Retirement Plan Administrator
for MVP Plan Administrators, Inc. in NC

ERISA/Employee Benefits Attorney
for Dinsmore & Shohl, LLP in DC, KY, OH

Communication/Education Specialist
for Benefit Plans Administrative Services (BPAS) in PA

Vice President, Plan Compliance Services
for Prudential in CT, IA, NJ, PA

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Webinar: Supreme Court Decision on Health Care Reform Law
Nationwide on June 28, 2012 presented by Seyfarth Shaw LLP

[Official Guidance]

Supreme Court Upholds ACA: Mandatory Purchase of Health Insur.ance, Else Pay the Tax, Is the Law of the Land (PDF)
[193 pages.] The entire ACA is upheld, with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read. The individual mandate is construed as a tax on individuals: "Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it." The Court holds that the mandate violates the Commerce Clause, but it becomes irrelevant because five Justices find the mandate to be constitutional under the taxing power. On the Medicaid issue, the Medicaid expansion is constitutional, but it is unconstitutional for the federal government to withhold Medicaid funds for non-compliance with the expansion provisions. "Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding." (Supreme Court of the United States via BenefitsLink.com)

New! Plan Document Software Module   [Advert.]

Wolters Kluwer Law & Business - ftwilliam.com has implemented lots of feedback and our own innovative ideas into a newly designed plan document software module. Join our webinar on July 10th for a sneak peek at our enhancements and what’s coming.

[Guidance Overview]

Don't Call It a Mandate—It's a Tax
"Salvaging the idea that Congress did have the power to try to expand health care to virtually all Americans, the Supreme Court on Monday upheld the constitutionality of the crucial—and most controversial—feature of the Affordable Care Act. By a vote of 5-4, however, the Court did not sustain it as a command for Americans to buy insur.ance, but as a tax if they don't." (SCOTUSBlog)

Supreme Court Decision Puts Pressure on Employers
"With all of the law's provisions still in place, employers will need to redouble their compliance efforts, especially regarding such immediate requirements as providing summaries of benefits and coverage to their employees ... [E]mployers also must report the value of employer coverage on IRS Form W-2, cap dollar limits on health care flexible spending arrangements, and increase Medicare withholding for high earners (those earning more than $200,000 per year). They must also comply with the reforms already in effect, such as coverage of dependents up to age 26." (Mercer)

How Health Benefits Have Changed in State and Local Governments: 1998-2011
"Although state and local governments still provide comprehensive coverage to most employees, the total percentage of employees who are covered by insur.ance has declined. In addition, a higher proportion of health care costs have shifted to employees, and a larger percentage of employees are now enrolled in contributory plans that require employees to pay premiums. Coverage for benefits has also changed; more employees have restricted health plans or plans with limited coverage, requiring them to pay deductibles or coinsurance." (U.S. Bureau of Labor Statistics)

Theft of USB Flash Drive Results in $1.7 Mil.lion HIPAA Security Settlement
"The settlement also includes a corrective action plan requiring the Alaska Department of Health and Human Services to review, revise and maintain policies and procedures to ensure compliance with the HIPAA security rules.... Although this enforcement action involved a state agency, the theft that led to HHS' investigation could just as easily have occurred under a private employer-sponsored health plan. The settlement is therefore a good reminder to health plans of the kinds of specific policies and procedures that should be in place to safeguard the security of ePHI." (Practical Law Company)

Webinar: Supreme Court Ruling on ACA and What It Means to You   [Advert.]

Join us for a breakdown of the Supreme Court ruling and how it affects you on Monday, July 2 at 2:00pm EDT. Click here to sign up for the HighRoads Webinar.

Employers Must Make Important Decisions on Health Strategies in Wake of U.S. Supreme Court's Ruling
"U.S. employers will turn to executing the strategies for 2013 and 2014 that they have so far put on hold. In turn, agencies such as the Department of Labor, the Internal Revenue Service and Health and Human Services, will need to work overtime to issue the significant amount of guidance employers need to implement these rules. Specifically [employers will need to]: (1) Focus on managing complex compliance issues, including the implementation of summaries of benefits and coverage, understanding preventive care requirements for women for non-grandfathered plans and managing the individual mandate's necessary reporting requirements. (2) Focus on communicating with their employees. (3) Determine a retiree health care strategy. (4) Explore alternative strategies like corporate health care exchanges to combat continued rising health care costs." (Aon Hewitt)

Six Charts to Explain Polls on Health Care Reform
"Pollsters have asked Americans hundreds of questions about the Affordable Care Act (ACA) in recent years. You can boil down all of that data into six charts[.]" (The Washington Post; free registration required)

Are Early Retiree Health Benefits a Form of Deferred Compensation?
"[W]orkers in firms offering RHBs have an incentive to stay with a firm in the years before they attain eligibility for RHBs, and a greater incentive than otherwise to retire thereafter. [This study examines] the age-specific relationship between workers' eligibility for RHBs and retirement. The findings suggest that workers in RHB-offering firms are less likely to retire at ages 50 and 51 than similar workers in firms that do not offer RHBs. Also, RHB-eligible workers aged 60 and 61 are more likely to retire than similar RHB-ineligible workers" (Upjohn Institute)

Federally Recommended Obesity Counseling Might Expand Coverage
"A federal health advisory panel's new recommendations could lead to a surge in insur.ance coverage for obesity-related counseling, treatments and services. The Preventive Services Task Force said ... doctors should provide counseling for obese patients, who have a body mass index of at least 30. Alternatively, they can refer patients to intensive, behavior-changing weight-loss programs that are at least 12 weeks long ... [T]he health reform law requires insurers to follow the task force's recommendations and cover the entire cost of obesity-related services because they fall under preventive care ... Regardless of the reform law's status, the recommendations could help compel insurers to cover weight-loss programs." (FierceHealthPayer)

In Quest for Lower Health Care Costs, CalPERS Considers Scrapping Use of Health Insur.ance Companies
"California's biggest healthcare buyer isn't happy about its $7-bil.lion annual medical bill climbing almost 10% next year, and the state's big insurers may be feeling the heat. The California Public Employees' Retirement System is preparing to rebid its health insur.ance business this fall for 1.3 mil.lion members, and two of its current plans, Anthem Blue Cross and Blue Shield of California, are likely to face intense competition as the giant pension fund considers its options. Perhaps the boldest move under consideration for 2014 would be to bypass insurers altogether in some areas of the state and begin contracting for medical services directly with large physician groups." (Los Angeles Times)

The Medical Home Bends the Cost Curve (PDF)
"While the Affordable Care Act is trying to manage health insur.ance, as well as mandating coverage, a number of projects around the country are trying to manage the underlying cost of health care. By bringing back the concept of a true primary care physician, who provides 90% of your care and coordinates with your specialists, these programs are bending the curve of health care cost trends. Most are seeing a reduction in emergency room visits and hospital days in the double digits." (International Society of Certified Employee Benefit Specialists)

Employers, Payers and Patients Are Looking Beyond Quality Measures in Provider Comparisons
"[A] comparison shopper, working on behalf of major employers, struggled to find prices she could trust as she scoured health insurers' websites this spring for the cost of procedures, laboratory tests and office visits. "It's not easy to get in a way that makes sense, in a way that is accurate," says ... a senior manager for ... a healthcare buyer coalition that includes Boeing Co., General Electric Co. and Target Corp. 'Nobody has the secret sauce,' ... But it's more than she could find a year ago, she says." (Modern Healthcare Online; free registration required)

Accountable Care Organizations Expected to Survive Regardless of Supreme Court's Ruling
"[Accountable Care Organizations ('ACOs')] have attracted a lot of attention due to the shared savings opportunities under Medicare. But private payers, providers, and physician networks also are investing in the concept, finding value in more accountable health delivery models. Even if the court were to wipe PPACA clean of ACOs ... the industry would continue to gravitate toward these structures." (Bloomberg BNA)

The High and Rising Costs of Health Care: What Can Be Done?
A video and podcast from a series that looks at a few of the most often-cited health care cost drivers. Excerpt: "This briefing focuses on efforts to improve health and health care at lower costs." (Kaiser Family Foundation)

Overview of Medical Loss Ratio Rebates
"Insurers in the large group market must achieve a medical loss ratio ('MLR') of 85%, while insurers in the individual and small group markets must achieve an MLR of 80%. Insurers that fail to achieve these percentages must issue rebates to their policyholders. The first of these MLR rebates are due in August of 2012, so plan sponsors should begin planning how to handle any rebates they might receive." (Spencer Fane)

The Legal Concerns Implicated by Corporate Wellness Programs
"On top of the financial justification for these programs, wellness programs help to foster happy and healthy employees, improving attendance and morale. It is no wonder that these programs are becoming increasingly popular with companies across the United States. However, employers must be aware of and proactively address a number of legal issues raised by these programs." (Snell & Wilmer L.L.P.)

Emerging Strategies for Managing the Cost of Prescription Drug Coverage
"As state and local governments slowly recover from the Great Recession by making tough budgetary decisions and structural changes, they continue to look for various sources of savings. One area of focus is prescription drug coverage, where cost trends are projected to increase at a rate far higher than general inflation. This Public Sector Letter discusses five strategies for managing the cost of prescription drug coverage." (The Segal Company)

CCIIO-Compiled List of Online Resources Pertaining to Creation of a Summary of Benefits and Coverage (SBC) (PDF)
Released June 26, 2012. Resources include: General CCIIO SBC Links, Sample Completed SBC, SBC Instructions for Individual Health Insur.ance Coverage, Guide for Coverage Examples Calculations - Maternity Scenario (including applicable codes), Narrative for Maternity Scenario, Guide for Coverage Examples Calculations - Diabetes Scenario (including applicable codes), Narrative for Diabetes Scenario, Coverage Example Calculator, Coverage Example Calculator Instructions, and Inputs for Coverage Example Calculator. (Center for Consumer Information & Insur.ance Oversight)

A Guide to Reading the Supreme Court's Health Care Ruling
"Supreme Court decisions are issued in a predictable format. What they say, though, is far from predictable. And ... figuring out what [the health care decision] says will be complicated by the near-certainty that the Court will not be unanimous.... While an opinion that speaks for a majority—that is, at least five Justices - will be the one that controls the bottom line (what is actually decided), any added opinions may better illuminate or even limit the scope of the outcome or, in fact, help to create multiple outcomes. [Finding out what is in each separate opinion] can be daunting." (SCOTUSBlog)

Half of Americans with Individually-Purchased Health Insur.ance Agree Employers Should Not be Required to Provide Employee Health Insur.ance
"[O]ver half of U.S. adults who have purchased health insur.ance individually (54%) think employers should not be required to provide employee health insur.ance compared to only 28% of Americans with employer-sponsored insur.ance who think this. Additionally, over half of those with individual health insur.ance (55%) think the government should play a role in assuring access to health insur.ance, compared to almost two-thirds of Americans with employer-sponsored coverage (64%)." (Harris Interactive)

[Opinion]

Statement of ERISA Industry Council on the U.S. Supreme Court's Decision
"With the legal uncertainty surrounding the Affordable Care Act now settled, ERIC urges policymakers to continue focusing on cost containment that does not simply result in artificial cost reductions and the shifting of costs from one payer to another. ERIC's members are committed to, and known for, providing high quality affordable health care for their employees and their families. Employers, however, do not have unlimited resources to spend on health care. The ACA included some provisions that may assist in bending the cost curve, but we believe more can be done, while also improving the quality and delivery of health care, as this remains of utmost importance among employers and individuals alike." (The ERISA Industry Committee)

[Opinion]

Statement of AHIP President on Supreme Court ACA Ruling
"As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries. The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed. "Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition. Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care." (AHIP Coverage)

[Opinion]

Statement of American Benefits Council President on Supreme Court ACA Ruling
"Throughout the legal challenges to the Patient Protection and Affordable Care Act ..., the vast majority of employers remained focused on meeting their obligations under the law. Whatever steps Congress and the Administration take from today forward must clarify—not complicate—employer responsibilities. If both branches of government focus on scoring political points, rather than helping employers and health insurers meet their obligations, then the majority of Americans who rely on employer-sponsored coverage will suffer[.]" (American Benefits Council)

[Opinion]

Statement of U.S. Chamber of Commerce on the Supreme Court's Health Care Decision
"While we respect the Court's decision, today's Supreme Court ruling does not change the reality that the health care law is fundamentally flawed. Left unchanged, it will cost many Americans their employer-based health insur.ance, undermine job creation, and raise health care costs for all. It is imperative that policymakers and the business community now work together to develop and support genuine reforms that control costs, improve access, ensure quality, and promote wellness." (U.S. Chamber of Commerce)

SEC Finalizes Rules for Compensation Committee and Adviser Independence (PDF)
"The principal changes in the final rules are: The definition of Committee includes, for certain purposes, members of the board of directors who oversee executive compensation on the board's behalf if there is no compensation committee or other board committee performing typical compensation committee functions; An additional independence factor is to be considered by the Committee when selecting an adviser; and The conflict of interest disclosure applies to a compensation consultant retained by management if the consultant's role is otherwise required to be disclosed under existing SEC rules." (Frederic W. Cook & Co., Inc.)

Uninsured and Fighting Blazes: Welcome to the Life of a Temporary-Status Federal Firefighter
"Thousands of federal firefighters charged with taming the blazes do not have health insur.ance.... Of all the jobs where you might want health insur.ance, firefighting near certainly ranks near the top of the list. Firefighters spend two-week shifts working 18 hour days in dangerous conditions. Some develop breathing problems due to smoke inhalation. But many federal firefighters are temporary employees, who only work six months out of the year ... Under federal regulations, temporary employees of the Forest Service do not receive benefits. That means no health care and no retirement pension." (The Washington Post; free registration required)

Stockton's Default Tied to Pensions and Big Stock Market Gamble
"[A muni bond portfolio manager looked at] expenditures for public safety, debt service, pension funding and other post-employment benefits. In a cross-section of 118 cities around the country with populations of between 150,000 and 400,000, the median expense of those four combined categories represented 72.6% of general fund expenses. In a smaller group of 27 California cities, which like the larger group included Stockton, the median expense of the four categories was 76.7% of general fund expenses. In the case of Stockton, a city of nearly 300,000, the four categories account for 95.7% of general fund expenses." (Investment News; free registration required)

Hot Topics in Employee Benefits (PDF)
Excerpt: "Presentation materials from June 27, 2012 webinar, 'Hot Topics in Employee Benefits—What We're Seeing,' which featured updates on hot topics or trends you should be following." (Morgan, Lewis & Bockius LLP)

Miller Chevalier Focus on Employee Benefits, June 27, 2012
This issue includes: ERISA and tax rules on medical loss rebates; New tax guidance on tips and service charges; Impending limits on health FSAs; Deductibility of local lodging expenses (Miller Chevalier)

Hodgson Russ Employee Benefits Developments, June 2012
Monthly newsletter; this issue includes a discussion of recent IRS Proposed Regs that permit deduction for local lodging expenses, and coverage of recent ERISA and benefits court cases, including articles titled: COBRA Election Notice Failure Results in Statutory Damages, Transgender Spouse Reinstated as an Eligible Plan Participant, Keogh Plan With Qualification Defects Found to be Exempt From Bankrup.tcy Estate, Court Upholds Plan Administrator's Valuation Decision for Plan Distribution, Severance Denied to Employee Who Retired Following Expiration of Medical Leave, and Presumption of Prudence Defeats Stock Drop Case. (Hodgson Russ LLP)