Senior 401(k) & DB Plan Administrator
Pension Management Consultants, Inc.
in CA

Bilingual Retirement Educator
Milliman
in TX

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Text of Agency Final Regs: Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections Under the ACA

20 pages. "On November 18, 2015, the Departments ... published ... Final Rules for Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections Under the [ACA] , regarding, in part, the coverage of emergency services by non-grandfathered group health plans ... including the requirement that non-grandfathered group health plans ... limit cost-sharing for out-of-network emergency services and, as part of that rule, pay at least a minimum amount for out-of-network emergency services. The American College of Emergency Physicians (ACEP) filed a complaint in the United States District Court for the District of Columbia, which on August 31, 2017 ... remanded the case to the Departments to respond to the public comments from ACEP and others. In response, the Departments are issuing this notice of clarification to provide a more thorough explanation of the Departments' decision not to adopt recommendations made by ACEP and certain other commenters in the November 2015 final rule."
Internal Revenue Service; Employee Benefits Security Administration EBSA, U.S. Department of Labor; and U.S. Department of Health and Human Services [HHS]

2018 EBIA May-June seminars: Multiple locations

ERISA Compliance for Health and Welfare Plans, ACA Compliance Strategies, Cafeteria Plans, HRAs and HSAs, Employee Wellness Programs, HIPAA Privacy and Security, COBRA Compliance for Group Health Plans. Register individually or for the full four days.

HSA Family Limit Reverts Back to $6,900

"If you (or your payroll vendor) reprogrammed your payroll systems to reflect the $50 limit cut, you can now undo that and go back to $6,900. Before automatically adjusting employee elections, you should make sure that employees have not made other changes to their elections." HUB International

Status Update on EEOC Wellness Regs

"In previous court filings the EEOC suggested it would publish new proposed regulations this summer ... However, in a recent court filing the EEOC explained that it has not decided how to proceed and, therefore, does not have plans to issue new regulations by any given date.... The EEOC is going to have a difficult time justifying 'voluntariness' whether it issues new regulations or tries to reissue the 2016 regulations. The EEOC has reportedly received little usable feedback from interested parties about evidence to support a voluntariness determination."
Lockton

Small Business Health Insurance: Costs, Trends and Insights 2017 (PDF)

"[T]he cost of small business coverage selected at eHealth increased by 8 percent between 2016 and 2017, after decreasing by one percent between 2015 and 2016.... Nearly 80 percent of small business owners say they worry about the cost of coverage; more than 6 in 10 (62 percent) said that a 15 percent increase in premiums would make their current group health insurance coverage unaffordable ... A majority of small business customers purchased silver plans in 2017; nearly half (47 percent) of small business owners say they currently pay 75-100 percent of their employees' monthly premiums." eHealth

CMS Interim Summary Report on Risk Adjustment for the 2017 Benefit Year (PDF)

"HHS evaluated whether issuers provided access to EDGE server data sufficient for HHS to release an interim risk adjustment summary report for each specific state.... The data displayed in this report is preliminary -- final risk adjustment data may differ significantly in magnitude and possibly direction of the transfers from the data presented in this report.... [T]he risk scores provided in this interim risk adjustment report will not necessarily be predictive of final 2017 benefit year risk adjustment transfers." [Also see: Appendix A : Interim Risk Adjustment State Averages with State Billable Member Months (XLSX); and Appendix B : HHS-operated Risk Adjustment Geographic Rating Factors (GCFs) (XLSX)]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Health Insurance in 2018 Finds ACA Gains Reversing

"The coverage declines are likely the result of two major factors: [1] lack of federal legislative actions to improve specific weaknesses in the ACA and [2] actions by the current administration that have exacerbated those weaknesses.... Signs point to further erosion of insurance coverage in 2019: the repeal of the individual mandate penalty included in the 2017 tax law, recent actions to increase the availability of insurance policies that don't comply with ACA minimum benefit standards, and support for Medicaid work requirements." The Commonwealth Fund

The State of North Carolina Conducted a Dependent Audit of Its Health Plan -- Should You?

"How many dependents are currently enrolled on your plan? Obviously, employers with more dependents would see more potential value. How much are dependents costing your plans in claims? Audits are more valuable for plans experiencing higher claims from spouses or children. How much the plan is subsidizing spousal and dependent tiers? Employers contributing very little (or nothing) towards dependents may create undue burden for employees and expense for the plan without generating savings." Hill, Chesson & Woody

Telemedicine Prescribing of Controlled Substances: The Dark Side of the New Congressional Bill

"Congress has taken another step forward to require the federal Drug Enforcement Administration (DEA) to activate a special registration allowing physicians and nurse practitioners to prescribe controlled substances via telemedicine without an in-person exam.... [T]his bill ... requires the DEA to issue 'interim final regulations.' ... Directing the DEA to issue interim final regulations, while expeditious, strips the public from the important need to review and comment on the DEA's approach to the special registration process." Foley & Lardner LLP

Health Plans: Is It Time to Bring Back 'Reasonable and Customary'?

"Since billed charges are no longer reasonable and their payment no longer customary, TPAs started tapping into these blind networks to limit non-network payment levels. And since some of these were already set up as shared savings arrangements, a new revenue model was born. How much revenue? When we can see it (it's often hidden in claims data), it has usually amounted to about 10% to 20% of administration fees -- not a bad source of added revenue!" Chelko Center for Benefits Management

ERISA: How to Argue That 'Conflict Discovery' Should Not Supplement the Administrative Record

"The Court rejected Plaintiff's request to supplement the record with [1] portions of Unum's Claims Manual addressing procedures Unum uses to assess the claimant's ability to perform her own occupation.... [2] requirements in Unum's Claims Manual regarding how reviews by non-examining physicians employed by Unum must be performed.... [3] requirements in Unum's Claims Manual that Unum 'giv[e] deference to the opinion of the claimant's [attending physician(s)].' " [ Prohkorova v. Unum Life Ins. Co. of Am. , No. 17-30064 (D. Mass. April 23, 2018)]
Lane Powell PC

California Abandons 30-Year-Old Test for Determining Independent Contractor Status, Broadens Definition of 'Employee'

"The new standard adopted by the Supreme Court (dubbed the 'ABC test') requires hirers to establish three factors in order to properly classify a worker as an independent contractor -- and in the process greatly expands the definition of 'employee' under California law: [A] The worker is free from the control and direction of the hirer in connection with the performance of the work, both under contract for the performance of such work and in fact; and [B] The worker performs work that is outside the usual course of the hiring entity's business; and [C] The worker is customarily engaged in an independently established trade, occupation, or business of the same nature as the work performed by the hiring entity." [ Dynamex Operations West, Inc. v. Superior Court of Los Angeles County , No. S222732 (Cal. Apr. 30, 2018)]
Proskauer Rose LLP

California Supreme Court Transforms Test for Who Is an Employee

"The state supreme court said in an April 30 ruling that a three-factor 'ABC' classification is the correct test under state law, shifting from a separate standard that looked at nearly a dozen different factors.... [The] decision could have a large impact in California, home to Silicon Valley. That's because California also is home to many lawsuits involving the classification of many app-based gig economy workers." [ Dynamex Operations West, Inc. v. Superior Court of Los Angeles County , No. S222732 (Cal. Apr. 30, 2018)]
Bloomberg Law

ICI and ARA Letter to EBSA on E-Delivery Study (PDF)

39 pages. "Allowing plans to make electronic delivery the default method for communicating with participants (while still allowing participants to opt for paper) will: [1] enhance the effectiveness of ERISA communications, particularly to individuals with disabilities or for whom English is not the primary language; [2] produce significant cost savings for 80 million retirement investors; [3] maintain security of information; and [4] reduce the environmental impact of tons of discarded paper every single year." Investment Company Institute [ICI]

Press Releases

Lockton Offices Merge to Form New Practice in the Midwest Lockton

U.S. DOL Investigation Results in Court Ordering Illinois Business Owner to Restore Losses to Retirement Plan and Trust after Fiduciary Violations Employee Benefits Security Administration [EBSA], U.S. Department of Labor

ICI Hires Cynthia Pullom as Director, Financial Services Policy Investment Company Institute

Financial Engines Announces Agreement to Be Acquired by Hellman & Friedman for $45.00 Per Share in Cash Financial Engines, Inc.

PSCA 2018 Signature Award Winners Announced at National Conference PSCA [Plan Sponsor Council of America]

Pepper Hamilton Strengthens Employee Benefits Services With Addition of Paul L. Porretta Pepper Hamilton LLP

NIPA to Announce Lifetime Achievement and Outstanding Volunteer Award Recipients at the 2018 NAFE NIPA [National Institute of Pension Administrators]

Advantus Capital Management Rebrands as Securian Asset Management Securian Financial Group

LIMRA and OMG Partner to Advance Technology Standards for Workplace Benefits LIMRA

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