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[Guidance Overview]
Exposure Draft for Update of NAIC ERISA Handbook: ACA Changes Incorporated Into ERISA (PDF)
"[F]or the first time a comprehensive structure of benefit mandates was added to ERISA requirements. Although HIPAA had added a few provisions to ERISA and the IRC that echoed similar language in the PHS Act ... those had been the exception rather than the rule. Traditionally, ERISA did not dictate to employers what benefits and protections had to be contained in employer health plans.... By contrast, the ACA is largely mandatory in nature."
ERISA (B) Working Group, Health Insurance and Managed Care (B) Committee, National Association of Insurance Commissioners [NAIC]
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![Sponsored by International Foundation of Employee Benefit Plans [IFEBP]](https://benefitslink.com/bnrs/2016/IFEBP_2016Annual_top.jpg "Sponsored by International Foundation of Employee Benefit Plans [IFEBP]")
Learn about today's most pressing issues, hear from industry thought-leaders, network and more at the Annual Conference. With more than 5,000 attendees, 200 speakers, 100 sessions, and 11 focused tracks, it is your source for employee benefits education.
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[Guidance Overview]
Exposure Draft for Update of NAIC ERISA Handbook: Association Coverage -- Is It Individual, Small Group or Large Group Coverage? (PDF)
"Since the passage of the ACA ... some association plans have sought treatment as large group plans so that they can continue offering health coverage to their members.... [CMS] acknowledged that there are limited exceptions to certain provisions of the guaranteed issue and guaranteed renewability laws for coverage offered through 'bona fide associations,' but emphasized that '[t]he bona fide association concept has no other significance under the PHS Act, and, importantly, does not modify or affect the analysis of whether health insurance coverage belongs to the individual or group market.' "
ERISA (B) Working Group, Health Insurance and Managed Care (B) Committee, National Association of Insurance Commissioners [NAIC]
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[Guidance Overview]
NYC Amends Mass Transit Benefit Rules (PDF)
"Starting in 2016, NYC law requires businesses to offer pretax commuter benefits to their 'full-time' employees who work in the city. The NYC Department of Consumer Affairs recently amended its rules to clarify recordkeeping requirements, enforcement provisions, and penalties effective September 7."
Xerox HR Services
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Oscar Feeling Grouchy About Obamacare
"After suffering 'significant losses,' health insurance startup Oscar Insurance Corp. is the latest to announce they'll be pulling out of Obamacare markets next year, signaling it will leave markets in the Dallas-Fort Worth, Texas, area as well as New Jersey."
Energy & Commerce Committee, U.S. House of Representatives
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PPO Deductibles Increase 50% in 2016, Employer Costs Remain Steady
"The median in-network deductible on an employer-sponsored PPO health plan increased ... from $1,000 to $1,500 in 2016 ... [N]early half of all employees continue to enroll in PPO plans ... [A]verage health plan costs for employers actually decreased slightly, from $9,736 in 2015 to $9,727 in 2016, while the employees' share increased as they continue to accept lower coverage levels. Of the $9,727, employees contributed an average of $3,378 and employers contributed on average $6,350, whereas in 2015, employers paid $6,403 of the $9,736 average overall cost, while employees paid $3,333."
United Benefit Advisors
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States, Religious Groups File Lawsuit Against Transgender Provisions in Obamacare
"Kansas, Kentucky, Nebraska, Texas and Wisconsin say in the latest lawsuit that the regulation infringes on their sovereign power. The lawsuit is being brought by the Becket Fund for Religious Liberty on behalf of these states and the Franciscan Alliance, a Catholic hospital network, and the Christian Medical & Dental Association. The plaintiffs say that the health care rule intrudes on their medical judgment and on their religious beliefs."
U.S. News & World Report
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Can Anything Contain U.S. Drug Costs?
"In the U.S., per capita spending on prescription drugs was $858 as of 2013, more than twice the $400 average for 19 other industrialized nations ... List prices for the top 20 drugs by revenue help explain this chasm. Combined, average list prices for these drugs were three times greater in the U.S. than in the U.K."
Reuters
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HHS Report to Congress: E-Health and Telemedicine (PDF)
15 pages. "While this report discusses various aspects of telehealth activities and challenges that apply in some cases to both federal government programs and the private sector, we focus the report primarily on activity occurring within HHS and discuss how delivery system reform initiatives may increase the use of telehealth. We close with a budget proposal related to telehealth in the Department's FY 2017 budget request."
Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]
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HIPAA Phase 2 Audits: What Has OCR Requested from Auditees to Date? (PDF)
"[W]hile HIPAA-covered entities that were not selected can breathe a deep sigh of relief (for now), the audit activity is far from over. As part of its Phase 2 audit program, OCR will next audit business associates based on the information the covered entities provide. Additionally, OCR will conduct onsite audits of covered entities and business associates."
Alston & Bird LLP
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The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform
"High drug prices are the result of the approach the United States has taken to granting government-protected monopolies to drug manufacturers, combined with coverage requirements imposed on government-funded drug benefits. The most realistic short-term strategies to address high prices include enforcing more stringent requirements for the award and extension of exclusivity rights; enhancing competition by ensuring timely generic drug availability; providing greater opportunities for meaningful price negotiation by governmental payers; generating more evidence about comparative cost-effectiveness of therapeutic alternatives; and more effectively educating patients, prescribers, payers, and policy makers about these choices."
JAMA
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[Opinion]
Health Care Is a Business, Not a Right
"[One author suggests] that we have a strong intuitive preference for altruistic health care -- for an enormous, practically unlimited amount of altruistic health care -- because health care is a way to demonstrate loyalty and caring to people you love.... That may explain why we like insurance that covers as much as possible and dislike any suggestion that the people who provide our health care are calculating what it will cost them to provide it. Bringing money into an altruistic exchange taints it ... The issue ... is not necessarily profit -- health insurers are not particularly profitable as industries go, and hospitals and other care organizations are often nonprofit. The issue is making decisions based on money."
Bloomberg
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Executive Compensation and Nonqualified Plans
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[Guidance Overview]
Non-Qualified Deferred Comp Plans: Don't Forget FICA
"In a typical NQDC arrangement, a senior executive is provided with a right to a payment or series of payments upon retirement, death, or disability. Generally, the executive vests in these payments ... many years before they are actually paid. If the plan is properly set up, which includes complying with the intricate requirements of Section 409A, income taxation can be deferred until the amounts are paid. However, while proper care can defer income tax, FICA is subject to different rules."
Baker Newman Noyes
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Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager
BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials
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