Health & Welfare Plans Newsletter

April 17, 2015

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Employee Benefits Jobs

Regional Sales Consultant - Mid Atlantic Territory
The Retirement Advantage, Inc.
in CT, DC, DE, MD, NJ, NY, PA, VA

DC Administrator
United Benefit Pensions Inc.
in NY

Retirement Specialist
Nationwide Retirement Services
in WA

Sales & Marketing Coordinator
Retirement Revolution
in CA

Pension Administrator
Associated Pension Consultants
in CA

Retirement Specialist
Nationwide Retirement Services
in OR

Financial Services - Office/Operations Assistant
Investment Advisory Firm
in FL

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Webcasts and Conferences

Developments in Washington
May 12, 2015 in TX
(ASPPA Benefits Council [ABC] of Central Texas)

Boeing?s Direct-to-Employee Benefits Model: A Case Study for Plans and Purchasers
May 21, 2015 WEBCAST
(Atlantic Information Services, Inc.)

2015 Ethics and Professionalism: Case Studies Two
June 3, 2015 WEBCAST
(McKay Hochman Co., Inc.)

HSAs and Consumer-Driven Health Plans in a Post-Health Care Reform World
June 17, 2015 WEBCAST
(Lorman Education Services)

Mutual Fund & Investment Advisor Compliance Summit
July 15, 2015 in NY
(Financial Research Associates)

View All Webcasts and Conferences



[Official Guidance]

Guidance for the Redacted Actuarial Memorandum (PDF)
"A Rate Filing Justification for single risk pool compliant plans consists of: Part I Uniform Rate Review Template (URRT), Part II Written Description Justifying the Rate Increase (only for rate increases of 10% or greater), and Part III Rating Filing Documentation (Actuarial Memorandum) ... To facilitate the release of the information ... health insurance issuers must submit two versions of the Actuarial Memorandum (AM). [if] their AM contains trade secrets or confidential commercial or financial information as defined in HHS's FOIA regulations: [1] a redacted AM that will be made available to the public (public version); and [2] an un-redacted version for regulatory review.... Issuers must not redact information unless its release would likely result in specific, reasonably foreseeable, and substantial competitive harm." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])


[Advert.]

Register -- MBGH Annual Conference for Health Benefits and Health Care

Sponsored by Midwest Business Group on Health [MBGH]

The Midwest Business Group on Health's 35th Annual Conference will be held April 29-30 in Chicago, featuring leading employers and industry experts providing objective, timely and practical information on the latest research, trends and best practices.



[Guidance Overview]

EEOC Finally Lets the Wellness Cat Out of the Bag
"[U]nder the HIPAA rules, the incentive can be up to 30% of the total cost of family coverage if spouses and dependents are eligible to participate in the wellness program. The EEOC's proposed rules contain no such expansion. It is not clear whether the EEOC feels it does not have jurisdiction over non-employees participating in a health plan or if it is trying to reign in the possible incentives under wellness programs." (Benefits Bryan Cave)

[Guidance Overview]

EEOC Issues Proposed Rule Addressing ADA Compliance and Wellness Programs
"The EEOC's proposed rule attempts to clarify what does and does not constitute a permissible wellness program in light of the ADA's protections.... The Commission stated that 'it has a responsibility to interpret the ADA in a manner that reflects both the ADA's goal of limiting employer access to medical information and HIPAA's and the Affordable Care Act's provisions promoting wellness programs.'" (Littler)

[Guidance Overview]

The EEOC's Proposed Wellness Plan Regulation: Some Progress, But Issues Persist
"While the rule, if promulgated, would provide some clarity for employers, it would also raise some important questions related to the EEOC's power to strip employers of a statutory defense, and potentially muddy the waters if an affordability standard is included. In addition, the NPRM opens the door to uncertainty with reference to wellness program-related claims under Title VII and the ADEA as well." (Seyfarth Shaw LLP)

[Guidance Overview]

California Employers, Beware: It's Time to Rewrite Your Sick Leave and PTO Policies
"The new law is clear that employers with existing PTO policies that provide for the accrual and use of time off that is at least equivalent to the requirements of AB 1522 do not need to provide additional paid sick leave. That is precisely why many employers may mistakenly assume that they do not need to make any changes to their existing policies." (Epstein Becker Green)


[Advert.]

Prevention and Well-Being Congress - May 5-6 - SanDiego

Sponsored by World Congress

Challenge the way you think about wellness and reposition your program. Understand the role of employer and employee accountability, comply with new incentives rules and integrate technology customized to impact your workforce.



New EEOC Proposed Wellness Program Regulations Finally Address ADA Concerns
"[T]he ADA rules do not fully incorporate the increased ACA/HIPAA 50% incentive threshold for smoking cessation programs. Any incentive tied to biometric screening or medical examination that tests for the presence of nicotine or tobacco must be limited to 30% to meet the ADA requirements (even though an incentive up to 50% would be permitted under the ACA/HIPAA rules). Only a smoking cessation program that merely asks employees whether or not they use tobacco (or whether or not they ceased using tobacco upon completion of the program), without any medical examination to verify tobacco use, is permitted to reach the higher ACA/HIPAA 50% incentive limit." (ABD Insurance & Financial Services)

Small Wellness Initiatives, Big Savings for North Carolina State Health Plan
"The plan included three wellness initiatives that members could finish in order to reduce their premiums: Name a primary care physician, complete a health risk assessment and complete a smoking cessation program.... Through these three initiatives, health plan members should save about $23 million on their premiums in 2015 ... [D]ata gathered from the risk assessments ... helped the health plan develop care management plans for members with catastrophic illnesses and care coordination plans for those with chronic conditions ... Collectively, these members represent 52 percent of the health plan's total enrollment but 88 percent of its overall costs." (FierceHealthPayer)

CMS Presentation: FF-SHOP Development Plan for 2016 (PDF)
28 presentation slides. "CMS will deliver 2016 Plan Year functionality in three sprints between now and the start of issuer testing. All issuer testing of new functionality will begin prior to November 1, 2015 (when 2016 plans begin displaying) and is scheduled to last approximately three [3] weeks." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

2015 Emerging Trends in Health Care Survey
"Health care costs for 2015 are projected to increase by 4% after plan changes. The 2018 excise tax on high-cost health benefits has placed a time clock on optimizing health plan performance. Employers expect to make moderate to significant changes to their health care benefits to combat rising costs." (Towers Watson)

Press Releases

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David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

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