Health & Welfare Plans Newsletter

March 9, 2015

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Compliance Testing Specialist
Kravitz, Inc.
in ANY STATE

Pension Administrator - DC
T R Paul Inc.
in CT

Client Service Manager, Defined Benefit
The Newport Group
in WI

401(k) Administrator
Highly respected pension administration firm
in CA

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TPA Firm
in CA

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New York Life Retirement Plan Services
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Webcasts and Conferences

Plan Recordkeeping
RECORDED
(IRS [Internal Revenue Service])

Building Engagement: Making HDHPs and HSAs a Success
March 12, 2015 WEBCAST
(Benz Communications)

23rd National HIPAA Summit
March 16, 2015 in DC
(Global Healthcare, LLC )

Dealing with Employee Abuse of ADA and FMLA
March 18, 2015 WEBCAST
(Clear Law Institute)

Pre-Approved 403(b) Plan Program
March 19, 2015 WEBCAST
(ASCi)

Voluntary Fiduciary Correction Program
March 24, 2015 WEBCAST
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Does Wellness ?Work? ? Implementing Effective Workplace Wellness Programs
April 8, 2015 WEBCAST
(Clear Law Institute)

2015 Enrolled Actuaries Meeting
April 12, 2015 in DC
(Conference of Consulting Actuaries)

ERISA Compliance for Health & Welfare Plans
May 6, 2015 in TX
(Thomson Reuters / EBIA)

HSAs, HRAs, and Consumer-Driven Health Care
May 6, 2015 in TX
(Thomson Reuters / EBIA)

Day at the Races ? Employee Benefits Update
May 15, 2015 in IL
(James M. Moyna. CPA, PC)

View All Webcasts and Conferences



[Guidance Overview]

IRS Publication 5200: Affordable Care Act -- What Employers Need to Know (PDF)
One-page information sheet; dated January, 2015. "The health care law contains tax provisions that affect employers. The size and structure of a workforce -- small, or large -- helps determine which parts of the law apply to which employers. The number of employees an employer has during the current year determines whether it is an applicable large employer ... for the following year." (Internal Revenue Service [IRS])


[Advert.]

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

Sponsored by Lorman and BenefitsLink

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 .



Federal District Court Rules Premium Increase Is Loss of Coverage for COBRA Purposes
"The case was brought by two employees who were suspended without pay and subsequently terminated. For both, coverage under their employer's health plan automatically continued during their suspensions -- a fact they first became aware of months later, upon receiving invoices for the full accumulated premium amount (both employer and employee contributions).... While acknowledging the employer's correct assertion that a reduction in hours alone is not sufficient to trigger a COBRA notice obligation, the court explained that the employer too narrowly construed 'loss of coverage' as a loss of eligibility." [ Green v. Baltimore City Board of School Comm'rs , No. WMN-14-3132 (D. Md. Jan. 22, 2015)] (Thomson Reuters / EBIA)

Comparing Employer-Sponsored and Federal Exchange Plans: Wide Variations in Cost Sharing for Prescription Drugs
"Analyzing prescription drug benefit design data for the federally facilitated exchanges, we found wide variation in enrollees' out-of-pocket costs for generic, preferred brand-name, nonpreferred brand-name, and specialty drugs, not only across metal tiers but also within those tiers across plan types. Compared to employer-sponsored plans, exchange plans generally had lower premiums but provided less generous drug coverage. However, for low-income enrollees who are eligible for cost-sharing subsidies, the exchange plans may be more comparable to employer-based coverage." (RAND Corporation)

Updated Doctor Directories to be Required in 2016 for Medicare Advantage and Federally-Facilitated Marketplace Policies
"Starting next year, the federal government will require health insurers to give millions of Americans enrolled in Medicare Advantage plans or in policies sold in the federally run health exchange up-to-date details about which doctors are in their plans and taking new patients.... Medicare Advantage plans must contact doctors and other providers every three months and update their online directories in 'real time.' Online directories for policies sold through healthcare.gov, the health law exchange run by the federal government in 37 states, must be updated monthly ... Inaccuracies in the Medicare Advantage directories may trigger penalties of up to $25,000 a day per beneficiary or bans on new enrollment and marketing." (Kaiser Health News)

Push for Earned Sick Leave Continues
"As expected, the Healthy Families Act, which never made it out of committee last year, was submitted for another try on February 12. The measure has been put before lawmakers every year since 2004. The bill (H.R. 932, S. 497) would allow workers in businesses with at least 15 employees to earn up to 56 hours or seven days of job-protected, paid sick leave every year." (Wolters Kluwer Law & Business)


[Advert.]

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

Sponsored by Institute for Healthcare Consumerism [IHC]

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!



Sick Leave Trend Continues in New Jersey, Constitutional Challenge Begins
"The New Jersey state legislature is considering a sick leave bill that, if passed into law in its current form, would not preempt the growing patchwork of local laws passed in the state. Yet, in a lawsuit [recently] filed ... in Mercer County Superior Court, several New Jersey business associations claim that existing state laws (e.g., New Jersey's Family Leave Act, Family Leave Insurance Law, and Temporary Disability Benefits Act) already preempt local sick leave laws (Trenton's, specifically). The Complaint also alleges that such local laws violate various clauses of the United States and New Jersey Constitutions." (Proskauer's Law and the Workplace)

New Massachusetts Parental Leave Act Offers More Than Gender Neutrality
"[W]hile the new law includes changes to notice requirements that favor employees, smaller employers in particular will benefit from a provision preventing leave time from being 'stacked' when both parents work for the same employer.... The sick leave law requires employers with 11 or more employees to provide up to 40 hours of paid sick leave. Smaller businesses are required to provide 40 hours of unpaid leave." (Mintz Levin, via Massachusetts Lawyers Weekly)

CBO Cost Estimate for H.R. 313, Wounded Warriors Federal Leave Act of 2015
"H.R. 313 would provide additional sick leave to veterans with a disability rated at 30 percent or greater who are newly hired by the federal government. That additional leave would have to be used for treatment of the employee's disability and would expire one year after it became available to the employee. CBO estimates that implementing H.R. 313 would cost $55 million over the next five years, subject to appropriation of the necessary funds." (Congressional Budget Office [CBO])

CBO Says ACA's Cost Is Falling as Fewer Receive Coverage
"The Congressional Budget Office announced on Monday that President Obama's major health-care reform law Monday will cost $142 billion, or 11 percent less, over the next 10 years, compared to what the agency had projected in January ... mainly because fewer people will sign up for Medicaid and federally-subsidized health insurance under the law. In total, the CBO said, 24 million instead of 25 million will sign up for the [ACA] over 10 years. That's because, among other reasons, fewer employers are canceling coverage than anticipated and more people already had private coverage than estimated." [CBO's full updated budget provisions are available online .] (The Washington Post; subscription may be required)

California Governor's Plan May Cut State Retiree Health Costs
"Part of the governor's proposal allows state workers to choose a new low-cost health plan, increasing take-home pay. If enough choose the new option, the average cost of four health plans used to set retiree health care insurance payments would be lowered. How many would choose the option is unknown. But the low-cost plan may have the potential to soon slow some of the rapid growth in health care costs, unlike other parts of the proposal that have delayed impact and require bargaining with labor unions." (Calpensions)

Oregon Abolishes Its Hopelessly Bungled Health Insurance Exchange
"No Oregonian was ever able to enroll online in a private plan under the [ACA] because the state exchange never had a functioning website, forcing insurance seekers to file paper applications. In April, state officials voted unanimously to switch over to the federal health insurance exchange, HealthCare.gov., citing the high cost of trying to fix the problematic state marketplace. The Oregon exchange had cost the state $248 million." (Los Angeles Times)

[Opinion]

Oklahoma Attorney General to Justice Kennedy: It's a Matter of Coequal Sovereigns, Not Coercion
"Justice Kennedy was asking, if Congress did in fact condition ObamaCare's tax credits on a state having set up an exchange, does that amount to an unconstitutional coercion of the states? In short: no.... [We] know that states had an option not to acquiesce in establishing health-care exchanges because they did not, as a matter of fact, acquiesce.... There is no merit to the argument that the states were unaware of the consequences of refusing to establish an exchange. Oklahoma ... sued the [IRS] months before making its decision to decline to set up an exchange, arguing that the ObamaCare tax credits and subsidies could not be given in Oklahoma.... King v. Burwell isn't about protecting the states from their choices, it is about allowing coequal sovereigns to make their choice and bear the consequences of that choice." (The Wall Street Journal; subscription may be required)

[Opinion]

Go Slow on Reference Pricing: Not Ready for Prime Time
"The use of reference pricing by health insurers and employee health benefit plans stands high on the policy and regulatory agenda because it is gaining popularity, particularly now that federal agencies have blessed its use by large group insurers and self-insured plans, while imposing only relatively lax requirements.... Reference pricing is superficially appealing because it invokes powers that consumers exercise every day, as they weigh cost and value for items ranging from cold cereal to new cars. But it also raises significant issues regarding quality and access to care and has the potential to discriminate against sick and vulnerable patients. The strategy may also prove costly in relation to the benefits it confers." (Health Affairs)

Benefits in General; Executive Compensation

En Banc Sixth Circuit Overturns Equitable Relief Award of $3.7 Million
"The Court's holding can be easily summarized: Absent a showing that the remedy for denial of benefits remedy under 502(a)(1)(B) is inadequate to make plaintiff whole, a recovery under Section 502(a)(3) is unavailable. This decision was animated by concerns that otherwise successful ERISA plaintiffs could collect huge damage awards ... [A] strong dissent from Judge Stranch argues that there the defendant committed two distinct wrongs, allowing for both remedies." [ Rochow v. LINA , No. 12-2074 (6th Cir. Mar. 5, 2015)] (Squire Patton Boggs)

Press Releases

The Centurion Group, LLC is Certified for Fiduciary Excellence Centre for Fiduciary Excellence [CEFEX]

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