Health & Welfare Plans Newsletter

September 9, 2016

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Employee Benefits Jobs

Payroll Audit Manager
Sheet Metal Workers' National Pension Fund
in VA

401(k) Retirement Plan Administrator
Alliance Pension Consultants, LLC
in IL

401(k) / DC Administrator
Continental Benefits Group, Inc.
in NJ

Sr Plan Administrator
American National Insurance Company
in TX

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Webcasts and Conferences

Determining Full-time Employee Status under the Affordable Care Act
September 22, 2016 WEBCAST
IRS [Internal Revenue Service]

Workplace Wellness Initiatives & Employee Engagement
September 27, 2016 in MA
Sapers & Wallack, Inc.

Employee Benefits Update: Latest Guidance and Developments in Health and Welfare Plans
October 14, 2016 WEBCAST
American Law Institute Continuing Legal Education Group [ALI CLE]

Data Mining
November 9, 2016 WEBCAST
Conference of Consulting Actuaries

Los Angeles Advanced Pension Conference
January 19, 2017 in CA
ASPPA College of Pension Actuaries [ACOPA]

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[Official Guidance]

Text of 2016 IRS Form 1095-A, 'Health Insurance Market Statement' (PDF)
"Form 1095-A is provided here for informational purposes only. Health Insurance Marketplaces use Form 1095-A to report information on enrollments in a qualified health plan in the individual market through the Marketplace. As the form is to be completed by the Marketplaces, individuals cannot complete and use Form 1095-A." [Published online Sept. 8, 2016.]
Internal Revenue Service [IRS]

[Advert.]

Changes to Cafeteria Plans: What You Need to Know to Prepare

Sponsored by Lorman and BenefitsLink

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.


[Guidance Overview]

Building Excellence in HIPAA Compliance: Not Just for Health Care Providers
"If you offer a group health plan and/or on-site health services, ... determine the existence and scope of your HIPAA compliance responsibilities. For businesses with direct compliance obligations: [a] Keep momentum strong. Compliance audits don't stop with Phase 2. [b] Learn from past enforcements. OCR trigger points include: [1] Security Rule risk analyses and risk management plans for ePHI; [2] Portable electronic device security; [3] Individuals' right to access their own PHI; and [4] Proper BA relationships. [c] Ensure buy-in. Engage your c-suite, and build a culture of compliance among the workforce. [d] Train your employees.... [e] Learn from your peers."
Ice Miller LLP

[Guidance Overview]

New ACA Marketplace Notices to Employers Require Action
"This article provides an overview of this new chapter in the ACA's implementation, the nature of the new Marketplace notices being sent to employers, why an employer may want to appeal a determination, how to file an appeal, the relationship between this process and the IRS process for the assessment of employer shared responsibility penalties, and how to reduce the risk of liability for retaliation claims by employees purchasing Marketplace coverage."
Vedder Price

[Guidance Overview]

DOL Permits Additional ACA Marketplace Information as Part of COBRA Election Notice (PDF)
"DOL clarified in an FAQ that plans may provide their qualified beneficiaries with more information on ACA marketplace coverage than the current COBRA model election notice contains. This information could explain how to get help with marketplace enrollment, the availability of financial assistance, and/or any other aspect of marketplace coverage that could help qualified beneficiaries choose between COBRA and marketplace alternatives."
Xerox HR Services

[Guidance Overview]

HHS Proposes 2018 OOP Maximums and Marketplace Guidance (PDF)
"In 2017, the OOP limits will be $7,150 for self-only coverage and $14,300 for other than self-only coverage. HHS has proposed 2018 OOP maximums of $7,350 for self-only coverage and $14,700 for other than self-only coverage.... [A table] summarizes the ACA indexed dollars limits for 2018 and prior years."
Xerox HR Services

[Advert.]

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Sponsored by WEB - Worldwide Employee Benefits Network

WEB members represent more than 25 professions and 30 areas of expertise within the pension and benefits industry-including administrators, consultants, attorneys, accountants, investment managers, communications experts and benefits managers. Join today.


Court Affirms Health Plan's Exclusion of Services Provided in an Educational Setting
"The court concluded that the participant failed to show that the treatment provided at the facility, which had a comprehensive and accredited educational program, fell outside the plan's exclusion for services provided in an educational setting.... This case, which involved expenses incurred at a mental health residential treatment facility in 2011, would likely have a different outcome under the final mental health parity regulations applicable to group health plans for plan years beginning on or after July 1, 2014." [Stephanie C. v. Blue Cross Blue Shield of Mass., No. 13-13250 (D. Mass. June 30, 2016)]
Thomson Reuters / EBIA

Monitor your Self-Insured Medical Plan with an Administrative Audit
"Studies have shown that TPAs fail to meet industry-standard accuracy measures 60 percent of the time. Performing such a review of your administrator will fulfill the [plan sponsor's] fiduciary responsibility as a plan sponsor as well as help you evaluate whether your claims are being paid correctly and in accordance with the plan's intended benefit provisions. It offers the best opportunity to create accountability, measure performance, and establish processes for continuous quality improvement."
Moss Adams LLP

CMS Releases Tool to Help Determine Covered Entity Status
"CMS has released an updated interactive tool to determine whether an individual or organization is a covered entity for purposes of HIPAA's administrative simplification rules.... The tool allows an individual or organization to answer a series of questions to determine whether it may be a covered entity. Different categories of covered entities are included in the tool (e.g., health plans, providers, and clearinghouses)."
Thomson Reuters / EBIA

Recent Rise in Health Coverage Due to Return of Jobs with Benefits
"70.2 percent of residents, age 18 to through 64, had 'private health insurance' ... in the first quarter of this year, which is which is the same rate as persisted until 2006.... What has really happened is a restoration of employer-based benefits as we have slowly clawed our way out of recession: 61.2 million people had non-exchange private insurance in Q1 2010. This included both employer-based benefits and the pre-Obamacare market for individual health insurance. By Q1 2016, this had increased to 66 million. Because most in the pre-Obamacare individual market have shifted into Obamacare exchange coverage, the increase in employer-based coverage will have been close to eight or nine million."
National Center for Policy Analysis Health Policy Blog

ACA Round-Up: Insurance Market Concentration, Statutory Reach, and Coverage Gains
"In 2011, the three largest insurers had 80 percent or more of the individual and small group markets in 33 states each. By 2014 the number of such states increased to 41 for the individual market and 40 for the small group market.... Although concentration of insurance markets was continuous throughout the period, the ACA has in fact changed health insurance markets."
Health Affairs

Public Funds Account for Over 70 Percent of Health Care Spending in California (PDF)
"[H]ealth care expenditures in 2016 are estimated to total more than $367 billion [in California] ... 71 percent of these expenditures will be paid for with public funds.... Private expenditures ... will comprise approximately 29 percent of total health care spending in California in 2016 ... [including] employer share of premiums (16 percent), employee share of premiums (6 percent), out-of-pocket expenditures for covered benefits (4 percent), and premium contributions for individually purchased insurance (3 percent)."
UCLA Center for Health Policy Research

Senators Warren and Sanders Launch Probe Into Insurer That Bailed on Obamacare
"Many Democrats have been suspicious that Aetna's decision came as a direct result of the unfavorable ruling from the White House. That speculation was fueled after a letter surfaced from Aetna's CEO last month that appeared to make a direct threat to Obama administration that the company would leave the exchanges if its merger was not approved."
The Hill

Benefits in General

Ninth Circuit Clarifies Remedies for Failure to Provide Documents Relevant to a Benefit Claim (PDF)
"[T]he Ninth Circuit clarified that the $110 per day penalty cannot be imposed for failure to provide documents relevant to a benefit claim in response to a request made under the claims regulations. While that penalty may be imposed for failure to provide required plan governing documents under ERISA Section 104(b)(4), it may not be imposed for the failure to provide documents relevant to a benefit claim." [Lee v. ING Groep, N.V., No. 14-15848 (9th Cir. July 25, 2016)]
Trucker Huss

Financial Wellness: The Newest Benefit Employers are Offering
"According to [one report], only 24% of millennials say that they are in control of their finances and 70% say that they need help understanding how benefits work. [Another] survey found that 85% of millennials don't feel financially secure, but expect to in the future.... [C]ompanies are now creating financial wellness programs to cater to employees' financial needs, instead of just having random one off sessions on budgeting 101."
Fox Business

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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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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