|
BenefitsLink Health & Welfare Plans Newsletter
|
|
|
|
|
New Guidelines on Obesity Treatment May Herald Expansion In ACA-Mandated Coverage
"Recently revised guidelines from the U.S. Preventive Services Task Force ... recommend that clinicians screen patients for obesity ... Further, they say patients who meet or exceed that level should be offered or referred to 'intensive, multicomponent behavioral interventions' to help them lose weight.... Under the [ACA,] new health plans and those whose benefits change enough to lose their grandfathered status must provide services recommended by the Preventive Services Task Force at no cost to members. For the 70 percent of employers that already offer weight management programs, that may mean just supplementing what they already offer ... But some employers are concerned they may be on the hook for ongoing treatment as employees make repeated attempts to lose weight."
(Kaiser Health News)
|
Seasonal Firefighters Face Many Dangers Without Health Insur.ance; Union Seeks Federal Coverage
"They work the front lines of the nation's most explosive wildfires, navigating treacherous terrain, dense walls of smoke and tall curtains of flame. Yet thousands of the nation's seasonal firefighters have no health insur.ance for themselves or their families. Many firefighters are now asking to buy into a federal government health plan, largely out of anger over a colleague who was left with a $70,000 hospital bill after his son was born prematurely. Their request has been bolstered by more than 125,000 signatures gathered in an online petition during this year's historic fire season in the West and the ongoing national debate over health care."
(The Washington Post)
|
Supreme Court's Decision Striking Down ACA's Medicaid Provisions Leaves Gap in Health Coverage for the Poor
"In states that choose not to expand Medicaid, substantial numbers of the very poor could be left out of coverage. The reform law provides tax credits to help people with incomes between 100 percent and 400 percent of the federal poverty level (about $23,000 to $92,000 for a family of four) buy private insur.ance. But the bill's drafters made no provision to provide subsidies for anyone below the poverty line because they assumed that those people would be covered by expanded Medicaid. But now that the expansion is no longer mandatory, the poorest adults—those without children and parents with incomes below the poverty line but above Medicaid eligibility (typically well below the poverty line)—could land in the gap, ineligible for both Medicaid and for tax credits to buy private insur.ance."
(The New York Times; free registration required)
|
Supreme Court Agrees to Resolve Circuit Split Over ERISA Plan Reimbursement Rights
"The case concerns the U.S. Airways ERISA welfare benefit plan's efforts to enforce the plan's reimbursement provisions, which require plan participants or beneficiaries to reimburse the plan for benefits the plan pays due to injuries caused by third parties out of any settlement fund recovered from a third party or other insur.ance.... The employer ... posed the issue as: '[w]hether the Third Circuit correctly held—in conflict with the Fifth, Seventh, Eighth, Eleventh, and D.C. Circuits—that Section 502(a)(3) of the Employee Retirement Income Security Act (ERISA) authorizes courts to use equitable principles to rewrite contractual language and refuse to order participants to reimburse their plan for benefits paid, even where the plan's terms give it an absolute right to full reimbursement.'" [U.S. Airways v. McCutchen, 3rd Cir (Nov. 16, 2011).]
(Littler Mendelson LLC)
|
|
Deloitte Health Care Reform Memo, July 9, 2012
The health care reform memos are issued on a weekly basis, highlighting news from the previous week's activities in the administration and implications for plan sponsors and various stakeholder groups. Articles include: Business groups seek clarity on ACA implementation issues; Retailers want changes to definition of full-time employee; Taxing authority, funding for ACA in Ways and Means, finance committees this week; Portable devices bill introduced; and various State legislation.
(Deloitte Center for Health Solutions)
|
Health Care Law Offers Wider Benefits for Treating Mental Illness
"Until now, people with mental illness and substance disorders have faced stingy annual and lifetime caps on coverage, higher deductibles or simply no coverage at all. This was supposed to be fixed in part by the Mental Health Parity and Addiction Equity Act of 2008, which mandated that psychiatric illness be covered just the same as other medical illnesses. But the law applied only to larger employers (50 or more workers) that offered a health plan with benefits for mental health and substance abuse. Since it did not mandate universal psychiatric benefits, it had a limited effect on the disparity between the treatment of psychiatric and nonpsychiatric medical diseases. Now comes the Affordable Care Act combining parity with the individual mandate for health insur.ance."
(The New York Times; free registration required)
|
ACA Exchange Participation Applications for Individuals, Small Employers and Health Insur.ance Brokers Now Available for Review
"[The] Centers for Medicare & Medicaid Services (CMS) published on its website four items regarding data collection to implement ACA provisions to extend health insur.ance coverage under the new Affordable Insur.ance Exchanges and Small Business Health Options Program (SHOP) Exchanges.... CMS anticipates that 90 percent of Exchange applications from individuals and small employers will be submitted online. For small employers, this figure reflects CMS' expectation that 85 percent of applications will be facilitated by a broker who will be required to submit information electronically."
(Wolters Kluwer Law & Business)
|
Creating IRS Reporting Forms Is First Step in Enforcement of the Health 'Tax'
"The Internal Revenue Service is now contemplating how to draft tax forms to gather information at tax time about how Americans are obeying the mandate to obtain health insur.ance. If the IRS follows the lead of Massachusetts, federal taxpayers may not find the task of reporting to be quick and easy. It won't be simply a matter of checking a single box on the tax return. But, easy or not, the way Massachusetts does it appears to be working. State officials report that 'some 97 percent of the taxpayers are complying with new health reform filing requirements.'"
(SCOTUSBlog)
|
Benefits in General; Executive Compensation
|
Terminated Executives Entitled to Payment Under Equity Awards Due to Problem in Plan Administration
"The US Court of Appeals for the Eighth Circuit held on July 5, 2012 that former executives were entitled to payments under performance share and restricted stock awards, despite their employer's determination that the executives forfeited their awards on their employment termination. The court's holding was based in part on its conclusion that the individual making that determination did not have authority to administer the plans. The decision in Schaffart v. ONEOK, Inc. highlights the importance of carefully drafting plan terms and ensuring that the persons making plan decisions have proper authority to administer the plan." [Schaffart v. ONEOK, Inc., Nos. 10-3862, 11-1062 (8th Cir. July 5, 2012).]
(Practical Law Company)
|
Still More Compensation Limits for Financial Institutions
"The Board of Governors of the Federal Reserve System, the Office of the Comptroller of the Currency, and the Federal Deposit Insur.ance Corporation jointly issued proposed rules that would require all financial institutions to comply with the complicated and severe bank capital standards from the Basel Committee on Banking Supervision to the Basel capital framework ('Basel III'). Unlike some parts of Dodd-Frank (e.g., Section 956), it applies to all financial institutions, regardless of their size. The proposed rules would implement a new capital conservation buffer framework, limiting payment of capital distributions and certain discretionary bonus payments to executive officers and key risk takers if the banking organization does not hold certain amounts of common equity tier 1 capital in addition to those needed to meet its minimum risk-based capital requirements."
(Winston & Strawn LLP)
|
Speakers Ask IRS for Clear Rules, Respect For States in Governmental Plan Rulemaking
"The Internal Revenue Service should avoid asking public retirement system administrators to enforce IRS rules that are unclear, uncertain, and impractical, public pension attorneys told IRS and Treasury Department officials at a regulatory hearing ... aimed at clarifying the definition of 'governmental plan' under Section 414(d) of the tax code ... Public retirement system administrators are most concerned that any IRS rules that would draw a brighter line between governmental and nongovernmental plans be 'clear, certain, and practical[.]'"
(Bloomberg BNA)
|
Annual Statistical Report on the Social Security Disability Insur.ance Program, 2011
"Disability benefits were paid to over 9.8 mil.lion people. Awards to disabled workers (998,980) accounted for over 89 percent of awards to all disabled beneficiaries (1,114,060). In December, payments to disabled beneficiaries totaled about $10.4 bil.lion. Benefits were terminated for 653,877 disabled workers. Supplemental Security Income payments were another source of income for about 1 out of 6 disabled beneficiaries."
(U.S. Social Security Administration)
|
Changes in IRS Nonbank Trustee Program (PDF)
"[As a result of a recent audit by] the Treasury Inspector General for Tax Administration [of] the Internal Revenue Service (IRS) Employee Plans oversight program for nonbank trustees and custodians (NBTs) ... the IRS undertook to ... [s]trengthen its processes for evaluating new applications to serve as an NBT.... [and expand] its audit program for NBTs ... Because the audits revealed a high level of compliance with applicable tax requirements, the Inspector General recommended, and the IRS agreed to consider, reducing the audit resources dedicated to NBTs and shifting them to the regular IRS retirement plans audit program."
(Sutherland)
|
Fourth Circuit Takes Expansive View of Equitable Relief for Plan Participants Against Fiduciaries
"Courts have traditionally interpreted ERISA Section 502(a)(3) as providing a very narrow opportunity for recovery, because the recovery had to be equitable, not legal, in nature; thus, claims for compensatory damages typically have not been not available. In Amara, the Supreme Court opened the door to a more expansive interpretation of 'equitable relief,' specifically including surcharge and equitable estoppel as possible remedies available under ERISA Section 502(a)(3). [In this case over an insur.ance company's denial of benefits for an ineligible dependent mistakenly enrolled in an employer's life insur.ance plan, the participant] argued that the equitable remedies of surcharge as well as equitable estoppel should be available ... to allow monetary compensation caused by MetLife's fiduciary breach. The Fourth Circuit Court of Appeals agreed[.]" [McCravy v. Metropolitan Life Ins. Co., 2012 U.S. App. Lexis 13683 (4th Cir. July 5, 2012).]
(Wombyle Carlyle)
|
[Opinion]
Consumer-Directed Health Plans: Reducing Costs and Maintaining Quality
"Over the past decade, the use of consumer-directed health plans (CDHPs) has increased substantially. In 2006, Indiana introduced plans with health savings accounts as a coverage option for state employees. A case study ... examined the outcome of Indiana's implementation and found generous cost savings and increasing annual enrollment. Another study ... found that greater use of CDHPs that use HSAs or HRAs could result in annual savings as high as $57 bil.lion in the overall health care system."
(The Heritage Foundation)
|
|
BenefitsLink.com, Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
Phone (407) 644-4146
Fax (407) 644-2151
Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager
Copyright © 2012 BenefitsLink.com, Inc. All rights reserved, but feel free to forward this newsletter if done without modification in any way.
All materials contained in this newsletter are
protected by United States copyright law and may not be
reproduced, distributed, transmitted, displayed,
published or broadcast without the prior written
permission of BenefitsLink.com, Inc., or in the case of
third party materials, the owner of that content. You
may not alter or remove any trademark, copyright or
other notice from copies of the content.
Links to Web sites other than those owned by
BenefitsLink.com, Inc. are offered as a service to
readers. The editorial staff of BenefitsLink.com, Inc.
was not involved in their production and is not
responsible for their content.
Useful links:
|
|