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February 27, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Employee Benefits Jobs

Sr. Plan Administrator - Defined Contribution
for American National Insurance Co. in TX

Survivor and Disability Benefits Team Leader
for The General Board of Pension and Health Benefits in IL

Business Development - Central/South Texas
for Simpkins & Associates in TX

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Webcasts and Conferences

42nd Annual Retirement and Benefits Management Seminar
in North Carolina on April 25, 2013 presented by CAPTRUST Financial Advisors

Managing Risk in Defined Benefit Plans: What U.S. Sponsors Have Done and What’s Next? Webinar
Nationwide on March 17, 2013 presented by Osler, Hoskin & Harcourt LLP

View All Webcasts and Conferences

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[Guidance Overview]

HHS Releases Essential Health Benefits Final Regs for Individual, Small Group Plans
"One change in the final rule gives 'states authority to regulate substitution of benefits where plans substitute actuarial equivalent benefits for the base benchmark plan benefits' ... That could give states power 'to regulate if not prohibit substitution of benefits.'" (Bloomberg BNA)


Learn About HRA Plans and the Annual Limit Prohibition with Wolters Kluwer

Sponsored by ftwilliam.com

Learn about recent guidance suggesting HRAs must be integrated with a major medical plan to be exempt from HCR's prohibition on annual limits. We'll cover other less-discussed exemptions that apply to HRAs under health care reform.

[Guidance Overview]

FAQs Address Cost-Sharing Limits and Coverage of Preventive Services
"The FAQs confirm that: Only non-grandfathered health insurance coverage and qualified health plans offered in the small group market must comply with the annual deductible limit ... [P]lans and insurers in the small group market may exceed the limit if they cannot reasonably reach a given level of coverage without exceeding the limit.... All non-grandfathered group health plans must comply with the annual out-of-pocket maximum limits under health care reform." (Practical Law Company)

[Guidance Overview]

Complaining Employees Get Added Protection Under ACA
"An employee's whistleblower activity is protected as long as the employee has a reasonable belief that a violation of the relevant law has occurred, even if such belief is mistaken.... Starting in 2014, the whistleblower provisions will extend to health insurance issuers, regardless of whether those issuers are the employer of the person retaliated against." (Holland & Hart)

[Guidance Overview]

New FAQs Clarify Out-of-Pocket Maximum Mandate and Numerous Preventive Services Issues
"Employer group health plans that have lost grandfathered status, whether insured or self-insured, will be affected by a new limit on total out-of-pocket (OOP) expenses beginning with the 2014 plan year.... [E]mployer group health plans that have lost grandfathered status already must comply with the mandate to cover certain preventive services with no participant cost sharing, and most of the new FAQs address very specific issues raised in connection with those preventive services, including contraceptive and other preventive services for women." (Towers Watson)

[Guidance Overview]

HHS Finalizes Essential Health Benefits and Related Health Plan 2014 Requirements
"The calculator and checklists are designed to allow plan sponsors to determine whether their plans provide adequate coverage under the pay-or-play rules. The final rules provide that these calculations may, with certain adjustments, take into account an employer's contributions to a Health Savings Account or Health Reimbursement Account that are limited to the payment of cost-sharing obligations." (Ballard Spahr LLP)


The Only Conference Series 100% Dedicated to Innovative Health and Benefit Management

Sponsored by IHC

The IHC FORUM East helps employers, TPAs, benefit brokers, consultants and regional health plan providers learn to implement health care consumerism strategies and save money on health and benefit management programs. May 9-10, Atlanta - Code LINK - $100 discount.

[Guidance Overview]

Agencies Issue New FAQs on ACA Issues
"Guidance offered by the FAQs includes the following: To the extent services are not available in-network, out-of-network services must be made available without cost-sharing. Over-the-counter medications such as aspirin must be covered without cost-sharing where 'recommended' by the designated agency and prescribed by a physician. Guidance on when immunizations and a number of other specific items and services must be covered without cost-sharing." (Ballard Spahr)

[Guidance Overview]

Seasonal Workers and the ACA: A Little Closer Look
"The good news is that even if you are large, you may not have to provide coverage to seasonal workers, even ones who work full time during the season. The 'safe harbor' rules for seasonal employees show us how to look at seasonal workers during a measurement period." (Fox Rothschild LLP)

[Guidance Overview]

ML Strategies Health Care Reform Update, February 25, 2013 (PDF)
Update on developments in federal and state health care reform legislation and regulations, including summaries of recent announcements and regulatory activity by HHS, CCIIO, IRS and CMS. (ML Strategies, LLC)

Benefit Design Effective in Encouraging Generic Use and Reducing Medicare Costs (PDF)
"Copays on generic drugs discourage their use. Charging any copay is associated with decreasing generic utilization by about 13 percent. Charging higher copays for brand-name drugs is associated with encouraging generic use. Zero copay for generics is most effective in encouraging generic drug use and adherence" (Robert Wood Johnson Foundation)

Spending on Wellness Incentives Has Doubled in the Last Four Years
"[According to a new survey,] corporate employers plan to spend an average of $521 per employee on wellness-based incentives within corporate health care programs. This marks an increase of 13 percent from the average of $460 reported for 2011, and is double the per employee average of $260 reported in 2009." (National Business Group on Health)

Census Bureau Reports Decline in Employment-Based Health Insurance
"The rate of employment-based health insurance coverage declined from 64.4 percent in 1997 to 56.5 percent in 2010 ... Among employed individuals, employment-based coverage declined from 76.0 percent in 1997 to 70.2 percent in 2010. During this time period, the employment-based coverage rate for those not in the labor force declined from 45.4 percent to 38.6 percent and for unemployed individuals declined from 33.5 percent to 30.8 percent." (U.S. Census Bureau)

Want Health Insurance? Get on the Scale
"In order to be eligible for some -- or all -- of the company health plan, 15% of employers now require employees to undergo biometric screening or fill out a health assessment, according to a [recent] survey ... While most of those companies required such measurements only for access to their richer, top-tier health plans -- which commonly offer higher employer reimbursement or a wider doctor network -- 3% of employers said they would cut benefits for workers who didn't complete the screenings." (MarketWatch.com)

Can the Cleveland Clinic Save American Health Care?
"[W]hat if we actually did take money out of the equation? What if we put doctors on salary and substituted relentless cost-control for 'anything goes'? ... [T]here are places where it works. One of them is the Cleveland Clinic, one of the nation's leading hospital centers. Along with other landmark institutions like Mayo, it was a model for the Accountable Care Organizations provisions in Obamacare -- provisions which, it was hoped, would help simultaneously control costs and improve care." (The Daily Beast)

The Impact of the Mental Health Parity and Addiction Equity Act on Inpatient Admissions (PDF)
"Substance use admissions grew by 19.5 percent in 2011. By comparison, between 2010 and 2011, mental health admissions grew by 5.9 percent and medical/surgical admissions declined by 2.3 percent for this population. Out-of-pocket payments for substance use hospital admissions grew at twice the rate of out-of-pocket payments for mental health or medical/surgical admissions between 2010 and 2011." (Health Care Cost Institute)

Text of GAO Report: ACA's Effect on Long-Term Federal Budget Outlook Largely Depends on Whether Cost Containment Sustained
"There was notable improvement in the longer-term outlook after the enactment of PPACA under GAO's Fall 2010 Baseline Extended simulation, which assumes both the expansion of health care coverage and the full implementation and effectiveness of the cost-containment provisions over the entire 75-year simulation period.... The Fall 2010 Alternative simulation assumed cost containment mechanisms specified in PPACA were phased out over time while the additional costs associated with expanding federal health care coverage remained. Under these assumptions, the long-term outlook worsened slightly compared to the pre-PPACA January 2010 simulation." (U.S. Government Accountability Office)

Issues Facing Employers Under ACA Impact More than a One-Time 'Pay or Play' Decision
"The employee population has come to expect, rightly or wrongly, that their company will offer a comprehensive benefits package as a part of total compensation. Should medical benefits no longer be offered, the employee is faced with the prospect of lower take home pay and the stress of having to ensure coverage is secured for themselves and their family members at an affordable rate. The employer must be aware of the compensation issues and expectations when removing something that ranks high on the list of employee 'wants'." (The Institute for HealthCare Consumerism)


GAO Says Obamacare Will Add $6.2 Trillion to Primary Deficit Over 75 Years
"Over the next 75 years, the Affordable Care Act -- Obamacare -- will add an estimated $6.2 trillion to the primary deficit under the most realistic outlook on federal spending, according to a new report by the [GAO] ... The GAO found that under the baseline simulation the deficit problem shrinks but is not solved. Under the alternative simulation over 75 years, the GAO found the 'primary deficit' would increase by 0.7 percent of gross domestic product (GDP) because of Obamacare." (The Heritage Foundation)


CMS' Proposed Medicare Advantage Cuts Will Result in Higher Costs, Fewer Benefits for Seniors
"[A new analysis by Oliver Wyman prepared for America's Health Insurance Plans] estimates that the new proposed payment cuts combined with the reform law's payment cuts and taxes will result in benefit reductions and premium increases of an average $50 to $90 per month for a typical Medicare Advantage beneficiary next year.... CMS recently proposed a 2.3 percent reduction in Medicare Advantage payments for 2014 at a time when medical costs are projected to increase by three percent." (America's Health Insurance Plans)

Benefits in General; Executive Compensation

[Guidance Overview]

Preparing for the 2013 Proxy Season
"Existing regulations require issuers to disclose the role of compensation consultants in determining or recommending the amount or form of executive and director compensation. Issuers must identify the consultants, state who retained the consultants, describe the nature and scope of the assignment and, in certain circumstances, disclose the aggregate fees paid to the consultants. Proxy statements for 2013 annual meetings must now also provide disclosure about any conflict of interest with the compensation consultant, including the nature of the conflict and how it is being addressed." (Michael Best & Friedrich LLP)

An Important Company Victory in the Proxy Disclosure Litigation Wars
"A review of the [Superior Court of California] decision ... should give companies substantial comfort that customary CD&A disclosures, absent unusual or bad facts, contain enough information on the material issues relating to executive compensation ... so as not to require more specific and/or insignificant information of the type sought by [this] plaintiff.... The court's decision may not only spell relief for companies in other say-on-pay proxy disclosure lawsuits that are now pending in the courts, but, coupled with recent decisions of other courts refusing to enjoin say-on-pay-votes, the decision could discourage the shareholder-plaintiff's bar from filing additional say-on-pay disclosure suits except in unusual situations." [Gordon v. Symantec Corporation, et al., No. 1-12-CV-231541 (Calif. Sup. Ct., Feb. 22, 2013)] (The Conference Board)

2013 Proxies and Compensation: Managing the Risk of Litigation and Evaluating Best Practices (PDF)
Webinar slides. Topics include: Selecting the best practices that will most effectively convey your company's message; Managing executive compensation litigation concerns; Addressing Institutional Shareholder Services and Glass Lewis 2013 policies; and Evaluating compensation committee independence and compensation consultant conflicts of interest. (Morgan Lewis)

Workers' Comp Releases Should Explicitly Release ERISA Claims and ERISA Plan
"Does that workers' compensation settlement agreement release the ERISA disability claim? Probably not, unless the release explicitly mentions ERISA claims and the ERISA Plan.... [According to a federal district court, the] standard language used in a workers' compensation claim release applies only to those claims that are within the scope of the workers' compensation system. [The employer] has the burden of proving its affirmative defense that the release precludes liability for [the employee's] ERISA claim." [Duncan v. Hartford Life and Accident Insurance Company, 2013 WL 506465 (E.D. Cal., Feb. 8, 2013)] (Lane Powell PC)

Press Releases

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