Healthcare Auditor
PBMares
in MD

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National Retirement Services, Inc.
in NC

Senior Associate or Counsel - Employee Benefits
Alston & Bird LLP
in DC

Retirement Plan Administrator for Defined Benefit Plans
Ingham Retirement Group
in FL

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Information Reporting Requirements for Providers of Minimal Essential Coverage
September 22, 2015 WEBCAST
(IRS [Internal Revenue Service])

Manager Selection, Due Diligence & Oversight: A Think Tank for Institutional Investors
November 9, 2015 in NY
(Financial Research Associates)

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Changes to the Federal External Review Program (PDF)
"The [ACA] made material changes to the appeals process for denied claims. These changes include applying the ERISA claim appeal rules to government plans and individual insurance plans. Now all claimants, regardless of their health plan, have the right to appeal an adverse benefit determination.... In many states, insured plans were already subject to external review under state insurance laws. However, most self-funded plans did not have an external review process before the ACA added this requirement." (Marsh & McLennan Agency LLC)

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Mercer Select's Guide to ACA Employer Shared Responsibility

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New IRS Guidance on 40% Excise Tax Previews Future Regulatory Complexity
"[ Notice 2015-52 ] proposes additional approaches related to [1] identification of the person or entity responsible for paying the tax, [2] determining the cost of applicable coverage, [3] age and gender adjustments to the applicable dollar limit and [4] notice and payment of the 40% Excise Tax. Although many of the approaches described by the IRS could work in the single-employer plan context, the approaches create a number of issues for multiemployer plans and the employers that contribute to them." (Proskauer's ERISA Practice Center)

IRS Issues Additional Cadillac Tax Guidance (PDF)
"The agencies' discussion of the 'coverage provider' definition is a central aspect of [ Notice 2015-52 ]. Under the ACA, the employer is required to determine the amount of the Cadillac tax on a monthly basis and then allocate that tax among 'coverage providers.' So, while the employer is the party required to calculate the tax, the coverage provider is the entity responsible for paying the tax. The identity of the coverage provider is clear under the statute in the case of insured health coverage (the insurer) and HSA contributions (the employer). For all other types of coverage, including self-insured plans, the coverage provider is 'the person who administers the plan benefits.' This term is not defined in the ACA or elsewhere in the Code." (Buck Consultants at Xerox)

IRS Notice Provides Additional Information on Cadillac Tax
"[ Notice 2015-52 ] raises a number of issues with respect to implementation of the excise tax and asks for public comments no later than October 1, 2015. While the new guidance still leaves many open issues, it seems that they have heard our requests related to: [1] the exclusion of carryover amounts from the Cadillac plan tax determination in subsequent years; and [2] the timing of account based plan accruals." (Employers Council on Flexible Compensation [ECFC])

IRS Raises the Stakes: New Trade Law Increases Penalties Applicable to ACA Reporting Requirements
"Effective January 1, 2016, each failure to file a return with the IRS is subject to a penalty of $250, not to exceed $3 million per year. Likewise, each failure to furnish a required statement to an affected individual is subject to a penalty of $250, not to exceed $3 million per year. The Trade Act also revised the maximum penalty amounts that apply when a failure is intentional, and the lower amounts that apply if a failure is timely corrected.... For 2015 only, the IRS will not impose these penalties if an ALE can show it made a reasonable, good faith effort to comply with the ACA reporting requirements, even if the reports contain incomplete or incorrect information." (Hanson Bridgett LLP)

Employer Pays for Failing to Provide FMLA Notice to Employee
"A federal district court judge approved a consent decree requiring Staples to pay $275,000 for failing to notify an employee of his [FMLA] leave rights to care for his critically ill wife over a period of two years. The [DOL] contended that the office supply chain's failure ... prevented [the employee] from making educated decisions when requesting leave to care for his wife, who was undergoing treatment for cancer. As a result -- after nearly two years of using his vacation, sick and personal leave, and working remotely to balance his work and obligations as a care-giver -- Staples fired [the employee] for failing to meet performance expectations." [ Perez v. Staples , No. 3-13-CV-1775 (D.S.C. May 27, 2015)] (Thompson SmartHR Manager)

The ACA Is (Apparently) Here to Stay: What Employers Need to Know
"Once you have decided how you will determine the full-time status of employees, and once you've written down those rules, you can tackle an issue that employers face nearly every day: how to treat employees during leaves of absence. In the past, employers subject to the Family and Medical Leave Act (FMLA) would offer COBRA to employees who need additional time off upon the expiration of their protected FMLA leave. For employers not subject to FMLA, employees on approved leaves of absence would often be offered COBRA at the beginning of their leave. That option is no longer available for employers who use the lookback measurement and stability period method to calculate eligibility." (Fisher & Phillips LLP)

Advocates Say Mental Health 'Parity' Law Is Not Fulfilling Its Promise
"Seven years after Congress passed a landmark law banning discrimination in the treatment of mentally ill people, many families and their advocates complain it stubbornly persists, largely because insurers are subverting the law in subtle ways and the government is not aggressively enforcing it.... [M]ost insurers have dropped annual limits on the therapy visits that they will cover. Higher copayments and separate mental health deductibles have become less of a problem. But many insurers have continued to limit treatment through other strategies that are harder to track ... Among the more murky areas is 'medical necessity' review -- in which insurers decide whether a patient requires a certain treatment and at what frequency." (Kaiser Health News)

Are Smaller Companies Poised to Self-Fund Health Care?
"The percentage of U.S. workers covered by health plans that are at least partially self-funded by their employers has been rising gradually for many years, reaching 61% in 2014, compared with 44% back in 1999 ... Switching from a fully insured health plan to a self-insured one reduces an employer's health-care costs because health-insurance pricing builds in a risk premium and the insurer's profit margin.... [T]he savings, absent any other changes, is typically 5% to 8% for large companies, and in many cases even more for others." (CFO)

Federal District Court Dismisses Tribe's Claim for Exemption from Employer Shared Responsibility
"The tribe argued, in essence, that tribal members would be better off with Exchange coverage than with employer-provided coverage, in light of the limited choice of group insurance available to employers in the state, the eligibility of most tribal members for premium tax credits and cost-sharing reductions on the Exchange, and the tribe's program to pay up to 80% of any remaining Exchange premium cost.... The court was not persuaded." [ Northern Arapaho Tribe v. Burwell , No. 2:14-cv-00247 (D. Wyo. July 2, 2015)] (Thomson Reuters / EBIA)

Bigger May Be Better for Health Insurers, But Doubts Remain for Consumers
"The insurers insist that combining companies will lead to lower prices and better care for their customers. They point to billions of dollars in efficiencies.... The companies also say the savings generated by these deals would ultimately benefit buyers.... After the mergers, regulators will be looking for changes in the competitive landscape, which will vary by location and the type of insurance -- whether it serves large employers or offers private Medicare Advantage plans.... For large employers that rely on national carriers to provide coverage to workers scattered across states, the pool of the five major entities would shrink to just three." (The New York Times; subscription may be required)

CMS Posts Fact Sheet and FAQs on State Innovation Waiver Process
"The FAQs provide basic information about waivers, including when and how to apply and how long the review and approval process will take. They also explain that a state must comply with public notice and comment requirements before submitting an application.... In addition to providing a high-level summary of the regulations on state innovation waivers, the fact sheet and FAQs serve as a reminder that states may already be preparing to obtain innovation waivers." (Thomson Reuters / EBIA)

SEC Proposes Rules to Implement Dodd-Frank Act Executive Compensation Clawback
"Although the timing for the new listing rules is uncertain, they could be effective within a year. Companies should consider taking the following actions: [1] Take a fresh look at their Section 16 officer group ... and develop additional record keeping procedures to track when Section 16 reporting status terminates. [2] Review existing clawback policies to consider what kinds of changes will be needed to conform to the new listing standards. [3] Review the current incentive compensation programs to identify various elements potentially subject to clawback as well as potential design changes. [4] Review the compensation committee charter to identify changes required for the committee's new responsibilities for overseeing enforcement of the clawback policy." (Perkins Coie LLP)

Use of Excess DB Plan Assets for Retiree Healthcare Extended to 2025
"The highway bill provision adds four years to the expiration date of Internal Revenue Code Section 420(b), which allows defined benefit pension plans that would remain funded above 125% to use assets for retiree medical costs or life insurance." (Pensions & Investments)

Final Pay Ratio Rule to Get Green Light from SEC August 5
"For the SEC and agency Chair Mary Jo White, the August 5th pay ratio vote should mark the end of weeks during which she endured vehement personal attacks by special interests seeking to accelerate a final rule. The vote also may set the stage for the departure of senior SEC Commissioners Dan Gallagher and Luis Aguilar, the latter of whom has stated his desire to leave the SEC upon the completion of the pay ratio which has led to a messy confirmation process among Democrats for his replacement." (HR Policy Association)

401k Essentials Launches New Website 401k Essentials

Retrofit Advances Market Expansion with Appointment of Health Management Industry Veteran to Strategic Health Plan and Partner Sales Role Retrofit Inc.

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