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June 1, 2012 Get Retirement News  |  Advertise  |  Unsubscribe  |  Past Issues  |  Search

Employee Benefits Jobs

Onsite Participant Counselor
for Diversified in TX

Onsite Participant Counselor
for Diversified in IL

Manager of Investment Operations
for MBM Advisors, Inc. in TX

Senior Client Executive
for Diversified in AZ, CA

RFP Specialist
for Prudential in CT

Key Account Manager - Investment Only
for MassMutual Financial Group in MA

Retirement Consulting Group Representative
for New York Life Retirement Plan Services in NJ

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Webcasts and Conferences

New England Fiduciary Summit 2012
in Massachusetts on June 14, 2012 presented by Fiduciary Plan Governance, LLC

Are You Prepared for the New Participant-Level Disclosure Rules?
Nationwide on June 14, 2012 presented by International Foundation of Employee Benefit Plans


We also publish the BenefitsLink Retirement Plans Newsletter (free): Subscribe

[Official Guidance]

Text of Proposed HHS Regs on Data Collection to Support Standards Related to Essential Health Benefits; Recognition of Entities for Accreditation of Qualified Health Plans
"This proposed rule would establish data collection standards necessary to implement aspects of the Patient Protection and Affordable Care Act ..., which directs the Secretary of Health and Human Services to define essential health benefits. This proposed rule outlines the data on applicable plans to be collected from certain issuers to support the definition of essential health benefits. A bulletin on HHS' intended benchmark approach to defining essential health benefits was published for comment on December 16, 2011, and we intend to pursue comprehensive rulemaking on essential health benefits in the future. This proposed rule would also establish a process for the recognition of accrediting entities for purposes of certification of qualified health plans." (Federal Register)


Bending the Health Care Cost Curve: June 6, 2012 Webinar   [Advert.]

Sponsored by CAWG (Change Agent Work Group)

This webinar, Population Health: Moving from Theory to Engagement with Successful Outcomes, will discuss proven and innovative health management delivery models and tools to enhance the engagement of your employees in their health. Register Today!


[Guidance Overview]

Health Reform Talk: Today's the Day, Mr. Insurer—Your MLR Report is Due to HHS
"June 1 is the date the medical loss ratio (MLR) annual report is due to the Department of Health and Human Services (HHS). If this reporting requirement applies to you (and it does if you are an insurer offering group or individual health insur.ance or if you are a group health plan (but not if you are a self-funded plan)), you'd better stop reading this and get cracking on filling out the reporting form [with its] 58 pages of instructions." (Health Reform Talk)

[Guidance Overview]

IRS Guidance Addresses Effective Date of $2,500 Limit on Salary Reduction Contributions to Health FSAs
"[A] caveat should be noted regarding the clarification that 'taxable year' refers to the plan year of a cafeteria plan. Specifically, if an employer's principal purpose in changing from a calendar year to a fiscal year is to delay application of the $2,500 limit, the change will not satisfy the 'valid business purpose' requirement under the proposed cafeteria plan regulations. As a result, the plan year will remain the plan year that was in effect before the attempted change." (Practical Law Company)

[Guidance Overview]

2012 W-2 Reporting of Health Care Coverage Costs
"The IRS has issued Notice 2012-9 providing W-2 reporting requirements for 2012 W-2 forms ... The IRS is providing reporting transition relief for: 1) employers who will file less than 250 W-2 forms in the prior calendar year, 2) stand alone dental/vision plans, 3) health reimbursement arrangements, 4) multiemployer plans, 5) self-insured plans that are not subject to COBRA (i.e. church plans), 6) relief with respect to certain forms W-2 furnished to terminated employees before the end of the year, and 7) certain employers with respect to coverage under an employee assistance program, on-site medical clinic or wellness program.... Below is a chart that outlines the provisions of Notice 2012-9." (TRI-AD)


The Business of On-Site Employee Health Clinics - July 24-26 - Chicago   [Advert.]

Sponsored by World Congress

The Next Phase of Worksite Clinic Innovation: Maximizing the clinic’s potential means not just offering acute medical care, but integrating the worksite clinic into the foundation of a strategic health and wellness roadmap.


[Guidance Overview]

IRS Delays Health FSA Limits
"If your FSA is run on a calendar year basis, the only significant impact will be that the document does not need to be amended for another 2-1/2 years. The $2,500 annual limit still comes into effect on January 1, 2013 for all calendar year FSAs. However, if your plan is on a non-calendar year basis, and if you have been worried about how to change payroll reduction elections come January 1, 2013, you can now rest easier -- no changes need be made until the beginning of the next FSA plan year." (Swerdlin & Company)

[Guidance Overview]

Alternative Provider Reimbursement Models: How Are They Treated Under MLR Rules?
"The line differentiating administrative expense and medical expense can be difficult to determine. Historically, most health insurers have reimbursed providers for clinical services rendered on a 'fee for service' basis. Such fees clearly qualify as incurred claims. Increasingly, alternative payment models are being used, including 'pay for performance' bonuses that measure a provider's performance against quality and/or cost (efficiency) criteria; bundled payment models; sharing 'pools' of funds based on relative value units; and capitation models. Sometimes these arrangements involve intermediary entities, such as independent practice associations (IPAs) or pharmacy benefit management companies (PBMs) that may also perform administrative services that include utilization review and claims payment. This article addresses whether such alternative reimbursement models qualify as medical expense, for purposes of calculating MLR." (Epstein, Becker & Green, P.C.)

[Guidance Overview]

Final IRS Regs Issued on Premium Tax Credits under Health Care Reform
"The Final Regulations clarify topics in the proposed regulations including rules on whether coverage is 'affordable' for an employee for a plan year and the impact of automatic enrollment." (Haynes and Boone, LLP)

The National Institute for Health Care Management Foundation Studies Health Spending
"Total spending on health care in the U.S. accounted for almost 18 percent of GDP in 2010—about 50 percent higher than in the next closest comparable developed countries—and is projected to reach nearly 20 percent in the next decade. ... By 2010, the most recent year of data now available, spending had reached $2.594 tril.lion, or more than $8,400 for each person in the country." (AHIP Coverage)

States Taking Sides on NYC Sugary Soda Restrictions
"A plan by New York City Mayor Michael Bloomberg to limit the sale of large sugary drinks is being met by apprehension by the food industry as other states' leaders consider what example the restrictions could provide for them." (Kaiser Health News)

To Gulp or to Sip? Debating a Crackdown on Big Sugary Drinks
"Some health experts said there might be some correlation between restrictions on soft drinks—many locales, including New York, already ban or limit them from schools—and a leveling off, or in some places even a decline, in childhood obesity. But one researcher whose work was cited by City Hall in defense of the policy said in an interview Thursday that he did not think it would work." (The New York Times; free registration required)

Sense of Peril for Health Law Gives Insurers Pause
"Health insur.ance companies, which would be freed from some of the already existing regulations limiting their profits, would have to readjust their thinking about how best to compete. While companies would continue to make money by carefully selecting which customers to cover and would adjust their business accordingly, many insurers say the health care market is deeply flawed. 'The system doesn't work,' said Mark T. Bertolini, the chief executive of Aetna. Something has to be done.'" (The New York Times; free registration required)

House Panel Approves Bill to Ease Health FSA 'Use-It-Or-Lose-It' Rule
"Under the Medical FSA Improvement Act of 2011, H.R. 1004, cleared by the House Ways and Means Committee on a 23-6 vote, employers could amend their FSAs to allow employees to withdraw as taxable cash up to $500 in unused balances remaining at the end of the plan year or at the end of an FSA grace period, if an employer has that feature. The distribution would have to be made no later than seven months after the close of the plan year." (Business Insur.ance)

Report: White House Pushed Hard for PhRMA Health Care Reform Deal
"The pharma.ceutical industry, headed by the trade group PhRMA, was the last of the health care industry groups to sign on to a commitment to help pay for health reform, according to the emails—a point that didn't sit well with the White House and led to numerous rounds of negotiations to get the industry's support." (Politico)

Emails Describe Deal-Making with Big Pharma on Obama Health Bill
"The emails indicate that the White House originally wanted about $100 bil.lion in savings and other breaks, in return for increasing the number of patients with health insur.ance and drug coverage. The emails show that drug makers won other unpublicized deals from the administration, which both the White House and the pharma.ceutical lobby repeatedly denied at the time but were later disclosed in news reports. They included a promise from the White House not to demand that drug makers negotiate Medicare prices with the federal government, which could have reduced drug costs." (The Wall Street Journal)

Which Path Leads to Health Care Cost Containment: Selection or Reputation?
"This study determined that current initiatives to report provider costs are unlikely to motivate consumers to select lower-cost providers. In fact, they may do the opposite. However, there is evidence that higher-cost providers—particularly hospitals—may positively respond to public reports if the measures signal wastefulness or poor quality." (RAND Corporation)

January 2012 Census Shows 13.5 Mil.lion People Covered by Health Savings Account / High-Deductible Health Plans
"Overall, enrollment in HSA/HDHP products in the group market rose to 11.0 mil.lion in January 2012, up from 9.1 mil.lion in January 2011. HSA/HDHP enrollment in the individual market rose to 2.5 mil.lion covered lives in January 2012, up from 2.4 mil.lion in January 2011." (AHIP Coverage)

Evolving Responses of the States to the Affordable Care Act
"No matter how the Court rules, states will be shaken from their firm positions. A ruling adverse to the law will force reconsideration of plans in those states that are leading the way toward implementation. A ruling in support of the law will bring opposing states one large step closer to having the federal government assume responsibility for major activities within their borders. And a ruling that upholds the law in part and rejects other parts could force the federal government and the states to consider modifications in order to avoid significant problems in the health insur.ance marketplace." (HealthAffairs Blog)

IRS Further Explains Reform Rules on Health FSAs
"There is good news for employers that offer grace periods ... The IRS says in the notice that amounts carried over in a grace period that extends from the 2012 plan year do not count toward the $2,500 limit for the 2013 plan year. The IRS is showing additional mercy to administrators: the deadline by which they must amend cafeteria plans to reflect the new limit is Dec. 31, 2014." (Thompson SmartHR Manager)

IRS Issues Guidance on Implementation of $2,500 Health FSA Limit
"The Notice provides transition relief for contributions in excess of the $2,500 limit that are due to a reasonable mistake (and not willful neglect) and that are later corrected by the employer. To accomplish this correction, the employer must refund the excess amount to the employee as taxable wages and then report that amount on the employee's W-2 for the year the refund is made. Interestingly, the Notice also requests comments on whether the IRS should modify the 'use it-or-lose it' rule applicable to health FSAs. Although the request for comments doesn't explicitly state this, the IRS seems to be looking for ways to soften the tax blow associated with the $2,500 limit. They may also be trying to head off legislative proposals along the same lines." (Spencer Fane)

State Legislation and Actions Challenging Various Federal Health Care Reforms, 2011-2012
"Between January and December 31, 2011, a total of 45 states considered more than 200 filed measures, opposing elements of health reform or proposing alternative policies. 2012 newly filed bills in Utah and Virginia raise the 2011-2012 total to 47 states with opposing legislation considered. As of May 8, 2012, at least 162 bills in 38 states were newly filed for 2012 sessions, or subject to carry-over from 2011." Latest updates include actions in Kentucky, Utah and Wyoming. (National Conference of State Legislatures)

ObamaCare Standing in Way of Lower Health Care Costs and Job Creation
"[On May 31,] a hearing entitled, 'Barriers to Lower Health Care Costs for Workers and Employers' .. examined changes enacted under the 2010 health care law that are undermining policies designed to make health insur.ance more affordable.... [Subcommittee Chairman Rep. Phil Roe (R-TN) said] 'Consumer-directed health plans offer commonsense options to help millions of individuals secure a benefit plan that meets their health care needs at an affordable price. Unfortunately, recent policy changes threaten the success of these important plans.'" (U.S. House Education and the Workforce Committee, Subcommittee on Health, Employment, Labor, and Pensions)

Ways and Means Committee Approves Health Care Legislation Including Restoring Ability of Health FSAs to Pay for OTC Meds
"Ways and Means Chairman Dave Camp (R-MI) [said, 'All] four bills considered today received bipartisan support. Particularly of note are the repeals of the job-killing medical device tax on U.S. manufacturers and the ban on using health-related savings accounts for over-the-counter medication, both contained in the Democrats' health care law.'" (U.S. House of Representatives, Committee on Ways and Means)

Mental Health and Substance Abuse Treatment Exclusions in Employer-Provided Health Insur.ance Coverage
"[T]his report provides information on the incidence of treatment exclusions for [Mental Health and Substance Abuse (MH/SU)] for the 2011 or 2010 plan year and the 2008 plan year for employers that responded to our survey. In total, for the 2011 or 2010 plan year, of the 96 employers that responded to our question about whether their most popular plan excluded coverage for any specific treatments related to MH/SU, 39 employers reported excluding a treatment. In comparison, for the 2008 plan year, of the 81 employers that responded to our question about whether their most popular excluded coverage for any specific treatments related to MH/SU, 27 employers reported excluding a treatment." (U.S. Government Accountability Office)

Consumers Beware: Health Care Costs All Over the Map
"Healthcare BlueBook, a company that tracks what large group health plans pay, found that in one Midwestern city, members in health care plans paid anywhere from $840 at a doctor's office to $4,481 at a medical center for a colonoscopy. In Hartford, CT, the negotiated 'network' price for a regular birth at one hospital was $5,249, but cost $8,941 at a hospital a few miles away." (CNN)

We Must Focus on Preventing Disease If We Want Our Nation to Thrive
"[S]trategies that can prevent disease and promote health are chronically underfunded. For every dollar spent on health care, less than four cents goes toward public health and prevention—programs and policies that hold the most promise for lowering costs by keeping us from getting sick in the first place." (The Atlantic)

On-Site Health Centers Save Local Governments Money
"For several years now, large private companies, including the Walt Disney Co. and American Express, have created on-site health clinics to foster healthy behaviors and to practice preventive medicine among their employees. More recently, public entities have begun to do the same. Several Florida cities, for example, have set up municipal on-site clinics to provide everything from checkups to flu shots to nutrition consults." (Governing)

[Opinion]

An Open Letter to the Supreme Court About Health Insur.ance
Cute series of cartoons expressing the artist's beliefs about the state of the U.S. health care system. (Kaiser Health News)

[Opinion]

What's Wrong With Health Insur.ance Exchanges
"The purpose of this paper is to describe why the health insur.ance exchanges defined in PPACA won't work, won't increase access to affordable health care, and won't do anything to improve health outcomes or increase value. The solution to affordable coverage isn't to be found in these new bureaucracies, but rather in reducing barriers to competition and consumer choice and removing regulations that make coverage unaffordable today." (Galen Institute)

[Opinion]

Health Insur.ance Rebates Are Drop In the Bucket, But Justifying Rates Means Real Savings
"But what if insur.ance companies could not overcharge us in the first place? The 80% rule in the federal law only encourages insur.ance companies to pay hospitals and doctors inflated prices, because it inflates the 20% that insur.ance companies get to keep. (It's like the Hollywood agent who gets a 15% cut—his personal incentive is to get the biggest price for his client.) With no real curbs in California on how much insur.ance companies can charge, they have no incentive to bargain for lower medical costs to begin with." (Consumer Watchdog)

[Opinion]

ObamaCare Standing in Way of Lower Health Care Costs and Job Creation
"[On May 31,] a hearing entitled, 'Barriers to Lower Health Care Costs for Workers and Employers' .. examined changes enacted under the 2010 health care law that are undermining policies designed to make health insur.ance more affordable.... [Subcommittee Chairman Rep. Phil Roe (R-TN) said] 'Consumer-directed health plans offer commonsense options to help millions of individuals secure a benefit plan that meets their health care needs at an affordable price. Unfortunately, recent policy changes threaten the success of these important plans.'" (U.S. House Education and the Workforce Committee, Subcommittee on Health, Employment, Labor, and Pensions)

Benefits in General; Executive Compensation

[Guidance Overview]

Proposed Regs Clarify 'Substantial Risk of Forfeiture' Under Section 83
"The proposed regulations narrow the scope of what constitutes a substantial risk of forfeiture in two ways. First ... a substantial risk of forfeiture can only be a service-based restriction or a condition related to the purpose of the transfer.... The second proposed amendment narrows the scope of the 'condition related to the purpose of the transfer' provision." (PwC)

[Guidance Overview]

Employee Benefits Developments, May 2012
Covers recent rulings, opinions, and cases. Articles in this issue include: Release Protects TPA From Negligent Misrepresentation Claim; Estate May Sue to Enforce Waiver and Recover 401(k) Benefits; Separation Policy Benefit Is Not an 'Early Retirement Subsidy' Subject to QDRO; Employer Is Not Liable for Allegedly Ambiguous Summary Plan Description; Acquired Employees Were Properly Denied Shutdown Benefits; PBGC Asserts Liability Against Foreign Control Group Member; Court of Appeals Holds That Union May Be Required to Reimburse Employer for Withdrawal Liability Associated With Multiemployer Plan. (Hodgson Russ LLP)

[Guidance Overview]

DOMA Ban on Same-S.ex Marriage Falls
"The benefits at issue are keyed to legal marriages. Whether all of those benefits would still be available if a legally married couple traveled to another state to live could depend upon whether their new state officially accepted their marriage as valid. One thing left uncertain in Thursday's ruling was the impact of the ruling on legally married gays who now live in states that refuse to recognize any such marriage. A part of DOMA that deals with this point—Section 2, giving states permission not to recognize such a marriage performed in another state—was not at issue before the First Circuit." (SCOTUSBlog)

Appeals Court Turns Back Marriage Act as Unfair to Same-S.ex Couples
"The decision, from the United States Court of Appeals for the First Circuit, in Boston, will have no immediate effect because the court stayed its ruling in anticipation of an appeal to the Supreme Court. Legal experts said the justices could agree as early as this fall to hear the case and arguments could come next spring, making it the first case involving the same-s.ex marriage law to be decided by the court. While the case dealt narrowly with the question of federal benefits for same-s.ex couples—not with the legality of same-s.ex marriage itself—many scholars said it was a significant moment in civil rights." (The New York Times; free registration required)

Massachusetts Senate Adopts Legislation Limiting Compensation of Non-Employee Officers, Directors, and Trustees of Public Charities
"Continuing a trend we are seeing in other states, the Senate legislation also authorizes the Massachusetts Attorney General to review the compensation of public charity directors, officers, and senior managers acting in an executive capacity for the purpose of considering appropriate compensation levels." (Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.)

[Opinion]

Some Commentary on First Circuit Ruling Against DOMA
"[The First Circuit] panel's characterization that DOMA will have 'adverse consequences' for same-s.ex couples and 'will penalize' them smuggles in a baseline that assumes that same-s.ex couples have the same right to marriage as opposite-se.x couples.... [Further, the] panel's federalism concerns ... are entirely misplaced.... The definition of marriage for purposes of provisions of federal law is inherently a federal matter." (National Review)

Press Releases



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