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May 29, 2012 Get Retirement News  |  Advertise  |  Unsubscribe  |  Past Issues  |  Search

Employee Benefits Jobs

Part Time On Call Participant Counselor
for Diversified in AR, CA, DC, GA, HI, MI, NC, NY, OH, UT

Consultant
for Associated Pension Consultants in CA

Compliance Team Leader
for Freedom One Financial Group in MI

Financial Analyst
for Evercore Trust Company, N.A. in DC

Benefits Consultant, Large Groups
for Northwestern Benefit Corporation of Georgia in GA

Senior Relationship Manager
for T. Rowe Price in MD

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[Official Guidance]
[Guidance Overview]
FAQs for Employees about the Mental Health Parity and Addiction Equity Act (PDF)
14 FAQs, directed to employees. "[The Mental Health Parity and Addiction Equity Act of 2008] generally applies to group health plans and health insur.ance issuers that provide coverage for either mental health or substance use disorder benefits and medical/surgical benefits. These FAQs provide basic information about the important protections MHPAEA provides with respect to parity in coverage of mental health and substance use disorder benefits and medical/surgical benefits provided by employment-based group health plans." (Employee Benefits Security Administration)


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[Guidance Overview]
Courts in the Fourth Circuit Continue Trend: Death from Driving While Intoxicated Is Not an 'Accident' (PDF)
"Magistrate Judge Patrick Auld, sitting in the Middle District of North Carolina, found in favor of an ERISA plan fiduciary who determined that a death resulting from driving while intoxicated was not an 'Accident' for purposes of an Accidental Death & Disability benefit under an ERISA-qualified employee benefit plan. Johnson v. American United Life Ins. Co., 2012 U.S. Dist. Lexis 32718 (M.D. N.C. 2012)." (Womble Carlyle)

[Guidance Overview]
Court Finds No Duty to Hold Participant Health Plan Contributions in Separate Trust Account
"The employee ... sued the employer for breach of fiduciary duty, alleging that the employer had failed to segregate employee contributions to the plan in a separate interest-bearing trust account. The court concluded that the employer had no such duty... [Rather] than taking comfort in this court's decision, a welfare plan sponsor not using a trust account to hold participant contributions must ensure that it satisfies the conditions of Technical Release 92-01." (Thomson Reuters/EBIA)

[Guidance Overview]
DOL web page Provides Resources And Guidance on Mental Health Parity, Including Two More Sets of FAQs
"One new set of FAQs answers common MHPAEA implementation questions, including who oversees implementation, how it interacts with state mandates, and current agency efforts promoting compliance. In particular, Q/A-5 notes that a health plan generally does not violate the MHPAEA by using a 'carve-out arrangement' with a separate managed behavioral health organization to provide utilization review and other services for mental health and substance use disorder benefits." (Thomson Reuters/EBIA)

[Guidance Overview]
HHS Releases Guidance on Exchanges, Including Draft Exchange Blueprint and Rules for Federally Facilitated Exchanges and SHOPs
"According to the guidance, federally facilitated Small Business Health Options Program ('FF-SHOPs') are expected to provide a number of tools and resources to help employers, employees, agents, and brokers evaluate coverage options. They will allow employers to model scenarios, for instance by changing the employer contribution percentage, before selecting coverage. The guidance explains that FF-SHOPs will collect a single, aggregated payment from each employer and distribute the payment to QHP insurers based on participating employee plan selections. FF-SHOPs are expected to offer additional administrative support, including employer billing, receipt of payments, disbursements to plans, and payment reconciliation." (Thomson Reuters/EBIA)


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[Guidance Overview]
Final Regulations Address Individual Tax Credit for Coverage Purchased Through Exchange
"The final regulations provide helpful clarifications but leave important questions unanswered. For example, they do not address how wellness incentives affect affordability. Also, the preamble notes that separate guidance will address how to determine minimum value." (Thomson Reuters/EBIA)

[Guidance Overview]
DOL FAQs for Employees Describe MHPAEA Compliance
"While plans may no longer have separate deductibles for medical/surgical benefits and mental health or substance use disorder benefits, they are generally permitted to combine these deductibles. The FAQs include the example of a plan that formerly had a: $500 deductible on medical/surgical benefits; and $500 deductible on mental health or substance use disorder benefits. The plan in this example could now use a combined $750 deductible for all benefits, though a separate deductible for mental health or substance use disorder benefits would not be permitted." (Practical Law Company)

With PSA Testing, The Power of Anecdote Often Trumps Statistics
"Imagine an auditorium filled with 1,000 men who had PSA screening tests and another auditorium with 1,000 men who didn't. That represents the kind of studies the federal task force was relying on.... In each auditorium, there would be eight men who died of prostate cancer. But among the thousand who got PSA tests, there would also be 20 men who were treated for prostate cancers that would never have grown and caused symptoms. And five of these needlessly treated men would have lifelong complications, such as impotence and incontinence." (National Public Radio)

Will Private Exchanges Become The New Travelocity?
"Since last year, private exchanges run by insurers have been cropping up around the country. Highmark and Blue Cross Blue Shield of Kansas City established exchanges last year. WellPoint, Blue Cross Blue Shield of Michigan and Health Care Service Corporation bought a 78 percent stake in Bloom Health, an online marketplace offering health plan options to almost 50 companies. And in Iowa, where state lawmakers decided not to pursue a state-run exchange, legislators are urging insurers to establish their own private exchanges." (FierceHealthPayer)

Insurers Forcing Patients to Pay More for Costly Specialty Drugs
"Thousands of patients in California and across the nation who take expensive prescription drugs every month for cancer, rheumatoid arthritis and other ailments are facing sticker shock at the pharmacy. Until recently, most of these patients typically paid modest co-pays for the advanced drugs.' (Los Angeles Times)

The Age Rating Game: Will Older Americans Pay More Under Health Reform?
"Today, in most states, there are no caps on how much insurers can charge a 60-something forced to purchase his own insur.ance. In the individual market, only New York State bans age rating altogether, and just three other states limit how much premiums can vary, based on age, to less than 3:1." (The Health Care Blog)

Setback for Obama Administration on Challenge to Defense of Marriage Act
"The Obama Administration's plea to speed up an appeals court's review of the constitutionality of the federal Defense of Marriage Act's ban on federal benefits for same-s.ex married couples has met a temporary setback. In an order issued last week, the Ninth Circuit Court denied the Administration's plea to send the case to an 11-judge en banc court, bypassing a three-judge panel." (SCOTUSBlog)

Costly Cancer Treatment Under Scrutiny
"According to Amitabh Chandra, a health economist at Harvard University's John F. Kennedy School of Government, these proton therapy centers are 'a metaphor for all the problems we have in American medicine' because of how they complicate the health care system.'" (American Journal of Managed Care)

EBSA Releases First Report on MHPAEA Group Health Plan Compliance
"[The] EBSA's statutorily-required report provides an overview of the MHPAEA itself, summarizes the agency's initial MHPAEA implementation efforts, discusses the MHPAEA interim final regulations issued by the EBSA, [IRS and HHS], outlines the agency's outreach and interpretive guidance efforts, and describes the agency's steps in developing an infrastructure for MHPAEA implementation." (Littler)

One in 10 Veterans Lacks Health Insur.ance
"The research, from the first-ever study to look at health coverage among veterans, finds that their uninsurance rate is just over half the level among the general population (17.9 percent).... Uninsured veterans tend to be younger than those with coverage and also less likely to have sustained an injury in combat. Uninsured veterans also tend to have higher rates of unemployment and lower levels of income and are less likely to be married—all of which lower the odds of receiving private coverage." (The Washington Post)

Medicare Beneficiaries' Out-of-Pocket Spending for Health Care (PDF)
"Medicare beneficiaries spent a median of $3,138 a year of their own money on health care in 2007, the latest year for which comprehensive data are available. Ten percent of beneficiaries—more than 4 mil.lion people—spent more than $7,861 a year. The oldest and poorest beneficiaries spent about one-quarter of their incomes on health care." (AARP Public Policy Institute)

CalPERS Must Offer Same-S.ex Couples Long-Term Care
"[A federal district judge in the Northern District of California], ruling in a state workers' lawsuit, said a federal statute outlawing g.ay marriage is unconstitutional to the extent that it bars same-s.ex spouses and domestic partners from enrolling in [the California Public Employees' Retirement System] Plan. The legislative record of the Defense of Marriage Act, which bars federal benefits to same-s.ex couples, shows evidence of anti-g.ay bias, and the act violates g.ay and les.bian couples'constitutional right to equal protection of the law, [the ruling states]. (Dragovich v. U.S. Treasury Department, 4:10-01564, N.D. Calif.)" (Bloomberg)

Life Insurer Committed Abuse of Discretion in Claim for Death Benefits Arising from 'Accident'
"[The defendant life insur.ance company, 'LINA'] appealed the district court's ruling that LINA abused its discretion in denying death benefits to Dawn McClelland based upon her husband's life insur.ance policy.... The court found that LINA committed an abuse of discretion ... because its interpretation was contrary to the language of the plan that it would cover 'loss of life' based upon an 'accident' and because substantial evidence did not support its decision. The court also found that the total [attorney] fee awarded should be $85,000 and remanded to the district court to enter an award in that amount." (Justia.com)

IRS Issues Guidance, Requests Comments on Smart Cards and Debit Cards Used for Transit Fares
"[The IRS] announced that its previous guidance on the use of electronic media to provide employees with qualified transportation fringe benefits (Rev. Rul. 2006-57) took effect Jan. 1, 2012. The effective date had been delayed several times to give transit systems more time to modify their technology to be compatible with the rules, but taxpayers could rely on the ruling even before it took effect.... The IRS [further] explained ... that when Rev. Rul. 2006-57 was issued there was not sufficient information to determine whether terminal-restricted debit cards were 'readily available.' Until the IRS issues guidance, employers are permitted to use cash reimbursement arrangements when the only available voucher or similar item is a terminal-restricted debit card." (Journal of Accountancy)

[Opinion]
Self-Insur.ance Is Good for Small Business, So Leave Stop-Loss Alone
"A Los Angeles Democrat is pushing legislation that would make self-insured health plans much riskier and expensive for small business, likely resulting in more Californians without employer-sponsored health benefits... Senate Bill 1431 sets unreasonable prohibitions on 'stop loss' insur.ance.... Although other states have established minimum attachment points, the bill's author has settled on an attachment point that is four times higher than the highest level anywhere in the nation($95,000). By pushing the dollar amount so high, California would effectively be taking self-insur.ance off the table as an option for small businesses." (MontereyHerald.com)

[Opinion]
Bloated Health Care System Needs a Trim
"In more instances than many people realize, doing more medically can be worse than doing less. Too often, costly, overly aggressive medical care causes more pain and suffering than if nothing had been done at all. Our expectations and demands of health care must change, and we must reckon with the incentives for tremendous waste that are now built into the system." (The New York Times; free registration required)

[Opinion]
Don't Force Consumers to Use Insur.ance Brokers in Purchasing Health Insur.ance Through an Exchange
"So-called navigators are supposed to act as public advisers to help connect people with appropriate plans, whether offered by Medicaid or private insurers.... The Obama administration should make clear Americans looking for help buying coverage will not be forced to use a commission-seeking broker." (The Des Moines Register)

Benefits in General; Executive Compensation

[Official Guidance]
Text of Proposed IRS Regs: Property Transferred in Connection with Performance of Services under Section 83
"The proposed regulations clarify that a substantial risk of forfeiture may be established only through a service condition or a condition related to the purpose of the transfer.... Similarly, confusion has arisen as to whether, in determining whether a substantial risk of forfeiture exists, the likelihood that a condition related to the purpose of the transfer will occur must be considered. ... A conclusion that such likelihood need not be considered would lead to anomalies not intended by the statute.... Finally, the proposed regulations would clarify that, except as specifically provided ..., transfer restrictions do not create a substantial risk of forfeiture, including transfer restrictions which carry the potential for forfeiture or disgorgement of some or all of the property, or other penalties, if the restriction is violated." (Internal Revenue Service)

Dewey Files for Chapter 11 in Record Law Firm Collapse
"Dewey's management promised millions in packages to about 100 partners, according to the court filing, leaving it strapped for cash when revenues fell during the recession." (The New York Times; free registration required)



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