Health & Welfare Plans Newsletter

December 22, 2016

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Empower Retirement / Great-West Financial
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Bates & Company
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Nationwide Financial
in PA

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WLR & ASsociates, Inc.
in NC

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[Official Guidance]

Text of 2016 DOL Form M-1: Report for Multiple Employer Welfare Arrangements (MEWAs) and Certain Entities Claiming Exception (ECEs) (PDF)
84 pages. "The Form M-1 is used to report information concerning a multiple employer welfare arrangement (MEWA) and any entity claiming exception (ECE). Reporting is required pursuant to ERISA section 101(g), 104(a), 505 and 734 of [ERISA], and 29 CFR 2520.101-2 and 103-1. You must file the Form M-1 electronically."
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Advert.]

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ECFC is dedicated to maintaining and expanding employee benefit programs on a tax-advantaged basis. Members include employers, TPAs, health plan providers, brokers, payers, providers, payment networks, processors, and financial institutions.


[Guidance Overview]

Agency FAQs Address Rules for QSEHRAs, Coverage of Preventive Services
"[T]he Departments indicate that: QSEHRAs, because they are statutorily excluded from the group health plan definition, are not subject to the group market reform requirements. The Departments' prior guidance nonetheless continues to apply to EPPs and HRAs that do not qualify as QSEHRAs.... [P]reventive services must be covered consistent with the updated guidelines for plan years beginning on or after December 20, 2017. Until the new guidelines apply, plans must provide preventive services coverage consistent with the previous HRSA guidelines and ACA preventive services rules for any items or services that continue to be recommended."
Practical Law Company

[Guidance Overview]

Paid Family Leave Law Approved by D.C. Council in Veto-Proof Vote
"D.C. employers will pay for the law, if enacted, by contributing into a 'Universal Paid Leave Fund.' The Fund would be an insurance fund, similar to unemployment insurance or social security. It does not require employers to pay the salaries of persons who are on leave directly. Instead, D.C. employers will pay into the Fund at a rate of 0.62% of salaries."
Jackson Lewis P.C.

Washington D.C. Council Approves Expansive Paid Leave Bill
"[The Act] would provide some of the most substantial leave benefits in the country ... [including] eight weeks of paid leave after the birth or adoption of a child ... [and] two weeks of sick leave for the employee's own illness and six weeks of paid leave to care for a family member. All private-sector employees working in the District of Columbia would be eligible for the paid leave, including nonprofit workers. Self-employed workers may also opt in."
Society for Human Resource Management [SHRM]

Despite Union's Decertification, Employer Must Contribute to Welfare Funds Until CBA Expires
"An employer was obligated to continue making contributions to welfare and pension funds until the expiration of the applicable collective bargaining agreement and it violated ERISA by halting such payments following the union's decertification, the Seventh Circuit ruled, affirming summary judgment in favor of the funds. Though the CBA became unenforceable by the union when it was decertified, the funds were still entitled to the agreed upon contributions and thus entitled to relief under ERISA[.]" [Midwest Operating Engineers Welfare Fund v. Cleveland Quarry, Nos. 15-2628, 15-3221, 15-3861, 16-1870 (7th Cir. Dec. 20, 2016)]
Wolters Kluwer Law & Business

[Advert.]

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Telehealth execs discuss engaging providers & consumers in digital health to optimize ROI & improve population health. Promo Code BLINK2 takes $200 off your registration (May not combine w any other offer. Not valid twd Govt Rate/Workshop Only/Webcast)


Terminating Employees and Preventing FMLA Interference Claims
"Taking these steps can help you prevent interference claims: [1] Formally consider all oral and written requests that could be deemed to qualify under the FMLA, even if the reasons given for the leave are multiple or suspect. [2] Be consistent in your process. [3] Watch the timing of any adverse actions against employees seeking/taking FMLA leave. [4] Even if you allow leave, take care when basing adverse action only on factors predating the employee's return-to-work because the employee may argue a link to FMLA leave. [5] Good documentation is crucial ... [T]rain your supervisors and managers to be careful about what they put in writing, particularly with e-mails."
HR Daily Advisor

Why Are Hospital Prices Different? An Examination of New York Hospital Reimbursement (PDF)
151 pages. "Hospital reimbursement practices are complex and extremely varied ... There are significant differences in overall price levels ... among hospitals of similar size, services, and teaching designation... Hospitals with higher prices do not necessarily have higher quality.... Hospitals ... that serve more Medicare and Medicaid patients garner lower prices in the private commercial market.... Higher-priced hospitals may be higher-priced as a result of various forms of market leverage, which gives them more bargaining power to command higher prices when negotiating with insurers."
Gorman Actuarial, Inc., for NYS Health Foundation

Exploring 'Repeal and Replace'
"[M]any of the Republican ACA replacement proposals have common elements.... One commonality ... is the enactment of changes to how the federal government funds state Medicaid programs.... The proposals ... also would permit insurers to sell insurance plans across state lines.... Another common element ... is medical malpractice liability reform."
Sheppard Mullin

6.4 Million Sign Up for ACA Plans, More Than in Previous Years
"Obama administration officials and health policy researchers who support the law have been taking precautions before Trump takes office.... [T]hink tank and university researchers have been downloading [ACA] data, reports and regulatory guidance housed online at HHS -- in case the new administration removes them as part of its efforts to wipe out the law.... [T]he material includes raw data on enrollment and insurance benefits prices, analyses by HHS's research arm and myriad interpretations the department has issued over the past six years about how the law should be carried out."
The Washington Post; subscription may be required

Humana Writes Off $591 Million in Risk Corridor Payments
"Humana said it anticipates collecting about $8 million in risk corridor receivables outstanding as of September 30, 2016, associated with the 2014 plan year. This is in addition to $30 million already collected from CMS in risk corridor payments for 2014. The risk corridor premium stabilization program expires December 31."
Healthcare Finance News

[Opinion]

Facts Don't Fit Ryan's 'Death Spiral' Claims
"[E]liminating the individual mandate immediately and the marketplace subsidies after two years or more, which the Republican ACA repeal plan would do, would encourage healthier people to begin dropping their coverage. Insurers would suffer financial losses and withdraw from the market entirely or hike premiums dramatically, making the pool of those with coverage even sicker and costlier to cover. In just two years, the individual market would essentially disappear."
Center on Budget and Policy Priorities

[Opinion]

Tick Tock: An Unforgiving Calendar for Health Plans Makes Orderly 'Transition' for ACA Repeal Unlikely
"In the face of projections that repeal of the ACA will lead to 22 million to 30 million Americans losing coverage, some congressional leaders have called for a multiyear transition period, during which the ACA's insurance reforms and subsidies will remain in place until a replacement plan is enacted. But the uncertainty that arises from this transition period, combined with an unforgiving insurance product and premium rate development calendar upon which the market relies, will cause major disruptions for consumers."
The Commonwealth Fund

Executive Compensation and Nonqualified Plans

Refining the Use of Total Shareholder Return: The Evolution of Long-Term Incentive Design in the Say-on-Pay Era
"[Total shareholder return (TSR)] use in S&P 500 companies rose from 30% to 51% from 2011 to 2015. As its use has increased, several design elements, including targeted percentiles, have become standardized. TSR-based modifiers increasingly are used by companies to link existing performance plans to TSR without redesigning the awards. TSR-based payout limiters are used to prevent excessive payouts by companies that already use relative TSR as a weighted payout metric in their long-term awards."
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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