Onsite Participant Counselor - Retirement Services
for Diversified in MI

Data Conversion Specialist - Client Implementation
for Diversified in NY

Employee Benefits Attorney
for Miller Johnson in MI

Pension Administrator
for Midwest Pension Actuaries, Inc. in MI

Defined Benefit/Defined Contribution Plan Administrator
for Actuarial Consultants, Inc. in CA

Defined Benefit Plan Specialist
for ACCG/GEBCorp - Association County Commissioners of Georgia's Government Employees Benefits Corporation in GA

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A, B & C Players: Staffing Great Organizations
Nationwide on July 17, 2012 presented by Davidson Marketing Group -- FutureOffice Network

 

[Official Guidance]

Text of CMS Final Regs on Data Collection to Support Standards Related to Essential Health Benefits; Recognition of Entities for the Accreditation of Qualified Health Plans (PDF)
"This final rule establishes data collection standards necessary to implement aspects of section 1302 of the Patient Protection and Affordable Care Act ..., which directs the Secretary of Health and Human Services to define essential health benefits. This final rule outlines the data on applicable plans to be collected from certain issuers to support the definition of essential health benefits. This final rule also establishes a process for the recognition of accrediting entities for purposes of certification of qualified health plans.... In this final rule, we have responded to comments submitted in response to the recognition of entities for the accreditation of QHPs within the scope of the proposal and this final rule." (Department of Health and Human Services)

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[Guidance Overview]

Hot Potato Coming Soon: MLR Rebate Checks for Insured Group Health Plans
"In the next few weeks, employers with insured group health plans, or insured options (such as an insured HMO) in an otherwise self-funded plan, may receive rebate checks from their insurers. Employers receiving these checks will need to consider how to apply the amounts in a manner that complies with applicable law.... A plan that is subject to ERISA needs to assess whether rebate amounts are plan assets that can be used only for plan purposes, whether any portion of the money needs to be allocated specifically for the benefit of employees participating in the plan, how to make that allocation, and what the tax consequences of an allocation might be. In general, policyholders will be required to apply the rebates to appropriate uses within three months." (Ballard Spahr)

[Guidance Overview]

Health Insur.ance Rebate Payments Subject To Employment Taxes for Some Employees
"While there is some flexibility in how the rebates are passed on to employees, several scenarios covered in a question-and-answer format by IRS said that 2012 rebate amounts to employees for pre-tax premiums, such as premiums paid under a qualified Internal Revenue Code Section 125 plan, are subject to employment taxes. How the rebate is paid to employees determines the level of involvement for payroll[.]" (Bloomberg BNA)

Insur.ance Company Not Liable as a Fiduciary for Declining to Permit Withdrawals Without Administrator's Approval
"The decision in this case makes no mention of the portion of ERISA's fiduciary definition that gives fiduciary status to persons who have authority or control over plan assets whether or not that control is discretionary. That portion of the definition is sometimes overlooked in the case law, and that might be what happened here. Alternatively, the omission here might illustrate a different point; namely, that fiduciary status is not an all-or-nothing proposition. The court might be saying that, under the circumstances, the insur.ance company was not a fiduciary with respect to any withdrawal requests. A conclusion that the company was not acting as a fiduciary with respect to withdrawal requests would not be inconsistent with fiduciary status in other matters, such as the handling of contributions and investments." [Turner v. Pan American Life Ins. Co., 2012 WL 2735328 (5th Cir. 2012)] (Thomson Reuters / EBIA)

Postal Service Set to Default on Billions in Prefunding of Retiree Health Benefits
"[T]he Postal Service, faced with continuing financial losses because of a drop in mail volume, expects to default for the first time on its annual payment for future retiree health benefits. The $5.5 bil.lion payment, which was deferred from the 2011 fiscal year, is due Aug. 1. The Postal Service is also scheduled to make a $5.6 bil.lion payment for 2012 in September. A spokesman for the agency said that barring intervention from Congress, it would default on both payments." (The New York Times; free registration required)

Provider Networks, Premiums Key Factors in Health Plan Choice (PDF)
"When given a choice, most individuals with traditional health coverage say they chose that option because it offered a good network of providers ... In contrast, among those with so-called consumer-driven health plans, most cited the lower premiums and opportunity to save money in a health account. While close to half of all private-sector workers who have health insur.ance are offered a choice of health plans, most of those with a choice work for large firms[.]" (EBRI)

Medicare Beneficiaries Less Likely to Experience Cost- and Access-Related Problems than Adults with Private Coverage
"Medicare beneficiaries are more satisfied with their health coverage than enrollees in either employer-sponsored plans or individual plans. Only 8 percent of Medicare beneficiaries age 65 or older rated their insur.ance as fair or poor, compared with 20 percent of adults with employer-sponsored insur.ance and 33 percent of adults purchasing coverage in the individual market." (The Commonwealth Fund)

Small Employers and Self-Insured Health Benefits: Too Small to Succeed?
"[L]arge employers increasingly have bypassed traditional health insur.ance for their workers, opting instead to assume the financial risk of enrollees' medical care through self-insur.ance. Because self-insur.ance arrangements may offer advantages—such as lower costs, exemption from most state insur.ance regulation and greater flexibility in benefit design—they are especially attractive to large firms with enough employees to spread risk adequately to avoid the financial fallout from potentially catastrophic medical costs of some employees. Recently, with rising health care costs and changing market dynamics, more small firms—100 or fewer workers—are interested in self-insuring health benefits." (Center for Studying Health System Change)

Federal District Court Rules Disability Claims Manuals Are 'Confidential Business Information' Entitled to Protection
"This case involves an ongoing claim for long term disability benefits under an ERISA plan. Plaintiff sought Hartford's claims handling policies, manuals and claims handling information. Plaintiff's counsel refused to enter into a protective order because he "want[ed] to be able to use whatever I get in another case against Hartford should one arise." Hartford moved for a protective order [which was granted]." [Takata v. Hartford Comprehensive Benefit Service Company and Battelle Memorial Institute (E.D. Washington June 29, 2012) ] (Lane Powell PC)

Employers Proceed with Implementing the PPACA
"PPACA's effects on employer-sponsored group health plans will differ in part on whether a plan is 'grandfathered' (i.e., existing in relatively unmodified form since the law's March 23, 2010 enactment), insured, or considered large, but many of the law's requirements apply regardless. This [article] summarizes PPACA's upcoming provisions for which employer-sponsored group health plans should prepare. Because the federal agencies with oversight ... have not published all necessary guidance to date, plan sponsors may face additional pressures and uncertainties about their responsibilities and with compliance issues." (Milliman)

[Opinion]

Addressing Further Myths About 'Obamacare'
"Myth #6: Unions that supported Obama don't have to comply with Obamacare.... Myth #7: Obamacare creates a secretive board of bureaucrats with power to cut off grandpa's dialysis or grandma's chemotherapy.... "Myth #8: Obamacare is a distraction from the main issue, which is jobs." (The New York Times; free registration required)

[Opinion]

Designing the Essential Health Benefits for Your State: A Consumer Advocate's Guide (PDF)
"As states move forward selecting their benchmark plan and defining their essential health benefits package, it's critical that consumer advocates are involved in the process. This guide includes an overview of the requirements a state's essential health benefits package will have to meet under the Affordable Care Act and outlines the process for defining these benefits using a benchmark plan. It then provides guidance on how to analyze your state's benchmark plan options and highlights potential avenues for advocacy." (FamiliesUSA)

Fourth Circuit Identifies Surcharge and Equitable Estoppel as Possible Remedies for Fiduciary Breach Under ERISA Life Insur.ance Plan
"This opinion applies one of the significant principles of the Amara opinion—that courts have greater latitude than previously recognized in fashioning remedies for fiduciary disclosure breaches.... [T]he takeaway for plans and insurers is to monitor eligibility, because after Amara the cure for accepting life insur.ance (and perhaps other welfare benefit) premiums for ineligible individuals may not be limited to simply returning those premiums." [McCravy v. Metro. Life Ins. Co., 2012 WL 2589226 (4th Cir. 2012)] (Thomson Reuters / EBIA)

Proskauer Rose ERISA Litigation Newsletter, July 2012
"[T]he authors examine the risks and exposures that employers may face in adjusting their programs to the new requirements imposed by the [ACA]. The authors also examine the litigation risks and potential causes of action that may arise in the wake of the [ACA]'s implementation. [A] second article examines deferred-compensation arrangements. Using recent judicial decisions as a guide, the author considers ERISA's relationship with deferred-compensation programs and ERISA's impact on disputes involving benefits payable under those programs. The author concludes with suggestions for employers considering such arrangements as part of their compensation programs." (Proskauer Rose LLP)

DOMA and Employee Benefits
"Although the recent case law may be indicative of the tide turning against the constitutionality of DOMA, it is too early to tell. More litigation on the issue is expected. The district court decision in San Francisco is not binding on other courts, even courts in the same district. The First Circuit decision has been stayed, so it also is not binding on other courts, although lower courts in the First Circuit as well as in other federal circuit courts of appeal may find it persuasive. What that means is that plan administrators will need to watch future decisions to determine whether they impact their respective plans. If a split develops in the federal circuit courts of appeal, administrators will have difficult decisions to make about whether or not DOMA is still applicable in their jurisdiction. If a benefit plan is applicable in more than one jurisdiction, plan administrators' jobs will be even more difficult because they may have to reconcile conflicting court decisions." (Precept Group)

Cedar Brook Financial Partners Hires Chief Experience Officer
(Cedar Brook Financial Partners)

Prudential to Discontinue Sales of Group Long-term Care Insurance Coverage
(Prudential Financial, Inc.)

NovaSom Announces Appointment of Ron Loeppke, MD to Board of Directors
(NovaSom, Inc.)