Defined Contribution Compliance Specialist
Shore Tompkins Actuarial Resources, LLC
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Shore Tompkins Actuarial Resources, LLC
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Customer Service-Retirement Services - Entry Level
MassMutual Financial Group
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Manager, Health Plan Claims
Directors Guild of America - Producer Pension and Health Plans
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Retirement Plans Management Director
University of Oregon
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Los Angeles Advanced Pension Conference
January 22, 2015 in CA
(ASPPA College of Pension Actuaries [ACOPA])

Business Executives and Managers Conference
January 25, 2015 in TX
(ASPPA [American Society of Pension Professionals & Actuaries])

Form 5500 Reporting Update
January 30, 2015 WEBCAST
(Lorman Education Services)

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Text of Proposed Regs: Summary of Benefits and Coverage and Uniform Glossary (PDF)
127 pages. "This document contains proposed regulations regarding the summary of benefits and coverage (SBC) and the uniform glossary for group health plans and health insurance coverage in the group and individual markets under the [ACA]. It proposes changes to the regulations that implement the disclosure requirements ... to help plans and individuals better understand their health coverage, as well as to gain a better understanding of other coverage options for comparison. It proposes changes to documents required for compliance ... including a template for the SBC , instructions [for group health plan coverage and individual coverage ], sample language , a guide for coverage example calculations , and the uniform glossary ." [Additional supporting documents, including proposed examples, guides and sample language, available on the CCIIO website .] (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; Internal Revenue Service [IRS]; U.S. Department of Health and Human Services [HHS])

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Text of CMS Fact Sheet: Proposed Summary of Benefits and Coverage and Uniform Glossary Rule (PDF)
"Today's proposed regulations would amend the final regulations published on February 14, 2012 ... [and] are designed to improve consumers' access to important plan information so that they can make informed choices when shopping for and renewing coverage, as well as to provide clarifications that will make it easier for health insurance issuers and group health plans to comply with providing this information. Today's proposed rules generally address the requirements for SBCs and uniform glossaries that, if finalized, would be available to consumers with respect to coverage that begins on or after September 1, 2015." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

CMS Presentation: Updates to the Plan and Benefits and Prescription Drug Templates for Plan Year 2016 (PDF)
35 presentation slides, dated December 18, 2014. "Template updates were made to achieve the following business goals: [1] To provide more complete and accurate information about plans, benefits and premiums to consumers; [2] To amend mapping options to the AV Calculator; [and] [3] To improve quality of QHP data by enhancing usability." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

Allowing Part-Time Employees to Make Health FSA Contributions May Trigger ACA Penalties
"Under the second condition, an employer may not offer only a health FSA, with no comprehensive medical plan.... [T]his condition applies on an employee-by-employee basis. Therefore, even if an employer offers medical coverage to substantially all of its employees (such as those meeting a 'full-time' definition), it would fail to satisfy this condition with respect to any employees who are not eligible for medical coverage (but who are nonetheless allowed to make health FSA contributions). The penalty for such an ACA violation would be $100 per day for each employee in this group." (Spencer Fane)

Expat Plans Exempt from the ACA -- But It's Not a Free Pass
"The Expat Act makes the temporary transition relief permanent and expands its application to include self-insured expat plans. Both come as a welcome adjustment for employers, but the gift from Congress is not without strings. Expat plans seeking relief under the Expat Act must satisfy participation and coverage requirements.... Perhaps most importantly, qualifying expat plans are considered minimum essential coverage for individuals and for employers sponsoring them. The same plans, however, will still be subject to the Cadillac Tax and employer's sponsoring such plans are still required to complete the Code Section 6056 reporting requirements (although statements to employees may be sent electronically)." (Hill, Chesson & Woody)

Is an Employer Required to Pay a Prorated Amount of Annual Bonus After Employee Takes FMLA Leave?
"Simply put, the regulations require employers to treat FMLA absences in the same manner they account for non-FMLA absences. Employees cannot be treated worse for taking FMLA leave than they would have been had the absences not qualified under the FMLA.... The regulations do not address whether an employer must pay a prorated portion of bonuses when an employee's FMLA leave impacts receipt of the bonus. But the same logic above would apply. Here, you must [be] careful[.]" (FMLA Insights)

Going Live with the ACA's Employer Shared Responsibility Rules on January 1, 2015 -- What Can Possibly Go Wrong?
"[T]he government has assembled a basic -- but by no means complete -- compliance infrastructure for employer shared responsibility. But challenges nevertheless remain. Set out below is a partial list of items that are unresolved, would benefit from additional guidance, or simply invite trouble. [1] Variable Hour Status ... [2] Common Law Employees ... [3] Penalties for 'legacy' HRA and health FSA violations ... [4] Mergers & Acquisitions ... [5] Reporting." (Mintz Levin)

Text of Opening Brief of Petitioners to the Supreme Court in King v. Burwell (PDF)
129 pages. "If the rule of law means anything, it is that text is not infinitely malleable, and that agencies must follow the law as written -- not revise it to 'better' achieve what they assume to have been Congress's purposes. This case may be socially consequential and politically sensitive, but that only heightens the importance of judicial fidelity to the rule of law and well-established interpretive principles. Under those principles, it is clear that the IRS Rule must fall." [ King v. Burwell , No. 14-1158 (4th Cir. July 22, 2014; cert. pet. granted Nov. 7, 2014)] (Competitive Enterprise Institute)

Supreme Court Sets March Hearing for King v. Burwell
"The Supreme Court has set a hearing for March to take up a new, high-profile challenge to ObamaCare. The court announced ... that it will hear the case on March 4, 2015. The move comes after the court first announced in November it would take up the challenge. At issue in the case is the legality of subsidies offered to help millions of low- and middle-income people buy health insurance." [ King v. Burwell , No. 14-1158 (4th Cir. July 22, 2014; cert. pet. granted Nov. 7, 2014)] (Fox News)

Top Health Plan Resolutions for the New Year
"Guide consumers toward high-value care.... Enhance transparency around price and quality.... Improve the quality of care.... Reform the payment system." (America's Health Insurance Plans [AHIP])

Analysis Finds No Nationwide Increase in Health Insurance Marketplace Premiums from 2014 to 2015
"This weighted analysis is the most comprehensive to date as it examines: premiums as well as deductibles in nearly all states and the District of Columbia (data from New York and Idaho are not currently available), and across all the metal tiers, differences in premiums between urban, suburban and rural areas within states, and insurer participation. The average premiums for the second lowest-cost silver plan -- or benchmark plan for calculating the federal subsidy in a given state -- were also unchanged. And the average deductible for a marketplace plan increased by just 1 percent year to year." (The Commonwealth Fund)

The Value of Workplace Health Promotion (Wellness) Programs
"It seems that too much of the debate and controversy surrounding workplace health promotion is focused narrowly on whether these programs save money. If that were the aperture by which we judged medical care in general, we would withhold treatment from almost every patient and for almost every procedure, with the exception of a few preventive services that are either cost-neutral or minimally cost-saving. That makes no sense for a compassionate society." (Ron Goetzel, in Health Affairs)

U.S. Chamber of Commerce Comment Letter to CMS on Notice of Benefit and Payment Parameters for 2016, Proposed Rule (PDF)
"As with the prior two iterations of the Proposed Rules for Benefit and Payment Parameters in 2014 and 2015, the Chamber is disheartened by this Proposed Rule's procedural failures which include an inadequately and improperly truncated comment period and lack of appropriate economic analysis. There are also several significant and substantively concerning provisions in the Proposed Rule." (U.S. Chamber of Commerce)

American Benefits Council Comment Letter to CMS on HHS Notice of Benefit and Payment Parameters for 2016 -- Minimum Value Interpretation for Eligible Employer-Sponsored Plans (PDF)
"The Council is very concerned about the Proposed 2016 [Notice of Benefit and Payment Parameters (NBPP)] as it relates to the definition of 'minimum value' to the extent the same or a similar definition becomes applicable for purposes of Code sections 36B and 4980H ... [We] are concerned that the expanded definition, as proposed, is contrary to the statutory language of the [ACA] as well as congressional intent. Moreover, we believe the rule, if adopted, would serve to further exacerbate employer concerns regarding the application of the 40 percent high-cost excise tax (i.e., the 'Cadillac Tax) to their employer-sponsored plans. For these reasons, we strongly oppose the proposed expansion of the minimum value definition." (American Benefits Council)

Text of 2014 Instructions for Form 8959: Additional Medicare Tax (PDF)
"Your employer is responsible for withholding the 0.9% Additional Medicare Tax on your Medicare wages or railroad retirement (RRTA) compensation paid in excess of $200,000 in a calendar year. Your employer is required to begin withholding Additional Medicare Tax in the pay period in which your wages or compensation for the year exceed $200,000 and continue to withhold it in each pay period for the remainder of the calendar year.... All wages that are subject to Medicare tax are subject to Additional Medicare Tax to the extent they exceed the threshold amount for your filing status." (Internal Revenue Service [IRS])

Society of Actuaries and Health Care Cost Institute Sign Health Data Agreement Society of Actuaries

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