Health & Welfare Plans Newsletter

December 30, 2016

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Defined Contribution Plan / 401k Plan Administrator
N.A. Falcone & Associates, Inc.
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Newport Group
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Newport Group
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Newport Group
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[Guidance Overview]

Excepted Benefits That Don't Cause ACA Concerns, Part 2
"An excepted benefit is a medical benefit that is exempt from ACA requirements, such as the prohibition on annual and lifetime maximums, maximum waiting periods and other provisions causing risk of penalty.... [This article addresses] categories which have been enacted or clarified largely because of the passage of the ACA: [1] Non-coordinated excepted benefits (such as hospital indemnity policies), [2] Supplemental medical benefits, [3] Wrap around benefits and [4] A new qualified HRA option for small employers."
Lockton

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[Guidance Overview]

IRS Delays Rules on Opt-Out Payments Under the ACA
"The IRS has finalized regulations on premium tax credits available to eligible individuals who enroll in the ACA's marketplace coverage.... The IRS is still examining issues related to opt-out payments and the impact such payments have on affordability of employer-provided health coverage for an individual. The IRS expects to finalize those proposed regulations separately in the future. But in the meantime, the transition relief provided in the proposed regulations for opt-out arrangements in effect before December 16, 2015 continues to apply into 2017."
Xerox HR Services

[Guidance Overview]

Washington, D.C. Council Passes Generous Paid Family Leave Bill
"To be eligible, workers need only to be employed in D.C., regardless of their place of residence. Low income workers who make up to 1.5 times the minimum wage can receive benefits totaling 90 percent of their salary. Employees earning more than that will receive 90 percent of their earnings up to $46,000 and 50 percent of their earnings above that. Benefits will be capped at $1,000 per week. Federal employees are excluded from coverage by this Act."
Thompson Hine

Obamacare Repeal Has Begun For Small Firms
"The advantage of HRAs and similar funding vehicles is that they allow employers to give money directly to employees, which they can spend on medical care. This gets around health insurers' bureaucracies, which add unnecessary administrative costs.... Like the HRA itself, the new reform is not perfect. For employees who are eligible for tax credits in Obamacare's exchanges, there is a claw-back of those tax credits if their employers fund HRAs for them. It is hard to imagine a small business wanting to substitute its own money for federal taxpayers' in the exchanges."
National Center for Policy Analysis Health Policy Blog

Rapid Developments in House v. Burwell
"On December 20, two of the 5.9 million cost-sharing reduction recipients asked the appellate court to allow them to intervene in the litigation, claiming that their interests were no longer represented with the end of the Obama administration and that they would be seriously injured by the termination of the payments. Both the government and the House refused to respond to the intervention request, claiming that the proceedings were stayed and thus no further action could be taken until the stay was lifted.... On December 29, 2016, the court lifted the stay for the purposes of hearing the motion to intervene and ordered the parties to respond to the motion by January 6, 2017, giving the interveners until January 11, 2017 to reply to their response."
Health Affairs

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[Opinion]

An Open Letter to the Trump Administration on Healthcare Reform
"Eliminating pre-existing conditions, benefit maximums and coverage rescissions is a critical change effected by ACA which must be retained.... We should have a coverage mandate; however, to make this effective it should have teeth.... Employers should have to provide coverage meeting minimum standards, but the convoluted state-mandated benefits should be simplified and national standards be established.... The Cadillac Tax is a stupid way to finance healthcare change.... The administrative complexity of ACA has to go."
Frenkel Benefits

Benefits in General

[Guidance Overview]

The New ERISA Claims and Appeals Regulations for Disability Benefits
"The new regulations add the following requirements to the claims and appeals process for disability benefits: [1] Claims and appeals must be decided independently and impartially, meaning that those who decide claims should not be incentivized to deny claims.... [2] Denial letters must include [certain specified items] ... [3] Before an appeal can be denied, claimants must be given notice and a fair opportunity to respond if the appeal denial is based on new or additional rationales or evidence.... [4] Claimants are not barred from suing due to failure to exhaust the plan's claims procedures where the plan itself failed to comply with its claims procedures (except for certain minor failures). [5] Retroactive rescissions of coverage are considered benefit denials that trigger the plan's appeals procedures."
Jackson Lewis P.C.

Seventh Circuit Finds Requirement to Contribute to Fringe Benefits Funds Can Extend Past Decertification
"Ultimately, the opinion appears to be driven by an increasing concern for the funding of multiemployer funds. The opinion mentions that the Funds had 'budgeted' for five years of contributions from RiverStone and recites that 'once [multiemployer plans] promise a level of benefits to employees, they must pay [the benefits] even if the contributions they expected to receive do not materialize.' ... By extension, this holding could also be applied to withdrawals of recognition and disclaimers of interest." [Midwest Operating Engineers Welfare Fund v. Cleveland Quarry, Nos. 15-2628, 15-3221, 15-3861, 16-1870 (7th Cir. Dec. 20, 2016)]
Ogletree Deakins

Executive Compensation and Nonqualified Plans

Analysis of New Stock-Based Compensation Rules
"[A recent FASB] update provides private companies, when granting stock to employees, with a one-time election to switch from measuring all liability-classified awards at fair value to measuring them at intrinsic value. In contemplating whether to make such an election, companies should be mindful that not all valuation methodologies are created equal.... [C]hoosing any of the various methods for allocating such values can have a major impact on a company's share price."
CFO

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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 those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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