Spencer Benefits Reports NetNews – September 4, 2015

About this Newsletter

The Spencer’s Benefits Reports is a summary of the week’s news items posted
in the WHAT’S NEW pages of Spencer’s Benefits Reports
For questions regarding this email service, contact Customer Service at (800)449-9525.

NetNews Subscription

Want to receive these Newsletters via E-mail?

hr.cch.com Resources

About Links in this Newsletter

To access the IntelliConnect™ full text documents you must be a subscriber
to the Spencer’s Benefits Reports IntelliConnect product
(depending on the link*).

Links within news stories display full text documents including legislation, regulations,
court decisions, rulings and government reports.

The first time you click on a link you will be taken to the IntelliConnect login page, where you will need to enter your ID and password. Subsequent links will take you directly to the desired document.


If you aren’t a subscriber call 800-449-9525, or let us contact you about,

Email Us

Contact us by sending an e-mail to

New Reports




September 4, 2015


Without rainy day preparations, share of employers subject to Cadillac tax will grow

If employers offering health benefits do not change their plans and health benefit costs increase at expected rates, the share of employers potentially affected by the Affordable Care Act’s tax on high-cost health plans, known as the Cadillac tax, will grow from 26 percent in 2018 to 42 percent in 2028. In a new analysis titled
How Many Employers Could Be Affected by the Cadillac Plan Tax?, the Kaiser Family Foundation (KFF) estimated the percentage of employers who offer one or more plans that would reach Cadillac tax thresholds for some employees and who would face a choice between paying the tax or restructuring their benefits to avoid it….

(Read Intelliconnect) »

Financial incentives greatly increase wellness plan participation

Offering financial incentives to workers to participate in workplace wellness programs has a big impact on the programs’ success, according to recent research from the Employee Benefit Research Institute (EBRI). Examining 2013 patient data with one large Midwest employer that enhanced its incentives to encourage participation in its wellness program, EBRI found a huge increase in the share of workers taking health risk assessments (HRAs) and biometric screenings, designed to identify chronic medical conditions….

(Read Intelliconnect) »

September 3, 2015


Employer plans that do not provide hospital coverage and physician services do not provide minimum value

The IRS has issued proposed regulations providing that an eligible employer sponsored group health plan does not provide minimum value if it excludes substantial coverage to employees for in-patient hospitalization services or physician services (or both). The proposed regulations are a response to reports that certain group health plan benefit designs that do not provide coverage for in-patient hospitalization services were being promoted to employers as plans that satisfy minimum value (MV) requirements as determined through use of the on-line MV calculator (known as “skinny” plans). The proposed regulations will apply for plan years beginning after November 3, 2014. However, for purposes of the employer shared responsibility provisions, the changes to the minimum value regulations may not apply before the end of the plan year beginning no later than March 1, 2015….

(Read Intelliconnect) »

Federal health care spending likely to exceed $1 trillion in 2015

The Congressional Budget Office (CBO) estimates that federal spending for major health care programs will jump about 13 percent ($106 billion) in 2015. Of this amount, $49 billion will be for Medicaid outlays due to the enrollment of the program’s newly eligible expansion population under section 2001 of the Patient Protection and Affordable Care Act (ACA). Total federal health spending is expected to be about $1.035 trillion for 2015, while the CBO projects that by 2025, $1.899 trillion will go toward Medicare, Medicaid, health insurance subsidies, and the Children’s Health Insurance Program (CHIP)….

(Read Intelliconnect) »

Teacher “threatened” after taking leave to care for son has FMLA claims revived

While an African-American teacher whose contract was not renewed after multiple absences due to his diabetes and/or to care for his son (who suffered from sickle cell anemia) failed to convince the Seventh Circuit U.S. Court of Appeals to revive his claims of race and disability bias and retaliation, he was given the go-ahead for a trial on his FMLA claims. Affirming summary judgment against him in part and reversing in part, the appeals court found that he never requested an accommodation, was not a qualified individual, and failed to provide adequate comparator evidence. However, his FMLA interference and reprisal claims were supported by his principal’s alleged comments suggesting he would suffer repercussions if he took any more time off to care for his son….

(Read Intelliconnect) »

September 2, 2015


Consumers give employer-based coverage a run for its money

Americans are spending more time evaluating their insurance options and are securing coverage from sources other than their employer. That’s according to “U.S. Attitudes Toward Health Insurance and Healthcare Reform,” a study by Valence Health. Survey data also reveals that consumers consider a health plan’s cost the most important factor when selecting coverage….

(Read Intelliconnect) »


Specialty pharmacy costs increase dramatically in 2015

Specialty pharmacy costs have jumped to 22.7 percent in 2015, up from 18.2 percent in 2014, according to recent research from Aon. The survey of 60 health care vendors found that average pharmacy cost trends, including specialty drugs, are expected to increase 10 percent, up from 6.3 percent in 2014….

(Read Intelliconnect) »

September 1, 2015


TPA with control of claims process must defend ERISA action against health plan

The Mental Health Parity and Addiction Equity Act of 2008 (the Parity Act) is enforceable by a beneficiary of a health plan in an action against the third party administrator to enjoin alleged violations under ERISA Sec. 502(a), and the third party administrator (TPA), which exercised total control over the claims process, is the proper defendant. In addition, the New York Psychiatric Association (NYPA) has standing to enforce the claims of its members against a health plan for violation of the Parity Act….

(Read Intelliconnect) »

Majority of remaining uninsured adults potentially eligible for full or subsidized coverage

One in 10 nonelderly adults remained uninsured as of March 2015, and 70.8 percent of them were potentially eligible for full or subsidized coverage through Medicaid or the health insurance marketplace. Most adults motivated to secure health insurance have already enrolled. An Urban Institute Health Policy Center report analyzed data collected in the March 2015 round of its Health Reform Monitoring Survey (HRMS) to analyze the type of adults that remain uninsured after two open enrollment periods and Medicaid expansion in various states, including their eligibility for financial coverage assistance under the Patient Protection and Affordable Care Act (ACA), and their reasons for remaining uninsured….

(Read Intelliconnect) »


Get Covered Illinois accepting applications for counselor positions

The Illinois Department of Public Health (IDPH) and Get Covered Illinois (GCI) is accepting applications from community organizations and other qualified entities that wish to participate in the 2016 Get Covered Illinois’ In-Person Counselor (IPC) Program, the outreach and education arm for the Patient Protection and Affordable Care Act (ACA) in Illinois….

(Read Intelliconnect) »


August 31, 2015


Vehicle-related benefits continue to rank high with corporate America

Powered by signs of an economic recovery, automobile allowances continue to be popular employee benefits programs for United States companies according to a new survey, “Vehicle-Related Benefits Programs” by WorldatWork and underwritten by Runzheimer International. WorldatWork conducted the 2015 survey of its membership to better understand the prevalence and perceptions of vehicle-related benefits programs. WorldatWork conducted similar vehicle-related surveys in 2011 and 2008….

(Read Intelliconnect) »

Employer-sponsored insurance mostly follows existing trends

Many changes in the employer-sponsored insurance (ESI) market from 2013 to 2014 are continuations of trends occurring over the 2003 to 2014 time period, according to the Medicare Expenditure Panel Survey (MEPS) Insurance Component Chartbook for 2014, issued by the HHS Agency for Healthcare Research and Quality (AHRQ). These include a small decline in offers of insurance coverage, a small increase in premiums, and increases in deductibles. The survey of 39,000 establishments, which garnered a 70 percent response rate, evaluated data by national trends, state variations, and firm sizes relevant to provisions of the Patient Protection and Affordable Care Act (ACA) defining small and large employers….

(Read Intelliconnect) »


After Supreme Court remand, ‘nothing changed’ in failed contraceptive mandate challenge

The Sixth Circuit U.S. Court of Appeals reaffirmed its position that the religious accommodation for the Patient Protection and Affordable Care Act (ACA) contraceptive mandate does not violate the Religious Freedom Restoration Act. After reviewing the Supreme Court’s decisions in
Burwell v. Hobby Lobby Stores, Inc. and Wheaton College v. Burwell, the appeals court adhered to its prior opinion—that a preliminary injunction was inappropriate because it was unlikely that the challengers would succeed on the merits of their claims—finding that “nothing in
Hobby Lobby” changed that conclusion….

(Read Intelliconnect) »