Health & Welfare Plans Newsletter

December 6, 2016

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Employee Benefits Jobs

DC Administrator
Retirement Systems of Arizona
in AZ, IN, OH

Plan Administrator
My Benefits, LLC & First Party Administrator, LLC
in GA, Telecommute

401(k) Plan Administrator
Growing Third Party Administrator
in NJ, NY

Account Management Specialist
Securian Financial Group
in MN

Director of Business Development, Qualified Plans
PGR Solutions, LLC - Retirement Plan Services
in CA, Telecommute

401k Relationship Administrator
Retirement Direct
in NC

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Webcasts and Conferences

Ethics for TPAs and Other Professionals
December 15, 2016 WEBCAST
Western Pension & Benefits Council

Institute for Apprenticeship, Training and Education Programs
January 16, 2017 in CA
International Foundation of Employee Benefit Plans [IFEBP]

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[Guidance Overview]

EEOC Clarifies Incentive Limits in Wellness Programs
"The ADA wellness rules apply only to wellness programs that require a medical examination and/or a response to a disability-related inquiry. If the same incentive can be earned with or without a medical examination and/or disability-related inquiry, then the ADA wellness rules do not apply to that wellness program. Employers may offer incentives only to employees who enrolled in the employer-sponsored group health plan and complete wellness activities. If the wellness incentive is the same for all the employer's health plans, the employer must use the lowest-cost option to calculate the applicable incentive limit[.]"
Willis Towers Watson

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Can Employer Recover Health Coverage Costs If Employee Doesn't Return from FMLA Leave?
"[T]he employer can try to recoup its cost of group health plan coverage for the unpaid portion, if any, of the FMLA leave period. For this purpose, 'returning' means returning to work for at least 30 calendar days, For self-insured plans, this amount is limited to the employer's share of allowable COBRA premiums, not including the 2-percent administrative fee.... The employer's responsibility to provide health coverage (and, for self-insured plans, to pay claims incurred) during the period of FMLA leave does not change."
Wolters Kluwer Law & Business

Yesterday's Luxuries Are Today's Necessities
"As prevalence of autism has increased, varying advocacy groups have been quite effective in persuading some state insurance departments and many large employers to incorporate [Applied Behavioral Analysis (ABA)] services as a covered benefit. In fact, proponents of coverage have effectively utilized the Mental Health Parity Act as further leverage with self-funded employers to exclude any dollar or hourly caps on ABA services. We are seeing faster adoption rates with each successive year as 1/3 of large employers are now covering the benefit after only seeing the most socially-progressive employers doing so a couple of years ago."
Frenkel Benefits

Decoding Two Common PBM Pricing Models
"Many employers don't understand the often jargon-filled and confusing terms and PBM pricing models, which might allow the TPA to manipulate the value proposition and maximize their own profits.... There are generally two PBM pricing models used with plan employers to deliver prescription benefits to employees: The traditional pricing model and the pass-through pricing model."
Corporate Synergies

Insurers' Flawed Directories Leave Patients Scrambling for In-Network Doctors
"As consumers review their coverage and shop for 2017 insurance through the federal health law's online marketplaces during the annual open enrollment period, many of the directories they are using are outdated and inaccurate. Some doctors in the directories are not accepting new patients and some are not participating in the network ... Still other physicians in the directories, who are listed as 'in-plan,' charge patients thousands of dollars extra per year in 'concierge fees' to join their practices."
Kaiser Health News

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Obamacare Fuels Rapid Rise in Health Spending
"The main coverage provisions of the ACA were implemented in 2014 and 2015. Health spending also rose 5.3% in 2014 after five years of historically low growth between 2009 and 2013.... [In 2014 and 2015,] the insured share of the population increased 4.9% to 90.9% and the federal share of health spending rose by 3% to 29%. The faster health spending growth, combined with lower growth in the overall economy, resulted in 0.6% increase in the health spending share of gross domestic product -- from 17.2% in 2013 to 17.8% in 2015."
CFO

Court Agrees to Temporary Delay of GOP Obamacare Lawsuit
"A federal appeals judge said House Republicans' lawsuit challenging [ACA] subsidies would be placed on hold until Feb. 21, 2017, a move that will give the Trump administration time to decide its next steps." [House v. Burwell, No. 16-5202 (D.C. Cir. Dec. 5, 2016)]
Morning Consult

Crossing State Lines Is No Easy Jaunt for Insurers and Local Regulators
"[T]he GOP is drawing some opposition from state insurance regulators -- many of them Republican -- and insurance-industry officials, who question how such a plan would work, given that many aspects of insurance are regulated differently by each state.... Some Democrats say there might be room to compromise on earlier GOP proposals that would allow for interstate sales, but they express concern about the erosion of state consumer protections."
The Wall Street Journal; subscription may be required

Benefits in General

2016 Retirement Confidence Survey of the State and Local Government Workforce (PDF)
25 pages. "One-third of public sector employees have been with their current employer for less than 10 years, and one-third for 20 years or longer.... Health insurance, retirement benefits, job security and salary are the most important job elements they would consider in deciding whether to switch employers. The vast majority are covered by a primary defined benefit pension plan; almost 20 percent of these workers reported changes to these benefits over the past two years. Two-thirds expect to receive retiree healthcare benefits from an employer when they retire; among these, one-quarter reported changes to their benefits over the past two years."
TIAA Institute, and the Center for State and Local Government Excellence

[Opinion]

American Benefits Council Comments to EBSA on Proposed Revision of Form 5500 Annual Information Return/Reports
33 pages. "[S]ome of the Proposed Revisions will create significant administrative burdens for employee benefit plan sponsors and service providers, unnecessarily increase the cost of operating employee benefit plans, and reduce the appeal of plan sponsorship. Further, ... many of the Proposed Revisions would require plan administrators, under penalty of perjury, to answer questions for which they do not have readily available information.... [We] urge the Agencies to withdraw their Proposed Revisions and repropose the Form 5500 overhaul."
American Benefits Council

[Opinion]

Changes to Form 5500 Open Up Employers to Litigation; Participants May See Increase in Fees
"ERIC asked for the current proposal to be withdrawn ... and if there must be changes, to take a less burdensome approach, including removing questions that would reveal confidential information.... The proposed changes to Schedule C will require employers to invest in developing new systems to collect, process and verify information. ERIC and the organizations are concerned that employers will be forced to pass that increase in cost on to plan participants and that participants may actually see their fees increase."
The ERISA Industry Committee [ERIC]

Executive Compensation and Nonqualified Plans

[Guidance Overview]

More Guidance on Section 409A
"[Chief Counsel Advice 201645012] is noteworthy because the IRS agreed that a 25% increase qualified as a materially greater amount, and thus deferred salary was subject to a substantial risk of forfeiture. The CCA may not be used or cited as precedent, but still gives good insight as to how the IRS might respond to similar facts and circumstances."
Winston & Strawn LLP

Press Releases

Kidder Advisers, LLC is Certified for Fiduciary Excellence
Centre for Fiduciary Excellence [CEFEX]

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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