Spencer’s Benefits Reports NetNews – September 30, 2016

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September 30, 2016

 

Health plan will remedy improper ‘grandfathered’ status, ERISA noncompliance

Fiduciaries of the Sierra Pacific Industries Health Benefits Plan have agreed to settle claims that they failed to comply with the Affordable Care Act (ACA) and ERISA when providing healthcare benefits and deciding worker claims for healthcare benefits. After an investigation by the DOL’s Employee Benefits Security Administration, the major western lumber producer’s plan has agreed to comply with the ACA and ERISA, to pay past benefit claims in compliance with the ACA, and to correct the way it makes decisions on future claims, EBSA said in a news release….

(Read Intelliconnect) »

Marketplace plans cost less than average employer-sponsored plan

Premiums for Patient Protection and Affordable Care Act (ACA) plans available on the health insurance exchange actually compare favorably—at 10 percent lower—than premiums for the average employer-sponsored plan, according to a recent study from the Urban Institute. The study, Are Nongroup Marketplace Premiums Really High? Not in Comparison with Employer Insurance, compared unsubsidized nongroup premiums for plans available on the ACA-created marketplace with the average premium for employer-sponsored plans, according to state and metropolitan area, and factoring in adjustments for differences in actuarial value and age distribution….

(Read Intelliconnect) »

September 29, 2016

 

2017 per diem rates issued for travel expense reimbursements

The IRS has provided the 2016-2017 special per diem rates for taxpayers to use to substantiate ordinary and necessary business expenses incurred while traveling away from home. The guidance provides the special transportation industry meal and incidental expenses (M&IE) rates, the rate for the incidental expenses only deduction, and the rates and list of high-cost localities for purposes of the high-low substantiation method. Taxpayers using the rates and list of high-cost localities provided must comply with Rev. Proc. 2011-47, IRB 2011-42, 520….

(Read Intelliconnect) »

Exchange customers satisfied, but worry about costs

Health insurance exchange customers are generally satisfied with their insurance coverage. In a required oversight survey, the Government Accountability Office (GAO) analyzed data from five national surveys of individuals enrolled in qualified health plans (QHPs) through the exchanges created by the Patient Protection and Affordable Care Act (ACA). It found that some enrollees have faced difficulties understanding QHP coverage terminology or accessing care after enrollment….

(Read Intelliconnect) »

September 28, 2016

No safe harbor, but employer’s ‘voluntary’ wellness program did not violate ADA

In the EEOC’s suit claiming an employer’s wellness program and related health risk assessment violated the ADA prohibition against medical exams and disability-related inquiries, the agency was denied summary judgment but the employer’s motion was granted in part. The wellness program did not fall within the ADA’s safe harbor provision for insurers, but a federal court in Wisconsin found that it was a “voluntary” program and so did not violate the prohibition against medical inquiries. However, the claim that the employer retaliated against an employee by firing her three weeks after she raised concerns about the wellness programs would go to trial….

(Read Intelliconnect) »

California lawmakers to HHS: Let our undocumented immigrants buy insurance

An estimated 170,000 additional Californians could access health insurance coverage if HHS approves California’s Section 1332 waiver to allow undocumented California residents to purchase health insurance on the state’s health insurance marketplace. A letter sent to HHS by California Democrats urging HHS to grant the waiver, noted that the request is consistent with the requirements stipulated by Section 1332, will expand access, and will not impact the federal budget….

(Read Intelliconnect) »

September 27, 2016

 

IRS webinar addresses full-time employee status under ACA

An IRS webinar, “Determining Full-Time Employee Status under the Affordable Care Act,” held on September 22, provided information on determining full-time employee status for the Employer Shared Responsibility provisions of the Code. Topics discussed included how to determine full-time status for seasonal and part-time employees and using the look-back method and monthly measurement method….

(Read Intelliconnect) »

ACA led to lower out-of-pocket expenses for many

Although the Patient Protection and Affordable Care Act (ACA) succeeded in its goal of expanding the percentage of Americans with health insurance coverage, it did not remove the possibility of prohibitively high out-of-pocket and premium costs. A study by the Commonwealth Fund found that significant reductions in combined out-of-pocket and premium costs were realized by residents of states where marketplace enrollment increased the most. The study concluded that the net effect of the ACA’s marketplace subsidies, cost-sharing reductions, out-of-pocket protections, and rating changes has been to reduce the number of people facing substantial costs….

(Read Intelliconnect) »

September 26, 2016

 

Clinton and Trump health reform proposals could both add to deficit, Commonwealth Fund says

Two new Commonwealth Fund reports analyze the different approaches to health reform by Hillary Clinton and Donald Trump. Trump proposes to repeal and replace the Affordable Care Act (ACA), while Clinton wants to maintain and modify it. The Commonwealth Fund reports find that some of Clinton’s proposals would increase the number of people with insurance by between 400,000 and 9.6 million in 2018, while some of Trump’s proposals would decrease the number of people with insurance by between 15.6 million and 25.1 million….

(Read Intelliconnect) »

ACA oversight: fright or partisan fight?

Lawmakers examined the outlook and oversight of the Patient Protection and Affordable Care Act (ACA) in a hearing held by Energy and Commerce Committee Subcommittee on Oversight and Investigations. Although 20 million more people have health insurance, six years after the enactment of the health reform law, the hearing raised concerns that agency mismanagement and consumer fraud are plaguing the ACA….

(Read Intelliconnect) »

Plan consultant not liable as ERISA fiduciary for erroneous calculation of participant’s benefits

A pension plan consultant who was charged only with calculating and communicating participant benefits lacked sufficient discretionary authority over the administration of the plan to qualify as a fiduciary under ERISA, according to the Tenth Circuit U.S Court of Appeals. As the consultant was not a fiduciary, neither her employer nor the plan could be subject to fiduciary liability for the erroneous calculation of a participant’s pension benefits….

(Read Intelliconnect) »