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Insurance Market Reform: Guaranteed Issue and Insurance Rating (PDF)

"Guaranteeing health coverage to anyone who applies is an important ingredient in getting everyone into the risk pool. As such, insurance companies are stripped of their ability to mitigate moral hazard where individuals wait to purchase insurance when they are sick or in need of medical attention and drop coverage if they recover. Moreover, the collapse and redistribution of rate bands and ratios and the limitation of under writing factors will reshuffle the insurance underwriting deck where the less healthy and older population will likely see their premiums lowered and subsidized by the remaining insureds in the risk pool."

DOL Redefines an ERISA 'Fiduciary' (PDF)

9 pages. "As a general theme, the exemptions differentiated a recommendation from general communication where a recommendation is deemed to be investment advice and subjects the advisor to be a fiduciary. Responsibilities are placed on the advisers intending to use an exemption to know or reasonably believe that the counterparty is a fiduciary.... An investment platform (which is often affiliated with or a part of recordkeeping services and asset managers) can avoid being considered offering recommendations if the communication is not individualized and clearly discloses in writing that the platform is not a fiduciary and should not be deemed as offering impartial investment advice."

Fiduciary Considerations in Controlling and Accounting for Plan Administration Fees (PDF)

"This paper narrowly focuses on the fiduciary considerations regarding the treatment of plan expenses under an individual account-based, self-directed defined contribution retirement plan ... The hide and seek nature of revenue generated by asset managers (e.g. mutual funds) under a proprietary or affiliated bundled service arrangement or under an open-architecture alphabet soup share class approach purposely or inadvertently confuses the fiduciary. It is truly a financial game of Whack-A-Mole."

90-Day Waiting Period and the Measuring Period Safe Harbor for New Hires (PDF)

"IRS Notice 2011-26 proposed the method for ascertaining the status of ongoing employees.... IRS Notice 2012-17 proposed the method for ascertaining the status of new employees.... IRS Notice 2012-17 states that ... if a new employee was reasonably expected to be employed an average of 30 hours of service per week on an annual basis and was employed full- time during the first three months of employment, the employer's group health plan would be required to offer the employee coverage as of the end of that period ... IRS Notice 2012-58 states that, for new employees who are reasonably expected to be full-time employees, an employer that maintains a group health plan that meets certain requirements will not be subject to an assessable payment under section 4980H for failing to offer coverage to the employee for the initial three months of employment."

ACA Definitions of Essential Health Benefit Package, AV and MV (PDF)

"For a non-applicable large employer interested in a non-grandfathered small group policy or an individual interested in coverage through an Exchange, beginning in 2014, all [Qualified Health Plans] will offer [Essential Health Benefits (EHBs)]. Through the standardization of the coverage tiers and the application of actuarial value standards, the plans will be subject to cost-sharing limits and a de minimis variation of +/- 2 percentage points. Small employers and individuals are expected to be able to compare health plans and costs in a more straight forward manner. For applicable large employers, none of the EHB Package applies. Instead, the health insurance offered must meet the MV and affordability guidelines established in order for an employer to not be subject to [penalties]."

Treatment of ACA Whistleblower Complaints (PDF)

"[T]he relationship between the employee's receipt of a subsidy and the potential tax penalty imposed (section 4980H) on an applicable Large Employer could create an incentive for the employer to retaliate against an employee.... [Therefore,] Applicable Large Employers may consider taking the following actions early to minimize or avoid the likelihood of causing retaliatory complaints by employees:"

Carrot or Stick: ACA Individual (Mandate) Responsibility (PDF)

Detailed discussion includes terminology, definitions, calculation of the premium tax credit, cost-sharing, and calculation of the individual penalty.

Health Reimbursement Accounts Under the ACA (PDF)

"[A] Stand-Alone HRA that covers active employees and provides any EHB is subject to the PHS Section 2711 no limits requirement. For all practical purposes, employers that have been offering Stand-Alone HRAs will abandon such arrangements since it is unlikely that any employer will grant an employee unlimited coverage for any EHB under an HRA."

Play-or-Pay Employer Shared Responsibility under ACA (PDF)

"For the purpose of determining (1) if an employer is an applicable Large Employer and (2) the status of an ongoing employee for offering eligible Employer-Sponsored Plan, a look-back regime is used. Notice 2011-36 provides [steps shown here in a flowchart fashion, for] determining if an employer is an applicable Large Employer."

Fiscal Year Health Plan Transition Relief Under the ACA (PDF)

"The relief applies to all employees (whenever hired) who would be eligible for coverage (whether or not they take the coverage) before the first day of the 2014 fiscal plan year if the following conditions have been satisfied: [1] The health plan must have been a fiscal year plan, as of December 27, 2012, and the plan meets Minimum Value and is Affordable by the 1st day of the 2014 fiscal plan year. [2] (a) the fiscal year plan (including any other fiscal year plans that have the same plan year) was offered to at least 1/3 of the employer's employees (full-time and part-time) at the most recent open season or (b) the fiscal year plan covered at least 25% of the employer's employees[.]"