Senior Tax Qualified Plans Specialist
for New York Life Insurance Company - Investments Group in NY

Benefits Assistant
for Arnold & Porter LLP in DC

Benefits Analyst
for Genuine Parts Company in GA

Defined Benefit Pension Analyst
for The Angell Pension Group, Inc. in RI

Retirement Plan Consulting, Administration & Design
for Retirement Plan Design, Consulting and Administration Business in CT, NY

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COBRA, HIPAA, Affordable Care Act Compliance Webcast
Nationwide on September 6, 2012 presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

COBRA, HIPAA, Affordable Care Act Compliance Webcast
Nationwide on September 7, 2012 presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

COBRA, HIPAA, Affordable Care Act Compliance Webcast
Nationwide on September 5, 2012 presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

Gateway St. Louis ASPPA Benefits Council - Legislative and Regulatory Update
in Missouri on September 19, 2012 presented by ASPPA Benefits Council of Greater St. Louis

 

[Guidance Overview]

IRS Issues 'Safe Harbor' Guidance on Full-time Employee Status and 90-Day Waiting Periods
"The guidance on determining full-time employees is primarily of importance to 'applicable large employers' with significant cohorts of seasonal employees (such as in the retail and agricultural sectors), and employees who fluctuate between full- and part-time working schedules (called 'variable hour employees' in the new guidance)." (E is for ERISA)

[Advert.]

Public Funds Defined Contribution Summit – Sept. 13 Washington DC

Free registration for qualified plan sponsors. Sponsored by Pensions & Investments - learn how to develop a defined contribution plan that meets the needs of your organization and your participants. Register now.

[Guidance Overview]

IRS Issues Q&As on ACA's Additional Medicare Tax
"Employers are responsible for withholding the Additional Medicare Tax. The tax is also levied on self-employed individuals whose incomes exceed the specified thresholds. (Self-employed individuals are not permitted to deduct this additional tax as a business expense.) Liability for the Additional Medicare Tax is on the employee only—there is no employer match." (Mintz Levin)

Utah Uninsured: State Health Plan Is Not Working
"Utah is sometimes held up as a model, because the Beehive State has adopted an insurance exchange ... But statistics now show Utah's percentage of residents who are uninsured is higher than ever at 13.4 percent, or 377,700 Utahns who are without coverage. And for some groups, the rate is even higher: 24 percent of young adults between age 19 and 34, 26 percent of adults with part-time jobs and 29 percent of those who are self-employed. Utahns earning less than $14,867 a year are four times more likely to be uninsured." (The Salt Lake Tribune)

Long-Term Disability Claims Rise As Coverage Falls
"The nonprofit Council for Disability Awareness warns that the number of employees protected by private disability income insurance declined in 2011 for the third consecutive year, while the number of long-term disability claims continued to rise. Top long-term disability insurance carriers paid $9.3 billion in 2011, according to the CDA, a 2% bump over 2010. Insured lives covered by employer-paid and employer-sponsored group long-term disability programs declined by half a percent." (Employee Benefit News)

California Crackdown on Small-Business Health Care Self-Insurance Faces Delay
"Efforts to more closely regulate a controversial form of healthcare self-insurance being sold to small employers ran into business opposition in the final weeks of the Legislature's session and got shelved for now.... Such policies guarantee that small employers won't be responsible for medical payments more than a certain amount per employee, perhaps as low as $10,000 or $20,000, with the rest paid by an insurer. Regulators and health-policy experts said this arrangement undercuts the notion of self-insurance because employers aren't bearing much of the risk." (Los Angeles Times)

[Advert.]

Executive Forum on Creating A Culture of Health - October 8-9, Chicago

Shifting organizational norms and behaviors to embody a true Culture of Health results in an exponential rise in employee health, engagement and performance. Gain perspectives to restructure resources and chart next steps in transforming your workforce.

Agencies Issue Notices on 'Full Time,' 90-Day Waiting Period Limitation Under ACA
"Internal Revenue Service Notice 2012-58 allows employers to rely on wages reported on employees' W-2 forms to determine whether health care coverage is affordable under the Affordable Care Act.... IRS has not yet ruled on how income will be defined to determine whether coverage is affordable. ACA stipulates that coverage will be considered affordable if the cost of a plan does not exceed 9.5 percent of the employee's household income, Notice 2012-58 noted." (Bloomberg BNA)

Corporate Health Care Exchange Survey
"Nearly all employers (94%) are committed to offering and financially supporting health benefit coverage for their workforce in the foreseeable future. The commitment is there but what about the solution? The average cost of health coverage per employee crossed the $10,000 mark for the first time in 2012. The cost of health care is projected to increase at an average rate of 7% to 10% in 2012. Meanwhile, salaries are expected to increase about 3% on average. This tenuous dynamic, coupled with the fact that many employees are becoming more educated and better stewards of their own health care choices, makes now the ideal time to explore other health care coverage options, including Exchanges." (Aon Hewitt)

The Emergence of Private Health Insurance Exchanges Fueling the 'Consumerization' of Employer-Sponsored Health Insurance (PDF)
"Health insurance in the U.S. is at the cusp of a major transition from an employer-driven payor model to a model directly involving many more employees and consumers. Private health insurance exchanges with a defined contribution approach represent a significant step toward catalyzing this change.... [This paper considers] the impact of this change on the payor industry and the strategic approach that leading companies need to take." (Booz & Company)

Employers Are Focused on Cutting Benefit Costs Before Cadillac Tax
"Although implementation of the 40% excise tax, better known as the 'Cadillac tax,' on high-cost health insurance doesn't go into effect until 2018, employers already are using a variety of tactics to drive down medical costs. Strategies include more employee cost sharing, greater use of consumer-directed health plans and financial incentives to encourage participation in wellness programs ... Most large employers are in the final stages for 2013 plan designs, yet many are deciding to make changes over a period of years, rather than make drastic changes just before 2018[.]" (AISHealth.com; free registration required)

HHS Says Health Plans Cannot Discriminate Against Transgender People
"With HHS declaring that it would be discriminatory for employers, insurers and others to deny health insurance coverage or benefits based on 'gender identity or failure to conform to stereotypical notions of masculinity or femininity,' advocates hope that transgender people—those who identify with a sex other than the one they were born as—will take another step toward achieving equality in health care." (Kaiser Health News)

HHS Clarifies Content Requirements for Benefit Denials by Governmental Health Plans
"Health care reform's requirement that non-ERISA plans comply with the DOL claims procedure rules is a significant obligation, requiring these plans to implement not only required benefit denial (and other) notices but also detailed procedures for claims, appeals, and external review. This helpful piece of guidance provides at least some small assistance in these compliance efforts." (Thomson Reuters / EBIA)

Final Regulations Adopt Unique Health Plan Identifier and Adjust Implementation Timeline
"While finalization of these parameters is welcome, more work needs to be done before health plans and other entities will be able to obtain HPIDs and OEIDs. The regulators have not yet developed the data fields or identified the information requirements for the enumeration system that would assign unique HPIDs and OEIDs. Health plans will want to develop an HPID implementation plan and keep an eye out for additional guidance. TPAs should review the OEID provisions of the final regulations and anticipate that their health plan clients may contractually require them to obtain -- and use -- OEIDs for a number of plan administration purposes." (Thomson Reuters / EBIA)

Counseling Refused by Employee Could Be Considered Prohibited 'Medical Examination' Under ADA
"Psychological counseling that an ambulance agency ordered an emergency medical technician to undertake could be considered a 'medical examination under the Americans with Disabilities Act' ... Noting that the meaning of 'medical examination' was an issue of first impression in the Sixth Circuit, ... the court [said] that an enforcement guidance issued by the Equal Employment Opportunity Commission in 2000 was the 'best interpretive aid.' ... Specifically, ... the counseling would have been administered and interpreted by a health care professional and was designed to uncover any mental health impairment [the employee] might have had.... Under Section 12112(d)(1), the statute's bar against disability discrimination 'shall include medical examinations and inquiries.' Section 12112(d)(4)(A) stipulates that an ADA-covered employer 'shall not require a medical examination and shall not make inquiries of an employee as to whether such employee is an individual with a disability or as to the nature or severity of the disability, unless such examination or inquiry is shown to be job-related and consistent with business necessity.'" (Bloomberg BNA)

Benchmark Set for California's Health Insurance Coverage
"Californians now have a clearer picture of what health insurance will look like when major provisions of the federal health care law debut in 2014. Acupuncture to treat pain and nausea will be covered, for example, as will tobacco cessation and vision screening. But the jury's still out on chiropractic care." (Silicon Valley MercuryNews)

Do Health Plans Risk-Select? An Audit Study on Germany's Social Health Insurance
"This paper evaluates whether health plans in Germany's Social Health Insurance select on an easily observable predictor of risk: geography.... [The study finds] that plans are less likely to respond and follow-up with applicants from higher-cost regions, such as West Germany. The results suggest that supply-side selection may emerge even in heavily regulated insurance markets." (RAND Corporation)

[Opinion]

The Health Care Dirty Dozen
"1. Imposes a Bevy of New Taxes.... 2. Expands a Nation of Takers.... 3. Creates a Maze of Cross Subsidies.... 4. Hands Control to Unelected Bureaucrats.... 5. Empowers the IRS.... 6. Imposes Perverse Economic Incentives. ... 7. Explodes Health Care Spending.... 8. Enhances Rationing under IPAB.... 9. Allows Fewer Health Insurance Options. ... 10. Creates More Inefficiency.... 11. Includes Pork and Calls It Prevention.... 12. Cooks the Medicare Books.... ObamaCare's Greatest Failure [is that it] imposes a mid-20th century health insurance model on a 21st century global economy." (Institute for Policy Innovation)

[Opinion]

If Premium Support is 'Fatal' for Medicare, Why is it Good Enough for Obamacare?
"[C]ritics of private-sector health insurance have long used this 14 percent figure to argue that private plans are 14 percent less efficient than public plans. But that's not correct. Medicare Advantage plans are severely restricted from passing along cost savings to seniors; instead, they're required by law to offer more generous benefits. Hence, while Medicare Advantage plans are costlier than traditional Medicare plans, they also have more generous benefits." (Forbes)

[Opinion]

Future of Large-Employer Health Benefit Programs
"Health benefit programs of large employers have been the mainstay of health care coverage for working families. The [ACA] relies heavily on the stability of these programs. However, only 23 percent of these employers are very confident that they will continue to offer health care benefits ten years from now.... [O]ne trend that is of concern is the greater reliance on high-deductible health plans with health savings accounts or health reimbursement arrangements ... Although these plans seem to be satisfactory for the healthy workforce and their young healthy families who really don't need much care, there remains the serious concern that such accounts deter patients with significant needs from receiving the care that they should have." (Physicians for a National Health Program)

Yes, Some Employers Do Provide Generous Employee Benefits
"Plenty of employers say workers are their most valuable asset. But when times get tough, companies look first to cutting their largest expenses, which are often employee benefits.... Why do some [employers] make a bigger commitment to employees' financial security than others?... What they have in common ... is a commitment from top management to make benefits a priority. And when times get tough ... these employers look for other ways to rein in costs, such as slowing the pace of hiring or not filling empty positions, before cutting benefits. They also involve workers in these decisions[.]" (Baltimore Sun)

Benefits Manager Who Lacked Discretionary Authority Is Not ERISA Fiduciary
"The [Second Circuit] rejected [the participant's] argument that [a mid-level benefits manager] was a fiduciary because [the manager] determined [the participant's] benefits and communicated the information to him. Applying eligibility rules, the court held, is a ministerial function. Although a fiduciary's responsibilities may include communicating plan information, the court noted, it held that the mere act of doing so is not sufficient to confer fiduciary status." [Tocker v. Kraft Foods N. Am., Inc. Ret. Plan, No. 11-2445-cv (2d Cir. Aug. 29, 2012).] (Practical Law Company)

Insufficient Delegation of Discretionary Authority Affects Standard of Judicial Review
"Although the benefit denials in both cases were upheld, these rulings should nevertheless remind plan administrators of the importance of plan language. In order to increase the likelihood of deferential review by a court, the plan must provide discretionary authority to parties making final benefit decisions, and any delegation of such authority must be duly authorized pursuant to the terms of the plan." [Aschermann v. Aetna Life Ins. Co., 2012 WL 3090291 (7th Cir. 2012); Decovich v. Venetian Casino Resort LLC, 2012 WL 3096696 (D. Nev. 2012)] (Thomson Reuters / EBIA)

Proposed Regulations Clarify the 50% Entertainment Limit for Expense Reimbursement Arrangements (PDF)
"The proposed Regulations clarify who is subject to the 50% deduction limit when multiple parties are involved, as only one party is subject to the limit[.]" (Groom Law Group)

Security Benefit Sounds Alarm On Impact Of New 401(k) Fee Disclosure Rules
Security Benefit

Cedar Brook Financial Partners Welcomes Certified Financial Planner® Andrew Denis As Partner
Cedar Brook Financial Partners