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December 4, 2012          Get Retirement News  |  Advertise  |  Unsubscribe
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Employee Benefits Jobs

Manager, Benefits Administration and Outsourcing
for Tegrit Group in OH

ERISA Attorney
for Bousquet Holstein PLLC in NY

Installation Coordinator
for Ascensus in PA

Senior Compliance Analyst
for T. Rowe Price in MD

ERISA Consultant I
for Ascensus in MN

Employee Benefits/ERISA Associate
for Sherman & Howard L.L.C. in CO

Conversion Specialist
for J.P. Morgan in CO, IL, KS

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Webcasts and Conferences

On the Right Track? Public Pension Reforms in the Wake of the Financial Crisis Webinar
Nationwide on December 5, 2012 presented by National Institute on Retirement Security

View All Webcasts and Conferences


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[Guidance Overview]

IRS Handout for Upcoming Phone Forum on Hurricane Sandy Relief (PDF)
12 presentation slides covering relief provided by IRS for hardship distributions and loans to plan participants affected by Hurricane Sandy. The Phone Forum takes place on December 11. (Internal Revenue Service)


[Advert.]

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You know that education is important for a successful career—but are you making it a priority? Start 2013 off right with an education resolution! Enroll now in an International Foundation e-learning course.


[Official Guidance]

CMS Requests Comments on Revised MLR Reporting Form for 2012 (PDF)
"[CMS has] simplified the format of the reporting form and the method by which issuers submit their data. For the 2012 MLR reporting year ... issuers will have the option to use either a Microsoft Excel (.xls) or a Comma Separated Value (.csv) file format.... The 2012 MLR Reporting Form and instructions also reflect changes for the 2012 reporting year and beyond ... as to whether certain already reported expenditures such as ICD-10 conversion costs are taken into account in calculating an issuer's MLR." (Centers for Medicare & Medicaid Services)

[Guidance Overview]

HHS Proposed Regs Include New Standards for Essential Health Benefits
"Despite the general flexibility afforded states in defining EHBs, the proposed regulations do establish a minimum standard for the scope of the required coverage under the tenth category: pediatric services.... Under the proposed rules ... the term pediatric services will be interpreted to mean services for individuals under the age of 19, consistent with other ACA provisions such as the prohibition on pre-existing condition limitations for children." (Spencer Fane)

[Guidance Overview]

IRS Issues Proposed Regs, FAQs on Additional Medicare Tax
"Although an employee's liability for the Additional Medicare Tax depends on his filing status as well as his compensation, an employer must withhold the Additional Medicare Tax from wages it pays to an employee in excess of $200,000 in a calendar year, regardless of the individual's filing status or wages paid by another employer. Therefore, an employee may owe more than his employer withholds or may be able to claim credit for any withheld Additional Medicare Tax against his total tax liability once he files his income tax return." (Practical Law Company)

Health Reform-Related Due Diligence Considerations for Buyers (PDF)
"While defined benefit pension plans have long demanded attention in the due diligence process, health benefits for employees generally have not. The [ACA] changes that by subjecting health benefit plans to a complex and comprehensive legislative and regulatory scheme with financial implications for plan sponsors. This document is designed to give buyers a basic framework to use when conducting due diligence on potential targets." (Deloitte)


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Some Health Exchange Plans to Mirror Federal Employees Health Benefits Program
"A multi-state insurance issuer could follow standards set by each pertinent state or could instead base an offering on one of the three largest nationwide FEHBP plans -- two of Blue Cross-Blue Shield and one of the Government Employees Health Association---- although they still would have to adhere to certain state requirements. The rules require that a multi-state plan's enrollee pool, whose claims rates will determine premiums, must be kept separate from the FEHBP population." (The Washington Post; free registration required)

Health Insurers Gear Up To Sell Directly To Consumers
"As the health care overhaul moves ahead, the nation's health insurers are scrambling to reinvent themselves, hoping to boost their image and entice millions of Americans to enroll, some for the first time. The new customers will mostly shop for and buy their own insurance -- a different and harder-to-reach group than the industry's traditional employer clients. So insurers are seeking novel ways to reach them -- online, in shopping centers, even when they're preparing their taxes." (Kaiser Health News)

Books-A-Million Hit with COBRA Penalties of $126K Due to Notice Failure
"An 'inefficient, unwieldy' notice process -- coupled with evasive and contradictory answers from employees on why a qualified beneficiary did not receive a COBRA election notice -- led a federal district court in Alabama to deem the notice failure as intentional. Initially, the court assessed the employer/plan administrator more than $83,000 in penalties and legal costs. Subsequently, this amount rose to more than $126,000 after the qualified beneficiary successfully protested the amount of her attorney's fee award." [Evans v. Books-A-Million, Civil Action No. CV-07-S-2172-S (N.D. Ala., Oct. 29, 2012) and 2012 WL 5954118 (N.D. Ala., Nov. 28, 2012)] (Thompson SmartHR Manager)

More ACA Provisions Take Effect in 2014: What Employers Should be Thinking About Now
"Employers have choices to make before 2014. They can offer health coverage, or not offer coverage and pay the penalty. Employers need to be aware that simply offering a health plan does not satisfy the employer mandate ... [T]he health plan must be affordable and offer minimum essential coverage." (BenefitsNotes, a blog by Leonard, Street and Deinard)

Using HIPAA Audit Protocols as a Compliance Tool
"The protocols establish 165 performance criteria, 77 of which focus exclusively on compliance with the Security Rule, and 88 of which collectively address the Breach Notification and Privacy Rule requirements. The protocols essentially mirror the requirements of the HIPAA Privacy, Security, and Breach Notification rules, but provide greater insight into what covered entities and business associates can expect if selected for an audit." (Mintz Levin)

The Huge (And Rarely Discussed) Health Insurance Tax Break
"Believe it or not, dollar for dollar, the most tax revenue the federal government forgoes every year is from not taxing the value of health insurance that employers provide their workers. Yet most people don't even realize that they don't pay taxes on the value of those health benefits." (National Public Radio)

HHS Contraceptive Mandate Challenger Gets Victory in U.S. Court of Appeals
"A three-judge panel of the Eighth Circuit Court of Appeals granted an order for a preliminary injunction ... [which] temporarily blocks the federal government from enforcing the HHS mandate -- which forces nearly all employers to cover abortion drugs and contraception in their health plans regardless of religious objections ... The panel's decision marks the first time a federal appeals court has weighed in on a case involving the HHS mandate." [O'Brien v. HHS, No: 12-3357 (8th Cir., Nov 28, 2012)] (The Heritage Foundation)

Obamacare Threatens Health Care Cost Containment
"Employers' health benefit cost growth had the smallest increase in 15 years -- only 4.1 percent in 2012 compared to 6.1 percent in 2011 ... The lower-than-usual increase in costs is attributed, in part, to increased usage of consumer-directed health plans (CDHP).... It will be difficult for CDHPs to meet the MLR requirement, because they have lower premiums, which reduces their total revenue.... Obamacare's hindrance of these plans comes in the face of their growing popularity and cost containment." (The Heritage Foundation)

Implementing Health Reform: The ACA's Multi-State Plan Program
"The ACA directs the [Office of Personnel Management, or 'OPM'], which administers the [Federal Employees Health Benefits Program, or 'FEHBP'], to contract with at least two insurers (one of which must be a nonprofit) to offer multi-state plans, which must initially cover at least 31 states and by the end of four years be available in every state.... The OPM is no stranger to the exchange concept. The OPM has for more than 50 years administered the FEHBP, which currently enrolls eight million federal employees, annuitants, and their families. FEHBP enrollees can choose among a broad menu of plans, including six nationwide plans each of which offers coverage in all 50 dates." (HealthAffairs Blog)

Self-Insured and Large Insured Plans Should Take Note of HHS Proposed Regs on Essential Health Benefits
"Although primarily of interest to health insurers that sell coverage in the individual and small group markets, the proposed regulations -- and their preamble -- contain some important information for self-insured plans and large insured plans. Sponsors of such plans will also want to watch for further guidance on the MV calculator, EHB, and limits on out-of-pocket maximums." (Thomson Reuters / EBIA)

Agencies Issue Proposed Wellness Regs
"Many laws affect employee wellness programs, and while these new regulations provide valuable guidance and may help increase employee participation, it is important to remember that they address only the requirements of HIPAA and health care reform. Sponsors of wellness programs must also be mindful of the requirements of the ADA, GINA, ERISA, and COBRA." (Thomson Reuters / EBIA)

Detailed Guidance on HHS Website Addresses How to De-Identify PHI for HIPAA Privacy Purposes
"[T]he rationale of the de-identification rule is to support secondary uses of data originating from [protected health information], like comparative effectiveness studies, policy assessments, life science research, and other endeavors. Of course, certain insurers, employers, and others working with employer health plans may use de-indentified information for various plan-related purposes, and the details of this guidance may be useful for these de-identification efforts as well." (Thomson Reuters / EBIA)

Deloitte Health Care Reform Memo, December 3, 2012
"[F]ederal spending on health care is a big deal: 25 percent of overall federal spending when Medicare, Medicaid, military health, federal employee health benefits, and other federal health programs like the Indian Health Service are factored in. It's a safe bet that health spending will slow in coming years because it's simply necessary, but slower growth does not mean the demise of the industry nor stifling of its innovation." (Deloitte)

Incentives, Commitments and Habit Formation in Exercise: Evidence from a Field Experiment with Workers at a Fortune 500 Company
"After the incentive period ended, [the authors] find that those offered incentives only continued to attend at higher rates, but the effect was quite modest in magnitude. The availability of a commitment contract, however, substantially improved the long-run effects of the incentive program both during the commitment period and well beyond, offering a promising new approach to increasing the long-run effect of incentive programs." (National Bureau of Economic Research)

Analyzing the Effects of Insuring Health Risks: Short Run Insurance Benefits vs. Long Run Incentive Costs
"[This paper] evaluate[s] the short- and long run effects of policies that prevent firms from conditioning wages on health conditions of their workers, and that prevent health insurance companies from charging individuals with adverse health conditions higher insurance premia.... [A] trade-off arises between the static gains from better insurance against poor health induced by these policies and their adverse dynamic incentive effects on household efforts to lead a healthy life.... [The] combination of both laws severely undermines the incentives to lead healthier lives. The resulting negative effects on health outcomes in society more than offset the static gains from better consumption insurance[.]" (National Bureau of Economic Research)

[Opinion]

Multi-State Plans Could Shake Up Health Insurance Market
"This time around, [association health plans] are called 'Multi-State Plans.' As before, they seek to let consumers, the self-employed, and small businesses from across the country band together into groups to buy a health plan from insurers competing across the country. These old-new plans were and are a powerful idea that could shake up local insurance markets, catalyze competition, and significantly reduce costs[.]" (The Health Care Blog)

[Opinion]

Can the States Sabotage Obamacare?
"After surviving near-death experiences on Capitol Hill, in the Supreme Court, and during the presidential election, the Affordable Care Act is now confronted with unanticipated sabotage in conservative state capitols.... Policy analysts always recognized that relying heavily on states to administer the act posed major challenges, but the unexpected depth and breadth of state-level resistance has created the real possibility of a fiasco come 2014." (The Washington Monthly)

[Opinion]

Business Roundtable Letter to Congress Supporting Bill to Repeal ACA Tax on Health Insurance Premiums
"Business Roundtable (BRT) strongly supports legislation (S. 1880 and H.R. 1370) that would repeal a new tax on health insurance premiums included in the Affordable Care Act. According to the Joint Committee on Taxation, this tax, which starts in 2014 but will be felt by individuals and businesses starting in 2013, will be passed on to consumers in the form of higher premiums, averaging $400 per year." (Business Roundtable)

[Opinion]

Pharmacists Comment on CBO's Conclusion That Use of Prescription Drugs Can Reduce Health Care Costs
"CBO's new analysis represents the tip of the iceberg in terms of the savings independent community pharmacists can produce for Medicare and other health plans. CBO examined only the quantity of prescriptions filled, not the qualitative benefits of strong patient-pharmacist relationships in helping patients take their medication appropriately. For years, private research has documented both patients' preference for their local community pharmacy as well as the cost-savings potential of face-to-face pharmacist-patient consultations to maximize the health benefits of prescription drugs." (National Community Pharmacists Association)

Benefits in General; Executive Compensation

Guidance Issued on Additional Medicare Tax
"In determining whether wages exceed $200,000, the employer does not take into account the employee's filing status or other wages or compensation that may affect the employee's liability for the tax. An employee may not request that the employer deduct and withhold additional Medicare tax on wages of $200,000 or less." (Journal of Accountancy)

CBO's Long-Term Projections for Medicare and Medicaid Spending in the United States
"If current laws remained in place, spending on the major federal health care programs would grow from more than 5 percent of GDP today to almost 10 percent in 2037 and would continue to increase thereafter. The aging of the population and the rising cost of health care would cause spending on the major health care programs and Social Security to grow from more than 10 percent of GDP today to almost 16 percent of GDP 25 years from now. By comparison, spending on all of the federal government's programs and activities ... has averaged 18.5 percent of GDP over the past 40 years." [Editor's note: The linked item is a set of 15 slides at a presentation to the "OECD Expert Workshop on Improving Health Expenditure Forecasting Methods."] (Congressional Budget Office)

Press Releases

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