Health & Welfare Plans Newsletter

June 2, 2015

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Webcasts and Conferences



[Official Guidance]

Text of CMS FAQs: Flexibilities for State-Based SHOP Direct Enrollment (PDF)
"Can state-based Small Business Health Options Programs (SHOPs) allow direct enrollment for 2015? And 2016? Can employers who use direct enrollment to purchase a SHOP QHP in such circumstances access the Small Business Health Care Tax Credit, if they are otherwise eligible? ... Can states use existing, approved Section 1311 grant funds for the work of establishing SHOP online functionality and, if necessary, can states request a no cost extension? ... What should issuers and a State-based SHOP tell small employers about direct enrollment in SHOP?" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])


[Advert.]

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[Guidance Overview]

GASB Improves Reporting for Health Insurance and Other Retiree Benefits
"[GASB] today voted unanimously to approve two Statements that will significantly improve the accounting and financial reporting by state and local governments for postemployment benefits other than pensions (OPEB), primarily retiree health insurance. The GASB also approved a third Statement establishing accounting and financial reporting requirements for pensions and pension plans that were outside the scope of the pension standards the GASB released in 2012.... GASB Statement No. 74, Financial Reporting for Postemployment Benefit Plans Other Than Pension Plans , addresses reporting by OPEB plans that administer benefits on behalf of governments. GASB Statement No. 75, Accounting and Financial Reporting for Postemployment Benefits Other Than Pensions , addresses reporting by governments that provide OPEB to their employees and for governments that finance OPEB for employees of other governments.... GASB Statement No. 73, Accounting and Financial Reporting for Pensions and Related Assets That Are Not within the Scope of GASB Statement 68, and Amendments to Certain Provisions of GASB Statements 67 and 68 ... establishes requirements for those pensions and pension plans that are not administered through a trust meeting specified criteria (in other words, those not covered by Statements 67 and 68).... Statements 73, 74, and 75 will be available for download at no charge from the GASB website in late June." (Governmental Accounting Standards Board [GASB])

[Guidance Overview]

Employer Reporting of ACA Coverage: IRS Forms and Instructions Supplemented by Updated Q&As
"[If] an employer separately reports for each of its two divisions, the employer must combine the offer and coverage information for any employee who worked at both divisions during the calendar year so that a single Form 1095-C is filed for that employee. In contrast, a full-time employee who works for two separate ALE members at different times during a year must receive a separate Form 1095-C from each employer reflecting coverage in the applicable months. However, if an employee works for two ALE members and receives an offer of coverage in the same month, the reporting ALE member for that month would be the one for whom the employee worked the most hours." (Seyfarth Shaw LLP)

[Guidance Overview]

Additional Coverage Required for Preventive Services Under the ACA
"The most significant benefit enhancements will likely involve contraceptive coverage. Plan sponsors and their pharmacy benefit managers that currently treat all hormone-based methods as one method, or exclude any one of the FDA-approved methods, will need to make significant changes to the plan.... [N]on-grandfathered plans should review all preventive benefits currently offered against federal guidelines and assure that they are provided with no-cost sharing when offered by a network provider." (Segal Consulting)

Public Review of Proposed Health Insurance Rate Increases for the 2016 Coverage Year
"[CMS has] publicly posted health insurance companies' proposed rate increases of 10 percent or more for the 2016 coverage year ... [These] proposed rate increases were submitted by health insurance companies for health insurance plans inside and outside the Health Insurance Marketplaces in all states using the HealthCare.gov Marketplace enrollment platform and some State-based Marketplaces. CMS has posted these proposed increases to the rate review site at RateReview.HealthCare.gov ." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

Seeking Rate Increases, Health Insurers Use Guesswork
"In a sign of the tumult in the health insurance industry under the Affordable Care Act, companies are seeking wildly differing rate increases in premiums for 2016, with some as high as 85 percent ... [F]ederal officials emphasized that it would be months before final rates were set. Regulators in some states have the authority to overrule rate increases they deem to be too high." (The New York Times; subscription may be required)

CMS Webinar: Completing the Risk Corridors Plan-Level Data Form 2014, June 1 and 3, 2015
48 presentation slides. "This session will explain the steps necessary to complete and submit the Risk Corridors (RC) Plan-Level Data Form. Intended for issuers of major medical Qualified Health Plans (QHPs) in the 2014 Benefit Year only.... Agenda: [1] Risk Corridors (RC) program overview; [2] Medical Loss Ratio (MLR) reporting in HIOS; [3] Reporting RC plan-level data: [a] Downloading & populating RC templates; [b] Uploading RC templates [c] Data validation & attestation." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

CMS Webinar: Qualified Health Plan (QHP) Year 3 Plan Preview Design Details, May 26, 2015
49 presentation slides. Topics include: [1] Review examples of the Plan Preview displays including new display elements for Plan Year 2016; [2] Updates for PY 2016 and Plan Preview Display Logic. [a] MOOP and Deductibles: Review data elements new to PY 2016 and display logic. [b] Copay and Coinsurance: Review data elements new to PY 2016 and display logic. [3] Common Issuer Problems: Review common problems and frequently asked questions that issuers encountered during PY 2015 testing. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

CMS Webinar: FF-SHOP Updates on Renewals and All Issuer Testing Overview of 2016 Functionality, May 19, 2015
34 presentation slides. Topics include: [1] Provide FF-SHOP issuers with updates on renewals; [2] Provide an overview of Group XML and 834 transactions for renewals; and [3] Provide an overview of all-issuer testing of FF-SHOP 2016 functionality. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

How Have Insurers Fared Under the ACA?
"For 2014, financial results depend heavily on how much insurers will receive in reinsurance payments under the ACA, which will not be known until June 30, 2015.... [The authors] estimate that the MLR in 2014 for the individual market ... will range from 81% to 87%.... This would suggest insurers overall had roughly comparable financial performance as in recent years, and that performance likely ranged from somewhat better to somewhat worse than in 2013." (Henry J. Kaiser Family Foundation)

Benefits in General; Executive Compensation

Supreme Court Seeks Government's View in ERISA Case Involving Venue Selection
"Although the [DOL] has long argued that venue selection clauses are incompatible with ERISA, a split panel of judges on the U.S. Court of Appeals for the Sixth Circuit held last fall that such clauses are valid and enforceable. The Sixth Circuit's majority opinion was noteworthy for its refusal to extend any deference to the position taken by the Department of Labor in two recent amicus briefs.... This call for the government's opinion represents the third time the Supreme Court has sought government input on ERISA cases this term, and at least the sixth time in the past two years." [ Smith v. Aegon Companies Pension Plan , No.13-5492 (6th Cir. Oct. 14, 2014)] (Bloomberg BNA)

Press Releases

Olson Mills Law, LLC Relocates Olson Mills Law Firm, LLC

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