Spencer’s Benefits Reports NetNews – March 11, 2016

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March 11, 2016


IRS reminds employers of their new reporting responsibilities for 2016

The IRS is reminding employers that they may have new information reporting responsibilities this year, depending on their size, and on whether or not they sponsor self-insured health coverage. As such, employers and health insurance providers should familiarize themselves with the various reporting requirements found in Sections 1502 and 1514 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). According to the ACA, certain employers—known as applicable large employers or ALEs—may be required to make an employer shared responsibility payment to the IRS if they do not offer health coverage that is “affordable” and that provides “minimum value” to full-time employees and their dependents. Also, all employers that sponsor self-insured health coverage—whether or not the employer is an ALE—have additional information reporting responsibilities that apply to health coverage providers….

(Read Intelliconnect) »

ICI survey shows more U.S. households view DC plans favorably

A majority of U.S. households have a favorable opinion of 401(k) plans and other similar retirement plans, according to an Investment Company Institute (ICI) report presenting survey results collected between mid-November 2015 and mid-December 2015. In the fall of 2015, 72 percent of U.S. households had very favorable or somewhat favorable impressions of defined contribution (DC) plan accounts, a little higher than 71 percent in the fall of 2014 and up from 66 percent in the fall of 2013….

(Read Intelliconnect) »

March 10, 2016


Expert reminds employers that 2015 transition relief has expired for 2016 plan year

In 2015, employers were able to take advantage of several different types of transition relief from some of the Patient Protection and Affordable Care Act’s (ACA) (P.L. 111-148) requirements. However, at a recent webinar,
What’s New With the ACA? Planning for 2016 and Beyond, sponsored by Ultimate Software, experts reminded employers that many of these transition rules expired in 2015. “It is important that you be aware of these and make adjustments,” noted Ann Carr Mackey, attorney at Ogletree Deakins….

(Read Intelliconnect) »

More states team up in fight against MCO provider fee

Six states have filed a complaint against the federal government, including HHS and the IRS, over the Health Insurance Providers Fee implemented by section 9010 of the Patient Protection and Affordable Care Act (ACA). Texas, Kansas, Louisiana, Indiana, Wisconsin, and Nebraska dispute the substantial fees on a constitutional basis, arguing that the ACA did not provide that states were required to pay the fee or risk the loss of federal matching funds for Medicaid and Children’s Health Insurance Program (CHIP) managed care. The states believe that they were not provided clear notice on the conditions of accepting federal funding….

(Read Intelliconnect) »

March 9, 2016


FAQs address how moratorium on 2017 fee will impact plan year rate changes

CMS’ Center for Consumer Information and Insurance Oversight has issued frequently asked questions (FAQs) on the 2017 moratorium on the health insurance provider fee. The Consolidated Appropriations Act, 2016 (P.L. 114-113) suspended collection of the fee for the 2016 calendar year. Thus, health insurance issuers are not required to pay the fee in 2017….

(Read Intelliconnect) »


HHS toughens up special enrollment weak spots

Health care consumers wishing to purchase health care coverage from the HealthCare.gov platform are going to have to start providing proof that they qualify to enroll during off times. Concerned that some individuals are waiting to purchase health coverage until they are sick, CMS is requiring these individuals to provide documentation when enrolling during special enrollment periods (SEPs). CMS also made clear that the new requirements are in no way meant to deter anyone from enrolling, they are only to avoid the use or misuse of SEPs….

(Read Intelliconnect) »

March 8, 2016


Vermont to seek ACA innovation waiver from federal SHOP requirement

The governor of Vermont signed into law a measure directing the Commissioner of Vermont Health Access, the agency that manages the state’s publicly funded insurance programs, to seek a waiver of the federal requirement to establish an Internet-based Small Business Health Options Program (SHOP), an Internet portal for employers to obtain health insurance for their employees. The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) permits states to apply for a five-year State Innovation Waiver of certain of its requirements, beginning January 1, 2017, to implement different ways of meeting PPACA coverage requirements….

(Read Intelliconnect) »

Lax oversight and improper payments alleged in HealthCare.gov

“CMS has assumed a passive approach to identifying and preventing fraud” in the federal health insurance marketplace, according to a Government Accountability Office (GAO) report. During undercover testing by the GAO, the federal marketplace approved subsidized coverage for 11 of 12 fictitious GAO phone or online applicants for 2014. These applicants obtained a total of about $30,000 in annual advance premium tax credits, plus eligibility for cost-sharing reductions at time of service. The fictitious enrollees maintained subsidized coverage throughout 2014, even though the GAO sent fictitious documents, or no documents, to CMS to resolve application inconsistencies. When asked about the GAO report at a House Energy and Commerce Committee hearing on the HHS budget, Secretary Burwell stated “with regard to the issue of making sure the right people are getting any taxpayer subsidy, we take it very seriously….”

(Read Intelliconnect) »


March 7, 2016


ERISA preempts Vermont’s health insurance reporting law

A Vermont statute that requires health insurers and other entities to report payments related to health care claims so that the information can be included in an all-inclusive health care database was preempted by ERISA, the U.S. Supreme Court has ruled in a 6-2 opinion. The duties imposed by the state law are inconsistent with ERISA’s central aim: “to provide a single uniform national scheme for the administration of ERISA plans without interference from laws of the several States even when those laws, to a large extent, impose parallel requirements,” Justice Kennedy wrote for the majority. Consequently, the Vermont law was invalid as applied to ERISA-covered plans….

(Read Intelliconnect) »

HealthCare.gov failures result of CMS and HHS missteps

The Office of Inspector General (OIG) reported on the implementation of HealthCare.gov in a review that spanned five years. The agency identified major missteps by CMS and HHS that contributed to the website’s breakdown at launch and reported steps taken to correct the problems in time for implementation of the federal marketplace through the second open enrollment period. In conducting the review, the OIG interviewed 86 current and former HHS and CMS officials, staff, and contractors who were involved with the website and examined thousands of documents, including management reports, internal correspondence, and website development contracts….

(Read Intelliconnect) »


Plan sponsor not liable as fiduciary for continued plan investment in company stock

The sponsor of a plan that delegated control over plan assets to an investment oversight committee was not a fiduciary subject to liability under ERISA for continued plan investment in artificially inflated company stock, according to a federal trial court in Texas. In addition, company officers who appointed the investment oversight committee did not breach a duty to monitor, as they were not required to keep the appointees apprised of material, non-public information affecting the stock….

(Read Intelliconnect) »