Benefit Services Specialist
for Northwestern Benefit Corporation of Georgia in GA

Administrator
for Benetech, Inc. in CA

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SunGard's Advanced Pension Conference - Orlando 2013
in Florida on February 6, 2013 presented by SunGard Relius

Just for ERPAs Workshop
in Florida on February 5, 2013 presented by SunGard Relius

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[Guidance Overview]

Proposed Wellness Regs Under ACA Differ From 2006 Guidance
"The proposed regulations did not deviate extensively from the previous wellness program guidance published in 2006. The 2006 wellness program guidance describes two types of wellness programs: one where the reward is not conditioned on the individual satisfying a standard relating to a health factor (non-contingent reward), and one where the reward is conditioned on the individual satisfying a standard relating to a health factor (health contingent reward). The non-contingent wellness programs remain the same, however the wellness programs that contain health contingent rewards have changed under the new guidance." [Ed. note: article includes a chart comparing the 2006 and new proposed regulations.] (McDermott Will & Emery)

[Advert.]

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Certificate Series courses combine valuable materials, outstanding instruction and networking opportunities. Attend in February to earn a Certificate in Retirement Plans, Health Care Plans or Benefit Plan Administration. Register Now!

[Guidance Overview]

New Guidance on Wellness Programs Issued
"The Proposed Rules apply beginning January 1, 2014 and they would apply to grandfathered as well as non-grandfathered group health plans.... The 2006 Regulations require a health-contingent wellness program to meet five requirements in order to comply with HIPAA's nondiscrimination rules. The Proposed Rules maintain the five requirements but provide important modifications and clarifications.... The Departments have invited comments on this list of factors as well as what, if any, additional facts and circumstances should be addressed by the Proposed Rules." (Proskauer Rose LLP)

[Guidance Overview]

Proposed Increases in Maximum Rewards Offered Under Wellness Programs
"The preamble [to the proposed regulations] states that the Treasury Department, the [DOL] and [HHS] decided to propose to increase to 50% the maximum reward for programs designed to prevent or reduce tobacco use because the [ACA] allows health insurers to vary premium rates in the individual and small group markets by a ratio of 1.5 to 1 for those who use tobacco (i.e., allowing a 50% premium surcharge for tobacco use). In another set of proposed regulations released by HHS on the same day ... insurers in the small group market that impose a tobacco use surcharge would be required to offer a wellness program consistent with the wellness program regulations provisions regarding programs designed to prevent or reduce tobacco use." (Sidley Austin LLP)

[Guidance Overview]

Proposed Regs Address Discrimination in Wellness Programs
"The new regulations continue to distinguish 'health-contingent' programs from 'participatory' programs. A health-contingent program rewards participants who achieve certain health standards, such as maintaining a particular cholesterol or blood pressure level. A participatory program does not do so. It may base a reward on activities, such as completing a health risk assessment or submitting to certain screening examinations, without regard to outcome, or it may not provide for any reward at all. A participatory wellness program simply needs to be available to all similarly situated individuals to satisfy the nondiscrimination requirements. A health-contingent program must meet ... five additional criteria to be considered nondiscriminatory[.]" (Ballard Spahr)

2013 Assessments on Health Plans, Insurers and MCOs Under the New York Health Care Reform Act
"Covered lives assessments under the New York Health Care Reform Act (HCRA) that are determined by county of residence will be higher in 2013 than in 2012 for both individuals and families in seven of the eight State regions, with percentage increases that range from less than 1 percent to 5 percent. The exception is the Northeastern region, where the covered lives assessments will be slightly lower in 2013 (47 cents lower for individuals and $1.54 lower for families).... Under HCRA, payers (i.e., self-insured plans and their administrators, health insurers and managed care organizations) are required to pay covered lives assessments and surcharges for plan participants who live in New York State." (The Segal Group, Inc.)

[Advert.]

Form 5500 Reporting Update - December 4

This live audio conference will help you understand when you need to file a Form 5500 and what you need to file, and will focus on some recent changes that may impact your filings. Discounted pricing for BenefitsLink readers.

Transcript of Oral Argument Before U.S. Supreme Court Addressing Equitable Remedies Under ERISA (U.S. Airways v. McCutchen) (PDF)
"JUSTICE KENNEDY: Justice Kagan's question had two parts. She said, tell me about the two boxes, subrogation and reimbursement. I think there is quite a bit to your argument that this is not subrogation. The plan is rather confusingly drafted. The plan calls it subrogation. I don't think it really means subrogation. If it's not subrogation, Justice Kagan's question was, what then? The -- the common fund rule still does not apply? Because? MR. KATYAL [Attorney for US Airways]: Because the common fund rule -- and this we are in agreement on, the parties -- the common fund rule is a doctrine based in unjust enrichment." (U.S. Supreme Court)

Supreme Court Hears Oral Argument on ERISA Equitable Remedies
"The Justices ... focused on whether the plan established a reimbursement agreement or a merely a right to subrogation.... Freestanding subrogation claims have one set of remedies or rights, and subrogation claims by agreement have another. Justice Sotomayor found 'unsettling' McCutchen's suggestion that the rights and remedies would be the same for express and implied agreements.... Several Justices ... also were concerned with the perceived unfairness of the plan's ability to seek reimbursement of the entire amount obtained from the third party without factoring in attorney's fees.... The argument also featured a heated exchange between the Justices over an issue that McCutchen did not raise on appeal -- the distinction between the language in the summary plan description and the formal plan document.... It thus is possible that the Court will revisit its Cigna Corp. v. Amara decision on the primacy of plan terms." (Seyfarth Shaw LLP)

Employer Strategies for Attaining Safer, Higher-Quality Hospital Care for Employees and Their Families (PDF)
"Despite a number of real and perceived barriers that companies face in their efforts to improve the safety and quality of their employees' hospital care, there are several examples where employers are successfully doing just that. This white paper provides an overview of a variety of strategies that employers use or could use to influence safety and quality of care. These include efforts to guide employees to safer, higher-quality hospitals and, by extension, place pressure on hospitals to improve outcomes." (Altarum Institute)

Summary of Obamacare's Many Contraception Lawsuits
"Dozens of lawsuits have been filed in protest of the Obama administration's policy that most employers include no-cost coverage of FDA-approved prescription contraceptives in health plans.... Here's a rundown on who is suing -- and the big legal issues at stake." (Politico)

Federal Judge Dismisses Lawsuit Filed by Diocese Seeking ACA Exemption, Says Case Brought Too Soon
"The diocese said the administration was violating its religious freedom by ordering the diocese to facilitate and, in some cases, pay for abortion-inducing drugs, birth control and other services to which its objects. U.S. District Judge Terrence F. McVerry said in his 28-page opinion that the diocese has not been harmed by the health insurance reform law because most of the regulations do not take effect until Jan. 1, 2014." (Pittsburgh Tribune-Review)

Self-Insured Health Plans: State Variation and Recent Trends by Employer Size
"In 2011, 58.5 percent of workers with health coverage were in self-insured plans, up from 40.9 percent in 1998. Large employers (with 1,000 or more workers) have driven the upward trend in overall self-insurance. The percentage of workers in self-insured plans in firms with fewer than 50 employees has been close to 12 percent in most years examined. The prevalence in self-insured plans varies by state, with Massachusetts having the third-highest prevalence of self-insurance in the small-group market (behind Hawaii and Alaska)." (EBRI)

8th Circuit Allows FMLA Interference Claim by Nurse Who Suffered Panic Attack and Was Sent Home
"A nurse who was sent home by her employer's human resources director after suffering a panic attack can pursue her interference claim under the federal Family and Medical Leave Act, the U.S. Court of Appeals in St. Louis has ruled. Reversing summary judgment in favor of the employer, the Eighth Circuit found that sufficient factual issues existed as to whether the employer had notice of the nurse's FMLA-qualifying condition before determining she allegedly had abandoned her position." [Clinkscale v. St. Therese of New Hope, No. 12-1223 (8th Cir. Nov. 13, 2012)] (Jackson Lewis LLP)

Determining Discounts for Health Care Costs
"Healthcare reform has grabbed the headlines with various cost-saving initiatives for employers and individuals alike. However, the potential for significant savings is available without any required change to the current structure.... This paper covers the most frequently asked questions about the calculation and evaluation of medical discounts, highlights various methods for estimating discount differences, and discusses how discount differences impact the overall medical cost to the employer." (Milliman)

Who Cares Whether I Give a COBRA Notice for My Company's Dental Plan?
"Employers ... may forget that COBRA extends to all group health plans, including dental, vision and medical flexible spending account plans. A recent federal district court decision highlighted the risk to employers who forget those facts.... [An] employee who at the time she terminated employment was covered by the group dental plan, but not the group medical plan ... obtained new employment about five months later that provided her with dental coverage and during the time she did not have dental coverage, she did not incur any dental claims.... The penalty to the employer: $37,950 for failure to give a dental COBRA notice ... [plus] 42,192.50 for attorney's fees and $2,910.87 for costs for an aggregate of $83,063.45. " [Evans v. Books-A-Million, No. CV-07-S-2172-S (N.D. Ala. Oct. 29, 2012)] (BenefitsNotes, a blog by Leonard, Street and Deinard)

The Cost and Benefits of Individual and Family Health Insurance Policies (PDF)
"The average premium paid nationwide for individual policies was $190 per month (a 3.8% increase vs. 2011), while the average premium paid for family policies was $412 per month (a decrease of 0.5%). For single-person coverage, only three states showed a double-digit percentage increase in average monthly premiums in 2012; seven showed a decrease in average monthly premiums. The average deductible for individual policies nationwide was $3,079 per year (a 4.9% increase vs. 2011), and the average deductible for family policies was $4,079 per year (a 5.2% increase). For family coverage, only one state showed a double-digit percentage increase in average monthly premiums -- twenty showed a decrease in average monthly premiums" (eHealth)

Why Did My S Corporation's Health Insurance Premiums Go Down?
"[Mr. Downs asked his] benefits administrators whether costs had gone down for just my company or in general. Here's the answer ... 'Dear Mr. Downs, It was about your group in particular (not the AIA as a whole) and that overall for the last 12 months your group ran well. What that means is that what the carrier paid out on behalf of your group in medical/rx claims did not exceed the amount they charged you in premium.' ... If this is true, it's pretty scary. This is confirmation that demographics of the people [hired] directly drive ... health costs. The system is incentivizing the hiring of younger, healthier workers ... and [providing] a perfectly rational reason to turn down older, potentially sicker applicants. That should be fixed." (The New York Times; free registration required)

[Opinion]

Troubles Ahead, Troubles Behind as ACA Implementation Begins
"Now that the election is over, the prospect of 'repeal and replace' of ObamaCare is virtually nil. But that was never the greatest threat to the law anyway. The real threat lies in implementation. [The author] said well before the law was enacted that is was so poorly conceived and so poorly written that it could never be implemented. That is even more evident today.... [E]verything the government itself was supposed to do has failed. Everything.... [T]his abysmal track record is only setting the stage for the big failures to come -- the Health Insurance Exchanges and the Individual Mandate." (John Goodman's Health Policy Blog)

[Guidance Overview]

Coming Up This Proxy Season: Comp Committee and Adviser Independence, ISS Guidelines and Shareholder Litigation
"Public companies preparing for the upcoming 2013 proxy season will need to keep in mind a number of new developments related to executive compensation, including: New Securities and Exchange Commission rules that require 2013 proxy statement disclosure of compensation consultant conflicts of interest; Proposed NYSE and NASDAQ listing standards that will impose new requirements for future proxy seasons regarding independence of listed company compensation committee members and compensation consultants and other advisers; and New ISS and Glass Lewis proxy voting guidelines relating to compensation that will apply for the 2013 proxy season." (Perkins Coie LLP)

ISS 2013 Policy Updates (PDF)
"The 2013 updates to the quantitative pay-for-performance evaluation (i.e., the say-on-pay analysis) should result in greater alignment between a company's self-selected peer group and the ISS peer group so that companies do not need to run two separate CEO pay-for-performance tests. Further, the inclusion of realizable pay in the qualitative say-on-pay analysis is consistent with a growing practice by many companies to disclose realized executive compensation in order to more accurately reflect pay delivery. The pledging determination is performed on a case by case basis and the onus is now on board members as part of their risk oversight duties." (Orrick)

2013 Standard Mileage Rates: IRS Taps the Gas Pedal Lightly
"With gas prices flat, the IRS has announced a 1-cent increase in standard mileage rates for the business use of a vehicle. Thus, that rate will be 56.5 cents per mile for business miles driven in 2013, up from 55.5 cents a miles this year. There also will be a 1-cent increase in the standard rate per mile driven for medical or moving purposes, to 24 cents, while the rate for miles driven for charitable purposes remains at 14 cents." (Financial Planning)

2013 Expiring and Changing Employee Benefit and Payroll Provisions
"The income tax exclusion for amounts paid by an employer under a qualified adoption assistance program is ... set to expire on December 31, 2012.... Employee contributions to health care flexible spending accounts will be reduced to $2,500 per year for plan years beginning in 2013.... Certain reimbursements for employer-provided educational assistance will expire at the end of 2012." (McDermott Will & Emery)

Benefits Expansion for Federal Employees' Domestic Partners Would Have Small Impact on Costs, CBO Says
"Currently, [same-gender] partners are eligible under some federal employee family benefits, such as counseling programs and certain travel and relocation payments. They also are eligible for the Federal Long Term Care Insurance Program ... and for a less generous form of a survivor benefit ... However, legislation would be required to make those partners eligible for two of the most valuable benefits, Federal Employees Health Benefits Program coverage and standard retirement survivor annuities. 'CBO expects that few federal employees (less than 1 percent) would choose to register a same-gender domestic partnership if given the opportunity,' [the report] said." (The Washington Post; free registration required)

Stadion Money Management to Offer 3(38) Fiduciary Protection for Target Date Retirement Funds
Stadion Money Management

The Principal Helps Financial Professionals Uncover ESOP Opportunities
The Principal Financial Group

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