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March 1, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Employee Benefits Jobs

Sr. Compliance Administrator
for VALIC in TX

Retirement Plan Administrator
for PenSys, Inc. in CA

RS Operational Consultant
for MassMutual Financial Group in MA

Retirement Plan Administrator
for Valley Forge Pension Management in PA

401(k) Administrator
for Mid-Atlantic Pension Specialists, Inc. in PA

Junior Pension Administrator
for Priority Pension Services, Inc. in CA

Assistant Manager, Distributions
for RPG Consultants in NY

Retirement Security Education Counselor, Part-time
for Prudential in NY

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Webcasts and Conferences

Voluntary Fiduciary Correction Program And Abandoned Plan Workshop
in Kentucky on March 18, 2013 presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

Employee Plan Compliance Resolution Systems (EPCRS)2013
Nationwide on March 28, 2013 presented by McKay Hochman Co., Inc.

Health Care Reform: Employer "Shared Responsibility" Penalty Recorded Webcast
Nationwide on March 31, 2013 presented by Jackson Lewis LLP

Form 5500 Update
Nationwide on March 26, 2013 presented by McKay Hochman Co., Inc.

Strategic Implementation of Employer Shared Responsibility Rules Webinar
Nationwide on March 21, 2013 presented by Findley Davies, Inc.

Healthcare Benefits Forum
in Pennsylvania on May 9, 2013 presented by Conrad Siegel

View All Webcasts and Conferences

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[Official Guidance]

ACA, HIPAA Self-Compliance Checklists Published by DOL
"This self-compliance tool is useful for group health plans, plan sponsors, plan administrators, health insurance issuers, and other parties to determine whether a group health plan is in compliance with some of the provisions of Part 7 of ERISA. The requirements described in the Part 7 tool generally apply to group health plans and group health insurance issuers. However, references in this tool are generally limited to 'group health plans' or 'plans' for convenience." (Employee Benefits Security Administration)


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[Official Guidance]

Text of Proposed HHS Regs on Establishment of Exchanges and Qualified Health Plans; Small Business Health Options Program
"[T]his proposed rule would amend existing regulations regarding triggering events and special enrollment periods for qualified employees and their dependents and would implement a transitional policy regarding employees' choice of qualified health plans (QHPs) in the SHOP." (Centers for Medicare & Medicaid Services, Department of Health and Human Services)

[Official Guidance]

Text of HHS Announcement of Notice of Benefit and Payment Parameters
"Key policies in today's rule include: [1] Reducing the incentives for health insurance issuers to avoid enrolling people with pre-existing conditions ... [2] Stabilizing premiums in the individual market for health insurance ... [3] Protecting health insurance issuers against uncertainty in setting premium rates ... [4] Helping working Americans afford health insurance in the Marketplaces ... [5] [Provisions that] help to ensure a competitive market in the small business health options program (SHOP) ... [6] [Amending] the Medical Loss Ratio program." (Department of Health and Human Services, Centers for Medicare & Medicaid Services)

[Official Guidance]

Text of Interim Final HHS Regs: Amendments to the Notice of Benefit and Payment Parameters for 2014
"This document will adjust risk corridors calculations that would align the calculations with the single risk pool provision, and set standards permitting issuers of qualified health plans the option of using an alternate methodology for calculating the value of cost-sharing reductions provided for the purpose of reconciliation of advance payments of cost-sharing reductions." (Centers for Medicare & Medicaid Services, Department of Health and Human Services)

[Official Guidance]

Text of Final HHS Regs on Notice of Benefit and Payment Parameters for 2014
483 pages. "This final rule provides detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for Federally-facilitated Exchanges; advance payments of the premium tax credit; the Federally-facilitated Small Business Health Option Program; and the medical loss ratio program." (Centers for Medicare & Medicaid Services, Department of Health and Human Services)


SouthWest Benefits Association 38th Annual Conference - May 8-10 - New Orleans

Sponsored by SouthWest Benefits Association

Staying up to date in the world of benefits has never been more critical. Changes in regulations, technology and the economy continue to influence benefits structures. Participation in the SWBA Conference is the most cost-effective way to stay informed.

[Official Guidance]

Text of Proposed IRS Regs on Health Insurance Providers Fee
"The proposed regulations provide guidance on the annual fee imposed on covered entities engaged in providing health insurance for United States health risks. Generally, each covered entity with aggregate net premiums written over $25 million in the calendar year immediately preceding the fee year (referred to in the proposed regulations as the data year) is liable for the annual fee due by September 30th of each fee year in an amount determined by the IRS under section 9010(b) and the proposed regulations." (Internal Revenue Service)

[Guidance Overview]

OSHA Issues Interim Final Rule on Whistleblower Protections Under ACA
"In 2014, the anti-retaliation provisions of Section 1558 will be expanded to apply to group health plans and health insurance issuers offering group or individual health insurance coverage. That is, employees will be protected from retaliation by their employers and by the insurance carrier who provides the health coverage. For example, employees will be protected from acts such as issuers limiting or cancelling their health insurance coverage." (Ballard Spahr)

[Guidance Overview]

OSHA Announces Procedures for Handling Whistleblower Complaints Under ACA
"What constitutes protected activity is under the ACA is potentially very broad. The law covers any employee who provides or is about to provide to their employer, the federal government, or the attorney general of a state, information relating to any act or omission that the employee reasonably believes to be a violation of Title I of the Act, testifies or is about to testify concerning such violation, assists or participates in an investigation of a violation, or objects to or refuses to participate in any activity, policy, practice, or task that the employee reasonably believes to be a violation." (Seyfarth Shaw LLP)

[Guidance Overview]

ACA Protects Employees from Employment Retaliation
"Certain large employers who fail to offer affordable coverage that provides minimum value may be assessed a tax penalty if any of their full-time employees receive a subsidy for coverage obtained through the Exchange. This creates an incentive for an employer to retaliate against an employee, and Section 18C is designed to protect employees against such retaliation.... [E]mployers will want to be in a position to demonstrate clear and convincing evidence that it would have taken the same adverse action in the absence of the employee's asserted protected activity." (Jackson Lewis LLP)

[Guidance Overview]

Cost Sharing Limits for Health Plans (PDF)
"HHS confirms that ACA's annual deductible limit applies only in the insured small group market. Thus, the annual deductible limit does not apply to self-insured plans or large group market plans.... The final rule provides that ACA's out-of-pocket maximum applies to all non-grandfathered health plans. This would include, for example, self-insured health plans and insured health plans of any size." (The Chelko Consulting Group LLC)

[Guidance Overview]

Navigating the HITECH 'Omnibus Final Rule': A Guide for Employers
"The Final Rule expands [the definition of business associate] to include persons who create, receive, maintain or transmit PHI in connection with performing a function or service for a covered entity, even if they do not actually view the PHI. Additionally, among the new categories in the definition of a business associate is a subcontractor who creates, receives, maintains or transmits PHI on behalf of a business associate. Thus, subcontractors of a business associate who use or disclose the covered entity's PHI are now directly subject to HIPAA." (McGuire Woods LLP)

[Guidance Overview]

HIPAA Compliance Update for Employee Benefit Plans
"Further guidance is anticipated related to two issues affecting group health plans that are not addressed in the Omnibus Rule: ... When business associates use, disclose, or request PHI, HIPAA requires them to limit PHI to the minimum necessary needed to accomplish the intended purpose.... A proposed rule on accounting of disclosure changes was released in May 2011 and has not yet been finalized. These changes will require covered entities and business associates to account for disclosures of PHI to carry out treatment, payment, and health care operations if such disclosures are made through an electronic health record." (Drinker Biddle)

[Guidance Overview]

Checklist for HIPAA Omnibus Rule Compliance
"Covered entities and business associates must ensure that their existing and future agreements contain the elements required ... Covered entities may also want to include indemnification or similar clauses to protect themselves.... Covered entities must generally respond to a patient's request to access their information within 30 days; the omnibus rule eliminated the provision that gave covered entities extra time to respond if records were maintained offsite." (Holland & Hart)

New HIPAA Rule Has Short Compliance Deadline, Lots to Do
"[T]he final HIPAA/HITECH rule ... gives covered entities only six months to comply with its numerous changes. Perhaps most challenging in the short time period are the changes affecting business associates.... [A] transition rule [allows] covered entities and business associates to operate under existing contracts for up to one year beyond the rule's compliance date of Sept. 23, 2013. Contracts that were in effect before Jan. 25, 2013, and that are not renewed or modified between March 26, 2013, and Sept. 23, 2013, qualify for the transition rule." (AISHealth.com; free registration required)

[Guidance Overview]

Employee Cost Sharing for Health Benefits
"Previously, there was a question as to whether the small group market caps would also apply to self-insured group health plans and health insurance policies sold to large employers. Recent final regulations by [HHS] and [DOL] FAQs Part XII ... resolve that question as follows: The cap on deductibles will not apply to self-insured group health plans and policies sold to large employers; but The cap on the out-of-pocket limit will apply to non-grandfathered self-insured group health plans and non-grandfathered policies sold to large employers. (Grandfathered plans and policies will be exempt while they continue to maintain grandfathered status.)" (Vorys, Sater, Seymour and Pease LLP)

[Guidance Overview]

Final HHS Regs Address Essential Health Benefits and Required Cost-Sharing
"[HHS] has released final regulations that establish ten categories of essential health benefits that small group and individual health insurance plans will have to provide under health care reform. The regulations also provide guidance on required cost-sharing and actuarial value calculations." (Practical Law Company)

Payment Matters: The ROI for Healthcare Provider Payment Reform
"As health care costs continue to affect employers? bottom lines, growing evidence that payment reform strategies can help control costs is spurring employer purchasers to switch from the inefficient fee-for-service model of paying for care, which encourages high volume and rewards poor quality, to payment models that reward high-value care.... [This study] examines employers' pilot programs testing four approaches to payment reform, including population-based payment, patient-centered medical homes, high-intensity primary care, and bundled payment. [Five] briefs explain the differences between these strategies, share results and lessons learned from employers pioneering these projects, and offer tips for employers looking to reward high-quality health care and make more efficient use of health care dollars." (Robert Wood Johnson Foundation)

Florida Panel Recommends Health Coverage for Part-Time State Employees
"Members of a Florida House panel reluctantly agreed Thursday that they would rather extend health coverage to part-time employees than pay a roughly $300 million fine under President Barack Obama's federal health care law.... State officials estimate it would cost about $35.6 million a year to cover 8,737 part-time employees who work an average of 30 hours per week. It's unclear how much employees would have to contribute to the plan." (Herald-Tribune)

Employers Seeing the Strengths of Group Legal Plans
"Two-thirds of employers who don't offer a group legal plan as part of their voluntary benefits would consider adding it if granted additional information ... [M]any worry about a legal offering increasing administrative burdens. Of those surveyed, however, 99% find group legal plans at least as easy to handle as other voluntary benefits -- if not easier." (Employee Benefit News)

DOL Issues Updated and Expanded FMLA Regulations, Forms and Poster to Match Current Law (PDF)
"Under the new regulations, qualifying exigency leave is expanded to include members of the Regular Armed Forces, along with the National Guard and Reserves. It is now triggered by the military family member's deployment to a foreign country, rather than just a call to active duty. It includes a new 'qualifying exigency' leave category -- parental care leave -- wherein an employee can take leave to care for a military member's parent who is incapable of self-care when the care is necessitated by the member's deployment, such as arranging for alternate care or caring for the parent on an immediate need basis." (Locke Lord)

Willis Health Care Reform Survey 2012-2013 (PDF)
"The goals of this year's survey were to identify: [1] What elements of Health Care Reform have affected employer cost (positively or negatively); [2] The strategies employers are using in offering/designing benefits; [3] The extent to which employers are retaining grandfathered status; [4] The expectations of employers regarding: [a] What they believe similar companies will do in reaction to Health Care Reform and [b] What plan design changes survey respondents expect to make as a result of Health Care Reform." (Willis)

Some Employers Aren't Calculating ACA Compliance Costs
"Around 60 percent of employers wanted to avoid cost increases, but more than 50 percent had not yet calculated what complying to healthcare reform provisions would cost their companies. These professionals tended to think that the legislation had not yet impacted the cost of their coverage. However, 17 percent of companies that did the necessary calculations found that their medical benefits increased in cost by more than 5 percent." (ConnectYourCare)

The CO-OP Health Insurance Program: A Health Policy Brief
"CO-OPs are likely to face major challenges ... as they prepare for open enrollment in October 2013. On top of the federal funding they have already obtained, CO-OPs will need significant private support to be financially viable.... CO-OPs will need to set their initial premium rates without the historical claims or utilization data on which those rates are usually based.... Some of these challenges in providing care -- such as having an integrated network of high-quality providers -- may be magnified if a CO-OP tries to operate in more rural or medically underserved communities." (HealthAffairs)

Census Report: Health Status, Health Insurance and Medical Services Utilization, 2001-2011
"A table package that highlights the relationship between the use of medical services (such as visits to doctors and nights spent in the hospital), health status, health insurance coverage and other demographic and economic characteristics. The statistics come from the Survey of Income and Program Participation." (U.S. Census Bureau)

DOL Asserts New Power to Seize Assets of Fraudulent Health Care Pools
"The Labor Department has prosecuted abuse of the insurance pools in the past, but the new rule would cut through the red tape associated with freezing assets and issuing a 'cease and desist order' to a deceptive insurance promoter. The rules allow the secretary of Labor to assess from a fraudulent program if there is 'probable cause' that the plan is in a 'financially hazardous condition'." (The Hill)


Senate, House Lawmakers Announce Bill To Repeal Job-Killing Employer Mandate
"'The employer mandate is a drag on our economy, forcing too many of our nation's job creators to stop hiring and grow their businesses in order to comply with this onerous provision in President's health law,' said [the bill's co-sponsor, Utah Sen. Orrin Hatch]. 'Instead of letting the federal government dictate how employers should allocate resources, let's repeal this job-killing mandate and let businesses get back in the business of hiring.'" (KCSG Television)


Some Comments on the Recent Census Report on Employment-Based Health Insurance
"[I]t is likely that there will be little tendency to increase the numbers of individuals with employer-sponsored coverage. In contrast, it is more likely that other employers will follow the lead of those who early on decide against providing coverage as they play games with the rules that determine whether there would be penalties or how much they would be." (Physicians for a National Health Program)


Health Insurance Tax Will Hurt Small Businesses, Self-Insured
"Beginning in 2014, millions of small businesses are set to take yet another hit from the billions in new health insurance taxes included in the president's health care law.... The estimated $100 billion in costs will ultimately fall on Main Street enterprises and the self-employed. And despite all the political rhetoric in Washington about 'shared sacrifice,' the nation's largest companies and labor unions are not subject to the tax. This is truly a tax on small business." (Daily World)

Benefits in General; Executive Compensation

Hodgson Russ Employee Benefits Developments, February 2013
Articles Include: Health Care Reform: HHS Proposes Substantial Reinsurance Fee; No ERISA Section 510 Violations Found in Pair of Sixth Circuit Cases; Failure to Process Rollover Request May Constitute Fiduciary Breach; Improper Delegation to TPA Results in Loss of Deferential Review; Eighth Circuit Upholds Company Denial of Severance Benefits. (Hodgson Russ LLP)

Press Releases

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David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

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