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November 27, 2012          Get Retirement News  |  Advertise  |  Unsubscribe
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Manager - Client Delivery
for Verisight, Inc. in CA

Manager of Retirement Plan Processing
for Aspire Financial Services in FL

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Webcasts and Conferences

Professionalism in the Everyday Life of an Actuary Webcast
Nationwide on November 30, 2012 presented by Society of Actuaries

Pension Risk Management in an Enterprise Risk Management Context Webcast
Nationwide on December 5, 2012 presented by Society of Actuaries


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[Official Guidance]

CMS Request for Information Regarding Health Care Quality for Exchanges (PDF)
"In preparation for the implementation of the quality provisions affecting QHPs in the new Exchange marketplace under the Affordable Care Act, HHS is requesting information through this notice from stakeholders regarding existing quality measures and rating systems, strategies and requirements for quality improvement, purchasing strategies to promote care redesign and patient safety, as well as effective methodologies to measure health plan value. This notice also offers the opportunity to provide recommendations on the most effective ways to enhance and align the quality reporting and display requirements for QHPs starting in 2016 in conjunction with existing quality improvement initiatives, such as the National Quality Strategy." Comments must be received on or before December 27, 2012. (Centers for Medicare & Medicaid Services)


[Advert.]

Summaries of Benefits and Coverage Now Available!

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Wolters Kluwer Law & Business � ftwilliam.com now offers the newly required Summaries of Benefits and Coverage (SBC). Contact us for a demo and if you have more than just a few plans, ask us about our batch printing option.


[Guidance Overview]

Agencies Issue New Wellness Regulations
"Consistent with existing rules, the new rules provide that the cost of coverage includes the total cost of employee coverage under the plan and may also include the cost of employee plus dependent coverage if dependents may participate in the health-contingent wellness program. The Departments acknowledged that questions have been raised about how to apportion the cost among participating dependents and invited comments on the issue -- for example, whether the reward should be prorated if only one family member fails to qualify for it." (Faegre Baker Daniels)

[Guidance Overview]

HHS, DOL and IRS Issue Proposed Regs on Nondiscriminatory Wellness Programs
"The proposed regulations would increase the maximum permissible reward under a health-contingent wellness program from 20 percent to 30 percent of the cost of health coverage and would further increase the maximum reward to as much as 50 percent for programs designed to prevent or reduce tobacco use. The regulations also include other proposed clarifications regarding the reasonable design of health-contingent wellness programs and the reasonable alternatives they must offer in order to avoid prohibited discrimination. The proposed rules would apply to both grandfathered and non-grandfathered group health plans and group health insurance coverage for plan years beginning on or after January 1, 2014." (Wolters Kluwer Law & Business)

EBSA Fact Sheet: The Affordable Care Act and Wellness Programs
"In order to protect consumers from unfair practices, the proposed regulations would require health-contingent wellness programs to follow certain rules, including: Programs must be reasonably designed to promote health or prevent disease.... Programs must be reasonably designed to be available to all similarly situated individuals.... Individuals must be given notice of the opportunity to qualify for the same reward through other means." (Employee Benefits Security Administration)

Proposed HHS Regs Address Wellness Program Incentives
"[The proposed regulations] [1] Increase the maximum allowed reward for standards-based wellness programs offered in connection with a group health plan from 20% to 30% of the cost of coverage. [2] Further increase the maximum allowed reward, for wellness programs designed to prevent or reduce tobacco use, to 50%. ... [3] include new sample language, applicable to standards-based wellness programs, for informing individuals of other means of qualifying for a reward.... [4] make clarifications regarding: The design of standards-based wellness programs [and] Reasonable alternatives that must be offered to avoid prohibited discrimination under standards-based wellness programs." (Practical Law Company)


[Advert.]

Executive Forum on Rewarding Healthy Behaviors - January 30-31, 2013 - San Diego

Sponsored by World Congress

The pre-eminent event for innovative workplace wellness and preventive health management initiatives designed to promote health behavior change within health insured populations. Evidence-based success strategies to contain healthcare costs.


ACA Rules on Wellness Programs May Boost Participation
"New proposed rules for wellness programs that were released last week under the Patient Protection and Affordable Care Act don't break much new ground, but they will likely provide the framework and clarity that will encourage more employers to participate, observers say." (HealthLeaders Media)

Working with the New $2,500 Annual Limit on FSA Contributions
"The new $2,500 annual limit applies only to employee salary reduction contributions. It does not apply to employer non-elective contributions (i.e., flex credits).... The new limit does not apply to other types of FSAs (adoption or dependent care FSAs), health savings accounts, or health reimbursement arrangements." (Verrill Dana LLP)

Supreme Court Orders New Look at Christian College's Challenge to ACA
"The court's action at this point means only that the 4th U.S. Circuit Court of Appeals must now pass judgment on issues it previously declined to rule on.... Liberty is challenging both the requirement that most individuals obtain health insurance or pay a penalty, and a separate provision requiring many employers to offer health insurance to their workers." (The Washington Post; free registration required)

Providers Worry Whether Exchanges Will Truly Serve the Uninsured and Broaden the Risk Pool (PDF)
"Providers say they worry whether the Exchanges will truly serve the uninsured and broaden the risk pool, or instead result in a huge shift of people currently covered by employer-sponsored coverage into the Exchange products marked by narrower networks, less choice, and rates that fail to cover the costs of providing high-value health care. Most providers surveyed say that under such a scenario, they would simply choose not to participate, leaving those covered by Exchange plans with restricted choice limited to hospitals and physicians desperate enough to take the low payment rates being offered." (ReviveHealth)

7th Circuit: Disclosure of Ex-Worker's Migraines to Hiring Firms Not ADA Breach
"The Seventh Circuit said the 'plain meaning' and statutory context of the relevant ADA section show that 'inquiries' refer only to medical inquiries. EEOC's attempt to stretch the provision to protect a worker's medical information gleaned from all 'job-related' inquiries cannot be squared with the ADA's language or purpose ... Since EEOC conceded the [company's email to the employee] was not a 'medical' inquiry, [the employer] was not required to treat [the employee's] response as a 'confidential medical record,' the court said." [EEOC v. Thrivent Financial for Lutherans, No. 11-2848 (7th Cir., 11/20/12).] (Bloomberg BNA)

How Private Health Insurance Policies Cover Tobacco Cessation Treatments
"This report focuses on a new consumer protection provision under the ACA that requires individual and group health insurance to cover tobacco cessation treatments.... None of the 39 contracts analyzed did all of the following: stated clearly that tobacco cessation treatment was a covered benefit (without general exclusions); provided coverage for individual, group and phone counseling, and FDA approved tobacco cessation medication; provided tobacco cessation treatments by in-network providers with no costsharing; and provided access to treatment without prerequisites such as medical necessity or health risk assessment." (Georgetown University Health Policy Institute)

Obama Administration Facing Huge Logistical and Financial Challenges in Setting Up Exchanges
"'You can't simply deploy one federal exchange across the board,' said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation. 'Each state is different -- their eligibility systems are different, their insurance markets are different. [HHS is] going to have to build these exchanges to fit into the context of each state.'" (The Hill)

Expert Discusses Impact of Election on Health Care
"Joseph Berardo, Jr., chief executive officer and president of MagnaCare ... says employers can expect the following: In its current form we should expect the number of uninsured to increase based on the lack of affordable products and the disincentives for small employers (under 30 employees) to continue to provide coverage.... The new health care paradigm revolves around provider accountability whereby groups of doctors, hospitals, and other health care providers collaborate to provide the full range of medical care for patients. This creates an environment in which the employer, not the insurance company, has the opportunity for direct contracting." (Wolters Kluwer Law & Business)

Mintz Levin Health Care Reform Update, November 26, 2012
Weekly update on developments in federal and state health care reform legislation and regulations. Includes summaries of recent announcements and regulatory activity by HHS, CCIIO, IRS and CMS. (Mintz Levin)

Small Employer Was Obligated to Provide COBRA Coverage Mistakenly Offered to Ex-Employee
"A recent district court decision from Ohio considered the situation of a small employer that issued a COBRA notice to a former employee who then elected and paid for COBRA coverage. After the former employee had been covered under COBRA for at least 12 months, ... The DOL informed the employer that it was not subject to federal COBRA law because of its small size. The employer at that point terminated the COBRA coverage ... The district court determined that the employer had superior knowledge of whether the employer was covered by COBRA and so was equitably estopped from now denying COBRA coverage to the former employee. " [Hanysh v. Buckeye Extrusion Dies, Inc., No. 4:11CV528 (N.D. Ohio, Sept. 5, 2012)] (BenefitsNotes, a blog by Leonard, Street and Deinard)

W-2 Reporting: Cost of Employee Group Health Insurance Coverage (PDF)
"Beginning in calendar year 2012, an employer required to file more than 250 Form W-2s for the preceding calendar year must report 'applicable employer-sponsored coverage' on employees' Form W-2s. Employers should carefully review their 'applicable employer-sponsored coverage' and adjust any costs that are excluded from aggregate cost calculations." (Chao & Company, Ltd.)

[Opinion]

Liberty University's Challenge to the ACA: Much Sound and Fury, But Likely Signifying Nothing in the End
"The Supreme Court created quite a stir on November 26, 2012, by resurrecting from the dead a challenge to the ACA brought by Liberty University.... It is not altogether clear what exactly the Fourth Circuit is supposed to reconsider." (HealthAffairs Blog)

[Opinion]

Too Many Choices Can Hurt, Not Help, Health Insurance Consumer Decision-Making (PDF)
"While a few choices are good, too much choice undermines consumer decision making, particularly high stakes decisions involving health insurance. Cognitive limits with respect to decoding and analyzing data lead individuals to take decision making short-cuts or avoid choosing altogether. Policymakers should explicitly consider limiting consumers' health plan choices in the new health insurance exchanges to a manageable number. Furthermore, they should provide robust decision making aids to improve consumers' ability to navigate the resulting choice set." (Consumers Union)

Benefits in General; Executive Compensation

Which Benefits Do Your Employees Value Most?
"[B]enefits that provide instant gratification are preferred over those that could produce more long-term value. Where an additional salary increase was offered ... it was preferred over all other options offered.... Employer contributions to DC or other retirement savings plans are also popular benefits, making the top three in four of the 9 markets: the U.S., Canada, Brazil and Italy." [Editor's note: Summaries for specific geographic markets as well as Global Survey Findings are available at the link.] (Mercer Marsh Benefits Research; free registration required for full report)

DOL Adds to Hurricane Sandy Relief for Benefit Plans (PDF)
"While the news release does not specifically mention the special deadline for employers of fewer than 100 employees to remit participant contributions and loan repayments (not later than the seventh business day following the day on which such amounts are received by the employer), there is no reason to believe that the relief does not also extend to such employers." (Buck Consultants)

Distribution to Employees of MLR Rebate Received by Employer Could Be 'Compensation' for Retirement Plan Purposes
"Any employers that returned all or a portion of the [medical loss] rebate to participants should (i) review the definition of "compensation" for their qualified retirement plans to determine whether the rebate amount would be 'compensation' for purposes of the plan; and (ii) work with their payroll departments or outside payroll providers to ensure that these rebate amounts are properly coded for retirement plan purposes." (Haynes and Boone, LLP)

Case at Supreme Court: Do Equitable Defenses Preclude ERISA Plan Subrogation Rights?
"The case will most likely have a huge impact on ERISA reimbursement. ... A very tough factual case -- McCutcheon was seriously injured and is now disabled. His attorneys already took 40% of the very limited settlement proceeds -- the tortfeasor had little or no assets or insurance; if the ERISA plan wins, McCutchen will have little or no recovery. Tough facts could result in some bad law." (Lane Powell PC)

What Is 'Appropriate Equitable Relief' Under ERISA in a Subrogation Case?
"Individuals who participate in a benefit plan sponsored by their employer are often entitled to have medical expenses paid for by the plan if they are injured. But if the employee later sues a third party responsible for the injury and recovers damages, to what extent is he or she obligated to reimburse the plan? And does the answer change if (as is frequently the case) a significant percentage of the damages award goes to pay the employee's attorneys? These are the questions that the Supreme Court will consider [on Nov. 27, 2012] when it hears arguments in U.S. Airways, Inc. v. McCutchen." (SCOTUSblog)

CBO Cost Estimate for S.1910, The Domestic Partnership Benefits and Obligations Act of 2011
"S. 1910 would make same-gender domestic partners of certain federal employees ... eligible to receive the same employment benefits as married spouses of federal employees ... [including] health insurance, survivor annuities, compensation for work-related injuries, and travel and relocation benefits. CBO estimates that enacting S. 1910 would decrease net direct spending by $13 million between 2013 and 2022. Pay-as-you-go procedures apply because enacting the legislation would affect direct spending. Over the same period, CBO estimates that implementing the bill would have a discretionary cost of $144 million, assuming appropriation of the necessary funds." (Congressional Budget Office)

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