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December 14, 2012          Get Retirement News  |  Advertise  |  Unsubscribe
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Consultant Retirement Plan Administrator
for Harbridge Consulting Group (a BPAS Company) in NY

Marketing Manager, Retirement Plan Services
for T. Rowe Price in MD

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for Retirement Plan Administration, Consulting and Design Business in CT, NJ, NY

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[Guidance Overview]

Agencies Issue Proposed Regs Changing Rules for Wellness Programs
"At first glance, it may appear that the proposed rule is very similar to the existing wellness rule. However, there are a number of changes that could have significant impacts on how wellness programs are designed and administered, including: New limits on incentives; Restrictions around physician verification; Expansion of the reasonable alternative requirement; New guidelines for what is a 'reasonable' program; and Updated language for wellness program communications." (Groom Law Group)


Healthcare Reform and Taft-Hartley Plans: A Look Toward the Future

Sponsored by Financial Research Associates, LLC

MIA 2013 brings together Trustees, Administrators, Consultants and top industry leaders to discuss topical issues about pension and investments (TRACK A) as well as health and welfare benefits (TRACK B). Mention FMP164 during registration for a 10% discount.

[Guidance Overview]

Proposed Wellness Regs Permit Increased Rewards (PDF)
"Even when both the reward for non-tobacco use and other health-contingent components of a wellness plan are less than their applicable percentage of total cost, a plan will fail to satisfy the maximum reward limitation if the sum of these rewards exceeds 50 percent of the total annual cost of coverage.... A reasonably designed health-contingent wellness program [must] actually consists of two elements: (1) the initial health standard that must be satisfied to qualify for the reward, and (2) a different reasonable course of action that individuals who cannot meet the standards may complete in order to qualify for the reward." (Buck Consultants)

[Guidance Overview]

HHS Issues Comprehensive Proposed Regs on Essential Health Benefits
"Self-insured group health plans, health insurance coverage offered in the large group market, and grandfathered health plans are not required to provide essential health benefits. Self-insured, large fully insured, and grandfathered plans will, however, be affected by the rules governing EHBs since these plans are prohibited from imposing lifetime limits and annual dollar limits on essential health benefits." (Mintz Levin)

[Guidance Overview]

Final Regs Issued on ACA's Comparative Effectiveness Research Fees
"The final rule notes that, because the fees are imposed on the plan sponsor, rather than the plan, the Department of Labor ... has concluded that paying these fees generally does not constitute a permissible expense of the plan under ERISA. However, the DOL is expected to issue separate guidance on this issue, including a discussion of special circumstances that may allow for payment by the plan. For example, the DOL could provide that in cases where the board of trustees are the plan sponsor, the fees could be payable from plan assets." (The Segal Group, Inc.)

Federal Government Will Have Outsize Role in Health Exchanges
"Consulting firm Avalere Health estimated two-thirds of people likely to purchase coverage on the marketplaces will buy through a federally administered or 'partnership' exchange. This trend means that 'key federal decisions about plan participation, the consumer interface and outreach activities, eligibility and enrollment, and options for small businesses will have a crucial impact on individuals' experiences with the exchanges'[.]" (The Hill)


COBRA - I Thought the Subsidy Was Over!! - Audio Conference January 11

Sponsored by Lorman and BenefitsLink.com

YES, the subsidy is over, but now we are living with the results. Let's look at the impact the subsidy had on COBRA election rates and claim utilization. And, what is the future of COBRA? Will we still have it after 2014? Discounted pricing for BenefitsLink readers.

Obama Administration Grilled About Insurance Markets In House Hearing
"Top Obama administration officials were called before a House subcommittee Thursday to answer questions about the implementation of the president's landmark health law, and what Republicans say is a lack of clarity over how online insurance markets and a massive expansion of Medicaid will work. Health officials from Republican-led states Louisiana, Wisconsin and Pennsylvania testified the law's timelines are unrealistic, and many of its requirements too rigid or unclear." (Kaiser Health News)

Availability and Cost of Healthcare Coverage for Workers in Small vs. Large Companies
"Of firms with 3 to 199 employees, 61% offer health insurance, a stark contrast to the 98% of firms with 200 or more employees that offer coverage to at least some of their employees. Very small firms (3-9 workers) are least likely to offer health insurance to employees, with only 50% of these firms offering coverage in 2012. Since most firms in the country are small, the overall offer rate is determined primarily by the percentage of the smallest firms (3-9 workers) offering health benefits." (Kaiser Family Foundation)

Employer Notice of Health Insurance Exchange Likely to Be Extended
"March 1, 2013 is currently set as the date that employers were expected to have a notice of exchanges to employees. Recent informal comments, though, suggest that the DOL will extend that deadline. The DOL is interpreting the statutory language for the notice of exchange similar to the statutory language for automatic enrollment. Under this interpretation, the notice would not be required until after the DOL provides regulations, which hasn't happened yet. Look for guidance in the coming weeks regarding the interpretation and extension." (Faegre Baker Daniels)

Only 15 States Plan to Operate Own Health Insurance Exchanges
"Experts say the number of states planning to operate their own exchanges could reach 18 and the District of Columbia by the time the deadline expires on Friday. But the administration would still be left to set up exchanges in at least 30 states, a challenge that is raising questions about how successfully U.S. officials can implement a key provision of [Obamacare]." (Insurance Journal)

More Than Three in 10 in U.S. Put Off Health Care Due to Cost
"More than half of those with no health insurance say they have had to put off care (55%), as have 30% of those with private health insurance -- while 21% of those who have Medicare or Medicaid say the same.... [A] new high of 76% of Medicare/Medicaid recipients are satisfied, versus 57% of privately insured Americans. This gap of 19 percentage points is a drastic change from the early 2000s, when both groups were about equally satisfied." (Gallup)

Insurers Face Jumbled Standards Under Varying State Exchanges
"Rules for the six state insurance exchanges that won conditional approval from the Obama administration ... are split evenly between those with strict criteria for companies that want to participate and states that have opened their exchanges to all comers, a scenario supported by the insurance industry. A high bar for inclusion could limit the number of insurers offering health plans in some states.... 'The challenge is it's all new,' says Kim Holland, executive director for state affairs at the Blue Cross Blue Shield Association, a Washington-based trade group that represents 38 state insurance plans. 'We have a really, really short period of time in order to get everything done.'" (Employee Benefit News)

Use It or Lose It: 10 Surprising Ways to Draw Down Flexible Spending Accounts
"Only about 28 percent of employees use FSAs.... For workers with traditional FSAs, December is usually the time to drain the account. There are creative ways to do that. Here are ten ways to find qualifying expenses you may not have considered." (Reuters)

The ACA's Comparative Effectiveness Research Fees as Applied to Public Employers
"Federal governmental programs, such as Medicare, Medicaid and the Children's Health Insurance Program (CHIP), would not be subject to the fee. This would appear to mean that Medicare Advantage plans would not be subject to the fee, although a Medicare supplemental self-insured plan would appear to have to pay the fee." (The Segal Group, Inc.)

U.S. Backs United Nations Measure in Favor of Universal Access to Affordable Health Care
"The United States has backed a United Nations draft resolution favoring universal healthcare coverage. The nonbinding measure calls on U.N. member states to ensure citizens' access to health insurance, and was approved by the U.N. General Assembly on Wednesday. Supporters say the draft resolution paves the way for the post-2015 development agenda to include universal health coverage." (The Hill)

Reducing Wasteful Spending on Health Care
"[T]he United States spent nearly $650 billion more than did other developed countries in 2006, and that this difference was not due to the U.S. population being sicker. This spending was fueled by factors such as growth in provider capacity for outpatient services, technological innovation, and growth in demand in response to greater availability of those services. Another $91 billion in wasteful costs or 14 percent of the total was due to inefficient and redundant health administration practices." (HealthAffairs)

ACA Lawsuits: The Contraceptive Mandate Versus Religious Freedom
"While the legal challenges pose no threat to the law as a whole, they have all the ingredients of a legal donnybrook that might well end up before the high court.... So far the scorecard on this issue in the federal district courts is three preliminary injunctions against the contraceptive mandate and two decisions upholding it, one of which was later stayed without comment on appeal[.]" (Kaiser Health News)

Access to Employer-Sponsored Insurance and Subsidy Eligibility in Health Benefits Exchanges
"Consumers offered employer-sponsored insurance (ESI) can be ineligible for subsidies in health insurance exchanges[.] Until better ESI data become available, HHS proposes using post-enrollment audits, rather than pre-enrollment verification for this eligibility requirement. Using the Health Insurance Policy Simulation Model ... we find that more than 70 percent of eligible consumers work for firms that do not sponsor ESI. HIXes could thus avoid the need to audit them by developing databases that show which employers sponsor ESI." (Urban Institute)


Exchanging Medicaid for Private Insurance
"$295 billion in projected federal Medicaid spending on new enrollees could be replaced by private insurers paying much higher market rates for medical care. Private health plans in the exchange will pay physicians about 50 percent higher fees than they would have gotten from Medicaid. If millions of Medicaid-eligible patients are diverted into private coverage, doctors and hospitals might enjoy nearly $518 billion in private medical spending." (National Center for Policy Analysis)


ACA's Essential Health Benefits Requirement Has Broad Impact
"The EHB requirement is much broader than what many individuals and small businesses choose to purchase today, which means that millions of people may be required to purchase coverage that is more expensive than they have now. [This] infographic highlights the impact of the Essential Health Benefits requirement[.]" (America's Health Insurance Plans (AHIP))


Walmart Workers At Risk In States Rejecting Obamacare Medicaid Expansion
"After Walmart's new policy takes effect in January, many part-time workers who stand to be denied company health benefits would eventually qualify for Medicaid once the Obamacare expansion takes effect in 2014.... But if states now threatening to forgo the Medicaid expansion follow through on those plans, many Walmart employees -- along with others in low-paid, service-sector positions -- run the risk of slipping through the cracks: They are likely to work too few hours to qualify for company benefits, yet earn too much to qualify for Medicaid under their states' restrictive standards." (The Huffington Post)

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