Health & Welfare Plans Newsletter

November 11, 2016

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[Official Guidance]

Text of CMS Draft 2018 Letter to Issuers in the Federally-Facilitated Exchange (PDF)
85 pages, dated Nov. 10, 2016. "This Letter provides issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Marketplaces (FFMs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs) with operational and technical guidance to help them successfully participate in any such Marketplace in 2018.... CMS welcomes comments on this proposed guidance."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Proposed Key Dates for Calendar Year 2017 (PDF)
"This document summarizes key dates for calendar year 2017 regarding some activities and policies that are outlined in other documents that have not yet been finalized, such as the Draft 2018 Letter to Issuers in the Federally-facilitated Marketplaces (November 10, 2016), the Patient Protection and [ACA]; HHS Notice of Benefit and Payment Parameters for 2018; Proposed Rule, (September 6, 2016), and the DRAFT Bulletin: Timing of Submission and Posting of Rate Filing Justifications for the 2017 Filing Year for Single Risk Pool Coverage Effective on or after January 1, 2018 (November 10, 2016). CMS is not soliciting additional comments on the substance of the underlying policies or the proposed key dates through release of this document."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

ACA Reinsurance Fee Filing Due November 15
"By November 15, 2016, group health plans must report to [HHS] using the Pay.gov website, the number of lives covered under the plan. HHS will use that number to calculate payments due for the temporary reinsurance program. For fully-insured health plans, the insurer is responsible for submitting the report. For self-insured health plans, the 'plan' is required to submit the information, though a third-party administrator may report on the plan's behalf."
Warner Norcross & Judd LLP

[Guidance Overview]

New Guidance on Cloud Computing and the HIPAA Privacy and Security Rules (PDF)
"A cloud service provider is a business associate under HIPAA even if the cloud service provider processes or stores only encrypted ePHI and lacks an encryption key for the data. Even 'no-view' cloud-based systems are business associates and require monitoring to ensure compliance with HIPAA. Employers should review their human resources and benefits systems to determine which are cloud-based and ensure that HIPAA protections are in place."
Segal Consulting

[Guidance Overview]

CMS Announces 2017 Medicare Parts A & B Premiums and Deductibles
"Because of the low Social Security COLA, a statutory 'hold harmless' provision designed to protect seniors, will largely prevent Part B premiums from increasing for about 70 percent of beneficiaries. Among this group, the average 2017 premium will be about $109.00, compared to $104.90 for the past four years. For the remaining roughly 30 percent of beneficiaries, the standard monthly premium for Medicare Part B will be $134.00 for 2017, a 10 percent increase from the 2016 premium of $121.80. Because of the 'hold harmless' provision covering the other 70 percent of beneficiaries, premiums for the remaining 30 percent must cover most of the increase in Medicare costs for 2017 for all beneficiaries." For detailed official announcements of the 2017 amounts see: [1] Medicare Part A Premiums; [2] Medicare Part B Premiums and Deductibles; and [3] Medicare Inpatient Deductible and Coinsurance Amounts.
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Washington's New Paid Sick Leave Become Law, with Fast-Approaching Effective Dates
"Initiative 1433 requires Washington employers to provide paid sick leave to employees beginning on January 1, 2018. The new paid sick leave requirement is similar in its construction to current municipal paid sick and safe leave ordinances in Washington in terms of accrual rates, reasons for leave, and carryover limits. The key differences are that the law fails to create a yearly accrual cap or a yearly usage cap for paid sick leave and may permit an employee to accrue more hours in one year than some municipal ordinances require."
Ogletree Deakins

Evidence from LinkedIn, IMDB Used to Support Denial of Benefits
"Be careful what you ask for. The Plaintiff in a recent case from the Central District of California learned that lesson when the Plan's re-evaluation of her claim for benefits revealed that she was apparently working as a stunt coordinator and stunt actress, despite having received disability pension payments for nearly ten years.... Plaintiff's personal website, LinkedIn profile, and IMDb page listed stunt and acting credits from 2004 through 2010. Plaintiff removed these posts after Defendants brought them to the court's attention in supplemental pleading." [Hoffman v. Screen Actors Guild-Producers Pension Plan, No. 16-1530 (C.D. Cal. Nov. 2, 2016)]
Seyfarth Shaw LLP

ACA Post-Election Outlook
"This summary provides a brief overview of the legislative and regulatory process considerations involved in repealing and/or replacing the [ACA], as well as speculation as to what a replacement health care law might look like (or what elements of the Affordable Care Act could be retained)."
Seyfarth Shaw LLP

Benefits in General

Want to Engage Millennial Workers? Try Technology
"[B]enefits administration technology makes [deadlines] easier to meet by 'pinging' employees on key dates using email, text messaging and social media. Millennials tend to be less interested in face-to-face meetings at open-enrollment time. But ... they are receptive to webinars, on-demand video meetings and email communication.... Starting company-based groups and web pages is a great way to push HR, benefits and other corporate information[.]"
Corporate Synergies

Possible HR Implications of a President Trump and a Republican Congress (PDF)
"If the parts of the ACA that can be eliminated via budget reconciliation are in fact trashed, but the remaining parts of the ACA that would require legislation to pass both the House and Senate are not, there will be significant tax and spending distortions that could very significantly add to the federal budget and overall health care costs in this country.... It is nearly impossible that the DOL could pull the [fiduciary] regulation prior to April 10th nor could it subject it to changes, a comment and subsequent review period prior to that date. Compounding the difficulty for a new administration is that the enforcement of the rule as written lay not with the DOL but through private legal action."
Kushner & Company

Executive Compensation and Nonqualified Plans

ISS Announces Pay-For-Performance Methodology Updates for the 2017 Proxy Season
"The methodology changes, which will take effect February 1, 2017, respond to investor and issuer calls for ISS to use financial metrics in addition to total shareholder return (TSR) when assessing pay-for-performance alignment. The adjustments ISS will be making to its pay-for-performance analytics are summarized [in this article]."
Willis Towers Watson

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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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