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December 21, 2012          Get Retirement News  |  Advertise  |  Unsubscribe
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Part Time On Call Retirement Planning Consultant
for Diversified in CA, HI, MO, NC, UT, WA

Defined Benefit Client Consultant
for Diversified in MA

Defined Benefit Calculation Analyst
for Diversified in MA

Participant Education and Enrollment Specialist
for MBM Advisors, Inc. in TX

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[Official Guidance]

State Health Insurance Marketplaces: Official HHS List of Conditionally Approved Exchanges
"Applications for approval of a State-based Exchange were due December 14, 2012, and applications to participate in a State Partnership Exchange are due February 15, 2013. [As of December 21], 24 states have submitted applications or letters of intent to run part or all of their health insurance marketplaces. [This page includes a] list of conditionally approved states to operate either a State-based or State Partnership Exchange [along with a link to the website for each exchange]. As of [December 21], 11 states have been conditionally approved to operate State-based Exchanges and one state has been conditionally approved to operate a State Partnership Exchange." (U.S. Department of Health and Human Services)


[Advert.]

Nat'l Health Benefits Conf & Expo (HBCE) Jan.29-30, 2013 -- Clearwater Beach, FL

Sponsored by Health Benefits Conference & Expo (HBCE)

Speakers wrote the books on wellness, onsite clinics, disease management, obesity and health reform. Hear from public employers, universities, Boeing, FirstEnergy, JetBlue, Mayo Clinic, many more. Low cost, high quality! HBCE.com Ph: 941-484-1430 info@HBCE.com


[Guidance Overview]

In 2014, Maximum Health Coverage Waiting Period Becomes 90 Days (PDF)
"For plan years beginning on or after January 1, 2014, a group health plan or group health insurance issuer shall not apply any waiting period that exceeds 90 days... [The law] does not require the employer to offer coverage to any particular employee or class of employees, including part-time employees. [It] merely prevents an otherwise eligible employee (or dependent) from having to wait more than 90 days before coverage becomes effective." (Chao & Company, Ltd.)

[Guidance Overview]

More on Transitional Reinsurance Sticker Shock
"Retiree plans are subject to the fee. However, CMS proposed that all plans (retiree or not) only need to pay for enrollees for which the plan is primary to Medicare as, of course, most are. No reinsurance fee is due with respect to participants for whom Medicare is primary. The good news is that the IRS has confirmed already that the fee is deductible, and it reports that the DOL has advised the IRS that the fee is a permissible plan expense." (Benefits Bryan Cave)

D.C. Circuit Puts Colleges' Lawsuits Challenging Contraceptive Mandate on Hold Pending Additional Guidance
"As the DC Circuit noted in its order, HHS' litigation position in this case goes further than its guidance issued to date and envisions a broad exemption or nonenforcement policy for health plans sponsored by nonprofit organizations like the colleges that have religious objections to offering contraception. Of course, the details of such a policy remain to be seen. The order also offers a clearer picture of the timing of HHS' proposed guidance, which can be expected (at least according to HHS' representations in this litigation) by the end of March 2013." (Practical Law Company)

Appeals Court Rules Against Hobby Lobby on Mandatory Coverage of 'Emergency Contraceptive' Drugs
"The U.S. Court of Appeals in Denver ruled against family-owned Hobby Lobby's assertion that the religious beliefs of its owners should relieve them from providing the 'morning after' and 'week after' pills to their employees, as required under President Barack Obama's signature healthcare reforms. Hobby Lobby vowed to appeal to the U.S. Supreme Court.... The medications at issue are classified as emergency contraceptives by the Food and Drug Administration, but the owners of Hobby Lobby call them 'abortion-inducing drugs' because they are often taken after conception." (ThomsonReuters)


[Advert.]

COBRA - I Thought the Subsidy Was Over!! -- Audio Conference, January 11

Sponsored by Lorman and BenefitsLink.com

YES, the subsidy is over, but now we are living with the results. Let's look at the impact the subsidy had on COBRA election rates and claim utilization. And, what is the future of COBRA? Will we still have it after 2014? Discounted pricing for BenefitsLink readers.


Employer-Sponsored Insurance and Health Reform: Doing the Math
"Almost 60 percent of Americans younger than 65 obtain health insurance through an employer, but the proportion is steadily declining, largely because of rising health care costs. The decline in employer coverage has disproportionately affected low-wage workers and those in small firms.... Following reform implementation in 2014, workers in large firms, those with a union presence and those in higher-wage industries, such as professional and financial services, will see modest changes in their employers' economic incentive to offer coverage. However, other workers will face large changes." (The National Institute for Health Care Reform)

The Managed Care Backlash on Health Care Costs: Evidence From State Regulation of Managed Care Cost Containment Practices
"During the late 1990s, there was a substantial cultural, media and legal backlash against the cost-containment practices of managed care organizations (particularly, HMOs).... [T]he backlash had a strong effect on health care costs, and can statistically explain much of the rise in health spending as a share of U.S. GDP between 1993 and 2005 (amounting to 1% to 1.5% of GDP).... [The author concludes that] managed care was largely successful in keeping health care costs on a sustainable path relative to the size of the economy." (Maxim L. Pinkovskiy, MIT Economics)

Prevention Is Key To Reducing Health Care Costs, Even for Employees with Chronic Conditions
"Cost savings associated with health risk reduction begin accumulating in as little as one year, particularly for those with chronic conditions ... For every health risk added, costs increased by 45 percent above the cost savings that resulted from eliminating a risk.... [A] greater immediate savings was realized from reducing health risks for people with chronic conditions than for the average employee." (Wolters Kluwer Law & Business)

Divorce Costs Thousands of Women Health Insurance Coverage Every Year
"About 115,000 women lose their private health insurance every year in the wake of divorce, according to a University of Michigan study. And this loss is not temporary: women's overall rates of health insurance coverage remain depressed for more than two years after divorce." (InsuranceNewsNet)

Group Health Plans: 2012 W-2 Reporting, Upcoming Changes, Summary of New Guidance
"As 2012 draws to an end, employers pass another milestone related to group health plan compliance with Patient Protection and Affordable Care Act (ACA) requirements and draw ever nearer to the revolutionary changes of 2014. This LawFlash reminds employers about 2012 and 2013 action items for group health plan sponsors and outlines recent regulatory guidance for 2014." (Morgan, Lewis & Bockius LLP)

General Inquiry About Employee's Absence Was Not ADA 'Medical Inquiry' by Employer, Seventh Circuit Rules
"An employer's email to a 'no call/no show' employee asking 'what is going on' is not a 'medical inquiry' under the Americans with Disabilities Act and therefore did not need to be treated as a confidential medical record, the U.S. Court of Appeals for the Seventh Circuit has ruled." [EEOC v. Thrivent Financial for Lutherans, No. 11-2848 (7th Cir. Nov. 20, 2012)] (Jackson Lewis LLP)

ACA Includes 'Gun Rights' Provisions
"Did you know the [ACA] stands up for gun rights? The 'Protection of Second Amendment Gun Rights' section says the health law's wellness programs can't require participants to give information about guns in the house. It also keeps the U.S. Department of Health and Human Services from collecting data on gun use and stops insurance companies from denying coverage or raising premiums on members because of gun use.... Public health scholars criticize the measure because they say it keeps doctors and nurses from doing their jobs." (National Public Radio)

All I Want for Christmas Is More Time to Comment on Proposed Regs -- Dec. 26, Dec. 31 Deadlines Loom
"Christmas may be just around the corner, but that doesn't mean health care stakeholders aren't busily working as the big day approaches. After all, many are likely feverishly working on comments on proposed rules dealing with essential health benefits (EHB) and market-reform rules that are due on Dec. 26, just 30 days after they were issued. Comments on a third rule dealing with reinsurance programs are due Dec. 31.... [S]ome stakeholders are questioning why they have been given such little time to comment on proposed rules that will have a major impact on how health insurance exchanges will run." (AISHealth.com; free registration required)

Bad Timing: Can an Employer Terminate an Employee Shortly After Requesting FMLA Leave?
"The coincidence is uncanny: a request for FMLA leave just as the employee is about to be handed the pink slip. It's one of the biggest headaches for any HR professional or in-house counsel. The timing of the request stops the employer dead in its tracks, and rightfully so. By terminating an employee immediately after he/she requests FMLA, the employer undoubtedly wonders whether it will find itself on the wrong end of FMLA interference and retaliation claims." (FMLA Insights)

Time to Gear Up for Mandatory State Exchange Notifications to Employees
"After U.S. employers have taken care of the new health care benefit cost-reporting requirement for 2012 W-2s (due to employees in January 2013), their attention should turn to an upcoming deadline to notify employees about the availability of state health insurance exchanges. Currently, March 1, 2013, is the mandated deadline for employers to notify employees about state-specific exchanges to be set up before 2014 by state governments (or by the federal government on the states' behalf). Many expect that the exchange notification deadline will be extended, however, as the [DOL] hasn't yet released proposed regulations or indicated whether it will provide a model notice." (Society for Human Resource Management)

[Opinion]

'Strong Portfolio' of Massachusetts Health Care Reforms Are Worth Watching
"[W]hen it comes to healthcare innovations, Massachusetts continues to be a step ahead of everyone else. Whether implementing the nation's first individual health insurance mandate or successfully launching a health benefits exchange, Massachusetts has beaten everyone else to the punch line. The latest wrinkle is a move away from fee-for-service and toward bundled or global payments[.]" (HealthLeaders InterStudy)

[Opinion]

'Essential Health Benefit' Rules Must Be Broad Enough to Empower Doctors and Patients
"If the EHB is too loose and insurers aren't required to provide coverage for some crucial treatments, patients in the exchanges will be forced to pay for those treatments out-of-pocket. Many won't be able to afford such expenses and will simply have to go without care. Therefore, it's vital that the EHB mandate is sufficiently expansive. In particular, exchange patients suffering from serious chronic illnesses need to have access to the advanced drugs and specialty care required to control and combat their conditions." (The Hill)

[Opinion]

Our Ever-Evolving Health Care System Should Culminate in Single-Payer Universal Coverage
"How did our healthcare get so tied up with our employment? In World War II, to preserve funds for the war effort, the government froze wages. To compete for workers, employers began to pay for health insurance, supported with business tax deductions. This quickly became an unfettered marketplace, with virtually no regulation on price or quality. Premiums began rising and problems emerged." (Physicians for a National Health Program)

[Opinion]

Text of Comments by Consumers Union to HHS on Health Insurance Market Rules and Rate Review (PDF)
"Consumers Union commends HHS for establishing standard rules with respect to fair health insurance premiums, which will apply uniformly to both the individual and small group markets inside and outside Exchanges.... Consumers Union encourages HHS to add ... language that makes explicit that a state may decline using tobacco use as a rating factor altogether, in addition to permitting states to use a ratio narrower than 1.5:1.... Consumers Union believes that relying solely on 'state-specific' thresholds 'based on factors impacting rate increases in a State' will be unlikely to prod issuers or providers to control costs." (Consumers Union)

Benefits in General; Executive Compensation

Court Orders Business Owners to Restore $69,000 in Retirement Funds, Health Care Premiums Withheld from Employees' Paychecks
"A federal court in Chicago has ordered John Dombek III and John Dombek Jr. to restore a total of $69,521.31 in health care premiums and retirement plan contributions withheld from the paychecks of employees at several companies that are part of the JJD Industries Group in Schiller Park, Ill. The judgment resolves a lawsuit filed by the [DOL] based on the findings of an investigation by [EBSA which] determined that both Dombek III and Dombek Jr. violated [ERISA] by improperly managing the company's benefit plans' assets.... Dombek Jr. and Dombek III have both previously filed for Chapter 7 bankruptcy protection.... [T]he U.S. Bankruptcy Court for the Northern District of Illinois .. [found] that the debts Dombek Jr. and Dombek III owed to the plans were not dischargeable in bankruptcy." (Employee Benefits Security Administration)

[Opinion]

More on Decoding the Fiscal Cliff: The Power of Doing Nothing and Other Ruminations on Opportunities for Cliff Maneuvers Inherent in New 3.8% Medicare Surtax and AMT Patch
"[New federal taxes to be paid by high-income taxpayers] should be taken into account, not just as a means of mediating the differences between the [fiscal cliff] negotiating parties, but because failing to do so undercuts the implied moral underpinning of the Obama position that one who does not pay a new, stipulated higher rate of federal ordinary income tax is not contributing his fair share to the public fisc, notwithstanding the payment of other new, higher federal taxes equivalently enhancing the fisc.... One tax in particular introduced in the health care reform legislation is especially well suited to the proposition, a 3.8% tax on net investment income (misleadingly labeled in the law as a 'Medicare contribution') that comes into force in 2013 at income levels matching exactly the $250k/$200k figures that have been the battle cry of Obama in the fiscal cliff war of words.... The AMT 'patch' also lends itself to being ready-made to contribute in much the same way to resolution of the current fiscal crisis deadlock." (Alvin D. Lurie, Esq. on BenefitsLink.com)

Press Releases

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