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Shipman & Goodwin LLP
in CT

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Employee Benefit Plans - 2016 Plan Sponsor Update
RECORDED
(PricewaterhouseCoopers LLP)

Maximizing Your HR Technology Investment & Analytics for Improved Outcomes
June 8, 2016 in TX
(Worldwide Employee Benefits Network [WEB] - Houston Chapter)

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IRS Information Letters Continue to Caution Against Assisting Employees with Individual Policy Arrangements
"While these four information letters do not break any new ground, they highlight the compliance problems and potential excise taxes posed by paying or reimbursing employees' individual health insurance premiums. [In particular,] Letter 2016-0019 notes that, although a formal opinion cannot be provided on any particular arrangement, employers should be wary of 'schemes' purporting to allow reimbursement of individual policy premiums without violating health care reform." (Thomson Reuters / EBIA)

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DOL Addresses Mental Health Parity, Again
"Two more disclosure issues were clarified in the [FAQs about ACA, Part 31] . [1] A potential plan participant/enrollee is able to request a copy of the medical necessity criteria. [2] The items that a plan must disclose to a provider acting as an authorized representative for an ERISA group health plan participant ... If the actual medical necessity criteria are requested, then providing a summary is not an appropriate substitute." (International Foundation of Employee Benefit Plans [IFEBP])

OCR Clarifies Flat-Fee Option for Recovering Costs to Copy PHI
"Responding to questions prompted by the earlier guidance, OCR has issued a new FAQ explaining that the $6.50 flat fee is not the maximum amount that can ever be charged for electronic copies, but rather is an option available to entities that do not want to calculate actual or average costs under the other two permissible methods." (Thomson Reuters / EBIA)

Understanding How Medicare Coverage Affects HSA Eligibility to Avoid Surprise Tax Penalties
"Beginning with the first month in which an individual is entitled to Medicare, his/her HSA contribution limit is reduced to zero.... The difficulty is determining when Medicare entitlement begins because there are common circumstances in which Medicare enrollment may be automatic, delayed by choice, and even retroactive (depending on the individual's situation)." (Trucker Huss)

An Employer's Guide to the Final EEOC Wellness Program Regulations
"The GINA regulations indicate that a program involving a spousal HRA is not reasonably designed to promote health or prevent disease if the incentive is conditioned upon the outcome of the spousal HRA (e.g., if the spouse's blood pressure must be below a certain level in order to qualify for the incentive).... HR staff should be trained on how to respond appropriately to employees who complain about HRAs. Otherwise, the HR staff's response could be viewed by the employee (and the EEOC) as an adverse employment action or other impermissible response taken to retaliate against the complaining employee." (Thompson Hine)

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EEOC Takes Aim at Erroneous Application of ADA 'Safe Harbor' to Wellness Programs
"Although the EEOC conceded that it is arguable that wellness programs are used by employers to make employees healthier and that this may, ultimately, reduce the employer's health care costs, it expressed its opinion that this does not constitute underwriting or the risk classification protected by the insurance safe harbor. The EEOC noted the lack of evidence in either case that the surcharge or decision to exclude an employee from coverage was based on the actual risks non-participating employees posed." (Benefits Bryan Cave)

New EEOC Guidance on Employee Wellness Programs
"Employers who have taken the position that their wellness programs need not comply with the 30% cap on incentives to participate -- either because the program is not part of a health plan or because the program lacks any outcomes-based component -- should take a close look at these EEOC regulations. Neither of these defenses will apply.... Employers who condition enrollment in a health plan -- or in any option thereunder -- should reconsider that approach." (Spencer Fane)

EEOC Issues Final Wellness Rules Under the ADA and GINA
"The essence of this final [ADA] rule is that employers may provide limited incentives (financial or in-kind) in exchange for an employee's participation in a wellness program that includes disability-related inquiries or medical examinations. The main changes from the proposed rule to this final rule are the limitations on incentives and the notice requirement.... The essence of this final [GINA] rule is that employers may provide limited inducements (financial or in-kind) in exchange for an employee's spouse providing information about his/her manifestation of a disease or disorder as part of a wellness program. The main change from the proposed rule to this final rule is the limitations on inducements that may be offered." (Trucker Huss)

Final EEOC Wellness Plan Rules: The Headache Continues
"[T]he ADA's incentive and notice rules do not apply to programs providing general health and educational information, or merely requiring employees to engage in certain activities, but those programs must provide reasonable accommodation for employees with disabilities. The reasonable accommodation requirement might equate to HIPAA/ACA's 'reasonable alternative standard', but the HIPAA/ACA rules do not require a reasonable alternative standard for participatory-only programs, only for health contingent programs." (Davis Wright Tremaine LLP)

Vermont Becomes Fifth State to Enact Paid Sick Leave Law
"Los Angeles and Chicago could be the next jurisdictions to enact paid sick leave ordinances. North Carolina and Arizona recently enacted preemptive legislation banning local governments from passing paid sick leave laws. As these laws become more widespread, multistate employers may wish to explore ways to craft a uniform policy that satisfies all jurisdictional requirements." (Willis Towers Watson)

Key Facts You Need to Know: Minimum Essential Coverage and the Individual Mandate Penalty (PDF)
7 pages. "The [ACA] requires most individuals to have minimum essential coverage (MEC) or pay a penalty.... [Q]uestions and answers [in this article] describe the individual mandate, the types of coverage that are considered MEC, and the penalty for not maintaining MEC." [Also available: Minimum Essential Coverage Reference Chart .] (Center on Budget and Policy Priorities)

Texas Insurer's 60% Premium Hike Request Spurs New Worries About ACA Plans
"In an effort to make up for more than $1 billion in losses over the past two years, Blue Cross Blue Shield of Texas is seeking a premium increase of nearly 60 percent on [ACA] plans ... BCBS of Texas lost $592 million in 2015 on top of $416 million in 2014[.]" (FierceHealthPayer)

North Carolina Blue Cross and Blue Shield Sues U.S. Over Health-Care Payments
"The suit ... says the U.S. failed to live up to obligation to pay the insurer more than $147 million owed under [the ACA 'risk corridors'] ... The suit follows a similar one filed last month by Highmark Health's insurance arm, and an earlier one in February from Health Republic Insurance Co., which is seeking class-action status." (The Wall Street Journal; subscription may be required)

Do CEO Stock Options Mean Trouble?
"The theory ... is that CEO pay should be aligned with the interest of company shareholders. But there's an active debate over whether stock options -- a very common part of CEO compensation packages -- are the best way to do that.... Dylan B. Minor offers evidence that stock options not only encourage CEOs to pursue bold innovation, but also to take dangerous risks." (HRE Daily)

DOL Obtains Judgment to Restore Nearly $20K to 401(k) Plan of Contractor Based in Jessup, Maryland Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Benefits.gov Website adds Location-Based Technology to Personalize, Enhance User Experience Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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