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March 15, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Staff Attorney
for USI Consulting Group in CT

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for Paul Global Benefits in NY

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for Christian Retirement Ministries in CO

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for Prudential in NJ

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[Official Guidance]

Corrections to Proposed IRS Regs on Shared Responsibility for Employers Regarding Health Coverage (PDF)
"This document contains corrections to a [proposed regulation] that was published in the Federal Register on Wednesday, January 2, 2013[.]" (Internal Revenue Service)


[Advert.]

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[Official Guidance]

Text of DOL Technical Release No. 2013-01: Extension of the Transition Period for the Temporary NAIC-similar State External Review Process under the ACA
"On June 22, 2011, the Departments issued Technical Release 2011-02 ... which established a transition period until January 1, 2012 for State external review process implementation and a set of temporary standards similar to the consumer protections set forth in the Uniform Health Carrier External Review Model Act issued by the National Association of Insurance Carriers (the 'NAIC-similar process') that would apply until January 1, 2014 for a State-administered external review process ... This technical release updates and clarifies T.R. 2011-02 and extends the applicability of the temporary NAIC-similar process standards until January 1, 2016. During this extended transition period, States that CCIIO has already determined to meet the NAIC-similar process standards will continue to be considered compliant ... until January 1, 2016." (Employee Benefits Security Administration)

[Guidance Overview]

New Guidelines on Preventive Care Benefits for Non-Grandfathered Plans
"In addition to providing clarity about coverage, the new guidance reminds plan sponsors of the flexibility they have in designing their preventive coverage benefits. For example, plan sponsors may choose to limit coverage for prescribed over-the-counter medications and other preventative benefits to in-network pharmacies or providers, or impose reasonable limitations on certain preventative benefits such as name-brand pharmaceuticals." (Segal)

[Guidance Overview]

Insured Expatriate Group Health Plans Temporarily Exempt from ACA Mandates
"Employer plan sponsors with insured expatriate group health plans should review this FAQ guidance to determine whether the temporary transitional relief is applicable to their expatriate group health plans. In addition, employer plan sponsors should confirm whether the insurers for such expatriate group health plans are aware of, and will be taking advantage of, this transitional relief." (Towers Watson)

[Guidance Overview]

Immediate Action Required under HIPAA/HITECH Final Rule
"[D]ue to the regulations' substantial broadening of the definition of 'Business Associate,' all businesses that encounter health information should perform an analysis to determine whether they are subject to the regulations and, if so, must act quickly to avoid potential criminal and civil liability." (Wolff Samson)


[Advert.]

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[Guidance Overview]

DOL Issues Final Rules on Multiple Employer Welfare Arrangements
"[A]ll employee welfare plans that file a Form M-1 must also file a Form 5500, even if the plan would otherwise be exempt, to demonstrate the plan's compliance with the Form M-1 filing requirement. Failure to answer the Form M-1 compliance question will cause the Form 5500 to be rejected as incomplete, which may subject the filer to civil penalties." (Haynes and Boone, LLP)

Michigan District Court Enjoins Enforcement of HHS Mandate against Thomas Monaghan and His Domino's Farms Corporation
"Federal District Court Judge Lawrence P. Zatkoff of the Eastern District of Michigan ... granted a Motion for a Preliminary Injunction against enforcement of the HHS Mandate [for] Tom Monaghan and his property management company, Domino's Farm Corporation. Judge Zatkoff previously ruled in favor of granting an emergency temporary restraining order. The preliminary injunction extends the previous ruling to protect the plaintiffs for the entire pendency of the case." (Thomas More Law Center)

Text of Michigan District Court Order Enjoining Enforcement of Contraceptive Mandate Against For-Profit Closely-Held Company (PDF)
"This case is analogous to Tyndale, Stormans and Townley -- though the Court finds the facts in this case much stronger. [Domino's Farms Corp., ('DF') a secular, for-profit property management company] does not present any free exercise rights of its own different from or greater than [Thomas Monaghan's] rights. Unlike Tyndale , Stormans, and Townley -- where the companies in question had multiple owners -- Monaghan is DF's sole shareholder, director, and decision-maker. As such, DF is even more closely-held than those companies, making the beliefs of DF and its owner even more indistinguishable." (U.S. District Court, Eastern District of Michigan, via Thomas More Law Center)

Why an MRI Costs $1,080 in America and $280 in France
"In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America's deficits would vanish. Workers would have much more money in their pockets." (The Washington Post)

Health Care Costs Expected To Increase 5.1% In 2013
"Over the next five years, 85 percent of employers say their strategy for employee cost sharing for health care coverage will be an important component of their overall strategy. However, confidence that they will continue to offer health care benefits ten years from now remains low (26 percent), suggesting that employers are uncertain about the direction of the marketplace in the coming years.... 66 percent of companies now have a consumer-driven health plan (CDHP) in place, and another 13 percent expect to add one in 2014." (Wolters Kluwer Law & Business)

Reconsidering Employer-Sponsored Health Care: Four Paths to Long-Term Strategic Change (PDF)
"Centered on a consistent need to have a workforce that is healthy, present and high-performing, employers face four strategic paths for consideration ... [1] Annual trend migration -- staying in; [2] Exit completely -- paying to get out [3] Leverage/subsidize exchanges -- playing, on a new field; [4] House money, house rules -- playing, by new rules. Each path presents not only opportunities, but also risks -- for employers, employees and the U.S. health care marketplace at large." (ISCEBS Benefits Quarterly)

Want Obamacare? Here's the 21-Page Draft Application.
"A lot of Americans don't envision filling out their application alone, and that means that this class of helpers is likely to be crucial to making the health care law work. One other note to keep in mind: Most Americans will never see this form. Most who access health insurance through the exchange are expected to do so online, not in paper." (The Washington Post)

Some Small Businesses Choose to Self-Insure
"As more small employers such as NorthBay avoid the [ACA's] requirements through self-coverage, small-business marketplaces intended to cover millions of Americans could break down and become unaffordable, they say. 'What you've got is basically a loophole for the small employer to get out of the ACA requirements,' says Robert Laszewski, a Virginia-based consultant and former insurance executive." (USA TODAY)

Let HR Strategy Guide Health Benefits
"Health care reform is a once-in-a-lifetime opportunity to rethink health care benefits delivery," [according to Gary Kushner, SPHR, president and CEO of Kushner & Co.] ... Strategic questions employers should be asking, he said, include: What is our overarching organization strategy? How is HR strategy aligned with the organization's strategy? What is our total rewards strategy? How do health care benefits fit in to the above strategic considerations?" (Society for Human Resource Management)

Employment-Based Health Insurance Continues to Decline
"... 42.9 percent of individuals who did not complete high school worked for an employer that offered health insurance, compared with 78.9 percent for individuals with a college degree. The likelihood of have coverage also increased by age: 75.7 percent of workers age 45 to 64 worked for an employer that offered health insurance benefits, compared with 60.0 percent for workers 19 to 25." (Wolters Kluwer Law & Business)

District Court Declines to Follow Amara Dicta, Denies Plaintiff's Claim for Reimbursement for Medical Procedure
"Despite Plaintiff's claim that the Supreme Court's discussion in Amara relating to equitable relief under Section 502(a)(3) supplants Eighth Circuit case law, the court concluded that the Eighth Circuit continues to rely on prior, binding Supreme Court precedent limiting relief sought under Section 502(a)(3) to equitable, not legal, relief." [Plambeck v. The Kroger Co., et al., No. CIV. 11-5054-JLV (D.S.D., Mar. 11, 2013)] (Seyfarth Shaw LLP)

A Key to Lowering the Cost of Drugs: Separate Medical and Pharmacy Benefits Into Separate Plans
"Over the next three years, brand-name drugs expected to drive $133 billion in revenue for drug makers during that time period will lose patent protection. That will generate downward pressure on prescription drug costs. Unfortunately for the bottom lines of corporate health-plan sponsors, the savings will be at least partially offset by the increasing use of specialty pharmaceuticals." (CFO.com)

[Opinion]

Bad for Business: HHS Pricing Restrictions Could Hurt Massachusetts Employers
"Massachusetts employers who were at the forefront of healthcare reform in 2007 know firsthand that health reform is expensive.... In addition to the number of new fees and taxes being added to health premiums in 2014 ... comes troubling calculations and new rating restrictions that may adversely impact most Massachusetts employers, particularly those with less than 100 employees. [An analysis shows] cost increases of between 3% and 14% on top of annual trends (8%) and the other PPACA taxes (3%)[.]" (William Gallagher Associates)

[Opinion]

GOP Effort to Roll Back Health Care Reforms Is Bad Policy
"Republican lawmakers, in their budget proposal released this week, showed they're determined to roll back President Obama's healthcare reforms, deny coverage to millions, limit treatment of the poor and essentially hand Medicare over to private insurers. This isn't just bad public policy. It's the perpetuation of a Darwinian struggle between those who have access to affordable healthcare and those who do not." (Los Angeles Times)

[Opinion]

Selling Expensive Health Care Lemons
"Businesses try to optimize prices and sales in order to maximize revenues. When 'consumers' (patients) have little or no information about what they're buying, [economist George Akerlof's] prediction that maximization of profits rather than value will dominate decision-making comes true. In other words, the asymmetry of information between patients (who possess little) and health care providers and administrators (who possess a lot) makes anything like a rational market in health care services impossible." (Physicians for a National Health Program)

Benefits in General; Executive Compensation

Third Wave of Executive Compensation Lawsuits Is Coming Ashore
"Ever since the Dodd-Frank Act was passed, shareholders have been finding creative ways to sue companies over their executive-compensation programs. The newest lawsuits may be more successful than their predecessors.... Unlike the lawsuits filed in the first two waves of shareholder litigation, which began in 2010 and 2012, the new ones have nothing directly to do with Say on Pay. But they are another attempt to take companies to task over executive compensation." (CFO.com)

Text of CBO Testimony on the Social Security Disability Insurance Program: Funds Run Out in Three Years (PDF)
"In the past four decades, the number of workers with disabilities who receive benefits from the [Social Security Disability Insurance ('DI')] program has increased nearly sixfold, rising from 1.5 million in 1970 to 8.8 million in January 2013.... Since 2009, the program has paid out more each year in benefits than it received in dedicated revenues..... In 2023, CBO projects, the program's spending will be 0.82 percent of GDP, and dedicated tax revenues will be 0.66 percent of GDP. CBO projects that the DI trust fund will be exhausted in 2016, nearly 20 years before the projected exhaustion of [the] trust fund for the Social Security retirement program." (Congressional Budget Office)

Press Releases

NCPA Supports Bill to Preserve Community Pharmacies, Protect Patient Choice
National Community Pharmacists Association (NCPA)

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