Spencer Benefits Reports Netnews – November 20, 2015

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Featured This Week


New Reports




November 20, 2015


Text: EBSA, proposed regulation, claims procedure for plans providing disability benefits

(Read Intelliconnect) »

A brief break at Spencer’s Benefits Reports

Spencer’s Benefits Reports is taking a brief break. Spencer’s news and reports will not be issued November 23 through 27. Publication will resume on November 30, 2015. Happy Thanksgiving to all of our subscribers.

(Read Intelliconnect) »

Proposed rule strengthens internal claim procedures for disability benefits

The Employee Benefit Security Administration (EBSA) has issued proposed regulations that would enhance existing disability benefit claims procedures under Sec. 503 of the Employee Retirement Income Security Act (ERISA). In issuing these proposed regulations, EBSA hopes to apply to disability benefits many of the claims procedural protections and safeguards that have been applied to group health plans under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148)….

(Read Intelliconnect) »

Premium increase modest, but employee out-of-pocket costs jump dramatically

While premium rate increases were modest in 2015 (a 2.4 percent increase over 2014), employee’s out-of-pocket costs continue to increase dramatically, according to recent research from United Benefit Advisors (UBA). The
2015 UBA Health Plan Survey found that median in-network deductibles for single plans increased 33 percent, from $1,500 in 2014 to $2,000 in 2015. For family plans, deductibles remained unchanged at $4,000….

(Read Intelliconnect) »

Most legislative attacks against ACA have failed

Many legislative actions meant to defeat the Patient Protection and Affordable Care Act (ACA) (have not made it past the Republican-led House of Representatives, as, up until relatively recently, the Senate was under Democratic control. A report by the Congressional Research Service (CRS) details the legislative actions to repeal, defund, or delay the ACA as well as the general effects of the ACA on federal spending….

(Read Intelliconnect) »

November 19, 2015


Text: IRS, HHS, DOL, final rules for grandfathered plans, preexisting condition exclusions, lifetime and annual limits, rescissions, dependent coverage, appeals, and patient protections under the ACA

(Read Intelliconnect) »

Interim no more, ACA insurance reforms promoted

A final rule governing grandfathered health plans, preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, coverage of dependent children to age 26, internal claims and appeal and external review processes, and patient protections under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) has been issued by the Departments of Labor, Treasury, and Health and Human Services; no major changes to a previous interim final rule (75 FR 34538, June 17, 2010) nor to the interim final rule as interpreted under current guidance were made. The final rule has an effective date of January 19, 2016, and an applicability date for group health plans and health insurance issuers beginning on the first day of the first plan year (or, in the individual market, the first day of the first policy year) beginning on or after January 1, 2017….

(Read Intelliconnect) »

Majority of employers focusing health benefit strategies on avoiding the Cadillac tax

The vast majority of employers (76 percent) are focusing their health benefits strategies on avoiding the Patient Protection and Affordable Care Act’s (ACA) (P.L. 111-148) Cadillac tax on high-cost health plans, according to recent research from the Midwest Business Group on Health (MBGH). The survey found that priorities for 2016-2017 are increasing employee engagement in health improvement programs (81 percent) and using preventive services (77 percent)….

(Read Intelliconnect) »

November 18, 2015


Artist asks Supreme Court to review Senate’s “gut-and-replace procedure”

The Pacific Legal Foundation (PLF), on behalf of Matt Sissel, has asked the Supreme Court to hear PLF’s Origination Clause challenge to the Patient Protection and Affordable Care Act (ACA). Both trial and appellate courts previously rejected Sissel’s claims, and in August 2015, the Court of Appeals for the District of Columbia Circuit denied Sissel’s petition for rehearing
en banc….

(Read Intelliconnect) »


Federal interest rates announced for pensions

The following interest rates have been announced for use in the operation and administration of qualified pension plans…

(Read Intelliconnect) »

PPOs on the decline in marketplace; HMOs increase

Analyses from Avalere Health and the Robert Wood Johnson Foundation (RWJF) indicates that the number of preferred provider organization (PPO) plans offered in the health insurance marketplace have decreased for the 2016 coverage year. Avalere suggests that marketplace PPO offerings decreased from 39 percent in 2014 to 27 percent in 2016; RWJF indicates that PPOs have been eliminated, “or greatly reduced” for 2016. Avalere also found that the percentage of health maintenance organizations (HMOs) increased from 41 percent in 2014 to 50 percent in 2016. Elizabeth Carpenter, vice president at Avalere, suggests the trend “is an indicator that exchange plans are moving toward networks with fewer providers….”


(Read Intelliconnect) »

November 17, 2015


HSA enrollment shows dramatic growth, new census survey shows

There has been an increase of approximately two million enrollees in Health Savings Account (HSA)-eligible insurance plans since January 2014, according to a new census released today by America’s Health Insurance Plans (AHIP), for a total of 19.7 million Americans with such coverage. The census of people covered by health savings accounts/high-deductible health plans (HSAs/HDHPs) is conducted annually by AHIP, which found that the large group market continues to lead in enrollment gains, and now represents 78 percent of all enrollment in these plans….

(Read Intelliconnect) »

Chamber of Commerce decries IRS’s expanded definition of minimum value

The Chamber of Commerce has submitted comments to the IRS in response to recent proposed regulations that provide guidance on determining whether health coverage under employer-sponsored plans provide minimum value (MV). The Chamber argues that MV should not be assessed based on the coverage of any specific benefits, much less be tied indirectly to the Patient Protection and Affordable Care Act’s (ACA) (P.L. 111-148) definition of essential health benefits….

(Read Intelliconnect) »


November 16, 2015


Montana updates procedures for external reviews of health insurers

Starting January 1, 2016, Montana law will no longer be preempted by federal law regarding external reviews of health insurers, according to an advisory memorandum issued by the Commissioner of Securities and Insurance (CSI) of the Office of the Montana State Auditor. Montana S.B. 83 of 2015 goes into effect on that date, and the Center for Consumer Information and Insurance Oversight has determined that the law satisfies certain federal minimum standards that Montana law had previously failed to meet, according to the memorandum….

(Read Intelliconnect) »

PBGC issues December 2015 interest rates for valuing terminating pension plans

For single-employer pension plans terminating October through December 2015, and for multiemployer plans involved in a mass withdrawal, the interest rate established by the PBGC for calculating immediate annuities is 2.46 percent, up from the 2.32 percent rate that applied in July through September 2015. The interest rate for calculating immediate lump sums in December 2015 is 1.25 percent, the same rate that applied in November 2015….

(Read Intelliconnect) »


EBSA clarifies its views on plan fiduciaries’ duties concerning economically targeted investments

The Employee Benefits Security Administration (EBSA) has issued new guidance clarifying the obligations of retirement plan fiduciaries related to the consideration and selection of economically targeted investments (ETIs) for their plans. ETIs are investments that are selected for the collateral economic or social benefits they create in addition to the investment return to the plan investor. EBSA is withdrawing Interpretive Bulletin 2008-01 and replacing it with the new guidance that reinstates the language of Interpretive Bulletin 94-1….

(Read Intelliconnect) »