401(k) Retirement Plan Associate
for Delaware Valley Retirement, Inc. in PA

Assistant General Counsel - Welfare Benefit Plans
for Insperity in TX

401(k) Pension Administrator
for Nicholas Pension Consultants in CA

401K & Pension Relationship Manager
for Paul Global Benefits in NY

Retirement Plan Consultant
for Sentinel Benefits & Financial Group in NY

Plan Administrator
for SMI Pensions in CA

Associate Pension Administrator
for Alliance Pension Consultants, LLC in IL

Medical Review Specialist
for Prudential in NJ

Registered Nurse (RN), Disability Case Manager
for Prudential in AZ, ME, NJ

401(k) Plan Third Party Administrator
for Applied Pension Services, LLC in NY

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Wellness Programs: Overcoming Compliance Hurdles and Looking Toward 2014
Nationwide on January 10, 2013 presented by Thomson Reuters / EBIA

Controlled Groups
Nationwide on December 14, 2012 presented by McKay Hochman Co., Inc.

Ethics and Circular 230
Nationwide on December 13, 2012 presented by McKay Hochman Co., Inc.

Pension De-Risking for Employee Benefit Sponsors Webinar
Nationwide on January 16, 2013 presented by Strafford Publications

Will Employers Play or Pay? Health Care Reform�s Shared Responsibility Provision
Nationwide on December 5, 2012 presented by Thomson Reuters / EBIA

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[Guidance Overview]

IRS Issues Final Regs on PCOR Fees on Health Plan Sponsors
"The PCOR fees are smaller than the reinsurance contributions that also apply to group health plans ... However, the regulations are already in effect and the first fees are to be reported and paid on July 31, 2013, so insurers and self-insured health plan sponsors that have not already begun collecting the necessary data must move quickly to do so. Note that the DOL has indicated that these fees (unlike the reinsurance contributions) generally are not permissible plan expenses under ERISA, since they are imposed on the plan sponsor and not the plan[.]" (Thomson Reuters / EBIA)

[Advert.]

Agenda Debut: Health & Benefits Leadership Conference

While other events focus on the administrative & legal aspects, we bring you thought leaders & senior execs at major employers to inspire & give you real solutions to enhance your overall HR strategy. April 22-24. Aria, Las Vegas. BenefitsConf.com

Court Denies Administration's Motion to Dismiss Suit Brought by Archdiocese of N.Y. Against HHS Mandate
"The judge concluded that 'There is no "Trust us changes are coming" clause in the Constitution.' The court further stated that 'ignoring the speeding train that is coming toward plaintiffs in the hope that it will stop might well be inconsistent with the fiduciary duties that plaintiffs' directors or officers owe to their members.'" (InsuranceNewsNet)

What If Supreme Court Is Not Done with Health Reform Law?
"The Supreme Court's decision to vacate its earlier denial to hear the case and send it back to the appeals court 'is a bit unusual, but only because of the particular procedural posture of the case,' said Daniel O. Conkle, a law professor at Indiana University Maurer School of Law. 'The Supreme Court's action merely returns the case to the 4th Circuit ... to consider issues not addressed by the Supreme Court in its decision last June.... It is difficult to say how these religious liberty claims will be resolved, but the issues might eventually take the ACA back to the Supreme Court.'" (American Medical Association)

Proposed OPM Regs Issued on Multi-State Health Plans on Insurance Exchanges
"One particular challenge lies in developing benefit requirements for MSPs -- insurers may prefer to offer an MSP structured as a national plan offering uniform benefits across all states, but such a uniform package might be inconsistent with state benefit mandates. OPM has indicated that it anticipates that its policy on EHB benchmark standards for the MSPP will evolve as HHS develops the final EHB rule." (Thomson Reuters / EBIA)

New Taxes to Take Effect to Fund Health Care Law
"The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains.... Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate." (The New York Times; free registration required)

[Advert.]

Executive Forum on Rewarding Healthy Behaviors - January 30-31, 2013 - San Diego

The pre-eminent event for innovative workplace wellness and preventive health management initiatives designed to promote health behavior change within health insured populations. Evidence-based success strategies to contain healthcare costs.

How to Find the Right Health Savings Account
"Larger employers may choose an HSA provider and dictate this as the only option for their employees. But when working for mid-size and smaller employers you can typically choose any HSA provider available. Selecting an HSA is a personal choice and you'll want to choose an HSA provider that suits your own individual needs." (CBS MoneyWatch)

D.C. Circuit Court Rules Loss of COBRA Eligibility Due to Union Lockout Violated NLRA
"After the lockout began, KLB hired replacement workers and terminated the health plan, which meant employees were ineligible for COBRA coverage. The union filed unfair labor charges against KLB, asserting a variety of claims. One of those claims alleged that the lockout was unlawful and the cancellation of health coverage and COBRA rights violated the National Labor Relations Act.... Note that under the NLRA, KLB was just required to restore the jobs and benefits and post a workplace notice. However, under ERISA, an employer/plan administrator found to have committed COBRA violations can be subject to financial penalties and damages." [KLB Industries, Inc. v. National Labor Relations Board, 2012 WL 6013449 (D.C. Cir., Dec. 4, 2012)] (Thompson SmartHR Manager)

MLR Rule Saved $1.45B on Health Insurance Premiums, Weakened Individual Market
"[P}remiums for individual plans only grew an average of 6 percent after the MLR rule was implemented, causing insurers that primarily sell individual plans to operate at a loss. The average insurer saw a drop of $31 per consumer, totaling $351 million in market-wide losses[.]" (FierceHealthPayer)

Text of DOL Amicus Brief in Case of Medical Provider Challenging Health Care Insurer's Denial of Benefits Under ERISA Plan
"[T]here is no reverse preemption under ERISA. Assuming, therefore, that Aetna can pursue an action against Tri3 for reimbursement on a common law fraud or wrongful payment theory without the action being preempted by ERISA, when an unresolved issue of plan interpretation lies at the heart of the dispute, it does not follow that Tri3's ERISA action fails to establish subject-matter jurisdiction or requires dismissal in anticipation of Aetna's hypothetical state-law cause of action. The district court was wrong to hold otherwise." (Employee Benefits Security Administration)

Young Americans Could Experience Sticker Shock When Exchanges Go Live
"[W]ith an age band as narrow as 3:1, premiums for younger people will be brought up considerably higher in order to compensate for older Americans, who typically utilize more health care services yet can only have premiums that, at most, are three times higher than those for younger people, who typically are light users of service. This, combined with a relatively low penalty for not getting coverage, could spell problems for risk pools, as the commissioners fear many young people will simple choose to pay the penalty and reject coverage." (AISHealth.com; free registration required)

Obamacare Tax May End Up Raising Your Veterinarian Bills
"According to a rule published Friday by the Internal Revenue Service, some medical devices used in veterinary practices will be hit by Obamacare's 2.3 percent device tax. Many of their manufacturers are expected to hike prices, meaning higher veterinary costs for the nation's pet owners." (The Heritage Foundation)

Health Sector Economic Indicators Briefs (PDF)
"National health expenditures in October 2012 grew by 3.5 percent relative to October 2011, down two-tenths from the September rate, and representing the sixth consecutive month of below 4 percent growth. At 3.7 percent, the six-month average growth rate is now below the all-time low (full-year) rate of 3.8 percent recorded in 2009.... October 2012 health care prices were 2.1 percent above October 2011, a rise from the historically low 1.9 percent September rate, but still well-contained." (Altarum Institute)

Applying the COBRA Small Employer Exception to Employers Under Common Control
"[A]n employer was sued for providing just three, rather than 18, months of COBRA coverage. Because it had a workforce of fewer than 20 employees, the employer tried to fend off those claims by arguing that it met COBRA's small employer exception. However, it was part of a controlled group with a combined workforce population exceeding the exception's threshold. Therefore, the exception did not apply[.]" [Warnecke v. Nitrocision LLC, 2012 WL 5987429 (D. Idaho, Nov. 29, 2012)] (Thompson SmartHR Manager)

[Opinion]

Obamacare HHS Mandate Affront to Religious Liberty, Say Many American Voters
"Many Americans -- and certainly the more than 110 plaintiffs suing over the mandate -- understand the offensiveness of the rule's current, miniscule religious exemption. But concern over the mandate's assault on religious freedom isn't merely caused by the narrowness of this particular religious exemption. The root of the mandate's disregard for Americans' freedoms is found in the broader coercion of an invasive health care law that dictates what insurance companies must cover, what employers must provide, and what individuals must purchase." (The Heritage Foundation)

[Opinion]

Covering Preventive Care Is Worthless If Consumers Don't Know About It
"[A] recent study has found that consumers don't know preventive care is covered, at least not people with high-deductible health plans. In fact, almost 20 percent of the 456 California-based healthcare consumers didn't know their high-deductible plans covered preventive office visits." (FierceHealthPayer)

[Opinion]

Obamacare: The Resistance Endures, With Good Reason
"After three years, Obamacare remains unpopular. Both the raw numbers and the intensity favor its opponents. Last month, for the first time ever, Gallup found that a majority of Americans oppose a government guarantee of health insurance for all.... Resistance will grow later this year as a result of 'sticker shock' at Obamacare's 'startling rate increases' of 30 to 40 percent in the individual market and 100 percent (!) for young adults." (Cato Institute)

[Opinion]

Improving the Quality and Efficiency of U.S. Health Care
"Paying for care on a fee-for-service basis -- the payment approach that predominates in the U.S.--encourages doctors to provide unnecessary care and drives up costs ... [The ACA] will help move us away from paying for individual services and toward paying for better health outcomes. The health care law also will help to streamline care by encouraging the adoption of electronic health systems and the establishment of accountable care organizations." (The Commonwealth Fund)

[Opinion]

Health Insurance Exchanges May Transform Health Care and Lower Costs -- But Only If We Get It Right
"Comparisons between health care and retail abound, and while we say it is ideal for the consumer experience to be the same in both industries, in fact they are much different.... [W]hat if the customer expected the same 'no questions asked' return policy ...? Or a money back guarantee? In health care, only recently has the federal government taken steps to impose financial penalties in instances of poor care (which is the health care system's equivalent of a 'return policy' from providers)." (The Health Care Blog)

[Opinion]

The Self-Insured 'Two-Step' Solution
"The good news is that real health care reform with savings on the order of $750 billion annually is very much possible, without cutting quality or benefits ... The bad news, however, is that no way has yet been found politically for real health care reform and to tap the $750 billion because of the inherent problems of the only method that has been used to date -- government.... What worked before in the 1980s-90s was that, without any legislation or government action, a few self-insured employer and union health benefit programs triggered a system-wide change in health care to a form of health benefits that did not exist in 1980 -- PPOs." (Cracking Health Costs)

Form 5500 for 2012 Plan Year Released
"There are few new elements in the 2013 Form 5500 and related materials, but familiarity with the changes is advisable in order to ensure complete and accurate plan filings. In particular, plan administrators should pay close attention to the signature requirements to reduce the likelihood that a filing will be rejected for electronic signature problems." (Thomson Reuters / EBIA)

Legal Plans Named a Voluntary Product to Watch in 2013
Hyatt Legal Plans, a MetLife company

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