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[Official Guidance]

Text of 2016 Instructions for IRS Form 1095-A (PDF)
"Form 1095-A is used to report certain information to the IRS about individuals who enroll in a qualified health plan through the Health Insurance Marketplace. Form 1095-A is also furnished to individuals to allow them to take the premium tax credit, to reconcile the credit on their returns with advance payments of the premium tax credit (advance credit payments), and to file an accurate tax return."
Internal Revenue Service [IRS]


Earn Your Certificate in Health Plan Navigation Online

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Health care benefits are complex, and your plan participants look to you for the answers. If you are on the front line of health care enrollment at your organization, the Certificate in Health Plan Navigation is the education you need. Enroll Now!

[Guidance Overview]

Spotlight on Transgender Health Coverage (PDF)
"In the case of an insured plan, the insurer -- not the employer -- may be a covered entity obligated to comply with Section 1557 requirements for all of its operations, including its policy terms. Carriers may (or may not) reach out to plan sponsors to alert them of changes to coverage in light of the final Section 1557 rules. It is not clear if the Section 1557 rules would allow an insurer to offer policies that would let an employer opt out of coverage for transgender healthcare services."
Xerox HR Services

[Guidance Overview]

Illinois Employers Must Provide Qualifying Employees Two Weeks of Unpaid Child Bereavement Leave
"Illinois is now the second state to require that employers provide unpaid bereavement leave to eligible employees under its Child Bereavement Leave Act. This Act provides that employers with at least 50 employees must provide two weeks (10 working days) of unpaid leave due to the loss of a child. In the event of death of more than one child in a 12-month period, an employee is eligible for up to six weeks of bereavement leave."
Drinker Biddle

Dismissal of Bully's FMLA Claim Proves Employers Can Safely Terminate an Employee on the Heels of FMLA Leave
"Insights for Employers: [1] Don't shy away from terminating an employee who has recently requested or taken FMLA leave.... [2] But Don't Rush to Judgment.... [3] Similarly, don't short circuit performance improvement plans (PIPs)." [Shell v. Tyson Foods Inc., No. 15-00037 (W.D.N.C. Aug. 25, 2016)]
FMLA Insights

Debit Cards: A No-Brainer for Employer-Sponsored Benefits
"In addition to incentivizing plan enrollment for employers, benefits debit cards can also streamline the process by reducing the need for extensive account administration and claims filing.... With an FSA, employees can use the card in store and online to pay for IRS-approved medical-related expenses.... A debit card for an HSA can be particularly useful for account holders enjoying rollover at years' end, which can result in significant account growth."


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.

Orphan Drug Expenditures in the United States: An Historical and Prospective Analysis, 2007-18
"In 2014 dollars, expenditures on orphan drugs totaled $15 billion in 2007 and $30 billion in 2013 -- representing 4.8 percent and 8.9 percent of total pharmaceutical expenditures, respectively. Our future trend analysis for the period 2014-18 suggests a slowing in the growth of orphan drug expenditures. The overall impact of orphan drugs on payers' drug budgets is relatively small, and spending on orphan drugs as a percentage of total pharmaceutical expenditures has remained fairly stable."
Health Affairs; purchase or subscription required to view full article

How the 2016 Presidential Election Could Impact Healthcare in America
"This presidential election could bring some changes to the U.S. healthcare system. As with all candidates in recent history, both of the two major party nominees have given lip service to controlling health care spending and reducing out-of-pocket expenses.... [A chart] provides a brief overview of each candidate's proposed healthcare solutions[.]"
Benefit Revolution

Republican Senators Unveil Bill Loosening Obamacare Individual Mandate
"A group of Republican senators on [Sept. 7] introduced a bill to exempt people from Obamacare's individual mandate if they live in a county with one or no options for coverage. The lawmakers ... argue that it is wrong for people to face Obamacare's financial penalty for lacking insurance if there is only one insurer offering coverage in their area, or none at all."
The Hill

Democrats Use Obamacare Crisis to Revive 'Public Option' Push
"A public option -- or insurance plan offered by the government -- had been written into early versions of the bill but failed to make the final cut in the law signed by Obama in March 2010. But with many states seeing private insurers exit Obamacare markets amid concerns over cost and other factors, Democrats see a silver lining to what critics are calling another Obamacare crisis -- a reason to bring the option back."
Fox News

Arizona's Pinal County Will Have an ACA Insurer After All
"Blue Cross Blue Shield of Arizona will offer plans on the [ACA] exchange in Arizona's Pinal County next year, resolving a situation that drew a national spotlight ... [It] will be the sole exchange insurer in 13 of Arizona's 15 counties in 2017.... Insurance officials in other states remain nervous about the possibility that other counties might lose all their exchange insurers if other companies decide in coming weeks to reduce their footprints."
The Wall Street Journal; subscription may be required


In Fact, Professor Reinhardt, This Is Obamacare's Fourth Death Spiral
"[1] Before they even took effect, ObamaCare's preexisting conditions provisions began driving insurers out of the market for child-only health insurance. Insurers ultimately exited that market in 39 states, causing the markets in 17 states to collapse. [2] ObamaCare's long-term care insurance program -- the CLASS Act -- failed to launch when the administration could not make it financially sustainable.... [3] Exchanges effectively collapsed in every U.S. territory, again prior to launch. [4] Now, a nationwide exodus of insurers has left one third of counties, one in six residents and seven states with only one carrier. In Pinal County, Arizona, every insurer has exited the Exchange."
Cato Institute


Don't Get Too Excited, Pinal County
"News broke of Blue Cross Blue Shield of Arizona remaining in the marketplace in Pinal County, Arizona late on Wednesday. Obamacare supporters will rejoice with a thunderous round of applause to the insurance company and positive vibes about how tax credits will keep costs low. But the folks in Pinal County have little to get excited about.... In their announcement to remain in the marketplace, their Senior VP of sales, strategy and marketing, Jeff Stelnik, said premiums will increase by 51%."

Benefits in General

Federal District Court Enforces Forum Selection Clause Contained in ERISA Plan
"[The court] observed that forum selection clauses further ERISA's goal of promoting a uniform administrative scheme by having the same court decide all cases relating to a single plan, and also found [the participant's] claim of physical and financial limitations irrelevant to its analysis.... In rejecting [contrary rulings by other courts], the court concluded that ERISA's policy that litigants have 'ready access to the Federal courts' was not intended to supersede the general enforceability of forum selection clauses. Thus, a plan may contractually limit the number of locations where an action 'may be brought.' " [Mathias v. Caterpillar, Inc., No. 16-1846 (E.D. Pa. Aug. 29, 2016)]
Proskauer's ERISA Practice Center

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David Rhett Baker, J.D., Editor and Publisher
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