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How Employers and Employees Can Reach Benefits Satisfaction via Decision Support Tools
June 26, 2018 WEBCAST
Hodges-Mace

Health Care Costs: What's a Fiduciary to Do?
September 6, 2018 WEBCAST
American Bar Association Joint Committee on Employee Benefits [JCEB]

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Text of CMS FAQs on Spanish Translation and Audit Requirements for Enhanced Direct Enrollment Entities Serving Consumers in States with Federally-facilitated Exchanges (PDF)

"[1] What are the requirements for Spanish translation of website content for the EDE pathway? ... [2] What communications must be translated into Spanish by DE Entities using the EDE pathway? ... [3] How should the DE Entity's Auditor review the Spanish-language version of the application UI? ... [4] What experience must an Auditor possess to demonstrate sufficient expertise to review the Spanish-language version of the application UI and associated critical communications? " Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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Final Rule Rapidly Eases Restrictions on Non-ACA-Compliant Association Health Plans

"The changes finalized by the Department include relaxing a long-standing 'commonality of interest' requirement that associations must exist for a reason other than offering health insurance and allowing self-employed 'working owners' to enroll in AHP coverage.... The rule does not disturb state regulatory authority over AHPs, but the Department leaves open the potential of granting exemptions for AHPs from state requirements in the future." Katie Keith, in Health Affairs

DOL Issues Final Rules for Association Health Plans

"Employers may band together in an association for the purpose of obtaining health coverage.... These rules will be implemented in three stages based on complexity and beginning with the least complex.... [S]tate MEWA laws will play a vital role in the overall adoption of AHPs as they may limit the viability of these plans in certain markets." HUB International

J, K, L, M and N: What's In a Letter?

"If you responded to a Letter 226-J, the reply from the IRS will come in the form of one of the following four 227 letters: ... [1] If you submitted a completed Form 14764, ESRP Response agreeing to the ESRP amount proposed in your Letter 226-J, the IRS will acknowledge its receipt using Letter 227-J and provide instructions for making the ESRP.... [2] Letter 227-K. You want this letter.... [3] The IRS acknowledges receipt of your response to Letter 226-J and notifies you of the revised ESRP amount, using Letter 227-L.... [4] Letter 227-M ... acknowledges receipt of the information you provided disputing the proposed ESRP amount in Letter 226-J but provides that the amount of the ESRP remains unchanged." Benefits Bryan Cave

DOL Finalizes AHP Rule in Slightly Narrower Form

"Like the version proposed in January, the final rule allows employers with a 'commonality of interest' to offer joint coverage without many of the restrictions that previously applied to coverage provided through associations. Under the final rule, however, a group offering an AHP must have at least one 'substantial business purpose' besides providing benefits, though doing so still may be its principal purpose.... DOL deleted a provision from the proposed rule that would have disqualified individuals eligible for group health coverage from another employer or a spouse's employer." HR Daily Advisor

Employee Health, Benefits, & Well-Being Congress | July 30-31

Who is moving the needle on employee health care? This event convenes HR, benefits, and wellness executives, TPAs, Brokers, Payers, and Providers to learn and discuss strategies to enhance employee health and improve outcomes while reducing costs.

Successor Not Liable for Misrepresentations by Past Fiduciaries Regarding Retiree Health Care

"Retired security guards had brought suit seeking to restore health care benefits to prior levels, alleging that they were promised stable premiums and retirement benefit levels similar to what they received as active employees. However, because the contractor did not assume control of the health care plans until after these representations had been made, the court granted its motion for summary judgment on the misrepresentation claim." [ Hatmaker v. Consolidated Nuclear Security, LLC , No. 15-351 (E.D. Tenn. May 30, 2018)]
Wolters Kluwer Law & Business

When to Consider Becoming Self-Insured

"Initially, the thought of not having a fixed premium, and being liable for unknown employee medical claims, may seem a little scary. However, if done right, this kind of strategy can help you reap financial rewards." Fidelity Health Marketplace

How Employers Are Working to Combat the Opioid Epidemic

"[E]mployers have addressed [the opioid epidemic] through innovative plan design and outreach.... Developing best practices ... Tighter controls on opiod prescriptions ... Comprehensive patient education ... Attention to drug prescription and interaction guidelines ... Collaboration with physical and mental health care providers." American Benefits Council

Failure to Encrypt Leads to $4.3 Million in HIPAA Civil Money Penalties

"The breach reports involved: The theft of an unencrypted laptop computer, used for teleworking, which contained the electronic protected health information (ePHI) of nearly 30,000 individuals, from a workforce member's residence. The loss of two unencrypted USB drives, which had belonged to a trainee and a visiting researcher (respectively), and collectively contained the ePHI of roughly 5,800 individuals.... The ALJ's ruling faults the CE, at length, for adopting policies that acknowledged the need for encryption and protecting confidential information (including ePHI), but not fully carrying out those policies in practice for years." Thomson Reuters Practical Law

Amazon, Berkshire Hathaway and JPMorgan Name C.E.O. for Health Initiative

"Amazon, Berkshire Hathaway and JPMorgan Chase, the powerful triumvirate that earlier announced its hope to overhaul the health care of its employees and set an example for the nation ... picked one of the country's most famous doctors to lead the new operation. Dr. Atul Gawande, a Harvard surgeon and staff writer for The New Yorker magazine, will become chief executive of the new company ... He said he was not stepping down from his current medical and other duties to take the job." The New York Times; subscription may be required

CalPERS Adopts 2019 Health Rates

"The CalPERS Board of Administration [has] approved health care rate and plan changes for 2019 that include an average 1.16 percent overall premium increase, marking the lowest health premium increase CalPERS has negotiated in over two decades.... Overall rates for seven of the nine HMO plans will be less than the 2018 rates.... A pilot program for reference-pricing pharmaceuticals will begin ... The PERS Select Basic PPO plan will adopt a value-based insurance design." California Public Employees' Retirement System [CalPERS]

Filings Due July 31: Forms 5500 and 8955-SSA

"Calendar year employee benefit plans are generally required to file the 2017 Form 5500 and Form 8955-SSA by July 31, 2018 unless an extension Form 5558 is timely filed with the [IRS] ... Automatic extension of this deadline is available in certain situations if the employer's federal income tax return has been granted additional time to file and the plan year corresponds with the same 12-month period.... Form 5558 is limited to the extension of a single plan." PKF O'Connor Davies

Simple Steps to a Stress-Free Enrollment

"[1] Consider the feedback you got on last year's campaign.... [2] Define success and then measure it.... [3] Cut the clutter.... [4] Know your purpose.... [5] Use straight talk.... [6] Start early and communicate often.... [7] Go for variety." Milliman Retirement Town Hall

Deal-Breaking M&A Issues Related to Employee Benefit Plans and Executive Compensation

"[S]ellers may defuse risks and streamline negotiations through proactive pre-sale planning.... [B]uyers are able to maximize their deal-related protections (and their post-closing alternatives) by assuring early stage attention to the items listed ... [This] list merely illustrates the range of benefit plan issues that may interfere with a change in corporate control (CIC) transaction. Disclosure schedules will often suggest other material issues, such as benefit plan defects and potential liabilities." The Wagner Law Group

Blockchain Tokens as Compensation

"[Tokens] are being used like equity or phantom-equity awards, granted as compensation for past or future services. They may be subject to vesting based on continued service or achievement of performance targets, and acceleration of vesting can be triggered based on designated events, such as the occurrence of a change of control transaction, the termination of an employee without cause, or the achievement of technical milestones." Jackson Lewis P.C.

Press Releases

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Cetera Launches 401k Practice Development Program Cetera

Salesforce Announces Health Cloud for Payers, Transforming Business Operations and Member Engagement for Insurers Salesforce

Oscar Expands to Six New Markets Oscar

LDIntelligence Taps Chip Moore to Lead iJoin Business Development LDIntelligence

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