May 2013
From the editors of CCH's BENE and BAN products, here are hot topics from recent Employee Benefits Management Directions newsletters as well as recent explanatory updates in Employee Benefits Management. Also included are recent explanatory updates to the Benefits Answers Now product.
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Hot Topics in Employee Benefits Management:
Agencies issue proposed regulations on 90-day waiting period limitation under ACA, Employee Benefits Management Directions, Issue No. 537, April 9, 2013 — The Internal Revenue Service, the Department of Labor, and the Department of Health and Human Services have issued a proposed rule that implements the 90-day waiting period limitation under the Patient Protection and Affordable Care Act (ACA).
IRS posts Retiree Drug Subsidy taxation FAQs, Employee Benefits Management Directions, Issue No. 537, April 9, 2013 — The Internal Revenue Service (IRS) has posted on its website Frequently Asked Questions (FAQs) regarding Retiree Drug Subsidy (RDS) taxation. These FAQs include scenarios on RDS-related tax provisions for plan sponsors.
SHOP Exchange choices under Affordable Care Act delayed until 2015 , Employee Benefits Management Directions, Issue No. 538, April 23, 2013 — The Department of Health and Human Services has provided transition relief that would allow Small Business Health Option Program (SHOP) exchanges to only offer one health insurance option until 2015.
Medical loss ratio reporting procedures for 2012 reporting year announced, Employee Benefits Management Directions, Issue No. 538, April 23, 2013 — The Center for Consumer Information and Insurance Oversight (CCIIO) has issued a memorandum that outlines the process by which health insurance issuers will submit their medical loss ratio (MLR) data to fulfill reporting obligations under the MLR provisions of the Patient Protection and Affordable Care Act (ACA). The report for the 2012 MLR reporting year must be filed by June 1, 2013.
What's New in Employee Benefits Management:
Waiting period — The proposed regulations on the 90-day waiting period limitation (see story above) are discussed at ¶10,100.
Fiduciary duty — The failure on the part of the trustees of a welfare benefit plan to collect contributions from participating employers sufficient to cover the plan's liabilities was a breach of fiduciary duty, the U.S. Court of Appeals for the Second Circuit (CA-2) has ruled. The decision in L.I. Head Start Child Development Services v. Economic Opportunity Commission of Nassau County, Inc. is discussed at ¶130,180.
MEWAs — The EBSA has published final rules, in accordance with the Patient Protection and Affordable Care Act (ACA) on reporting requirements for multiple employer welfare arrangements (MEWAs) and entities claiming exception (ECEs), along with details on its enforcement authority to crack down on fraudulent health plans. The rules are discussed at ¶10,020.
Executive compensation — The IRS has released proposed regulations on the application of the $500,000 deduction limitation for remuneration provided by certain health insurance providers under Code Sec. 162(m)(6). The regulations are discussed at
¶100,050.
What's New in Benefits Answers Now (BAN):
Agencies issue proposed regulations on 90-day waiting period limitation under Patient Protection and Affordable Care Act. The Internal Revenue Service, the Department of Labor, and the Department of Health and Human Services have issued a proposed rule that implements the 90-day waiting period limitation under the Patient Protection and Affordable Care Act (ACA). The ACA provides that a group health plan or health insurance issuer offering group health insurance coverage shall not apply any waiting period that exceeds 90 days. This 90-day waiting period limitation applies to both grandfathered and non-grandfathered group health plans and group health insurance coverage for plan years beginning on or after Jan. 1, 2014. To find out more about allowable waiting periods, see ¶20,110.
HHS amends SHOP standards in proposed rule. The Department of Health and Human Services has issued a proposed rule that would implement provisions of the Patient Protection and Affordable Care Act (ACA) regarding health insurance exchanges and the Small Business Health Option Program (SHOP). Specifically, this proposed rule would amend existing regulations regarding triggering events and special enrollment periods for qualified employees and their dependents and would implement a transitional policy regarding employees’ choice of qualified health plans (QHPs) in the SHOP exchange. Find out more about the SHOP exchanges at ¶20,065.
EBSA extends transition period for state external review process under health reform. EBSA has issued a technical release that provides guidance for states on state external review processes under the Patient Protection and Affordable Care Act (ACA). T.R. 2013-01 also extends the applicability of the temporary National Association of Insurance Commissioners (NAIC)-similar process standards until January 1, 2016. For more information about the external review process, see ¶20,057.
Survey highlights important role of incentives in U.S. employers’ efforts to improve workforce health and performance. Incentives—in the form of both rewards and consequences—are playing an increasingly important role in helping employers drive participation in health programs and encouraging employees to take actions to improve their health, according to new survey findings from Aon Hewitt. The survey of nearly 800 large and mid-size U.S. employers representing more than 7 million U.S. employees found that 83 percent offer employees incentives for participating in programs that help employees become more aware of their health status. These actions may include taking a health risk questionnaire (HRQ) or participating in biometric screenings. An overview of the incentive-based wellness programs can be found at ¶23,105.
What's New in Spencer’s Benefits Reports:
FMLA. These reports summarize the provisions of the FMLA, including recent final regulations (Reports 327.1.-1 and 327.1.-5).
HIPAA Privacy Standards. This report provides three model documents employer plans might use in complying with the HIPAA privacy rules (Report 502.-27).
Health Insurance Exchanges. Under the ACA, by 2014, states will be required to establish Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges. This report describes the basic Exchange provisions (Report 540.-1).
MEWAs. DOL regulations set forth the criteria to determine whether a health care benefit plan is collectively bargained and, therefore, exempt from state regulations governing multiple employer welfare arrangements (MEWAs). This report analyzes the DOL regulations (Report 606.1.-1).
Preventive Care. The ACA includes a requirement that group health plans provide coverage, without cost-sharing, for certain preventive services. This report details regulations issued on this provision since 2010 (Report 514.1.-1).
New Pension/Benefits Titles Added:
401(k) Advisor (May 2013)
Benefits Law Journal (Summer 2013)
Employee Benefit Plan Review (May 2013)
Journal of Pension Planning and Compliance (Summer 2013)
Pension Benefits (May 2013)