Obama Aides Seek To Calm Storm Over Contraceptive Rule
"Administration suggests there may be ways to meet religious groups' concerns but insists that the president is committed to the policy." (Kaiser Health News)
Employers: Employees Don't Understand Benefits
[L]ess than 19 percent of employers think their employees have a very good understanding of their benefits, (LifeHealthPro)
Milliman's Monthly Benefit News and Developments, February 2012 (PDF)
The newsletter provides a summary of the previous month's legislative, regulatory, and judicial information on employee benefits and upcoming key dates. (Milliman)
[Guidance Overview] Effect of New Michigan Health Insurance Claims Assessment Act on Group Health Plans
"Employer plan sponsors with Michigan employees should discuss payment of the HICA tax with their medical, dental, vision, prescription drug and wellness TPAs. Plan sponsors may want to review their service agreements with their TPAs to determine whether the plan sponsor has any obligation to reimburse the TPAs for the tax." (McDermott Will & Emery)
Employers and the Exchanges under the Small Business Health Options Program: Examining the Potential and the Pitfalls
"To attract employers, the exchanges must be able to keep costs affordable and limit the burden posed by the insurance process; perform administrative functions; manage enrollment periods; and, perhaps most important, protect against 'adverse selection,' which would lead to a disproportionate number of sicker individuals in the exchanges." (The Commonwealth Fund)
[Guidance Overview] Maintaining 'Grandfathered Plan' Status for Group Health Plan Critical to Avoiding New Mandate on Coverage for Contraceptives
"Multiple religious organizations have expressed opposition to the Section 2713 mandate, including the U.S. Conference of Catholic Bishops, the National Association of Evangelicals, and the Union of Orthodox Jewish Congregations of America, among many others. Given the limited options available for avoiding the new mandate for nongrandfathered group health plans, those employers who will not be able to comply with the new rules due to their religious beliefs but who wish to continue offering group health plans to their employees must pursue other courses of action." (Hinshaw & Culbertson LLP)
[Opinion] An Affront Catholics Agree On
"Liberal and conservative Catholics don't agree on much, but they're both outraged by a new rule on contraception coverage." (Los Angeles Times)
Lowe's Sued over Cancelling Health Plan Participants' Coverage
"A lawsuit was filed on behalf of all participants in Lowe's Companies' Group Medical Plan who had their health coverage terminated and were denied medical benefits by Lowe's for part or all of the 2011 calendar year." (PLANSPONSOR.COM)
[Opinion] Comments of American Academy of Actuaries on HHS' Research Brief Entitled 'Actuarial Value and Employer-Sponsored Insurance' (PDF)
"The American Academy of Actuaries' Health Practice Council appreciates the opportunity to provide comments on the recently released [HHS] research brief, 'Actuarial Value and Employer-Sponsored Insurance.' . . . There are additional factors that should be considered when interpreting the results and formulating policies to regulate [actuarial value] calculations for [employer-sponsored insurance]: . . ." (American Academy of Actuaries)
[Guidance Overview] EEOC Issues Final Rule Extending Title VII And ADA Recordkeeping Requirements to GINA
"The EEOC issued a final rule extending the existing recordkeeping requirements under Title VII and the ADA to entities covered by Title II of the Genetic Information Nondiscrimination Act of 2008 (GINA). Effective April 3, 2012, employers with 15 or more employees must retain all personnel and employment records for at least one year, and must retain documents relevant to charges filed under GINA until their final disposition." (Practical Law Company)
[Guidance Overview] Estoppel in ERISA: Simple Mistakes Can Lead to Costly Litigation
"Even if the participant ultimately fails in proving the elements of estoppel, defending against such claims is costly and time-consuming. Accordingly, employers and plan administrators should take the following steps to protect themselves from these types of claims: . . . ." (Employee Benefits Law Report)
Domestic Policy Council Director's Statements on White House Blog About Contraceptive Mandate
"Over half of Americans already live in the 28 States that require insurance companies cover contraception: Several of these States like North Carolina, New York, and California have identical religious employer exemptions. Some States like Colorado, Georgia and Wisconsin have no exemption at all." (The White House Blog, written by Cecilia Mu?oz, Director of the White House Domestic Policy Council)
Anger Brewing on the Left About Mandatory Contraceptive Coverage for Employees of Religious Employers
"Megan McArdle, senior editor of the Atlantic, wrote yesterday that it might be in Americans' interest to be more flexible with faith-based organizations because they provide such a depth of social services (publicly funded in many cases, of course) . . . ." (Washington Post)
[Guidance Overview] Slide Presentation: Form W-2 Reporting Requirements for Employer-Sponsored Group Health Coverage (PDF)
"Overview: Informational nature of reporting requirement; Effective date; Special transition relief for small employers; Employers subject to the new rules; Plans that must be reported; Determination of the aggregate cost; [and] Open issues" (Crowell Moring via American Benefits Council)
[Guidance Overview] ACA Terminology Related to Essential Health Benefits, Minimum Essential Coverage and Minimum Value (PDF)
"This memorandum addresses [three terms that] are or will be very important to employers in understanding their obligations under the ACA. Attached to this memorandum is a chart addressing the application of each of these terms to different types of employer-sponsored coverage." (Crowell Moring via American Benefits Council)
Use of TPAs to Outsource Benefit Plan Administation Increased Substantially During Past Four Years (PDF)
"[R]oughly two in five plan sponsors (37%) say they are increasing the use of third party administrators (outsourcing benefits administration) to some extent in order to manage costs. Among those using this strategy, 65% indicate it has been successful in achieving desired cost savings." (Prudential)
[Opinion] Aging Groups Argue That Most Health Reform Law Provisions Affecting Seniors Should Not Be Tied To Supreme Court's Ruling on Individual Mandate (PDF)
"The [recently filed amicus] brief . . . highlights the parts of the ACA that greatly benefit people aged 65 and older that should not be affected should the Court decide to invalidate the minimum coverage provision, including: Reduced cost-sharing for Medicare beneficiaries for prescription drugs by substantially reducing the coverage gap or so-called donut hole; Elimination of cost-sharing for annual wellness visits and other screening services; Medicare Advantage plans are prevented from charging higher cost-sharing for chemotherapy and dialysis than permitted under traditional Medicare . . . ." (National Senior Citizens Law Center)
[Opinion] Comments of American Benefits Council on HHS 'Essential Health Benefits' Bulletin (PDF)
"[T]he Bulletin does not expressly reaffirm . . . that insured large group health plans and self-insured group health plans may continue to utilize a good faith effort to comply with a reasonable interpretation of the term 'essential health benefits' as provided in interim final regulations issued in June 2010. To avoid any confusion, we request . . . that the Department issue clarifying guidance that reaffirms that plan sponsors and issuers may continue to use a good faith effort . . . ." (American Benefits Council)
[Guidance Overview] Health Care Reform Update, by ML Strategies (PDF)
A succinct listing of recent health care reform legislation, regulations, and initiatives. (ML Strategies, LLC)
[Guidance Overview] Deadline for Calendar Year Health Plans to Submit Creditable Coverage Disclosures to CMS is February 29 (PDF)
"Group health plan sponsors that provide prescription drug coverage to those eligible for Medicare Part D must disclose to CMS on an annual basis whether the coverage qualifies as creditable or non-creditable." (Buck Consultants)
[Guidance Overview] Disenrollment Was Proper After Ignored Document Requests
"A plan participant's disregard of health plan requests to verify dependent eligibility was a proper basis of a plan's action to remove his dependents from coverage and garnish wages to recover about $23,000 in benefits overpayments, a federal court ruled in Muhammad v. Ford Motor Co. . . . (E.D. Mich., Jan. 12, 2012)." (SmartHR)
Employee Benefits Developments, January 2012
Various rulings, opinions, and cases are summarized. (Hodgson Russ LLP)
[Guidance Overview] Headlines in Employee Benefits Law E-Alert, January 2012 (PDF)
The newsletter covers select compliance deadlines and reminders, and retirement plan, health and welfare plan, and general developments. (Reinhart Boerner Van Deuren s.c.)
How Will the Affordable Care Act Affect Small Businesses and Their Employees? (PDF)
"This fact sheet explains the changes that are likely to take place with reform, when they go into effect, and which businesses will be affected." (The Henry J. Kaiser Family Foundation)
[Official Guidance] Second Quarter Update to the 2011? 2012 IRS Priority Guidance Plan (PDF)
"The second quarter update to the 2011-2012 plan reflects 14 additional projects that have become priorities and/or guidance we have published during the period from October 1, 2011 through December 31, 2011 of the plan year. In addition, the update reflects one project we have closed without publication because the statute was subsequently repealed." (U.S. Internal Revenue Service)
Establishing and Administering an OPEB Trust
"The Government Finance Officers Association (GFOA) recommends creating a qualified trust fund to prefund OPEB obligations. To ensure that the trust is established and administered properly, governments should consult qualified legal counsel and fully understand the following issues . . . ." (Government Finance Officer's Association)
[Guidance Overview] Practitioners' Forum Discussion: Evans v. Sterling Chemicals, Inc.
"In Sterling, the Fifth Circuit held that an asset purchase agreement that included a provision in which the purchaser committed to providing post-retirement medical and life insurance coverage to acquired employees at the same levels provided under the seller's plans constituted an amendment to the purchaser's employee welfare plans." (Compensation Planning Journal via The Bureau of National Affairs, Inc.)
[Guidance Overview] Significant Compensation and Benefit Due Dates for 2012 (PDF)
"This Compliance Calendar assumes a plan administered on a calendar year basis by an employer with a calendar fiscal year." (Aon Hewitt)
[Guidance Overview] American Health Benefit Exchanges
"In 2014, individuals and small business will be able to purchase private health insurance through state-based Exchanges. This document reflects information and guidance issued through statute, rule, or communications from the federal government concerning the activities and options as they related to the development of a health benefit exchange." (National Conference of State Legislatures)
Health Care Reform Law Requires Greater Collaboration Between HR and Finance Executives
"According to a Towers Watson/Forbes Insights survey of more than 300 HR and finance executives, both groups of respondents see changes ahead in their own roles when it comes to reward programs, as the provisions of the 2010 Affordable Health Care Act take effect." (Human Resource Executive Online)
[Guidance Overview] Prepare for Health Plan Participant Fee
"Many questions about the fee are currently unanswered, including when it must be paid. Proposed regulations are expected on this and other matters. In the meantime, Notice 2011-35 provides information for plan sponsors and issuers to ensure they have properly budgeted for this expense." (Dorsey & Whitney LLP)
State of the Union: Time to Trim the Regulatory Fat in Health Care
"As Obama continues to shift away from touting the Affordable Care Act and focus on its implementation, it's clear that streamlining federal regulations will be a top priority for the White House this year. And as one of the nation's most heavily regulated sectors, health care stands to be significantly affected." (California HealthCare Foundation)
ERISA Preemption of Michigan Paid Claims Assessment Act
"Since its enactment, several plan sponsors have wondered whether the Act will be preempted by ERISA. The courts will now weigh in on that issue in Self-Insurance Institute of America v. Snyder . . . . In that case, the Self-Insurance Institute of America, Inc. . . . seeks both a declaration that the Act is preempted by ERISA and an injunction against implementation or enforcement of the Act." (Faegre Baker Daniels LLP)
Report on 2011 U.S. and Canadian Legislative and Regulatory Developments for Health and Retirement Plans
"Much of the activity related to health care in the U.S. was focused on the implementation of the Patient Protection and Affordable Care Act of 2010 . . . . Retirement security garnered attention with U.S. Congressional hearings, governmental reports and initiatives geared to the consumer." (International Foundation of Employee Benefit Plans)
[Official Guidance] DOL Releases Semiannual Regulatory Agenda for Fall 2011
The regulatory agenda is a listing of all the regulations DOL expects to have under active consideration for promulgation, proposal, or review during the coming six- to 12-month period. (U.S. Office of Management and Budget / U.S. General Services Administration)
State Progress toward Health Reform Implementation: Timely Analysis of Immediate Health Policy Issues (PDF)
"In this paper, we combine information from the National Conference of State Legislatures . . . and [HHS] to group states based on their progress toward implementing health insurance exchanges. All designations are current as of January 17, 2011." (Robert Wood Johnson Foundation)
[Guidance Overview] DOL's Proposed New Rules that Will Affect Multiple Employer Welfare Arrangements (PDF)
"The two areas of concern are: (1) the Secretary of Labor's ability to issue a cease and desist order or a summary seizure order; and (2) the reporting and disclosure requirements for MEWAs. The DOL has also proposed revisions to the Form 5500 and the Form M-1 for MEWAs." (Conrad Siegel Actuaries)
Health Care Reform: Small Health Insurance Companies Feel Squeezed By New Law
"critics say the administration's stepped-up reviews and heightened scrutiny are more about showcasing the value of the new health law in the run-up to the 2012 elections, a charge the Department of Health and Human Services denies." (Chicagotribune.com)
[Opinion] U.S. Chamber of Commerce's Comments on Final HHS Regs for Medical Loss Ratio (MLR) Requirements Under the Patient Protection and Affordable Care Act
"[T]he Chamber . . . offers the following suggestions to further improve the rule with regard to rebate distribution requirements: 1. Simplify the rebate distribution rules for the group markets; 2. Extend the time frame during which rebates can be applied to premiums; and 3. Simplify rebate notice requirements." (U.S. Chamber of Commerce)
[Guidance Overview] Internal Claims, Appeals and External Review: a Refresher for 2012
"The new year brings new claims and appeals obligations for non-grandfathered group health plan sponsors, as the enforcement grace periods established over the past two years begin to expire. Let's start 2012 with a refresher on what's new and what's ahead." (Beyond Health Care Reform Blog)
[Guidance Overview] ERRP Reminder: March 30 Deadline for Submission of Full-Replacement Claim List
"Last month the CMS announced that the ERRP would be closed for claims incurred after December 31, 2011, due to the projected exhaustion of funds." (Deloitte via BenefitsLink.com)
Litigation and Compliance Risks for Plan Sponsors in the New Health Reform Environment
"This article addresses five aspects of [PPACA] that could result in significant costs to a plan sponsor if steps are not taken to ensure compliance: plan design mandates, internal and external claims review, enhanced notification requirements, nondiscrimination, and play or pay." (Paul Hastings LLP)
[Guidance Overview] 2011 Form M-1 Now Available; New Question Addresses Compliance with Health Care Reform Mandates
"Administrators accustomed to the detailed information in the self-compliance tool may find the references to the health care reform web page considerably less helpful, but presumably they will have worked with their advisors to confirm compliance with the health care reform mandates before preparing the filing." (Thomson Reuters/EBIA)
[Guidance Overview] Updated IRS Procedures for Issuing Letter Rulings, Determination Letters, and Other Employee Plan Guidance
"These revenue procedures are an important resource for anyone seeking plan-specific guidance from the IRS. Those new to employee benefits will welcome the practical tools offered in the procedures, including sample formats and checklists for letter ruling requests, definitions of basic terms, user fee schedules, and descriptions of how the 2012 procedures differ from their 2011 counterparts." (Thomson Reuters/EBIA)
Auditing Health Plan Dependent Eligibility
"Employers that allow dependents to be covered under their health plans need to be aware of health care reform rules that may limit their ability to retroactively remove ineligible dependents from coverage." (Perkins Coie LLP)
[Guidance Overview] Your 2012 PPACA Checklist (PDF)
"As we all know, there was a big push under PPACA for plan sponsors to amend health plans for the 2011 plan year. While there are not as many changes to be made in 2012, there is still work to do to ensure you are in compliance for the year. [First published online November 2011.]" (PLANSPONSOR.COM via Groom Law Group)
[Guidance Overview] Medical Loss Ratio Requirements Rules
"As of January 6, 2012, seventeen states have requested adjustments. Six states have received relief from application of the 80 percent MLR (Georgia, Iowa, Kentucky, Maine, Nevada, and New Hampshire).[See footnote 4] The relief allows each of these states to implement an MLR that is lower than 80 percent." (Epstein Becker & Green, P.C.)
The Expansion of Private Insurance
"[Looking at how health benefits are managed, rather than how they are financed ? it becomes clear that in some ways] we are increasingly relying on the private insurance industry to provide health coverage. And, even when coverage is publicly-managed, health care services are primarily purchased from private providers." (The Henry J. Kaiser Family Foundation)
[Guidance Overview] 2012 Reporting & Disclosure Calendar for Multiemployer Plans (PDF)
"The [calendar] summarizes compliance requirements for multiemployer plans." (The Segal Group, Inc.)
2012 Progress Report: States Are Implementing Health Reform (PDF)
"[A]ll States have taken some action to implement health reform. For example, forty-four States are participating in the new premium rate review system where insurers must justify the rationale for any double-digit insurance premium increase. And 28 States and the District of Columbia are on their way toward establishing their own Affordable Insurance Exchange ? an essential component of the law." (The White House)
Health Care Reform Update, January 17, 2012 (PDF)
Read this week's update on health care reform legislation, regulations, and initiatives. (ML Strategies, LLC)
[Guidance Overview] Health & Welfare Plan Reporting and Disclosure Checklist (PDF)
"There are numerous reporting and disclosure requirements for Health & Welfare Plans. We have expanded and replace our previous chart containing only disclosure requirements to include reporting requirements." (ERISAdiagnostics, Inc.)
[Guidance Overview] Employee Benefits & Executive Compensation Advisory: The Health & Welfare Benefit Year in Review (PDF)
"[Briefly outlined are] the major legislation, regulations and other federal guidance that either became effective or was issued in 2011 thathad or will have a profound effect on health plans and other welfare benefits." (Alston & Bird LLP)
[Official Guidance] EBSA Publishes 2011 Form M-1 for Multiple Employer Welfare Arrangements
"The 2011 Form M-1 is now available for online filing." (U.S. Employee Benefits Security Administration)
[Guidance Overview] 2012 Reporting & Disclosure Calendar for Benefit Plans (PDF)
Sibson Consulting's 2012 Reporting & Disclosure Calendar for Benefit Plans summarizes compliance requirements for qualified, single employer benefit plans. An interactive version of this calendar is available at http://www.sibson.com/publications-and-resources/rd-calendar/. (The Segal Group, Inc.)
[Guidance Overview] The ERISA Litigation Newsletter, January 2012
"This month, [an article takes] a look back at the most significant ERISA litigation decisions of the past year and what they portend for 2012. The article addresses the implications of two major Supreme Court decisions, Cigna Corp. v. Amara and Walmart Stores, Inc. v. Dukes, and developments in 401(k) plan excessive fee and employer stock drop cases. We also focus on a recent Second Circuit decision addressing the issue of when the statute of limitations on benefits claims commences, and its potential implications for both individual and class action benefit claims. As always, be sure to review the section on Rulings, Filings, and Settlements of Interest." (Proskauer Rose LLP)
[Guidance Overview] IRS Notice 2012-9 Modifies Form W-2 Reporting on Group Health Plan Coverage
"The Notice clarifies that the cost of coverage that is includible in the income of a highly compensated individual under Code ? 105(h) -- or payments or reimbursements of health insurance premiums that are includible in the income of a two percent (2%) shareholder-employee of an S corporation -- are not included in the aggregate reportable cost." (Deloitte via BenefitsLink.com)
HHS Approves More Mini-med Health Care Plan Waivers
"The Department of Health and Human Services has approved 229 new waivers for sponsors of mini-med and other limited health care plans from meeting minimum dollar coverage amounts for essential benefits each year." (Business Insurance)
Texas Asks Feds to Delay Health Insurance Medical Loss Ratio Rebates
"Seventeen states asked the federal government for relief from the new 80 percent rule. The feds analyzed their insurance markets; six states were granted permission to phase-in the new rule gradually. But eight states were turned down. A decision on the Texas request is expected any day now." (NPR)
[Guidance Overview] Form W-2 Information Reporting of Health Care Costs (PDF)
"Employers may now want to review that their payroll providers have taken appropriate steps to prepare for this new obligation. Failure to comply can result in a penalty of $200 per Form W-2, up to a maximum of $3 million." (Reinhart)
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