Benefits/Tax Attorney
New York City Law Firm
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ESOP Client Advisor
Spinnaker Trust
in ME

Retirement Services Specialist
ANB Bank
in CO

Plan Distribution Specialist
Northern NJ Firm
in NJ

Chief Compliance Officer
The Newport Group
in FL

Long Term Care Claims Specialist
OneAmerica Partners Inc
in IN

Senior Account Manager
Johnson & Dugan
in CA

Employee Benefits / ERISA Associate
Sherman & Howard L.L.C.
in CO

Retirement Specialist
Nationwide Retirement Services
in IL

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403(b) Universal Availability
RECORDED
(IRS [Internal Revenue Service])

HIPAA Compliance in a Hazardous World: Check-Up for Employer Plan Sponsors and Business Associates
RECORDED
(Thomson Reuters / EBIA)

FMLA Master Class for Florida Employers: Overcome Compliance and Employee Leave Challenges
March 24, 2015 in FL
(HRhero.com)

401(k) Advisor Symposium
April 9, 2015 in TN
(401k Rekon)

401(k) Advisor Symposium
April 9, 2015 in MA
(401k Rekon)

Cafeteria Plans
May 5, 2015 in TX
(Thomson Reuters / EBIA)

View All Webcasts and Conferences

CMS MLR 2014 Calculator and Formula Tool [XLSM]
From the instructions at the first page of the spreadsheet: "The 2014 MLR Annual Reporting Form does not automatically perform the MLR and rebate calculations. When a completed form is submitted, CMS' Health Insurance Oversight System (HIOS) will alert companies if their submitted values do not match HIOS calculated values. Companies may do the MLR and rebate calculations themselves, following the 2014 MLR Annual Reporting Form Filing Instructions.... Companies may also use this MLR Calculator file to perform and/or verify their MLR and rebate calculations for the 2014 MLR reporting year. " [Also available: MLR 2014 Annual Reporting Form (XLSX) and Risk Corridors 2014 Plan-Level Data Form (XLSX), both as submitted to OMB for approval.] (Center for Consumer Information & Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

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Changes to Cafeteria Plans: What You Need to Know to Prepare - March 26 webinar

This webinar explores design choices to consider within the regulatory framework established by the IRS, and provides tools to ensure that plan design, documentation and administration are in compliance with applicable requirements. BenefitsLink discount .

IRS Notice 2015-17: A Pardon for Employer Payment Plans, or Just a Stay of Execution? (PDF)
"[ Notice 2015-17 ] clarifies several aspects concerning the scope of IRS Notice 2013-54 . First, the IRS makes clear in this guidance that an employer's payment of Medicare Part B and/or D premiums is an impermissible employer payment plan except as provided in the Notice. Second, by excluding more traditional HRAs (i.e., HRAs that reimburse expenses other than premiums) from the transition relief, the IRS makes it clear that the Notice 2013-54 prohibitions apply to all arrangements that pay for or reimburse individual market health premiums. Many had previously taken an erroneous position that HRAs that reimburse solely individual market premiums were allowable under the prior Notice. Presumably, the limited transition relief is an acknowledgment of the confusion on this issue." (Alston & Bird LLP)

CMS Presentation: Guidance for Web-Brokers Participating in the Federally-Facilitated Marketplaces (PDF)
42 presentation slides. Topics include: [1] Review of Key Regulatory Requirements and Best Practices for Web-brokers in the Federally-facilitated Marketplaces (Website Display Requirements and Best Practices, Consumer Protection Requirements and Best Practices, FFM Privacy and Security Requirements, and Website Use by Third-party Agents/Brokers); [2] Resources for Web-brokers (Public 2015 FFM Web-broker List, and Additional Resources). (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

Implementing the Affordable Care Act: Delays, Extensions, and Other Actions Taken by the Administration; Updated March 3, 2015 (PDF)
"Table 1 summarizes the more significant actions taken to date, which target implementation of the ACA's complex set of interconnected provisions to expand private insurance coverage for the medically uninsured and underinsured. These actions are not the result of a single policy decision. Instead, they represent many separate decisions taken by the Administration to address a variety of factors affecting the implementation of specific provisions of the law." [CRS Report RL43474] (Congressional Research Service [CRS])

Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act (ACA); Updated March 2, 2015
"This report summarizes legislative actions taken to repeal, defund, delay, or otherwise amend the ACA since it was signed into law. The report is divided into two sections. The first section focuses on authorizing legislation, and the second section discusses appropriations bills.... [A] brief overview of the ACA's core provisions and its impact on federal spending is provided. This material is included to help provide context for the discussion of ACA legislative activity that follows. This report is updated periodically to reflect legislative and other developments." [CRS Report RL43289] (Congressional Research Service [CRS])

[Advert.]

Join us at the 2015 IHC FORUM & Expo in Atlanta June 23-25

The 6th Annual IHC FORUM & Expo Atlanta is part of the ONLY conference series 100% dedicated to HealthCare Consumerism?where employers, brokers, health plans, TPAs, consultants & providers gather under ONE roof to LEARN, CONNECT and SHARE!

Text of Federal District Court Opinion: ERISA Does Not Pre-empt Texas Prompt Payment Statute (PDF)
"ALIC claims that the Providers may not seek prompt payment penalties under the TPPA because the TPPA 'relates to' ERISA plans, and thus is expressly preempted by Section 514(a).... The only impact on ERISA plans asserted by ALIC is the increased cost it will incur for administering ERISA plans as a result of the imposition of prompt payment penalties, which the Court finds speculative at best.... [T]he parties in this case are not all traditional ERISA entities, nor do the Providers 'stand in the shoes' of ERISA plan beneficiaries.... Furthermore, the Providers are not making demands for payment of benefits under ERISA plans. No coverage determination is implicated.... ERISA does not go so far as to eliminate the ability of parties on the periphery of ERISA plans to contract with one another, nor the right of state legislatures to pass laws that impact those contracts." [Aetna Life Ins. Co. v. Methodist Hospitals of Dallas, No.3:14-cv-347-M (N.D. Tex. Mar. 4, 2015)] (U.S. District Court for the Northern District of Texas)

Insurer's Agreements with Providers Were Not Per Se Antitrust Violations
"After a round of litigation through the Iowa courts, the plaintiff chiropractors maintained one antitrust claim: they alleged that Wellmark combined or conspired with self-insured plans and out-of-state BCBS entities to price fix by establishing a maximum price for services of Iowa chiropractors in violation of the Iowa Competition Act's corollary to Section 1 of the Federal Sherman Antitrust Act.... The key to a per se theory, however, is to convince the court that the conduct falls into the unique category of agreements that can have no procompetitive value whatsoever. And in this case, the Iowa chiropractors failed to reach that bar. The Iowa Supreme Court held that Wellmark's arrangements are not 'naked price-fixing arrangements but are more akin to joint ventures.' " [ Mueller v. Wellmark, Inc. , No. 13-1872 (Iowa Feb. 27, 2015)] (Faegre Baker Daniels LLP)

New Health Models Drive Payer Outsourcing Boom
"Over the last year, the traditional [business processing outsourcing (BPO)] services rose only 13 percent, even as 7.2 million new members enrolled in ACA plans and millions more gained coverage through Medicaid managed care.... At the same time, contracting has nearly doubled for ... 'inventive and unchartered administrative services' -- analytics, new plan design, claims modernization and alternative payment services. This kind of spending by commercial insurers, government payers, ACOs and provider-sponsored plans is increasing the payer BPO market from estimated $5 billion in 2014 to an expected $8 billion in 2016[.]" (Healthcare Payer News)

2014 Year-End Credit Union HSA Research Update
"HSA assets held at credit unions reached $988 million, up 20.8% year over year. The average HSA balance at credit unions is an estimated $2,030. 810 credit union hold HSA assets, representing about 12.7% of all credit unions." (Devenir)

2015 State Legislation on Health Exchanges / Marketplaces Structure (PDF)
"In 2015, at least 10 to 11 states have bills that propose converting their current federally facilitated marketplaces into state-run or state-federal partnership exchanges. At least 10 states have bills proposing to eliminate their state-run exchange or prohibit forming one." (National Conference of State Legislatures [NCSL])

King v. Burwell Oral Argument: A 'Straightforward Case of Statutory Construction'?
"Justices Sotomayor and Kennedy both raised concerns over petitioners' argument that subsidies were limited to state exchanges in order to encourage states to adopt exchanges ... In response, Justice Scalia and counsel for petitioners pointed out that if the unambiguous Act subsidy language were unconstitutional, then the entire subsidy provision would be struck down, rather than adopting the IRS interpretation." (McGuireWoods LLP)

Unpacking the Supreme Court Oral Arguments in King v. Burwell
"The argument was supposed to last an hour, but in fact went on for almost an hour and a half. It is a masterpiece -- two highly competent counsel thoroughly in control of their arguments being grilled by Justices who had obviously read the briefs, thought about the issues, and prepared themselves to ask probing and difficult questions.... Justice Alito ... asked the central question in the litigation: If Congress meant to empower federal exchanges to grant tax credits, why did it use the phrase 'established by the State,' rather than 'established under the Act,' or 'established within the State'? Why not say that a federally facilitated exchange is a state exchange? General Verrilli responded by saying that the statute in fact says 'established by the State under section 1311,' and that 1311 includes federal exchanges." (Timothy Jost, in Health Affairs)

Actually, Justice Kennedy, IRS Did Tell Congress Section 36B Contains 'Contradictory Language'
"[T]he head of the IRS testified to Congress that there is in fact language in the [ACA] that contradicts [the] government's argument ... in King v. Burwell that the statute unambiguously authorizes the disputed taxes and subsidies in states with federal Exchanges.... [T]he IRS commissioner made this concession before the IRS rule had been challenged in court. The hearing was in August 2012, and the first challenge was filed in September 2012." (Cato Institute)

How Data from Fitness Trackers, Medical Devices Could Affect Health Insurance
"Pricing risk as accurately as possible is a worthwhile endeavor, but the jump into trackables and wearables is froth. We've avoided pricing risk in healthcare on the mistaken belief that healthcare is 'special.' This is why the [ACA] disallows pricing risk on anything except the most basic parameters (location, age, family size, and smoking status).... Doing periodic fitness-test-based pricing is all the insurance industry needs and has needed for some time. Unfortunately, it's not all they want." (Vik Khanna)

Text of ISS FAQs on the 2015 U.S. Equity Plan Scorecard (Updated March 3, 2015) (PDF)
13 pages. "EPSC factors are not equally weighted. Each factor is assigned a maximum number of potential points, which may vary by model. Some are binary, but others may generate partial points. For all models, the total maximum points that may be accrued is 100. The passing score is 53 in all cases, i.e., slightly more than half of the potential maximum factor scores. [A chart] summarizes the scoring basis for each factor." (Institutional Shareholder Services)

ISS Releases Four Sets of FAQs, Glass Lewis Provides an Update, and FASB and IASB Make Certain Decisions Relevant to Equity Compensation Plans (PDF)
"ISS [has] issued additional frequently asked questions on 'Selected Topics,' which ... are effective for annual meetings after February 1, 2015.... Glass Lewis [has] announced ... certain 'enhancements' to performance metrics that it uses in its US and Canadian pay-for-performance models and its US equity plan model ... FASB [has] added to its agenda a project to improve and simplify accounting for stock compensation under FASB Accounting Standards Codification (ASC) 718.... [And IASB has] proposed changes to also address the classification of share-based payment transactions where a portion of the shares are withheld for taxes.... Each of these accounting developments is likely to have some impact on equity awards and/or equity compensation plans." (Morgan Lewis)

Text of Sixth Circuit Opinion Denying Recovery of Disgorged Profits in Addition to Improperly Denied Benefits (PDF)
43 pages, including concurrence and dissent. "ERISA remedies are concerned with the adequacy of relief to redress the claimant's injury, not the nature of the defendant's wrongdoing. The district court's use of equitable relief under Section 502(a)(3) as the vehicle for its disgorgement award misses the mark. Instead of focusing on the relief available to make Rochow whole, the award reflects concern that LINA had wrongfully gained something [by denying Rochow's benefit claim], a consideration beyond the ken of ERISA make-whole remedies.... By withholding payment of benefits until the denial was either finalized or rectified, LINA did not violate a second, distinct duty owed to Rochow and did not inflict a second injury. " [Rochow v. LINA (Life Ins. Co. of N. Am.), No. 12-2074 (6th Cir. Mar. 5, 2015)] (U.S. Court of Appeals for the Sixth Circuit)

Panel Proposes Rules for Unclaimed Insurance Policies and Annuities
"Insurance companies will be allowed to keep funds in unclaimed insurance policies and annuities for three years, under uniform rules being drafted by [Committee to Revise the Uniform Unclaimed Property Act of the Uniform Law Commission (ULC)]. However, they will be required to use the Social Security Death Master File (DMF) or a similar database.... The draft rules will include a dormancy period of three years running from the date of notice of death, unless the insurance company is unable to confirm the death[.]" (InsuranceNewsNet.com)

Be Careful What You Promise Employees Who Leave Your Employment
"Clients sometimes like to ease the transition for employees who are retiring or whom the client would like to encourage to leave. One strategy is to continue the employee 'on payroll' for a period of time with the expectation that all benefits will remain in place. However, the practice makes benefits lawyers nervous because the benefits that are supposed to continue may be offered under plans that do not recognize an employee who has stopped working as eligible for continued benefits." [ Sanford v. Life Insurance Company of North America , No. 14-5332 (6th Cir. Feb. 13, 2015)] (Stinson Leonard Street)

Retirement Plan Advisor Paul D?Aiutolo, AIF?, PRP? Joins the Retirement Advisor Council Retirement Advisor Council

Retirement Plan Advisor Robert A. Kieckhefer, AIF? Joins the Retirement Advisor Council Retirement Advisor Council

Prudential Retirement Names New Head of Pension Risk Transfer Business Team Prudential Retirement

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