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Is Rate Review the Answer to Lower Health Insurance Premiums?
RECORDED
(Robert Wood Johnson Foundation)

FMLA, ADA and Beyond: Current Leave and Accommodation Issues
December 2, 2015 in TX
(Littler Mendelson)

It?s The End of 2015 ? What?s Your ACA Compliance Status?
December 15, 2015 WEBCAST
(Tango Health)

New Trustees Institute
February 15, 2016 in FL
(International Foundation of Employee Benefit Plans [IFEBP])

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Today's Discussions on the BenefitsLink Message Boards

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Sick Leave Laws Are Sweeping the Nation, Giving Ulcers to Employers Everywhere (PDF)
12 pages. "Few employment laws have taken off in multiple jurisdictions like sick leave laws have in recent years. The appeal of such laws to family rights organizations and employees is obvious. The appeal of these laws, however, has been somewhat lost on most business groups and they have opposed the laws on several grounds, including that it will make them less competitive by adding to their overhead costs, and also by adding to administrative headaches because of the requirement to track sick leave. These concerns largely have fallen on deaf ears of lawmakers and activists. Are these concerns valid? In order to answer these questions, it is helpful to examine the current legal landscape." [Article includes a detailed description of the sick leave laws of five states and 18 municipalities.] (Fox Rothschild LLP via Bloomberg BNA Tax Management Compensation Planning Journal)

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IRS Issues Guidance for Integrated HRAs
"In a recent Chief Counsel Advice ( CCA 201547006 ), the IRS has provided guidance for employers wishing to offer health reimbursement arrangements (HRAs) that both [1] provide reimbursements on a tax-free basis, and [2] satisfy the 'market reform' requirements of the Affordable Care Act. In particular, this CCA focuses on HRAs (and similar 'employer payment plans) that reimburse employees for medical premiums paid for coverage under a health plan maintained by a spouse's employer. The key to making these reimbursements on a tax-free basis is that the HRA may reimburse only those premiums that were paid on an after-tax basis." (Spencer Fane)

Departments Finalize Rules for ACA Market Reforms (PDF)
"[I]mportant clarifications regarding the market reform rules include: [1] Adding an employer to a grandfathered multiemployer plan will not affect grandfathered status ... [2] Prohibiting HMOs from excluding dependents under age 26 because they live outside the service area ... [3] Right to receive new or additional evidence or rationale automatically in connection with appeal ... [4] Health reimbursement account (HRA) integration rules." (Groom Law Group)

D.C. Residents Love the Idea of Paid Family Leave -- Just Not Paying for It
"The wide contrast in support underscores a deep political divide nationally on the issue. It also sets up a major hurdle for proponents in the District to build a consensus around a plan to give employees the most-generous family-leave benefit in the nation. Under a bill that District lawmakers will begin debating Wednesday, private employers in the city would be required to pay the equivalent of as much as 1 percent of all employees' salary costs into a citywide fund to cover the universal benefit." (The Washington Post; subscription may be required)

Interesting Facts You Probably Didn't Know About HSAs
"An employee who has significant medical spend and meets his/her medical deductible can then convert a limited-purpose FSA into a traditional full-purpose FSA for the remainder of the year -- effectively allowing some HSA participants to shield $9,300 from taxable income in 2016 ($6,750 maximum HSA funding and $2,550 maximum healthcare FSA funding).... Three states -- California, New Jersey and Alabama -- will tax employer and employee HSA contributions at the state level. Funds will always be exempt at the federal level." (Frenkel Benefits)

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Controlling Health Care Costs With Self-Funded Plan Options

December 14 webinar - Factors that may motivate employers to self-insure; how self-insurance influences benefit design, benefit claims decisions, and financial exposure; and practical tips for decision-making. BenefitsLink discount .

Retiree Health Benefits Post-Tackett: The Need for Clear and Unambiguous Language (PDF)
"The [ M&G Polymers v. Tackett ] majority's rulings that ordinary contract principles apply, that lower courts should not construe ambiguous writings to create lifetime promises, that contractual obligations generally cease upon termination of the bargaining agreement, and that courts should not infer that parties intended benefits to vest for life when the contract is silent regarding their duration, clearly tend to tip the scale in favor of finding no contractual vesting. However ... there is still an opportunity for courts to rule in favor of participants when the CBA is ambiguous by employing the use of extrinsic evidence as advocated by Justice Ginsburg in her concurrence." (Proskauer Rose LLP)

Justices Urged to Save State Health Databases
"More than 40 industry groups, states and individuals are urging the U.S. Supreme Court to protect states' efforts to collect health claims data from health plans funded by employers.... Many of the groups filing briefs in support of Vermont's database emphasized that the utility of such databases would be compromised if self-funded health plans were excused from submitting their data. Self-insured plans cover nearly 60 percent of workers with health insurance ... According to Vermont -- and echoed by the AARP and other groups -- excluding these plans would skew the data, because individuals covered by such plans tend to be younger and healthier than the population as a whole." (Bloomberg BNA)

Immediate Action Required to Prepare for 'Phase 2' HIPAA Compliance Audits of Both Covered Entities and Business Associates
"Audited HIPAA entities should expect to receive a data request from OCR requiring a response within two weeks. All information supplied by the audited organization -- which will likely be submitted to OCR through a new web portal -- must be current as of the data request date.... Late submissions or failing to respond to a data request could subject an entity to further investigation and enforcement action. Accordingly, Covered Entities and Business Associates do not have the luxury of waiting to see if they receive a data request before ensuring they are HIPAA compliant." (Chiesa Shahinian & Giantomasi PC)

Critics of Health Insurer Mergers Urge States to Act
"State regulators have a mandate to look at whether the mergers would hurt the public interest ... DOJ officials have less expertise than state regulators do concerning local health insurance markets, and the DOJ's process is not as transparent as state processes ... State regulators also have more remedies they can use to mitigate any anticompetitive effects[.]" (Bloomberg BNA)

UnitedHealth Says It Should Have Avoided Obamacare Longer
"While the company's other lines of business are growing, instead of expanding into Obamacare next year, the company should have kept waiting, UnitedHealth CEO Stephen Hemsley said at an investor meeting in New York.... Losses from the plans this year and next will total more than half a billion dollars, the company has said, and UnitedHealth will scale back efforts to market coverage to millions of people shopping for 2016 insurance on the Affordable Care Act's new marketplaces." (Bloomberg)

Blue Cross Sued Over Denying Patients Hepatitis C Treatment
"In California, a class action lawsuit has been filed on behalf of ... thousands of Blue Cross beneficiaries who are living with hepatitis C. According to the lawsuit, Blue Cross is limiting authorization to only its sickest patients.... In May, a class action lawsuit was filed in Florida against Blue Cross and Blue Shield of Florida, alleging that it had wrongly denied beneficiaries Harvoni." (American Journal of Managed Care)

Horizon's OMNIA Could Change Maternity Patterns in New Jersey
"As Horizon faces 2 separate legal challenges to OMNIA, the tiered network formed to implement its cost-cutting initiative, state regulators weighed whether they would reverse their approval.... An examination of NJ Department of Health and CDC data suggests that OMNIA could have far-reaching effects on where babies are born, including the state's above-average number of twins and triplets." (American Journal of Managed Care)

Illinois Insurer Land of Lincoln Halts New Small Biz Enrollees
"Land of Lincoln Health is no longer taking new small-business customers. The move comes just one month into the third year of the Obamacare health insurance exchange ... Land of Lincoln had more than 55,000 customers in October, including individuals and businesses. It wants to end 2016 with only about 15,000 more." (Crain's Chicago Business)

Small Businesses Aren't Getting a Break from Health Care Law
"The Affordable Care Act has been so ineffective for small businesses since it became law that 95% reported that their health plan costs have increased in the last five years. The higher cost of health plans has meant less for investment and employees. Sixty-three percent said they cut back on growing their businesses, 45% held off on worker pay raises, and 25% didn't hire more people." (U.S. Chamber of Commerce)

DOL's New Disability Claim Rules Add to a Plan Administrator's Duties Under Welfare and Retirement Benefit Plans
"These new proposed disability claim rules attempt to preserve all defenses available to benefit plans prior to ERISA benefit litigation.... These proposed rules would apply to any disability-based ERISA benefit claim, whether the claim arises under a welfare plan (e.g., a long-term or short-term disability plan) or a retirement plan (e.g., a disability retirement benefit under a pension plan).... The rules would require that plans not make hiring, compensation, promotion or termination decisions based upon a claim adjudicator candidate's propensity for denying disability benefits. Plans would also need to review a medical expert's professional qualifications rather than his/her reputation for outcomes in contested cases." (McDermott Will & Emery)

Interpleader Can Prevent Overpaying for Death Benefits
"If two or more parties are claiming to be the rightful beneficiary of a deceased participant's benefit, one option is to review all the facts and make a determination applying the plan's terms through its claims procedures. The risk of this approach is that if the administrator makes a decision that is overturned on review by a court, the plan could end up paying twice. A second option is for plan administrators to preemptively file an interpleader action. A plan can file an interpleader action as a plaintiff in a case, name the disputing beneficiaries as defendants, and then tender the benefit to the court and let the court resolve who is the rightful owner. A recent case illustrates how choosing between these forums can mean drastic differences in determining who receives the benefit." [ Jenkins-Dyer v. Drayton , No. 2:13-CV-02489-JAR (D. Kan. Sept. 25, 2015)] (Thompson SmartHR Manager)

Honda Motor Co. Raises Retirement Age to 65 for Japanese Workers
"Other proposed changes ... include a shift to child care and nursing allowances, rather than family allowances ... Honda also plans to introduce a work-from-home and partial-workday system, and adopt a salary and bonus structure that widens the pay gap between higher and lower performers. The moves could position Honda as one of the Japan's most aggressive companies seeking programs and policies to help deal with a population that is aging at the fastest pace in the developed world." (Pensions & Investments)

Triple-S Management Corporation Settles HHS Charges by Agreeing to $3.5 Million HIPAA Settlement U.S. Department of Health & Human Services

Ascensus Celebrates Grand Opening of Cranbury, New Jersey, Office Location Ascensus

Morneau Shepell Acquires Bensinger, DuPont & Associates Morneau Shepell Inc.

Wells Fargo to Offer Personalized Investment Solution for 401(k) Plan Participants Wells Fargo

House Subcommittee to Discuss Principles for Protecting Workers? Retirement Security U.S. Senate Health, Education, Labor, and Pensions Committee

Towers Watson Names Executive Compensation Practice Leader in Seattle Towers Watson

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