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February 12, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Employee Benefits Jobs

Defined Benefit Plan Administrator
for Chicago area TPA firm in IL

Business Development Representative
for Next Generation Trust Services in NJ

Retirement Plan Administrator
for Smaller but growing TPA Firm in CO

Pension Plan Administrator
for White Plains, NY in NY

Relationship Manager
for Verisight, Inc. in CA

DB Data Administration Analyst
for Milliman in TX

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Webcasts and Conferences

New EPCRS Procedures
in California on February 21, 2013 presented by Western Pension & Benefits Council - Orange County Chapter

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[Guidance Overview]

Health Care Reform: Employer Play or Pay Penalties
"[This flow] chart provides the basic analysis used to determine an employer's potential play or pay penalty. Additional rules, safe harbors, exceptions and transition periods may also apply in specific circumstances." (Lindquist & Vennum)


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[Guidance Overview]

New HIPAA Regs Affect Business Associates and Subcontractors
"The final rule lists four categories of persons or entities that are not business associates. A plan sponsor that has amended its group health plan to include the required HIPAA provisions is not a business associate with respect to disclosures by a group health plan (or by a health insurance issuer or HMO with respect to a group health plan) to the plan sponsor." (McDermott Will & Emery)

[Guidance Overview]

The ACA 'Play-or-Pay' Provisions: IRS Guidance for Employers and Individuals
"For large employers, the prospect of paying an additional tax of $2,000 per employee should encourage the employers to ensure that their health plans offer minimum essential coverage. Providing affordable coverage with minimum value may be more challenging." (McGuire Woods LLP)

The Next Step in Pharmacy Benefit Management
"Pharmacy benefit management is expanding beyond the focus on higher co-payments and moving employees to generic prescription drugs. Several new-to-market vendors are bringing fresh perspective and solutions to the business." (Human Resource Executive Online)

Are Self-Insured Health Plans Good for Small Employers?
"More [small employers] are considering a shift to self-insuring, and some are even taking the previously rare step. Why? Factors include ever-increasing health-care premiums and differing health-coverage mandates from state to state. But perhaps an even bigger reason is general frustration with the fact that insurers generally don't provide small corporate clients with full claims data on plan participants when presenting pricing for a new plan year. That leaves a company with little negotiating leverage." (CFO.com)

Health Law Regs on 'Essential Benefits' Sent to White House for Final Review
"The White House has begun a final review of two major rules drafted to implement President Obama's healthcare law. Both of the rules, written by [HHS], are considered significant, meaning they each carry an annual economic impact exceeding $100 million. The first would, among other provisions, create new standards for defining 'essential health benefits' to be provided under the landmark law.... The other rule ... involves parameters of programs designed to protect health insurers from financial losses. Those losses, administration officials contend, would likely be passed along to patients." (The Hill)

IBM's Watson Could Be Healthcare Game Changer
"IBM announced the release of three new health care decision-support applications [which use Watson, IBM's 'cognitive' computing platform]. The three new applications include one for recommending cancer treatment options and two for reviewing and authorizing treatments and related health insurance claims.... The doctor uses touch navigation to browse the latest symptoms and test results. The decision support is delivered as a prioritized list of recommended tests and treatment regimens together with confidence scores and links to supporting research." (InformationWeek)

The Importance of Administrative Cost Benchmarking
"The individual and small group health insurance markets are poised for ... dramatic change, driven by the now familiar concept of the online marketplace, known in the health insurance industry as the exchange.... This new presentation format, which allows consumers to choose one product over another based on a small dollar price difference, discourages significant price variation among competitors for similar products.... [A] dashboard coupled with benchmarks can provide management the tools they need to effectively manage their price competitiveness in this new distribution paradigm." (Healthcare Town Hall)

Text of DOL Amicus Brief in Support of De Novo Review of Participant's Claim for Health Benefits
"Without a record of a reasoned discussion or even notice of the emergency or urgent care issue: (1) the reviewing court cannot know if the administrator actually exercised its discretion on the issue; (2) the court is deprived of the benefit of any analysis by the plan that it can review; and (3) the claimant (here pro se) is not alerted to the issue she should be addressing or the information she should supply so that she can develop the record and make responsive arguments. These pervasive and fundamental violations establish that [the plan] did not substantially comply with the regulation[.]" [Halo v. Yale Health Plan, Case No. 3:10-CV-1949 VLB, D.C. Conn.] (Employee Benefits Security Administration)

Employers Show Commitment to Wellness Programs
"As health promotion takes its place as a top consideration among drivers of profitability and performance, an increasing number of companies recognize their role in managing employee health -- 87 percent in 2012 vs. 75 percent in 2010." (Society for Human Resource Management)

1 in 3 Health Plans' Out-of-Pocket Costs Fail ACA Standards
"[T]he Bronze Plan's out-of-pocket limit was lower than 29% of the plans examined. However, further analysis revealed that 38% of the plans did not include the plan's deductible within their out-of-pocket limit, concealing the full amount a beneficiary could pay annually if the Summary of Benefits wasn't read carefully.... When the deductible amounts were added to the out-of-pocket limits for these plans, 36% of plans had higher out-of-pocket limits than the Bronze Plan." (HealthPocket)

With Just Nine Months Until Open Enrollment, 2013 Will Be Perilous Year for Exchanges
"[S]tate exchanges, health plans and enrollees will face obstacles in building the new marketplaces, coordinating with other entities and attracting participants.... [F]actors such as guaranteed issue coverage, the compression of age-rating bands, the inclusion of essential health benefits (EHB), compliance with actuarial values for metal tiers and participation fees could push coverage costs out of reach of some young and healthy consumers who might opt to stay out of the risk pool." (AISHealth.com; free registration required)


Deloitte Health Care Reform Memo, February 11, 2013
"Health care spending -- at 5.7 percentage year-over-year growth for the next decade per the CBO -- is a major contributor to the government's spending problem. And dollars spent on health care -- whether appropriately or not -- compete with dollars for defense, education, and infrastructure. They're not secure in a lock box where competing priorities have no keys. Our system of health has failed to deliver optimal value to its customers -- employers, individuals." (Deloitte Center for Health Solutions)


Evolving Health Care Structures: Playing Fifty-Two Card Pick Up
"The health care industry today resembles this game. All of the cards have been thrown into the air and we are gradually picking them up. But the order has changed completely. Things are no longer assembled in tidy boxes by suit and number but completely re-ordered into new relationships. [The author is] not speaking here about 'health reforms' as envisioned by Washington, but about what is happening in the market. The 'reforms' just add to the complexity of the environment for the real players in health care. If anything, Washington will serve to retard the transforming re-arrangements." (John Goodman's Health Policy Blog)


Welcome to the (Regulatory) Jungle
"[As] proposed and final rules begin to circulate from Washington, [the author is] beginning to wonder if we need to remind regulators that the actual name of the law in question is the Patient Protection and Affordable Care Act and that the purpose of the legislation is... well, patient protection and affordable care. Some of the new rules seem to lose sight of that goal." (The Huffington Post)

Benefits in General; Executive Compensation

IRS Reopens Online PTIN System
"On Friday, Jan. 18, 2013, the United States District Court for the District of Columbia enjoined the Internal Revenue Service from enforcing the regulatory requirements for registered tax return preparers. In accordance with this order, tax return preparers covered by this program are not required to complete competency testing or secure continuing education. The ruling does not affect the regulatory practice requirements for CPAs, attorneys, enrolled agents, enrolled retirement plan agents or enrolled actuaries. On Friday, Feb. 1, the court modified its order to clarify that the order does not affect the requirement for all paid tax return preparers to obtain a preparer tax identification number (PTIN). Consistent with this modification, the IRS has reopened the online PTIN system." (Internal Revenue Service)

Here Are The Benefits Same-Gender Military Couples Will Receive
"[T]he two most important benefits -- subsidized health care (TRICARE) and housing allowances -- were not included.... [A White House] memo helpfully lists the benefits that same-gender military spouses or domestic partners are entitled to immediately.... Those benefits [do include]: ... Thrift Savings Plan Beneficiary [and] Survivor Benefit Plan Beneficiary for Retirees." (Reuters via Yahoo News)

Press Releases

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