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What's in Your Sandwich: The Impact of the Sandwich Generation and Retirement Readiness
March 30, 2016 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

Form 5500 Update
April 26, 2016 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

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Text of DOL Report to Congress: Improving Health Coverage for Mental Health and Substance Use Disorder Patients Including Compliance with the Federal Mental Health and Substance Use Disorder Parity Provisions (PDF)
337 pages. "Since the passage of the Mental Health Parity and Addiction Equity Act (MHPAEA), the Departments of Labor, Treasury and Health and Human Services have enforced the law, assisted consumers, and continuously clarified the responsibility of plan sponsors and insurance companies providing mental health and substance use disorder coverage.... Through investigations of employment-based plans, regulations and guidance, and outreach, the Departments strive to ensure that coverage for mental health and substance use disorder treatment is provided comparably with that offered for other medical care.... This report includes examples of situations where EBSA was able to intervene on behalf of participants and ensure that participants received coverage for the healthcare they needed." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])

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IRS Delays Enforcement Action Against Employers Offering Premium Reduction Arrangements in Connection with Student Health Coverage
"[T]his guidance does not grant any relief to colleges and universities who are using student health insurance coverage to satisfy the employer shared responsibility requirement to offer coverage to full-time employees or pay a potential penalty. Since student health insurance coverage is not group health plan coverage, an institution providing such coverage to graduate students who are full-time employees of the institution may also face additional penalties under the employer shared responsibility regulations." (Ice Miller LLP)

Preview of Medicare Advantage and Part D Advance Notice and Call Letter: CMS Likely to Address Risk Adjustment, Provider Network, and Other Issues
"The federal government will soon kick off the all-important annual sub-regulatory cycle for the Medicare Advantage (MA) and Part D programs, issuing proposed policy changes and payment rates for calendar year 2017. The proposed guidance -- expected to be issued on February 19 -- is likely to include substantial proposed changes to the MA risk adjustment methodology and may address increased provider network oversight for MA Organizations (MAOs), among other topics." (McDermott Will & Emery)

Text of Sixth Circuit Opinion: No Lifetime Health Benefits for Moen Retirees (PDF)
"[T]he Moen-UAW collective bargaining agreements do not provide unalterable healthcare benefits for life to the [plaintiff retirees] and their dependents.... First and foremost, nothing in this or any of the other CBAs says that Moen committed to provide unalterable healthcare benefits to retirees and their spouses for life.... Second, ... everything they say about the topic was contained in a three-year agreement.... Third, each of the last three CBAs says that '[c]ontinued hospitalization, surgical and medical coverage will be provided without cost to past pensioners and their dependents prior to March 1, 1996.' ... Fourth, while the authors of the CBAs opted not to say that retiree healthcare benefits were vested for life, they explicitly vested pension benefits for qualifying retirees.... Fifth, the agreements contain reservation-of-rights clauses that evidence an intent not to vest and that apply to employees and retirees.... Sixth, these principles yield a similar conclusion when applied to the plant closing agreement.... Seventh, the above analysis not only respects the language of the relevant agreements and Tackett , but it also brings our court into alignment with other circuits around the country." [Gallo v. Moen, No. 14-3918 (6th Cir. Feb. 8, 2016)] (U.S. Court of Appeals for the Sixth Circuit)

Are There Exceptions to the Exhaustion of Administrative Remedies Requirement?
"You already know that claimants with a denied claim must submit an appeal and exhaust administrative remedies before filing suit. But are phone calls sufficient to trigger the appeal process? And, can a claimant trump the exhaustion requirement by alleging the denial was in 'bad faith' and, therefore was a 'special circumstance?' .. Claim denial letters are not contracts.... Alleging bad faith by the insurer fails to constitute a 'special circumstance' sufficient to waive the exhaustion of administrative remedies requirement.... Phone calls are insufficient to constitute an 'appeal.' " [ Moss v. Unum Group , No. 15-30341 (5th Cir. Feb. 3, 2016; unpub.)] (Lane Powell PC)

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HIPAA Breach Notification Deadline Fast Approaching
"Breaches discovered in 2015 and involving fewer than 500 individuals should be reported to the Secretary through the Office of Civil Rights Breach Portal no later than February 29, 2016." (Troutman Sanders)

'Panda Days' and Paid Time Off: What Perks Perk Up Employees
"Perks are essential in attracting and retaining talent, and companies are offering more and more varied perks to hire the very best they can. Nearly 3 in 5 (57%) job seekers reported benefits and perks being among their top considerations before accepting a job ... The perks vary widely, but common themes emerge among the most popular benefits, namely parenting, lifestyle, education or skill building, and cash perks." (OneExchange from Towers Watson)

Farm Contractors Balk at Obamacare Requirements
"Contractors who provide farm labor must now offer workers health insurance are complaining loudly about the cost in their already low-margin business. Some are also concerned that the forms they must file with the federal government under the Affordable Care Act will bring immigration problems to the fore. About half of the farm labor workforce in the U.S. is undocumented." (National Public Radio)

San Diego Church Challenges California Abortion Coverage Mandate
"California's mandate does not include an exemption for group health insurance plans purchased by churches or other employers that have religious beliefs against abortion. Skyline claims the mandate is at odds with the way the Knox-Keene Act treats religious employers, citing an exemption that allows religious employers to opt out of providing contraceptive coverage. Religious employers are also exempt from providing health insurance coverage for infertility treatments, according to the complaint." (Courthouse News Service)

More Than 10 Million People with Medicare Have Saved Over $20 Billion on Prescription Drugs Since 2010
"Nearly 10.7 million Medicare beneficiaries have received discounts over $20.8 billion on prescription drugs -- an average of $1,945 per beneficiary -- since the enactment of the Affordable Care Act. In 2015 alone, nearly 5.2 million seniors and people with disabilities received discounts of over $5.4 billion, for an average of $1,054 per beneficiary. This is an increase in savings compared to 2014, when 5.1 million Medicare beneficiaries received discounts of $4.8 billion, for an average of $941 per beneficiary." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

State Health Coverage Innovation and Section 1332 Waivers: Implications for States (PDF)
10 pages. "This health policy brief presents a number of potential waiver-associated coverage alternatives, including those being discussed by some states.... [S]tates may include multiple innovative concepts in their applications.... [E]ven with the new HHS and Treasury guidance, the analysis required to support a 1332 waiver application may require states to leverage actuarial, policy, technology, and data expertise.... If a state can show that its state law would more effectively accomplish the ACA's coverage, affordability, and regulatory goals, the law gives states the flexibility and autonomy to try new approaches." (Deloitte Center for Health Solutions)

Why Another Healthcare Consortium Warrants Pessimism
"The suggestion that this employer group will discover efficiencies in the market which these large insurers ... have not, is a slap in the face to the intelligence and motives of these large national insurers. Their data and expertise on this subject is far greater than that of this loosely tied group.... [We] already know the reason why the U.S. healthcare system is so costly.... The three largest drivers were administrative complexity, overtreatment as well as fraud and abuse. In order to fix the U.S. healthcare system on the macro level, it needs to be greatly simplified and better regulated." (Frenkel Benefits)

J.P. Morgan adds ERISA Strategist Daniel Notto to Retirement Solutions Group J.P. Morgan Asset Management

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