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[Official Guidance]
Text of OPM Proposed Regs: FEHB Employee Premium Contributions for Employees in Leave Without Pay or Other Nonpay Status
15 pages. "Under current regulations, a Federal agency pays the employee's share and the Government's share of FEHB premiums if an employee in [leave without pay (LWOP)] or other nonpay status elects to continue coverage while in LWOP or other nonpay status and agrees to repay the agency ... for their employee share upon return to employment for up to 365 days. In other words, the agency must allow an employee to incur a debt for the employee contribution to premium.... This proposed rule would provide an agency with the flexibility to require that all of its employees in LWOP or other nonpay status, except as a result of lapse of appropriations, pay their employee share for FEHB coverage directly to the agency and keep the payments current, if those employees elect to continue FEHB enrollment."
U.S. Office of Personnel Management [OPM]
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[Guidance Overview]
Changes to the 2016 IRS Form 1095-C According to the Draft Instructions
"Part II presents the largest challenge with the Form 1095-C.... Lines 14, 15, and 16 of part II largely remain unchanged.... Line 14 has two new codes that won't be relevant to most employers.... It is vital that the Form 1095-C has accurate codes inserted for each employee for all 12 weeks.... Part III should only be completed by an employer who sponsors a self-insured plan in which the employee or another individual enrolled."
Accord Systems, LLC
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[Guidance Overview]
IRS Increases Shared Responsibility Affordability Percentages and Assessment Amounts (PDF)
"The IRS has increased the applicable contribution percentage used for determining whether employer-sponsored coverage is affordable for purposes of premium tax credit eligibility. It also clarified that the same applicable percentage applies to the shared responsibility affordability safe harbors and increased the $2,000 and $3,000 shared responsibility assessment amounts.... [T]hese, and other ACA indexed amounts, [are summarized] in a table at the end of this [article]."
Xerox HR Services
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[Guidance Overview]
New Illinois Employee Sick Leave Act Mandates Greater Flexibility on Use of Leave Benefits
"The Illinois Employee Sick Leave Act (Public Act 99-0841) requires Illinois employers who provide personal sick leave benefits to their employees to allow employees to take such leave for absences due to the illness, injury, or medical appointment of the employee's child, spouse, sibling, parent, mother-in-law, father-in-law, grandchild, grandparent, or stepparent. The leave must be granted on the same terms under which the employee is able to use sick leave benefits for his or her own illness or injury. The Act goes into effect on January 1, 2017."
Jackson Lewis P.C.
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The Benefit of Anti-Assignment Provisions in ERISA Health Plans
"To protect the plan, the anti-assignment language should be drafted carefully to make clear that the plan does not recognize assignments to third parties for any reason (including potential fiduciary breaches). The provision should also disclose that, although the plan may make payments directly to providers, such payments do not make a provider an assignee or otherwise confer on the provider any rights under the plan or ERISA. Additionally, the plan should cite its anti-assignment provision at the outset of any dispute with a provider and avoid taking any action that could be construed as a waiver of the provision."
Morgan Lewis
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[Advert.]
Changes to Cafeteria Plans: What You Need to Know to Prepare
September 21 webinar. Explores design choices available within the regulatory framework established by the IRS, and provides tools to ensure that cafeteria plan design, documentation and administration are in compliance with applicable requirements.
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Cost Savings Possible from Reducing Use of Low-Value Health Services
"[R]esearchers found that spending on 28 low-value medical services totaled $32.8 million during 2013 among the group. That accounted for 0.5 percent of total spending or more than $22 per person annually.... The study ... examined medical services that experts have agreed provide little value to patients given the cost and available alternatives."
RAND Corporation
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HIPAA Audit Check-Up: Where We Are and What's to Come
"Business associates should verify that risk analysis, risk management, and breach notification policies and procedures, and supporting documentation, are in place and readily available ... Covered entities should focus on likely areas of future desk audits, such as device and media controls, transmission security, privacy safeguards, privacy training, encryption and decryption, and facility access controls."
Davis Wright Tremaine LLP
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Promoting Access to Affordable Prescription Drugs (PDF)
110 pages. "This report includes a series of recommendations to assist regulators, lawmakers, and the [NAIC] on ways to promote access, affordability, nondiscrimination, transparency, and meaningful oversight of prescription drug coverage.... [E]ach section includes an overview of a specific issue, examples of state approaches to addressing that issue, and recommendations for consumer-protective policies to be considered by state and federal policymakers."
23 Consumer Representatives to the National Association of Insurance Commissioners [NAIC]
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Nearly Half of Americans Think Their Employer Isn't Investing Enough in Their Health and Wellness
"While benefits matter a lot for employees of all ages, they're most important when it comes to attracting and retaining seasoned professionals. The study shows that 58 percent of workers who are over 60 rate benefits as 'very important', as do 66 percent of those aged 45-60, and 59 percent of 30-40-year-olds. Less than half (45 percent) of 18-29-year-olds rate benefits as 'very important' to how they feel about their job and their employer."
Wolters Kluwer Law & Business
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Aetna's Retrenchment Is No Big Deal
"[N]ational firms such as Aetna, United, and CIGNA are far better positioned to serve national employers and other large, self-insured groups than to compete for individual households.... The vast majority of purchasers on the ACA Marketplace are low-to-moderate income households, who are searching for low-priced health plans.... As a result, the Blue Cross Blue Shield and other regional plans generally ... enjoy a cost and premium advantage over national plans and tend to dominate their Marketplaces."
Health Affairs
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Humana Exits Obamacare Market in Utah
"Humana will stop offering plans on the state's individual insurance marketplace in 2017 ... Humana's exit leaves only three insurers in the state which will be offering plans in the marketplace ... Two years ago, six insurers offered plans in the state."
Healthcare Finance News
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Healthcare Exchange Sign-Ups Fall Far Short of Forecasts
"A big reason the CBO projections were so far off is that the agency overestimated how many people would lose insurance through their employers, which would force them into the exchanges.... In some markets, a shortfall in enrollment is testing insurers' ability to balance the medical claims they pay out with income from premiums.... Some of the first companies to enter the market made bad bets on how healthy customers would be, resulting in unprofitable health plans. Proponents say it's natural for new entrants to replace them, with better information and more competitive plans."
The Washington Post; subscription may be required
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[Opinion]
Why a Single-Payer Health-Care System Is Inevitable
"Health insurers spend lots of time, effort and money trying to attract people who have high odds of staying healthy (the young and the fit) while doing whatever they can to fend off those who have high odds of getting sick (the older, infirm and the unfit). As a result, we end up with the most bizarre health-insurance system imaginable -- one ever better designed to avoid sick people."
Robert B. Reich, in The Seattle Times
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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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