Health & Welfare Plans Newsletter

August 5, 2016

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Employee Benefits Jobs

401(k) Conversion/ Installation Specialist
Professional Capital Services
in PA

Pension Consultant Administrator
Growing TPA Firm
in CT

Pension Administrator
Pension Planners, Inc.
in FL

Director of Accounting
Chicago Laborers' Pension and Welfare Office
in IL

Implementation Account Manager
Nova 401(k) Associates
in AZ, TX, Telecommute

ERISA Attorney
Smith & Downey, P.A.
in MD

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Webcasts and Conferences

Successfully Implement A Full Replacement Consumer Driven Health Plan
August 30, 2016 in TX
Worldwide Employee Benefits Network [WEB] - Dallas Chapter

Open Enrollment is Coming - Is Your Health Plan Up to Date?
September 15, 2016 WEBCAST
ABA Joint Committee on Employee Benefits [JCEB]

ACA Employer Reporting Update for 2016: What Is New and What Has Changed
October 18, 2016 WEBCAST
HRWebAdvisor

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[Official Guidance]

Text of Health Insurance Marketplace Employer Appeal Request Form (PDF)
"If you received a Marketplace notice stating that you may be subject to the Employer Shared Responsibility Payment, you can request an appeal by submitting this form ... This appeal may determine if an employee was eligible for help with the costs of coverage through the Marketplace at the same time that you may have offered them affordable health coverage that met the minimum value standard. This appeal will NOT determine if your organization has to pay the Employer Shared Responsibility Payment."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Responding to Marketplace Notices
"The appeal process serves an important purpose in overall compliance with [employer shared responsibility (ESR)] requirements by both setting the record straight with respect to potential ESR assessments by the IRS and ceasing the payment of additional governmental subsidies to employees who may not be eligible for such subsidies ... With the complicated nature of the ESR rules, health care eligibility and offers of coverage, it is to be expected that employees may make mistakes in reporting the details of their insurance and even who is their actual employer."
McDermott Will & Emery

[Guidance Overview]

ACA Reporting Update: 2016 Draft Forms and Instructions Released
"For the most part, the 2016 ACA reporting requirements are similar to the 2015 requirements ... The draft instructions to the C-Series Forms provide more detail and examples on how ALEs should prepare the forms.... [T]wo new indicator codes for Line 14 of Form 1095-C ... ask employers to indicate whether a conditional offer was made to a spouse.... Going forward, reporting penalties may be waived only upon the standard showing of reasonable cause.... The draft instructions to the C-Series Forms include new information related to coding for COBRA continuation coverage."
Proskauer's ERISA Practice Center

[Guidance Overview]

IRS Proposes Information Reporting Rules with Guidance on HRAs and TIN Solicitation
"The proposed regulations clarify that TIN solicitations made to the responsible individual (generally, the individual who enrolls him or herself and others in minimum essential coverage [MEC]) would be treated as TIN solicitations of every covered individual on the policy or plan. However, to avoid penalties, a coverage provider would have to solicit TINs separately for any individual added to a policy or plan. The preamble also clarifies rules for electronic TIN solicitations."
Thomson Reuters / EBIA

Health Care Bills Would Affect Mental Health Parity, HSAs and FSAs
"On July 6, the House approved legislation ... [that] would clarify that benefits for eating disorders (including residential treatment) must comply with the MHPAEA. A separate House bill ... would: [1] Repeal the provision in the [ACA] that prohibits HSAs, health FSAs and HRAs from paying or reimbursing drugs or medications unless they are prescribed; [2] Increase the HSA contribution limits; [3] Allow both spouses to make catch-up contributions to the same HSA; [4] Allow reimbursement of medical expenses incurred before the HSA is established."
Willis Towers Watson

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The Labor Market Impacts of Paid Sick Leave
"In 2012, Connecticut became the first U.S. state to enact a law requiring private employers to provide paid sick leave. Four years later ... [the authors found that] one-third of the 86 surveyed businesses had reduced other employee benefits to account for the law's costs, one-fifth had raised prices, and a similar number had reduced hours or staffing levels."
Employment Policies Institute

State Court Lien Adjudication Claim Subject to Removal and ERISA Preemption
"[T]he question is whether an ERISA plan participant may avoid ERISA's preemptive provisions by filing a state court petition to adjudicate a health plan's reimbursement provisions.... Does state law impose an independent legal duty? This is the second prong issue. The Court concluded that it did not.... And the Court found that interpretation of plan terms formed an 'essential part' of state law Petition.... Thus, the state law claim was properly removed to federal court and preempted by ERISA." [Rudel v. Hawaii Mgmt. Alliance Ass'n,, No. 15-00539 (D. Haw. Aug. 1, 2016)]
Health Plan Law

TPA Transformation: Turning Data into Decisions
"Many TPAs are transforming their organizations from reactive, claims-paying service providers to proactive, strategic health plan management partners. The foundation for this transformation is data. TPAs are capitalizing on the vital role they play as the repository of vast amounts of plan, utilization, cost and health data to offer employers and their brokers insight to make informed health plan and benefits decisions."
Benefitfocus

Outpatient Services Are the Largest Driver of 2017 Premium Increases
"Outpatient spending accounts for 29.9 percent of 2017 rate increases and represents 27.4 percent of spending in these plans, according to 2015 allowed claims data. This finding is similar to 2016 premium trends.... [Prescription] drugs are responsible for 14.3 percent of premium growth in 2017. This is lower than 2015 claims experience, which shows plans spent 17.7 percent of total medical spending on drugs."
Avalere Health

Aetna, Humana Try to Save Their Merger by Selling Assets to Molina Healthcare
"On August 2, [Aetna and Humana] announced that they each have separate agreements with Molina Healthcare to sell Medicare Advantage assets. However, the deals are subject to a successful completion of Aetna's proposed acquisition of Humana. Through the deal, Molina will gain nearly 300,000 Medicare Advantage members in 21 states. According to Aetna, the deal addresses a key concern of the DOJ in its challenge of the transaction."
American Journal of Managed Care

GAO Report: Information on Approval Process for ACA State Innovation Waivers
"GAO was asked to examine the status of the Departments' implementation of the review and approval process for section 1332 waivers. This report provides information on HHS's and Treasury's approach to [1] applying the statutory approval criteria and [2] coordinating the review and approval of 1332 waiver proposals across HHS, Treasury, and their related agencies."
U.S. Government Accountability Office [GAO]

Executive Compensation and Nonqualified Plans

[Guidance Overview]

Final Regs Eliminate Taxpayer Requirement to File Section 83(b) Election with Income Tax Return
"A taxpayer still is required to file the 83(b) election with the IRS no later than 30 days after the property is transferred. There are no exceptions to this timing requirement. A taxpayer also still is required to submit a copy of the 83(b) election to his or her employer."
Wilson Sonsini Goodrich & Rosati

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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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