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Senior Pension Administrator
Scholz & Friends Enlightened Retirement Group, Inc.
in TX

Counsel - Corporate Benefits & ERISA Attorney
M&T Bank
in DE, NY

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[Official Guidance]

Text of Draft 2018 IRS Form 1095-C: Employer-Provided Health Insurance Offer and Coverage (PDF)

July 11, 2018. "The 'Plan Start Month' box will remain optional on the 2018 Form 1095-C." Also released: Draft 2018 Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns.
Internal Revenue Service [IRS]


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DOL Issues Final Association Health Plan Regs

"The rules would permit more employers to form AHPs, which would be regulated as large health plans. The final regulations do not change existing ERISA preemption rules that authorize broad state insurance regulation of AHPs. The attorneys general of New York and Massachusetts say they plan to sue the Trump administration over the final regulations."
Willis Towers Watson

Health Plan Costs Rose Significantly for Small Employers in 2017

"Employers across the board saw health plan costs rise for a variety of reasons, but employers with less than 500 workers were especially vulnerable to cost effects ... The survey attributed the cost increases to a number of factors, namely expensive new treatment options and a rapidly aging population. A new cost driver is the slow rise of uninsured patients, which ticked up in 2017 and is likely to lead to providers shifting the costs of uncompensated care onto employer health plans[.]"
HealthLeaders Media

Taking the Pulse of Employee Wellness Programs

"Why are employers investing in employee well-being? ... [S]tock values for a portfolio of companies that received high scores in a corporate health and wellness self-assessment appreciated by 235% compared with the S&P 500 Index appreciation of 159% over a 6-year simulation period.... [And one survey] found significantly lower turnover rates among companies doing the most to help employees thrive compared to those doing less."

A New Twist in the Ongoing Out-of-Network Provider Lawsuit Saga

"Perhaps the most interesting part of this case relates to the claim that the plan used an improper reference pricing model ... The Hospital cited the FAQs under ACA which provide that reference pricing cannot be used as a subterfuge for otherwise prohibited limitations ... Specifically, a 2016 FAQ provides that a plan using a reference price without ensuring adequate access at that price will not be considered to have established a network for purposes of Section 2707(b) of the Public Health Service Act which relates to cost-sharing requirements and permissible MOOPs. The court found this argument somewhat convincing and declined to dismiss this claim." [Salinas Valley Memorial Healthcare Sys. v. Monterey Peninsula Horticulture, Inc., No. 17-7076 (N.D. Cal. May 31, 2018)]
Kilpatrick Townsend


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Senate Subcommittee Hearing: Examining the Importance of Paid Family Leave for American Working Families

Hearing held July 11, 2018; statements from Committee Members Sen. Bill Cassidy (R-LA) and Sen. Sherrod Brown (D-OH), along with statements from witnesses [1] Sen. Joni Ernst (R-IA); [2] Sen. Kirsten E. Gillibrand (D-NY); [3] Andrew G. Biggs, Ph.D., American Enterprise Institute; [4] Vicki Shabo, National Partnership for Women & Families; and [5] Carolyn O'Boyle, Deloitte Services, LP.
Subcommittee on Social Security, Pensions, and Family Policy, U.S. Senate Committee on Finance

Is Panic Over Risk Adjustment Loss Much Ado About Nothing?

"The loss of the risk adjustment payments that healthcare insurers depend on to remain profitable under the [ACA] could be another devastating blow that drives them away from the marketplace and further increases premiums.... The problem could be fixed by changing the payment formula CMS uses, without any legislation or regulatory maneuvers."
HealthLeaders Media

House Committee Contemplates Bill That Would Reduce Employer Health Benefit Costs

"Among one of the bills considered is legislation ... [which] would provide retroactive relief from the ACA's employer mandate from 2015 through 2018 and delay for one additional year (until 2023) the 40% Cadillac Tax."

Proposal Could Save Pre-Retirees Over $4,600 Per Year on Health Insurance Premiums

"According to an analysis of H.R. 6311 ... pre-retiree adults ages 55 to 64, who typically pay the highest premiums in the individual market, could save an estimated $384 per month, or $4,608 a year by purchasing a copper plan instead of a bronze plan."


Ways and Means Bills Would Expand HSA Tax Breaks, Weaken Insurance Marketplaces

"The House Ways and Means Committee is marking up several bills this week that would raise contribution limits for [HSAs] and expand the allowable uses of these accounts, at a cost of $41 billion over ten years ... The bills also include other problematic provisions providing premium tax credits to people who buy plans offered outside the [ACA] marketplaces and delaying the ACA's excise tax on high-cost plans ... In all, the bills would cost $92 billion over the next decade[.]"
Center on Budget and Policy Priorities


The Health Care Choices Proposal: Charting a New Path to a Down Payment on Patient-Centered, Consumer-Driven Health Care Reform

"The proposal ... would repeal the Obamacare federal spending scheme and replace it with a more fiscally responsible block grant to the states. The proposal ... [restore] state authority over some critical health insurance regulation. Thus, states would have the ability to adjust insurance rules to their own insurance market conditions, which differ sharply from state to state.... [It] recommends changes to health savings accounts (HSAs), enabling consumers to use them with greater flexibility in meeting their health care wants and needs."
The Heritage Foundation

Benefits in General

Time to 'Tune Up' Your Employee Benefit Service Provider Agreements

"[A]reas of potential concern with service provider agreements that may warrant a closer look. [1] Use of employee data ... [2] Indemnification.... [3] Agreement term."
Wilkins Finston Friedman Law Group LLP

Executive Compensation
and Nonqualified Plans

CEO Compensation in the Largest U.S. Companies

"[T]he long-term incentive (LTI) grant value/opportunity -- that is, not the eventual payout value -- has increased anywhere from approximately 3-8% annually, depending on the year and the industry.... LTI payouts can be two or three times the size of the initial grant value. Couple this with the fact that LTI grants make up more than a majority of the total annual pay opportunity for CEOs, and it is clear that perceived high pay levels are largely due to the long-term incentive pay component."
Meridian Compensation Partners, LLC

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