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Human Resources Analyst, Employee Benefits Department
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July Business Services

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July Business Services
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Webcasts and Conferences

Voluntary Fiduciary Correction Program and Abandoned Plan Program
August 17, 2016 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Today's Plan Changes Create Tomorrow's Fiduciary Problems
August 17, 2016 WEBCAST

Final Wellness Program Regulations from the EEOC: New Rules and Challenges in Design and Administration
August 23, 2016 WEBCAST

Health Benefits Laws Compliance Workshop
August 23, 2016 in TX
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Specialty Drug Management: How to Control the Cost Explosion in your Health Plan
August 24, 2016 in IL
Worldwide Employee Benefits Network [WEB] - Chicago Downtown Chapter

Safe Harbor 401(k) Notices
September 28, 2016 WEBCAST
Lorman Education Services

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[Official Guidance]

Text of CMS FAQ: Language Access Taglines (PDF)
Dated Aug. 10, 2016. "When may entities subject to 45 C.F.R. Section 155.205(c)(2)(iii)(A) and (B) aggregate limited English proficient populations across multiple states to determine the top 15 languages in which they must provide taglines on Web sites and critical documents? ... When providing the taglines ... on Web site content, must Marketplaces, QHP issuers, and agents or brokers subject to 45 C.F.R. Section 155.220(c)(3)(i) (web-brokers) provide taglines on each Web site page?"
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Advert.] ACA Forms Module Complete. File. Deliver.

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Meet the ACA reporting requirements with this module from, which offers automated data upload, batch and e-filing capabilities. To learn more, attend our upcoming webinar.

[Guidance Overview]

Conversation with IRS Clarifies Confusion with Regard to Incorrect TINs
"[T]he IRS has informed [the author that] no solicitation effort is triggered for an incorrect TIN by an AIRTN500 error message.... An employer will still have to fulfill its solicitation obligations for missing TINs discussed in the previous article. The regulations are clear that a TIN is considered missing if it does not contain nine digits or includes one or more alpha characters (a character or symbol other than an Arabic numeral) as one of the nine digits[.]"
Accord Systems, LLC

[Guidance Overview]

CMS Announces 2018 Changes to Medicare Advantage Value-Based Insurance Design Model
"In the second year of the model, beginning January 1, 2018, CMS will: [1] open the model test to new applicants; [2] conduct the model test in three new states -- Alabama, Michigan, and Texas; [3] add rheumatoid arthritis and dementia to the clinical categories for which participants may offer benefits; [4] make adjustments to existing clinical categories; and [5] change the minimum enrollment size for some MA and MA-PD plan participants."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Must an Employer Accept FMLA Medical Certification from an Online Health Care Provider?
"Before you slam the door on this FMLA request, reacquaint yourself with the definition of 'health care provider' in the FMLA regulations.... There, the DOL has inserted a rather weaselly, catch-all provision for health care provider. Way down there, in subsection 125(b)(4), the regulations state that there are 'others' capable of providing health care services[.]"
FMLA Insights

Most Major U.S. Companies Will Offer Telehealth Benefits
"In 2017, 90 percent of large employers will offer their employees access to telehealth services -- broadly defined as a remote connection with a health-care provider... By 2020 ... 97 percent of large employers will offer their employees access to telehealth services.... In 2012, just 7 percent of employers offered access to telehealth services."
Bloomberg BNA


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.

Court Examines Plan's Residential Treatment Restriction Under Mental Health Parity Rules
"This case would likely have turned out differently under the final mental health parity regulations applicable to group health plans for plan years beginning on or after July 1, 2014 ... Unlike the 2010 interim final regulations, the preamble to the final regulations clarifies that the mental health parity requirements apply to restrictions and exclusions on the 'scope of services' or 'continuum of care' that is provided for mental health conditions and substance use disorders. The term 'scope of services' refers to the 'types of treatments and treatment settings' that are covered by a group health plan. At its simplest, this could include coverage for outpatient visits and inpatient hospital stays." [Danny P. v. Catholic Health Initiatives, No. 15-5024 (W.D. Wash. Jun. 30, 2016)]
Thomson Reuters / EBIA

Court Nixes Class Action Suit Alleging Fiduciary Breach for Supplemental Life Pricing
"A federal district court in Connecticut has dismissed a class action suit ... [which] alleged the employer negotiated a discount on the company-paid basic life insurance by increasing the rates charged employees who purchase supplemental coverage. The plaintiffs alleged this 'cross subsidization and kickback scheme' was a violation of the insurer's and the employer's fiduciary duties.... The plaintiffs have filed an appeal with the U.S. Court of Appeals for the Second Circuit, which has not yet indicated whether it will hear the case." [Hannan v. The Hartford Financial Services, Inc., No. 15-395 (D. Conn. Mar. 29, 2016)]

Technological Innovation in Healthcare and Benefits
"Americans are uncomfortable navigating healthcare. Employees don't want paper materials or a one-time enrollment meeting. They want information when they want it. Healthcare is exploding with technology tools to guide in making healthcare decisions with an emphasis on cost transparency."
Frenkel Benefits

Suicide Prevention: Access to Behavioral Health Services Lacking
"There are a number of barriers that could be keeping individuals from receiving services that would reduce their likelihood of engaging in self-harm behavior. The differences in the use of services by individuals with commercial and Medicaid insurance indicates that access to care is one of those barriers. The commercially insured were more likely to have a primary care visit, specialty care visit, and prescription drug filled for a behavioral health medication prior to an intent-to-harm-self emergency department encounter. People with Medicaid were more likely to have an emergency department encounter."
Health Affairs

'Moderate' Health Spending Growth Projections Exceed What We Can Afford
"Why shouldn't we expect the growth rate to return to the historically low pre-expanded coverage levels (averaging 3.7 percent from 2009 through 2013)? First, economy-wide price inflation is projected at 2.2 percent in the out years while it averaged 1.7 percent during the pre-expanded coverage years of 2009-2013. Econometric models show that health spending responds quickly to such price inflation so this should push health spending growth up by about 0.5 percentage points compared to 2009-13."
Health Affairs

Initial Insights from Year 2 of the ACA Risk Adjustment Program
"Total risk adjustment transfer payments at the national level remained at about 10% of premium in the individual market and 6% of premium in the small group market. Roughly one in four issuers offering plans in a given state or market in both 2014 and 2015 switched between payer and receiver status. Statewide risk scores rose more year-over-year than the movements in market demographics and average plan benefit richness would have suggested. Where available, the interim risk adjustment report did not provide a reliable indication of the ultimate value of the 2015 risk score."

Should Big Insurance Become Like Walmart to Lower Health Costs?
"Now that hospitals have themselves combined, in many cases, into companies that dominate their communities, insurance executives argue the only way to fight bigness is bigness.... In metro areas with only a few big insurers, hospital and doctor bills tend to be lower than what economists would otherwise expect. If only one or two insurers are bidding to include providers in their networks, hospitals and doctors must submit to the offered deal or risk getting shut out of a huge piece of business."
Kaiser Health News

Changes in ACA Individual Market Costs 2014-2015: Near- Zero Growth Suggests an Improving Risk Pool (PDF)
"[A]fter making comparability adjustments described [in this memo], per-member-per-month paid claims in the ACA individual market fell by 0.1 percent from 2014 to 2015. For comparison, per-enrollee costs in the broader health insurance market grew by at least 3 percent.... Available evidence indicates that the slow ACA individual market cost growth resulted at least in part from a broader, healthier risk pool.... Nearly all states saw continued growth in Marketplace enrollment in 2016, suggesting continued risk pool improvement."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Benefits in General

Active Life Expectancy in the Older U.S. Population, 1982-2011: Racial Differences Persisted
"[The authors] examine changes in active life expectancy in the United States from 1982 to 2011 for white and black adults ages sixty-five and older. For whites, longevity increased, disability was postponed to older ages, the locus of care shifted from nursing facilities to community settings, and the proportion of life at older ages spent without disability increased. In contrast, for blacks, longevity increases were accompanied by smaller postponements in disability, and the percentage of remaining life spent active remained stable and well below that of whites. Older black women were especially disadvantaged in 2011 in terms of the proportion of years expected to be lived without disability."
Health Affairs

Executive Compensation and Nonqualified Plans

[Guidance Overview]

IRS Issues Proposed Revisions to Section 409A Regs
"The proposed regulations clarify that the provisions relating to payments made upon death of a service provider apply equally to beneficiaries of a service provider. In addition, 409A will also allow payments to beneficiaries upon their disability or in the event of an unforeseeable emergency.... The proposed regulations clarify that ... if a service recipient maintains multiple plans of the same type that cover different unique employee populations, all such plans must be terminated if the service provider wishes to use the bankruptcy rule to terminate one or more such plans -- even though no employee participates in more than one such plan of the service provider."
Alvarez and Marsal

CEO Pay Ratio: Tricky to Calculate, Communicate
"335:1. 276:1. 247:1. 71:1. Those figures represent alternative ways to calculate the ratio of CEO pay to worker pay in the United States -- a ratio that every public company will be required to report starting in 2018.... [T]here is some flexibility in the SEC rule that allows a company to select its methodology for identifying its median employee and that employee's compensation. The question remains how the ratio should be calculated to create the most direct comparison between how CEOs and employees are paid."

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David Rhett Baker, J.D., Editor and Publisher
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016, 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, 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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