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January 4, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Employee Benefits Jobs

New Business Consultant/Sales
for TRA, Inc. in NC, VA

DC Plan Administrator
for Capital Retirement Plan Services, Inc. in PA

Senior Health Benefits Analyst
for The Segal Company in DC

IRT Relationship Manager 3
for Wells Fargo in MN, NC

Retirement Plan Coordinator
for Hefren Tillotson in PA

Senior Vice President, Chief Legal Officer
for USI Consulting Group in CT

Regional Retirement Plan Wholesaler
for Nationwide Insurance in KY, OH

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Webcasts and Conferences

"Plan Corrections: When Good Plans Go Bad" - 19 cities, January 9-25, 2013, Covers EPCRS Rev. Proc. 2013-12
Nationwide on January 9, 2013 presented by SunGard Relius

"EPCRS 2013: What's Changed? What's New? What Does It Mean?" Web Seminar
Nationwide on January 11, 2013 presented by SunGard Relius

"EPCRS 2013: What's Changed? What's New? What Does It Mean?" Web Seminar
Nationwide on January 25, 2013 presented by SunGard Relius

Employers Beware - Taxes and Fees Under the Affordable Care Act
Nationwide on January 29, 2013 presented by ABA Joint Committee on Employee Benefits

"401(k) Testing Techniques" Web Seminar
Nationwide on January 29, 2013 presented by SunGard Relius

"The Fundamentals of Cross-Tested Plans" Web Seminar
Nationwide on February 12, 2013 presented by SunGard Relius

"Fundamentals of 401(k) Plans Web Series"
Nationwide on January 7, 2013 presented by SunGard Relius

FMLA In Real Life
Nationwide on January 10, 2013 presented by International Foundation of Employee Benefit Plans

View All Webcasts and Conferences

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[Guidance Overview]

Pay or Play: Determining Whether and When an Employer Is Subject to the Mandate
"[Y]ou must total the FTE count for each calendar month and divide by 12. If you equal or exceed 50, you are subject to the pay or play mandate. In calculating this final number, you will disregard any fractions -- thus, if your final average is 49.9, you would round down to 49. If you are close to meeting the threshold for the 2013 look-back year, you may be able to qualify for special transition relief that allows you to use any 6-consecutive month period during 2013, rather than the whole year." (McKenna Long & Aldridge LLP)


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.

[Guidance Overview]

Flowchart of Employer Shared Responsibilities and Potential Penalties Under the ACA
"The Affordable Care Act does not require businesses to provide health benefits to their workers, but larger employers face penalties starting in 2014 if they don't make affordable coverage available. This simple flowchart illustrates how those employer responsibilities work." (Kaiser Health Reform)

[Guidance Overview]

IRS Proposes Regulations on ACA Employer Penalty
"For a given month beginning after 2013, if an employer does not offer minimum essential coverage to 'substantially all' of its full-time employees and their dependents and a full-time employee obtains subsidized Exchange coverage, the employer must pay a penalty equal to $166.67 multiplied by the number of its full-time employees in excess of 30. Under the proposed regulations, 'substantially all' means all but 5% of full-time employees or, if greater, 5 full-time employees." (Jackson Lewis LLP)

[Guidance Overview]

HHS Issues Proposed Regs on Transitional Reinsurance Program Fees
"In 2014, contributing entities must report the total number of covered lives to HHS by November 15. In turn, HHS will notify plans of their fee assessment by December 15. Plans will then be required to submit payments to HHS within 30 days of receiving the fee notices. Given the financial impact of the reinsurance fees, group health plan sponsors are advised to begin estimating the amount of reinsurance fees that their plans will be assessed and to factor these amounts into their 2014 budgets." (HighRoads)

Health Care CEO Charged With Failure to Pay Premiums
"The North Carolina Department of Insurance issued the following news release: Insurance Commissioner Wayne Goodwin today announced the arrest of Rebecca Horne Wood, 36, of ... Rocky Mount; she is charged with one count each of failing to pay premiums deducted from employee pay and failing to notify employees of insurance cancellation [while acting as CEO and president of Alpha/Omega Health Care in Raleigh]." (InsuranceNewsNet.com)

Dental Insurance for Some Children Mandated in Two States
"The states of California and Washington will require people who buy medical insurance through new health plan exchanges to also buy pediatric dental benefits regardless of whether they have children ... Together the 2 states are offering some of the first responses to a conundrum embedded in the new law: Although the law requires everyone to have health insurance or pay a penalty, it exempts dental benefits from this 'individual mandate.' However, it lists pediatric oral health services among the 10 'essential benefits' that health plans must include when sold to small groups[.]" (Medscape; free registration required)

Implementing Health Reform: Moving Forward on Exchanges
"The surge of Affordable Care Act implementation momentum that ended 2012 seems to be continuing into 2013.... The biggest surprise among this group was the Utah exchange, as Governor Herbert has made amply clear his intent to stick with Utah's current exchange model rather than to comply with the ACA. The approval of the Utah exchange, however, was contingent upon Utah developing an ACA-compliant exchange that conforms to the exchange regulations and implementation progress milestones. Indeed, HHS has no legal authority to approve a state exchange that does not comply with the ACA." (Timothy Jost, in Health Affairs Blog)

Wisconsin Employer Challenges 'Moral' Mandate
"When the officers of Grote Industries sat down to discuss a possible legal challenge to the contraceptive mandate in the national health care law, the vote was immediate and unanimous. 'We decided that it was definitely against our beliefs,' says chairman and CEO William Grote III.... As of Jan. 1, the company had no choice in the matter. It either covers such services or faces steep daily fines imposed by the federal government. 'The penalty is absolutely onerous,' Grote says. 'It would easily destroy the company should we not do it'.... With 1,150 employees worldwide, Grote Industries could be looking at [$41] million a year." (pal-item.com (Gannett))

Utah's Health Exchange, Avenue H, Wins Conditional Nod from HHS
"Utah must submit by Feb. 1 a timeline for upgrading its 3-year-old insurance portal. The state must also show that it can fund it and that it has legal authority to set up a consumer-outreach program to help shoppers navigate their insurance options.... Utah already has a 'shop' exchange for small businesses, Avenue H, which officials have said would cost between $15 million and $30 million to expand to individuals starting in October." (The Salt Lake Tribune)

Red States, Too, Get Health Care Nod From Obama Administration
"With open enrollment for millions of uninsured Americans just nine months away -- Oct. 1, 2013 -- the four GOP-led states became part of a group totaling 17 states plus Washington, D.C., that have gotten an initial go-ahead to build and run insurance exchanges.... The new marketplaces are supposed to take the confusion and anxiety out of buying private health insurance for individuals and families who buy their coverage directly. Exchanges are meant to have the feel of an online travel site, an Expedia or Orbitz. Exchanges will also offer some relief from sticker shock. Under the new law, about 8 in 10 customers in the new marketplaces will be eligible for income-based federal aid to help pay their premiums. Small businesses will have separate access to their own exchanges." (The New York Times; free registration required)

U.S. Approves Health Exchanges in Four Republican-Governed States
"The U.S. Department of Health and Human Services said Idaho, Nevada, New Mexico and Utah joined a list totaling 17 states and the District of Columbia that have all won conditional approval to establish their own state exchanges, with operations set to begin on January 1, 2014. A fifth Republican-governed state, Mississippi, applied to operate a state exchange, but has not received approval because of a dispute about how much authority state officials should exercise over the operations of its prospective online marketplace, officials said. The U.S. administration also cleared an exchange that Arkansas plans to run in partnership with the federal government." (The New York Times; free registration required)

Consumer Discretionary Health Care Spending: Analysis of Direct and Indirect Out-Of-Pocket Costs to Consumers
"In 2010, total U.S. health-related expenditures were an estimated $3.2 trillion or 23.9 percent higher than reported in the National Health Expenditure Accounts (NHEA). This translates to $10,392 per person. An additional $621 billion in direct and indirect costs was estimated for goods and services above what is captured in NHEA accounting. Of this additional amount, $492 billion (79 percent) is the imputed value of unpaid supervisory care given to individuals by family or friends." (Deloitte Center for Health Solutions)

HIPAA Breach Settlement Shows Plans and Other Covered Entities At Risk From Small Breach Reports, Too
"[H]ealth plans and their fiduciaries, sponsors and administrators, health care providers, health care clearinghouses and their business associates should review plans, practices and data security as affecting [electronic protected health information (ePHI)] and other protected health information on mobile and other devices. On January 2, 2013, [HHS Office of Civil Rights (OCR)] announced [Hospice of Northern Idaho (HONI)] will pay OCR $50,000 to settle potential HIPAA violations that occurred in connection with the theft of an unencrypted laptop computer containing ePHI. The HONI settlement is the first settlement involving a breach of ePHI affecting fewer than 500 individuals." (Solutions Law Press)

List of Approved State Health Insurance Marketplaces
"A list of conditionally approved states to operate either a State-based or State Partnership Exchange [appears at this link to the CCIIO website]. As of [January 2, 2013], 18 states have been conditionally approved to operate State-based Exchanges and two states have been conditionally approved to operate a State Partnership Exchange.... The applicable websites are indicated where available." (U.S. Department of Health and Human Services)


To Fix Health Care, Turn Patients Into Customers
"[The author's] answer to those who argue for national health insurance or for a market-based system is to do both. Let's provide national insurance to everyone but not for everything. Then let's have individuals use their own health savings accounts to pay for those health-care expenses that aren't catastrophic -- from routine exams to the management of illness and the infirmities of old age. Achieving this reform in full would take time, maybe as long as two generations." (Bloomberg)


Text of Comments to HHS on MLR Provisions in Proposed Regs on Benefit and Payment Parameters (PDF)
"[The Work Group has] some technical concerns with the proposed changes ... regarding the precise manner in which the various distinct types of premium stabilization payments and receipts should be incorporated into the MLR metric. Under the proposed rule, all of these types of premium stabilization payments and receipts would be treated in the same fashion -- they would be backed out of the MLR denominator (as necessary) and included in the MLR numerator. A more nuanced approach is technically sounder [as detailed in this comment letter]." (American Academy of Actuaries, MLR Work Group)


Text of Comments to HHS on Proposed Regs on Notice of Benefit and Payment Parameters for 2014 (PDF)
"Generally speaking, the details provided in the notice were very helpful and answered several of the questions our work group identified after the March 2012 release of the final rule on Standards Related to Reinsurance, Risk Corridors and Risk Adjustment. In order to better understand, analyze, and assist CMS, we need clarification and additional information on several issues.... The individual and small group market may include some participants age 65 and older. The risk model was calibrated using data for people age 0 through 64 and includes demographic factors with the top age band at 60 and older. This suggests that it may not predict cost levels adequately for enrollees age 65 and older and would affect risk adjustment results to the extent that carriers differ in their proportion of 65 and older members." (American Academy of Actuaries, Risk Sharing Workgroup)


Text of Comments by AHIP to HHS on Proposed Regs on Essential Health Benefits, Actuarial Value, and Accreditation
14-page comment letter includes the following sections: Benefit Design Innovation Is Key to Affordable Coverage; Prescription Drug Coverage Requirements -- Providing Flexibility in Formulary Design Will Promote Access to High-Quality and Cost-Effective Coverage; Flexibility to Waive Caps on Small-Group Deductibles Will Help Promote Affordable Coverage; Clarification with Respect to Annual Limits on Cost-Sharing Allows Plans to Use Their Networks of Providers to Promote Cost-Effective Care; Actuarial Value; and Pediatric Dental Coverage Requirements. (America's Health Insurance Plans (AHIP))


Text of Comments by AHIP to HHS on Proposed Regs for Health Insurance Market Rules, Rate Review
Sections of the 28-page letter include: Guaranteed Availability / Guaranteed Renewability -- Additional Strategies Are Necessary to Encourage Participation, Minimize Disruption, and Mitigate Rate Shock; Adjusted Community Rating -- Additional Steps Can Be Taken to Promote Affordability of Coverage and Minimize Disruption of Rates in the Current Market; The Single Risk Pool Requirements Provide Flexibility For Developing Rates and Innovative Health Care and Payment Models; Consistent Treatment of Student Health Plans is Critical to Promote Affordability and Minimize Disruption; and The Regulatory Review Process Should Continue to Be Streamlined to Reduce Duplication, Promote Efficiency and Minimize Administrative Costs. (America's Health Insurance Plans (AHIP))

Benefits in General; Executive Compensation

[Guidance Overview]

New Tax Rates in Effect for 2013
"[E]ffective January 1, 2013, the Social Security Tax holiday that was in effect in 2011 and 2012 has expired. As a result, the employee-side social security tax withholding rate for 2013 is 6.2%. The Social Security wage base for 2013 is $113,700.... Effective January 1, 2013, the Medicare tax rate applicable to wages in excess of $200,000 ($250,000 for married individuals filing jointly; $125,000 for married individuals filing separately) will increase to 2.35%. Employers are required to withhold and report Medicare tax at the 2.35% rate on all wages over $200,000 with respect to their employees. The Medicare tax on wages of $200,000 or less will remain at the 1.45% rate." (Baker & McKenzie)

[Guidance Overview]

President Signs Fiscal Cliff Bill Including IRA, Retirement Plan and Educational Savings Account Provisions
"Coverdell education savings account (ESA) provisions of the Economic Growth and Tax Relief Reconciliation Act of 2001 (EGTRRA) that were set to expire at the end of 2012 are made permanent. The IRA qualified charitable distribution (QCD) that permits an IRA owner age 70-1/2 or older to contribute up to $100,000 of IRA assets per year tax-free to qualifying charities, has been extended for two years, including 2012 and 2013.... [T]ransition relief ... allows certain distributions taken in January of 2013 to be considered qualifying QCD contributions for 2012, and certain distributions paid directly to IRA owners in December of 2012 to be considered eligible for QCD treatment." (Ascensus)

[Guidance Overview]

Highlights of Fiscal Cliff Legislation Affecting Employee Benefits
"Employers providing educational assistance to employees through a qualified education assistance plan may continue to provide those benefits tax-free to participants of up to $5,250 per year. Although this provision had historically been extended period-by-period, the new legislation has permanently extended employer-provided educational assistance for undergraduate and graduate-level courses beginning after December 31, 2012.... The pre-tax allowance for mass transit expenses has been increased from $125 to $240 per year effective retroactively to January 1, 2012 through the end of 2013." (Holland & Hart)

2012-2013 Regulatory Agendas for Employee Benefits Published by DOL and Treasury (PDF)
"The DOL's agenda and related materials include eight pending projects related to employee benefits, which are listed in the chart [in the linked article] in order of the projected timetable for next steps.... The IRS Business Plan includes 36 pending items addressing retirement benefits and 24 pending items addressing executive compensation, health care and other benefits." (Sutherland)

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David Rhett Baker, J.D., Editor and Publisher
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