Health & Welfare Plans Newsletter

August 13, 2015

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Employee Benefits Jobs

Sr. Plan Administrator/Consultant
Dallas Area TPA Firm
in TX

Defined Benefit Plan Administrator
Great Lakes Pension Associates, Inc.
in MI

Plan Administrator
NestEggs, Inc.
in FL

Retirement Implementation Manager
CUNA Mutual Group
in WI

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Webcasts and Conferences

Mergers and Acquisitions
August 26, 2015 WEBCAST
(Multnomah Group)

Benefits for Same-Sex Spouses and Domestic Partners: Impacts From the Supreme Court and EEOC
September 9, 2015 WEBCAST
(Thomson Reuters / EBIA)

Legislative Update
September 17, 2015 in TX
(ASPPA Benefits Council [ABC] of Dallas/Fort Worth)

2015 Large Employer Reporting Seminar
September 22, 2015 in VA
(TFA Benefits)

2015 Large Employer Reporting
September 24, 2015 WEBCAST
(TFA Benefits)

Handling IRA Legal Issues
October 20, 2015 WEBCAST
(Ascensus)

2016 Business Management Conference
January 13, 2016 in AZ
(NIPA [National Institute of Pension Administrators])

View All Webcasts and Conferences


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[Official Guidance]

Text of CMS FAQ: Rate Review Student Health Plans (PDF)
"Q: Are issuers of non-grandfathered Student Health Insurance Plans (SHPs) subject to federal rate review requirements? A: Yes.... Because some issuers have expressed confusion regarding the filing requirements for SHPs, CMS is extending the deadline for submission of the Preliminary Justification to CMS for SHPs with a rate increase effective on or before December 31, 2015 [depending on the effective date and amount of rate increase]." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])


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CMS Webinar: Marketplace Payment Process (PDF)
52 presentation slides; dated August 12, 2015. "This Marketplace Payment Processing Session will : [1] Provide key updates to the monthly manual payment process. [2] Provide Submitters with instructions for Workbook submission for September payment." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

Teladoc's Sales Show Virtual Doctor Care Is No Passing Fad
"Health plans see a way for patients to get high quality care from a physician and the potential to avoid a more expensive trip to a hospital emergency room. Teladoc executives also said they are seeing growth in mental health, dermatology and potentially, smoking cessation programs. 'We saw growth in the employer segment as well as the health plan segment,' Jason Gorevic, Teladoc's chief executive officer [said], adding that health insurers are rolling out coverage 'more aggressively.' " (Forbes)

Achieving Mental Health Parity: Slow Going Even in the 'Pace Car' State
"[The California Department of Managed Health Care] last year began requiring insurers under its watch to show -- at least on paper -- that they were complying with federal parity law. The results were not encouraging: Of 26 managed care insurers, from Aetna to Western Health Advantage, zero were able to prove that they were fully in compliance. Most filed incomplete or flawed documents, state officials said." (Kaiser Health News)

What You Can Learn from Millennials Can Improve Your Workplace Wellness Program
"Because their habits tend to be significantly healthier than those of the Baby Boomers (born between 1946 and 1964) and Generation X (born between the Baby Boomers and Millennials) who together dominate the workplace and will for some time to come, Millennials warrant a close look. This article explores what sets this generation apart and what organizations can learn from them that will improve the health of the entire workforce." (Sibson Consulting)

Wellness Programs Can't Be a Ruse to Ask About Pregnancy
"Workers in small companies seem especially concerned, because an employer with only a handful of employees is far more likely to connect responses with an individual worker than a human resources office responsible for thousands of employees. Major insurers who run wellness programs on behalf of employers insist the data are aggregated and employees have nothing to fear, but advocates say women aren't so sure." (American Journal of Managed Care)

Employees Underutilizing Employee Assistance Programs
"[O]bstacles to using EAP services include stigma associated with seeking help with mental health issues, as well as fear of repercussions for missing work. However, employers... can help employees by identifying the sources of stress for employees, developing an action plan, embracing technology, and adequately communicating the program so employees are aware of what it offers.... [T]here are three areas poised to improve the use of EAP services: Digital/mobile access ... Telemedicine ... Wellness/wellbeing programs." (OneExchange from Towers Watson)

Essential Health Benefits Provided by Each State's Benchmark Plan
"States had some discretion in choosing their benchmark plans and the benefits within these plans can vary greatly from state to state. [This] dataset contains data on a selection of EHBs offered by the states including private duty nursing, hospice care, adult dental and vision care, provisions for generic drugs, organ transplants, dialysis, emergency transport and ER services, x-rays, and infertility treatments." (Robert Wood Johnson Foundation)

Lessons from the Small Business Health Options Program: The SHOP Experience in California and Colorado
"For business owners, employee choice was the most important reason cited for considering SHOP, with ease of administration a distant second.... [B]usiness owners consider insurance brokers to be an important source of enrollment assistance. Those in the insurance and policy communities perceived small-business owners to be poorly informed about available tax credits; business owners disagreed, saying the credits were simply not key to their decision to elect SHOP." (The Commonwealth Fund)

Massachusetts State Lawmakers, Backed by Consumers and Health Plans, Seek to Rein in Prescription Drug Costs
"An alliance of lawmakers, consumers, and health insurers is pushing for a law that would force biotechnology and pharmaceutical companies to justify their prices by disclosing how much they spend on research, production, and marketing. It also would allow the state's Health Policy Commission to limit the prices of especially costly drugs, something not done anywhere in the country." (The Boston Globe)

Aetna-Humana Deal Followed Months of Private Negotiations Among Major Insurers
"[A new SEC] filing by merging insurers Aetna and Humana offers a unique peek into the behind-the-scenes negotiating that ultimately would reshape the industry. Aetna and Humana announced their $37 billion deal July 3, but not before Humana executives spoke to other major insurers about possible deals in months prior and along with its board of directors, weighed these overtures against Aetna's, the filing reveals." (FierceHealthPayer)

Boston Bruins Raise Controversy by Arguing That Meals Are Deductible, Team Is 'World-Class'
"At issue is whether the Boston Bruins hockey club may deduct 100% of the costs it incurred to provide its players and staff with meals while travelling to away games.... [T]he Bruins indeed raise a compelling argument that the Tax Court would be elevating form over substance by distinguishing [the team's hotels during away games] from business premises merely because they are not traditional business premises. " [Jacobs v. Commissioner, No. 19009-15 (petition filed July 27, 2015)] (Bloomberg BNA)

[Opinion]

A Response to the New York Times Editorial on the Cadillac Tax
"[The editorial's] reasoning for tweaks to the law, rather than outright repeal of the tax, was based on many inaccurate assumptions.... [T]he shift of premium expenses for maintaining the same plan does nothing to reduce the tax. Under IRC Section 4980I, the tax is based upon the total premium cost of the plan, regardless of the percentages paid by the employer or employee.... The overall conclusion of the editorial may actually have it right, despite all of its inaccuracies." (Kushner & Company)

Benefits in General; Executive Compensation

[Guidance Overview]

SEC Issues Final CEO Pay Ratio Rule (PDF)
10 pages. "The SEC clearly tried to further address registrants' concerns regarding the feasibility and cost of determining the median annual total compensation of all employees and gave registrants the ability to use the median employee identified for up to three years unless there has been a change in its employee population or employee compensation arrangements that the company reasonably believes would result in a significant change to its pay ratio disclosure." (ExeQuity)

Press Releases

PSCA Provides Free DC Plan Benchmarking Data PSCA [Plan Sponsor Council of America]

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