administrative costs.... Sponsors of small ERISA-covered group health plans that have long enjoyed exemption from the Form 5500 reporting requirements that would have to comply with the proposed reporting requirements beginning with the 2019 plan year may well wish to make comments to the Agencies."  Cheiron

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Advocate Health Care Settles Potential HIPAA Penalties for $5.55 Million
"This significant settlement, the largest to-date against a single entity, is a result of the extent and duration of the alleged noncompliance (dating back to the inception of the Security Rule in some instances), the involvement of the State Attorney General in a corresponding investigation, and the large number of individuals whose information was affected by Advocate, one of the largest health systems in the country."  U.S. Department of Health and Human Services [HHS]

Banner Health Nailed by Huge Cyberattack
"Banner Health revealed that hackers may have accessed the healthcare, payment and health plan information of up to 3.7 million individuals. Attackers reportedly gained access through payment processing systems for food and beverage purchases at the Phoenix-based health system.... Stolen information may have included names, birthdates, social security numbers, addresses, dates of service and claims information, as well as health insurance information as a current or former member of one of Banner's health plans or as a beneficiary of a Banner Health employee benefits plan."  Healthcare Finance News

Improved Claims Data Drives Use of Employee Benefit Insurance Captives
"The use of captive insurance companies for financing employee benefits continues to evolve ... [T]he primary driver for nearly half (44%) of companies with employee benefits in their captive is to control and improve their claims data to help with ongoing cost management. This is up from a quarter (24%) in last year's study. Conversely, the study finds that the proportion of companies for whom the main driver is cost savings dropped from two-thirds (67%) in 2015 to 44% in 2016."  Willis Towers Watson

Small Businesses Are Dropping Health Coverage; Large Employers Holding Steady
"Among larger employers, health insurance offer rates -- the percentage of employers offering health insurance benefits to their workers -- have held steady.... But health coverage among smaller employers has been falling in recent years. From 2008 to 2015, offer rates at small organizations declined ... For employers with fewer than 10 employees, from 35.6 percent to 22.7 percent (a 36 percent dip). For employers with 10 to 24 employees, from 66.1 percent to 48.9 percent (a 26 percent dip). For employers with 25 to 99 employees, from 81.3 percent to 73.5 percent (a 10 percent dip)."  Society for Human Resource Management [SHRM]

Benefits Continuation during Leave of Absence?
"Under the FMLA, employers are required to maintain healthcare coverage for employees during leave under a group health plan at the same level and conditions of coverage that would have been provided had the employees not taken leave.... If the leave is pregnancy-related, under federal law, you must provide the same leave benefits to women affected by pregnancy that you provide to employees with temporary disabilities."  HR Daily Advisor

Can a Group Health Plan Have a General Exclusion for Weight-Management Services for Adult Obesity?
"While plans may use reasonable medical management techniques to determine the frequency, method, treatment, or setting for recommended preventive services (to the extent not specified), they are not permitted to impose general exclusions. Thus, your company's major medical plan cannot include a general exclusion that would encompass weight-management services for adult obesity that are specified in USPSTF recommendations."  Thomson Reuters / EBIA

Employees Are Still Unprepared for Increasing Healthcare Responsibilities
"In an effort to save healthcare costs, many employers continue to shift more responsibilities onto their employees.... 66% [of U.S. healthcare consumers] rated planning for out-of-pocket costs as the most challenging and stressful aspect of managing their healthcare. More than half said they lack the knowledge and the tools to predict out-of-pocket costs for this year and the future."  Employee Benefit News

Anthem Sets Deadline for Cigna Acquisition
"The Department of Justice's timeline for antitrust trials on two insurer megamergers is a 'cynical proposal,' lawyers for Anthem say, and it will kill the deal. Antitrust lawyers for the Department of Justice 'enjoyed the benefit of a year-long, one-sided investigation,' the lawyers said in lawsuit documents, accusing them of 'already impeding Anthem's efforts to prepare for trial.' ... Anthem is pushing for an expedited trial, one that would start in October and conclude around the end of the year. The government says that one of the trials should start Feb. 17, and the judge can decide later whether it will be Aetna-Humana or Anthem-Cigna."  InsuranceNewsNet.com

[Opinion]

Eight Possible Fates for the ACA Exchanges
"In other countries, the minister of health can be as important as the minister of defense ... We seem well on our way to being one of those normal civilized nations.... On the other hand, those countries made that transition at a time when populations were still growing, delivering economic growth and a demographic profile that eased the burdens of paying for it all. They implemented their systems before the kind of hypertrophic growth that U.S. health-care prices underwent in the 1970s and 1980s. Slowing the rate at which costs grow is a much easier political task than actually cutting reimbursements."  Bloomberg

[Opinion]

According to Aetna, We Have Two Kinds of Insurance Companies Under Obamacare: The 'Less Worse Off' and the 'Worse Worse Off'
"[The complaint of the CO-OPs] is that they'd be doing fine if it weren't for the Obama administration's flawed risk adjustment program ... The irony that the risk adjustment system is telling us that these CO-OPs have the healthiest consumers and are still going broke should not be lost. Meantime, one of the legacy carriers, that has been benefiting from these payments, Aetna, is threatening to pull out of the exchanges because of their big 2016 Obamacare losses and is blaming part of it on the failure of the same risk adjustment system to adequately reimburse them for their losses!"  Bob Laszewski's Health Care Policy and Marketplace Review

Benefits in General

[Guidance Overview]

Proposed Overhaul of Form 5500 Slated for 2019 Plan Years (PDF)
"Many new questions are designed to make fiduciaries evaluate plan compliance with tax and ERISA requirements, as well as to provide the Agencies with improved tools for enforcement.... Particularly in light of the recent IRS curtailment of determination letter requests ... the Agencies may see the Form 5500 as a way to support compliance reviews -- whether performed by the Plan Administrator or the Agencies via audit."  Xerox HR Services

Significant Changes Proposed for Employee Benefit Plan Reporting
"The 2019 proposed changes ... include language requiring [retirement plan] sponsors to identify whether the plan failed to pay benefits when due ... The major change for health plan sponsors ... is the addition of Schedule J ... [which] would include the number of individuals offered and receiving COBRA continuation health coverage; whether the plan covers spouses, children and/or retirees; the number of participants and beneficiaries covered at the end of the plan year; and whether the plan requires participant contributions or is 100 percent employer paid."  Bloomberg BNA

Press Releases

AFT Applauds New Jersey Public Pension Hedge Fund Divestment
American Federation of Teachers [AFT]

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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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