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[Guidance Overview]
Rules on 90-Day Waiting Period Limit and Identifying Full-Time Employees Released (PDF)
"The new guidance adopts the rules proposed in Notice 2012-17 and expands upon those rules in several respects. The rules are described as temporary guidance that will remain effective at least until December 31, 2014, with regulations or other future guidance becoming effective after adequate time for employers to comply with any new requirements."
(Sutherland)
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Missouri Lawmakers Override Governor's Veto; Expanded Exemption from Birth Control Coverage Mandate Becomes Law
"Missouri lawmakers enacted new religious exemptions from insurance coverage of birth control ... overriding a gubernatorial veto and delivering a political rebuke to an Obama administration policy requiring insurers to cover contraception. Although Missouri and 20 other states already had some sort of exemption from contraceptive coverage, Missouri's newly expanded law appears to be the first in the nation directly rebutting the federal contraception mandate, according to the National Conference of State Legislatures and supporters of the law."
(San Francisco Chronicle)
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Consumer Advocates Worry Blue Cross Blue Shield Changes Would Mean Higher Rates
"Since 1980, Blue Cross has been governed by PA 350 as Michigan's insurer of last resort. The law exempts Blue Cross from paying state and local taxes in exchange for offering coverage to people with pre-existing conditions. It also sets more stringent regulations over rate increases. The new structure would include a separate, independent nonprofit entity funded with $1.5 billion in contributions from Blue Cross over the next 18 years. This would serve as a continuation of the organization's charitable mission."
(mLive.com)
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The ACA's Pre-Existing Condition Insurance Plan: Enrollment, Costs, and Lessons for Reform
"Nearly 78,000 people have enrolled since the [federal Pre-Existing Condition Insurance Plan (PCIP)] was implemented two years ago. This issue brief compares the PCIP with state-based high-risk pools that existed prior to the [ACA] and considers programmatic differences that may have resulted in lower-than-anticipated enrollment and higher-than-anticipated costs for the PCIP. PCIP coverage, like state high-risk pool coverage, likely remains unaffordable to most lower-income individuals with preexisting conditions, but provides much needed access to care for those able to afford it. Operational costs of these programs are also quite high, making them less than optimal as a means of broader coverage expansion."
(The Commonwealth Fund)
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ACA's Pre-Exisiting Condition Insurance Program Serving Its Purpose as a Bridge Program
"The Pre-Existing Condition Insurance Plan [PCIP], the name for the federal high-risk health insurance pool established by the [ACA], is serving its purpose as a bridge program ... [by] providing a coverage option for people with pre-existing health conditions until they are eligible to purchase insurance through the new state exchanges in 2014, with much of their costs subsidized. However, the program's high costs and relatively low enrollment numbers indicate that high-risk pools, which are designed to cover people excluded from the individual insurance market because of a health problem, are not a tenable long-term solution."
(The Commonwealth Fund)
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Government Safety Net Leads to Declining Uninsured Rates for Those Under Age 65
"According to a report released today by the U.S. Census Bureau, the number of uninsured Americans under age 65 fell from 49.2 million in 2010 to 47.9 million in 2011. When including those 65 and older, the number of uninsured Americans fell from 50.0 million to 48.6 million over this period."
(Economic Policy Institute)
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2012 Summary of Findings from Annual Employer Health Benefits Survey (PDF)
"The key findings from the survey, conducted from January through May 2012, include modest increases in the average single and family insurance premiums and little change in the premium contributions and cost sharing that workers face since last year. Enrollment in high deductible plans with a savings option, such as a health savings account or health reimbursement arrangement, did not increase significantly over the previous year for the first time since 2009."
(Kaiser Family Foundation and Health Research & Educational Trust)
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Comprehensive Survey Released on Employer-Sponsored Health Coverage
"Although premiums rose at a faster rate than both wages (1.7% rise) and general inflation (2.3% rise), this year's premium increase is 'strikingly low' according to Kaiser's President and CEO Drew Altman. Specifically, the survey found that the average annual 2012 premiums for employer-sponsored coverage were $5,615 for single coverage and $15,745 for family coverage. While the premium rise was relatively low compared to prior years, it 'still takes a growing bite out of middle-class workers' wages, which have been flat or falling in real terms, said Altman[.]"
(Littler Mendelson LLC)
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Detailed Results of 2012 Survey of Employer-Sponsored Health Plans (PDF)
"The average annual premiums in 2012 are $5,615 for single coverage and $15,745 for family coverage. Average premiums increased 3% for single coverage and 4% for family coverage in the last year. Consistent with recent years, average family premiums for small firms (3-199 workers) ($15,253) are significantly lower than average family premiums for larger firms (200 or more workers) ($15,980).... While nearly all large firms (200 or more workers) offer health benefits, small firms (3-199 workers) are significantly less likely to do so. The percentage of all firms offering health benefits in 2012 (61%) is statistically unchanged from 2011 (60%), and also similar to the reported percentages from 2004 through 2009."
(Kaiser Family Foundation and Health Research & Educational Trust)
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Employers Use Carrots and Sticks to Promote Worker Health
"Nearly two-thirds (63 percent) of firms offering health benefits offer at least one wellness program to employees, like nutrition classes or programs that help people lose weight or stop smoking, according to the 2012 Employer Health Benefits report from the Kaiser Family Foundation and the Health Research & Educational Trust. About a tenth offer some sort of financial incentive for participation, like smaller premium contributions, smaller deductibles, higher health-savings account contributions, gift cards, merchandise or even cash."
(The New York Times; free registration required)
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Roundup of 2012 Health Care Reform State Ballot Initiatives
"Five states have approved ballot initiatives for the upcoming November election in response to the [ACA]. In Alabama, Florida, and Wyoming voters will be asked to vote on proposed amendments to their state constitutions. Missouri and Montana voters will also decide questions on the federal law's reach within their states."
(Wolters Kluwer Law & Business)
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Employers Still Face Unknowns in Deciding Their Next Moves on Employee Health Benefit Programs
"Until fairly recently, most discussions about a company response to the ACA took place at the human resources level, but now CFOs and their key reports are getting more involved ... Many corporate executives are waiting to see whether their competitors will abandon health care and pay the penalty ... From a purely financial standpoint, doing so would be a wise choice for most employers that offer health benefits, because their per-employee health-care costs are typically several times greater than $2,000 per year, often $10,000 to $15,000. Standing in the way, though, are recruiting and retention concerns."
(CFO)
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Cost Uncertainty Roils Health Care Even Before 2014
"'Shifting costs to employees is not going to impact your trend of rising health costs,' said Renee Frisch, a Mercer senior consultant ... 'For years, employers have been looking at other ways to mitigate the trend ... But at the end of the day, if they need short-term cost savings, the fastest way is to increase co-pays or increase deductibles.'"
(The Philadelphia Inquirer)
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Fewer People Were Uninsured in 2011; One-Year Drop of About 2-1/2%
"New data released by the U.S. Census Bureau today show that the number of people without health insurance declined by 1.3 million in 2011, falling to 48.6 million people.... This is excellent news -- the number of uninsured has increased by 12 million people over the past decade, and the latest numbers suggest an important turning point in this upward trend. The decline in uninsured Americans in 2011 was the largest one-year drop in the past decade."
(The Commonwealth Fund)
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Preview of Mercer's Health Benefits Survey Finds Cost Will Rise 6.5% in 2013
"Early responses from a Mercer survey still in the field suggest that the average per-employee cost of health coverage will rise about 6.5% in 2013. This rate of increase is similar to the actual increase in 2011 of 6.1%, and slightly higher than the 5.7% increase predicted for 2012. A majority of employers—58%—are planning to shift cost to employees to keep the 2013 increase down."
(Mercer)
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Despite Slight Drop in Uninsured, Last Year's Figure Points to 48,000 Preventable Deaths
"The Census Bureau's official estimate that 48.6 million Americans lacked health insurance in 2011 means approximately 48,000 people died needlessly last year because they couldn't get access to timely and appropriate care, a health policy expert said today. The estimated death toll is based on a peer-reviewed Harvard study published in the American Journal of Public Health in 2009, widely cited during the health reform debate, which found that for every 1 million persons who were uninsured there were about 1,000 related, preventable deaths."
(Physicians for a National Health Program)
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Income, Poverty, and Health Insurance Coverage in the United States: 2011 (PDF)
"Both the percentage and number of people [in the aggregate] without health insurance decreased between 2010 and 2011.... In 2011, the rate and number of those with private health insurance coverage were not statistically different from 2010 ... Both the rate and number of people covered by employment-based coverage in 2011 ... were not statistically different from 2010. The rate ... and the number of people covered by direct-purchase insurance ... in 2011 were not statistically different from 2010. The percentage of people covered by government health programs increased to 32.2 percent in 2011 from 31.2 percent in 2010 ... The percentage and number of people with Medicaid coverage increased in 2011 to 16.5 percent and 50.8 million from 15.8 percent and 48.5 million in 2010. In 2011, the percentage and number of people with Medicare coverage also increased, to 15.2 percent and 46.9 million from 14.6 percent and 44.9 million."
(U.S. Census Bureau)
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Overview of the Uninsured in the United States: A Summary of the 2012 Current Population Survey Report
"The percentage of people without health insurance in 2011 decreased from 2010. In 2011, the percentage was 15.7%, compared to 16.3% in 2010. During 2011, an estimated 48.61 million people were without insurance, a statistically significant decrease of 1.34 million from the estimated 49.95 million uninsured in 2010. Young adults (19-25) were the age group that experienced the greatest decline in the percentage without insurance over the past year, from 29.8% in 2010 to 27.7% in 2011. For the first time in the last 10 years, the rate of private insurance coverage did not decline in 2011. Employer-sponsored insurance continues to be the largest source of health insurance coverage in 2011, covering 55.1% of the population, which was not statistically different from 2010."
(Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services)
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[Opinion]
The New Census Numbers: Some Good News, But Major Challenges Remain
"The one genuinely bright spot in the Census Bureau report ... is the reversal of two worrisome trends: the steady increase in the number of uninsured and the steady drop in the number of people insured through work. Both trends reversed in 2011."
(HealthAffairs Blog)
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Benefits in General; Executive Compensation
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[Guidance Overview]
December 31 Is IRS Deadline to Correct Section 409A Tax Rule Violation Due to Severance Conditioned on Release of Claims
"The IRS clarified that it believes that a release contingency for payment of severance or other deferred compensation could violate Section 409A of the Internal Revenue Code if not drafted correctly. Section 409A governs taxation of deferred compensation and has strict rules that prohibit employees and other service providers from choosing the tax year of their compensation at the time the payment is to be made. The IRS believes that release contingencies could violate Section 409A because employees could manipulate when they are subject to tax on the severance or other payment by either returning the release right away or waiting until the next tax year."
(DLA Piper)
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Sixth Circuit Affirms Decision Finding Entities With Any Control Over Funds Are Fiduciaries
"The Court specifically rejected PBA's argument that it could not be a fiduciary because it lacked discretionary authority over plan assets, explaining that it merely has to exercise any authority or control over plan assets to be a fiduciary. It also explained that any language in a contract purporting to limit its fiduciary status did not override its functional status as a fiduciary. Thus, because PBA, as a third-party administrator, had the power to write checks on the plan account and exercised that power, it was an ERISA fiduciary to the extent that it did so." [Guyan International Inc. v. Professional Benefits Administrators Inc. (6th Cir. No. 11-3126, August 20, 2012)]
(Seyfarth Shaw LLP)
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The DOL's Move to Increase ERISA Audits
"The Department of Labor has announced that it plans to 'substantially increase the number of ERISA compliance audits it conducts each year.' That announcement may strike fear into the hearts of many HR professionals, particularly those responsible for this area.... The DOL conducts more than 3,000 audits each year, [says a consultant, who reports that] in 70 percent of the audits they find some sort of failure, either in the operation of the plan or in the interpretation of the plan provisions. There are exorbitant amounts of money fined against plan sponsors[.]'"
(Human Resource Executive Online)
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When Has an Employee Provided Sufficient Notice of the Need for FMLA Leave?
"[This Third Circuit] case follows a growing line of cases that seems to put the onus on employers to ask the questions necessary to determine whether the FMLA is applicable. The lesson here? Stay in touch, ask questions (especially when the request is vague or ambiguous) and insist that the employee maintain contact with you (pursuant to your call-in policies) to communicate the timing and duration of his or her absence. Keep in mind: employees are not required to specifically state 'FMLA' as a reason for their absence; rather, the FMLA puts the responsibility on employers to decide whether FMLA is in play, and to inquire further if there is any ambiguity in the leave request." [Lichtenstein v. University of Pittsburgh Medical Center (3rd Cir. No. 11-3419, August 3, 2012)]
(FMLA Insights)
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Press Releases
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