Plan Administrator Support Analyst
for Nationwide Insurance in OH

Defined Contribution Retirement Plan Administrator
for Gilliam Coble & Moser, L.L.P. in NC

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Challenges to the Validity of DOMA: Planning for Impacts on Domestic Partner Benefits
Nationwide on September 13, 2012 presented by Thomson Reuters / EBIA

What Benefit Provisions Should Be In M&A Credit Agreements
Nationwide on October 30, 2012 presented by ABA Joint Committee on Employee Benefits

 

Health Plans Suffer Diminishing Ability to Enforce Subrogation Provisions
"The growing ability of plaintiffs to block plans trying to recover overpaid health benefits will be ruled on by the U.S. Supreme Court (it granted certiorari to the case on July 12). In U.S. Airways, Inc. v. McCutchen [on appeal from the Third Circuit] the High Court will decide whether individuals holding settlements from third parties have equitable defenses to limit a plan's right to recover all benefits it paid. This will be the third important subrogation/reimbursement case reviewed in the last decade[.]" (Thompson SmartHR Manager)

[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.

Prevalence of Consumer-Driven Health Plans Is Growing
"Consumer-driven health plans (CDHPs) have surpassed health maintenance organizations (HMOs) to become the second most common plan design offered by U.S. employers ... [A recent] survey of nearly 2,000 U.S. employers representing over 20 million U.S. employees and their dependents found in 2011 that 58 percent of employers offered a CDHP and 38 percent offered HMO plans. Preferred provider organizations (PPOs) continue to be the most widely offered plans, with 79 percent of employers offering these plans in 2011." (Aon Hewitt)

Small Business Health Insurance Premiums Going Up Faster Than Costs Paid by Large Employers
"The news for small businesses—not particularly surprising and not particularly good—in the Kaiser Family Foundation's latest study of employer-sponsored health insurance is that the trend lines are unchanged. Costs continue to go up, and the number of companies offering insurance does not. While across all employers, premiums for family coverage grew at the modest rate of 4 percent over the last year, small businesses faced an increase double that—the biggest annual increase in family plans since 2004. For individual coverage, small-company premiums increased 5 percent, which was also more than the increase in the broader market." (The New York Times; free registration required)

Survey Finds that Wellness Programs Provide Savings for Employers
"Employers who have analyzed the financial impact of their wellness programs have discovered overall positive results. According to the report titled, A Closer Look: Wellness ROI by the International Foundation of Employee Benefit Plans, most of these employers reported $1 to $3 decreases in their overall health care costs for every dollar spent." (Wolters Kluwer Law & Business)

Federal District Court Rules Cocaine User's Overdose Met AD&D Plan's Definition of 'Accidental' (PDF)
"Dispute between the parties centers around whether the insured's death was 'unexpected'; whether it arose from a source external to decedent; and whether it was independent of 'illness, disease or other bodily malfunction.' ... [I]t is far from clear a jury would necessarily conclude that on the existing record, a reasonable person with the insured's characteristics would have viewed his death as 'highly likely to occur,' especially in light of the decedent's history as a seasoned cocaine user.... Of note is the fact that the Policy did not exclude death from alcohol or drug use." (U.S. District Court for the District of Massachusetts)

HRAs Not the Only Way to Start a Wellness Program
"Health risk assessments and biometrics, while an important source of wellness data, are not always the best place to start when implementing a wellness program, a wellness expert said in a [recent] webinar.... 'Many companies started with an HRA to set a baseline for measuring employee wellness, and there's nothing necessarily wrong with that, but it may make sense to "build a relationship first,' he said." (Thompson SmartHR Manager)

Hearing Panelists Call for Final HHS Rules on Affordable Care Act
"Speaking on behalf of the National Retail Federation, E. Neil Trautwein ... recognized that agencies are balancing competing concerns, but said that 'the fate of health insurance exchanges will be a significant indicator for the success or failure of the ACA itself.' He noted that the 'clock is ticking,' and that employers in the retail industry typically need 6-9 months to prepare for coverage in an average benefits year, and that 2014 'will not be normal.' Therefore, 'employers will be hard pressed to make intelligent choices regarding their options in 2014 without key details' such as what constitutes an essential health benefits ('EHB') package." (Littler Mendelson LLC)

Implications of Medicaid Expansion Decisions on Private Coverage Premiums and Penalties (PDF)
"Whether and to what extent states expand Medicaid eligibility will affect not only access to coverage and costs to the federal government and the states, but also the premiums for private insurance coverage.... Individual market premiums could increase in states that opt out of the Medicaid expansion, due to health status differences of new enrollees.... Exchange premiums also may increase due to spreading fixed reinsurance subsidies over a larger enrollee population.... Basic Health Program decisions by states, pending clarifications from HHS, can affect the risk profile of enrollees in an exchange.... Employers may be at greater risk of penalties in states that don't expand Medicaid eligibility." (American Academy of Actuaries)

State by State Enrollment in the Pre-Existing Condition Insurance Plan, as of July 31, 2012
"The [Pre-Existing Condition Insurance Plan (PCIP)] program is administered by either the state or the federal government: 23 states and the District of Columbia elected to have their PCIP program administered by the federal government while 27 states have chosen to run their own programs. The PCIP program began accepting applications for enrollment July, 2010 (July 1, 2010 for the federal program, dates for state programs varied). The chart below details the date when each state began providing benefits to people accepted into the program and the number of people enrolled in the program by each state as of July 31, 2012." (Healthcare.gov)

Implementation of Medicare Savings Program Requirements Aimed at Increasing Enrollment
"Using data from the Centers for Medicare & Medicaid Services (CMS), GAO estimates that [Medicare Savings Program (MSP)] enrollment increased each year from 2007 through 2011. The largest increases occurred in 2010 and 2011 (5.2 percent and 5.1 percent respectively), the first 2 years that the MIPPA requirements were in effect. Several factors may have contributed to the higher levels of growth in MSP enrollment during these 2 years, including SSA application transfers and outreach, other MIPPA provisions related to MSPs, and the economic downturn. For example, while there are no nationwide data demonstrating the effects of the SSA application transfers, officials from 28 states reported that MSP enrollment had increased as a result of the transfers." (U.S. Government Accountability Office)

Health Insurers Hike Rates, Ignore HHS Rate Reviews
"When [California insurance] commissioner Jones found Aetna's small-employer rate hikes unreasonable in April, the health insurance company ignored the ruling, raising those plans' annual premiums by an average of 8%, and increasing some as much as 21%. 'I have no authority to actually enforce a reasonable rate here,' Jones says. 'At the end of the day, the health insurers and HMOs have the ability to set the rates wherever they see fit.' This limitation hampers the effectiveness of rate reviews and leaves regulators with little power besides the bully pulpit[.]" (MarketWatch.com)

[Opinion]

Testimony to House Ways and Means Subcommittee on Health on Implementation of Health Insurance Exchanges and Related Provisions (PDF)
"We believe that the EHB package must be affordable for families and small businesses and that affordability should be the cornerstone of consideration in defining the EHB package. The nonpartisan Institute of Medicine—in its recommendations to HHS—underscored the need to ensure affordability in defining the EHB standard and cautioned that 'if cost is not taken into account, the EHB package becomes increasingly expensive and, individuals and small businesses will find it increasingly unaffordable. If this occurs, the principal reason for the ACA—enabling people to purchase health insurance, and covering more of the population, will not be met.'" (America's Health Insurance Plans (AHIP))

Executive Compensation and Corporate Governance in the U.S.: Perceptions, Facts and Challenges
"While average CEO pay increased substantially through the 1990s, it has declined since then. CEO pay levels relative to other highly paid groups today are comparable to their average levels in the early 1990s. In fact, the relative pay of large company CEOs is similar to its average level since the 1930s. The ratio of large company CEO pay to firm market value also has remained roughly constant since 1960. This suggests that similar forces, likely technology and scale, have played a meaningful role in driving CEO pay and the pay of others with top incomes." (National Bureau of Economic Research; purchase required)

IRS Ruling Explains How Recharacterizing Wages as Expense Reimbursements Fails to Satisfy Accountable Plan Rules
"The IRS emphasizes that prohibited recharacterization can occur even when an employee has deductible business expenses, if expense reimbursements are paid in lieu of wages that the employee would have received if the employee had not incurred business expenses. Equally helpful, the ruling also confirms that an employer who has historically expected employees to pay their expenses out of after-tax income can effectively start over, reducing the compensation paid to employees and then instituting an accountable plan, provided reimbursements are only made to employees who actually incur and substantiate qualifying expenses." (Thomson Reuters / EBIA)

Home Depot Goes Big with Child Care Center
"In 2009, Home Depot was looking at the spectrum of dependent care solutions. On one end, it considered national discounts for dependent care and at the other, onsite dependent care. Implementing onsite child care at the more than 2,000 Home Depot locations across the U.S. wasn't viable, but a child care facility at the corporate office in Atlanta—which houses 5,000 staff—was possible. In addition, the facility is open to all Home Depot employees in the Atlanta area, not just those who work at the head office." (Employee Benefit News)

Proskauer ERISA Litigation Newsletter, September 2012
"[This issue examines] the application of ERISA pre-emption to state-law misrepresentation claims by medical providers against ERISA plans or their insurers. The Fifth Circuit, which has issued several of the leading appellate decisions on ERISA pre-emption of provider claims, recently granted en banc review of such a claim in the Access Mediquip case. Oral argument is set for September 19, and the en banc ruling will likely have wide-ranging implications regarding the scope of ERISA pre-emption in the context of medical-provider claims." (Proskauer Rose LLP)

IRS Revisits Pay Arrangements That Attempt To Convert Taxable Wages Into Nontaxable Expense Reimbursements (PDF)
"The IRS recently issued Revenue Ruling 2012-25 that reiterates its long-standing position that the tax-free, accountable plan treatment is limited to reimbursements of bona fide business expenses. Specifically, the ruling explains that employers cannot restructure compensation packages to obtain tax savings, which result in paying the employees the same gross amount, regardless of the amount of deductible employee expenses the employee actually incurs." (Groom Law Group)

[Opinion]

Rising Executive Compensation At Children's Hospitals Threatens The Public Trust
"Freestanding children's hospitals (FCHs) are reporting record profits and paying their executives millions, all while soliciting for community donations. FCHs have an opportunity to be leaders in healthcare by adopting new standards of transparency and new guidelines for executive salaries, while addressing rising costs and aggressively pursuing innovation in patient safety. If they do not enact these reforms, Congress should reconsider the not-for-profit status of these institutions and the large government subsidies they receive. Moreover, FCHs risk damaging the longstanding trust of doctors and hospitals among their donors and communities." (HealthAffairs Blog)

McGraw Wentworth Promotes Jackie Webster To Account Director
McGraw Wentworth

Retirement Savings? Now There’s an “App” for That!
Employee Benefit Research Institute (EBRI)

2012 PSCA Signature Award Winners Announced
Plan Sponsor Council of America (PSCA)

Hyatt Legal Plans Receives a 97 Percent Positive Rating in Annual National Attorney Network Survey
Hyatt Legal Plans, a MetLife company