EmployeeBenefitsJobs.com logo BenefitsLink.com logo

BenefitsLink Health & Welfare Plans Newsletter

April 2, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
         Past Issues  |  Search

Employee Benefits Jobs

Benefits Specialist
for Sonepar - US in SC

Assistant General Counsel
for IAM National Pension Fund and National IAM Benefit Trust Fund in DC

Corporate Benefit Associate
for Financial Services Firm in NY

Pension Consultant/Administrator
for Wender & Company in OH

Conversions Specialist
for The Newport Group in NC

Senior Consultant, Income Planning
for Nationwide Insurance in AR, IA, LA, MO, NE, OK, TX

Consultant, Retirement Plans
for Cammack LaRhette Consulting in NY

Post Your Job on employeebenefitsjobs.com

View All Jobs

RSS feed for jobs RSS Feed: All Jobs

Webcasts and Conferences

Level I - IRA Seminar
Nationwide on May 1, 2013 presented by Wolters Kluwer Financial Services

Level II - IRA Seminar
Nationwide on May 1, 2013 presented by Wolters Kluwer Financial Services

IRA Live Streaming Webinar - Level I, Part 1
Nationwide on May 2, 2013 presented by Wolters Kluwer Financial Services

IRA Live Streaming Webinar - Level I, Part 1
Nationwide on May 16, 2013 presented by Wolters Kluwer Financial Services

Valuation and ERISA Fiduciary Liability: How to Protect Yourself
Nationwide on May 14, 2013 presented by BVR (Business Valuation Resources)

The Triple Aim Goes Global Briefing
in District of Columbia on April 11, 2013 presented by Health Affairs

Communications - Half-day Seminar
in Florida on May 21, 2013 presented by ASPPA Benefits Council of Central Florida

Health Care Reform Webinar: Transparency & Accountability
Nationwide on April 19, 2013 presented by Davidson Marketing Group -- FutureOffice Network

Health Care Reform Webinar: Mandates & Exchanges
Nationwide on May 3, 2013 presented by Davidson Marketing Group -- FutureOffice Network

Health Care Reform Webinar: Operational Changes for Health Plans
Nationwide on May 15, 2013 presented by Davidson Marketing Group -- FutureOffice Network

Health Care Reform Webinar: New Taxes and Other Revenue Raisers
Nationwide on May 30, 2013 presented by Davidson Marketing Group -- FutureOffice Network

View All Webcasts and Conferences

We also publish the BenefitsLink Retirement Plans Newsletter (free): Subscribe


[Official Guidance]

CMS Rate Announcement Details Plan Payments and Other Program Updates for 2014
"After careful consideration of public comments, key changes and updates finalized in the Rate Announcement and final Call Letter include: Lower Out-of-Pocket Drug Spending ... Improved Risk Adjustment Model ... Improved Coordination of Care ... The 2014 statutory updates to the annual parameters for the defined standard Part D prescription drug benefit are finalized as proposed: [Deductible: $325 (2013), $310 (2014); Initial Coverage Limit: $2,970 (2013), $2,850 (2014); Out-of-Pocket Threshold: $4,750 (2013), $4,550 (2014)]" (Centers for Medicare & Medicaid Services)


ACA University Debuts Today!

Sponsored by IFEBP (International Foundation of Employee Benefit Plans)

The International Foundation's ACA University is a virtual learning center providing essential information for employers to navigate the Affordable Care Act. Offering live webcasts, Q&A sessions, podcasts, industry networking and more.

[Official Guidance]

DOL Annual Report to Congress on Self-Insured Group Health Plans (PDF)
"The Form 5500 data show that approximately 49,000 health plans filed a Form 5500 for 2010, a decrease of more than 3 percent from the approximately 50,000 health plans that filed a Form 5500 for 2009. Of health plans filing a 2010 Form 5500, about 19,800 were self-insured and approximately 4,000 mixed self-insurance with insurance ... Self-insured plans covered approximately 30 million participants in 2010 and held assets totaling about $58 billion." (Employee Benefits Security Administration)

[Official Guidance]

Appendix A of DOL Annual Report to Congress on Self-Insured Group Health Plans, March 2013 (PDF)
The document is entitled 'Group Health Plans Report: Abstract of 2010 Form 5500 Annual Reports Reflecting Statistical Year Filings.' Excerpt: "In 2010, fewer than 20,000, or 41 percent, of the approximately 49,000 private sector employer-sponsored group health plans that filed a Form 5500 can be categorized as self-insured.... Of the 49,000 group health plans mentioned above, 83 percent offered other welfare benefits in addition to health benefits (such as dental, vision, life, disability, etc.). Of these 40,000 plans, 9 percent can be described as having both self-insured and fully-insured characteristics ... Fifty-three percent of all private sector single employer group health plans that filed a 2010 Form 5500 provided fully-insured health benefits to their employees." (Employee Benefits Security Administration)

[Official Guidance]

Appendix B of DOL Annual Report to Congress on Self-Insured Group Health Plans, March 2013 (PDF)
The document is entitled 'Self-Insured Health Benefit Plans.' Excerpt: "The primary findings include: [1] The fraction of self-insured or mixed-funded (fund ed through a mixture of insurance and self-insurance) Form 5500 filing health plans declined from 56% in 2001 to 48% in 2010. However, over the same period, the percentage of plan participants covered by self-insured or mixed-funded plans increased from 75% to 83%.... [2] From 2009 to 2010, the percentage of self-insured Form 5500 filing health plans remained at 40%, whereas the percentage of mixed-funded plans decreased slightly from 9% to 8%.... [3] [S]top-loss coverage among self-insured plans declined from 29% in 2009 to 28% in 2010. This fraction had ranged between 31% and 33% since 2001." (Deloitte and Advanced Analytical Consulting Group, for Employee Benefits Security Administration)

[Guidance Overview]

Narrowing the Scope: Applying the HIPAA Final Rule to Group Health Plans
"The Final Rule confirms that HHS will consider the following factors, which may either mitigate or aggravate the amount of the civil monetary penalty: [1] The nature and extent of the violation ... [2] The nature and extent of the harm resulting from the violation, including whether ... the violation hindered an individual's ability to obtain health care. [3] The history of prior compliance. [4] The financial condition of the group health plan or business associate, including whether the entity had financial difficulties that affected its ability to comply[.]" (Thompson Hine)

[Guidance Overview]

ACA Helps Small Businesses Shop for Health Insurance for Their Employees (PDF)
"SHOPs have unique functions, including, but not limited to, the following: [1] The SHOP must adhere to certain enrollment and eligibility requirements; [2] The SHOP must allow a qualified employer to select a level of coverage in which all qualified health plans (QHPs) within that level are made available to the qualified employees of the employer; [3] In addition to allowing employers to select a specific level of coverage, the SHOP may also allow the qualified employer to make one or more QHPs available to qualified employees by a different method than the employer choice method[.]" (Reinhart Boerner Van Deuren s.c.)

[Guidance Overview]

OCR Director Leon Rodriguez Speaks on HIPAA Final Rule
"Breaches will continue to happen and OCR knows it. The key to avoiding costly fines and penalties is to be able to show OCR what was in place to prevent the breach in the first instance, to investigate and mitigate the effects of the breach when it occurred, and to review the HIPAA compliance program generally as a result of the breach to prevent it from recurring. The only way to be able to establish this is to document everything." (K&L Gates, LLP)

[Guidance Overview]

Proposed Rules Issued on 90-Day Waiting Period
"If a plan only offers coverage to employees who work a minimum number of hours per period (full-time employees), an employer may establish a measurement period that does not exceed 12 months to determine if a variable-hour employee meets the hourly requirement. If the employee satisfies the hourly requirement, he/she must be eligible for coverage within 13 months after his date of hire." (Clifton Budd & DeMaria, LLP)

[Guidance Overview]

Controlled Group Issues Under the Pay-or-Play Rules
"A large employer is permitted a reduction of 30 full-time employees per month for purposes of calculating penalties due for failing to offer coverage under 4980H(a). This 30-employee reduction must be done ratably across all members of a controlled group based on each member's number of full-time employees, so employers can't chose which members will benefit from the reduction. However, if the controlled group has more than 30 members and the ratable allocation to some members is greater than zero but less than one, the proposed regulations allow rounding up to one employee for that member -- which could result in an overall reduction to all members of more than 30 employees." (Faegre Baker Daniels)

Small-Business Insurance Market Delayed
"Starting in 2014, workers at companies with fewer than 100 employees were supposed to have been able to choose from a variety of health plans through new small-business insurance marketplaces. They'll instead wait until at least 2015, according to regulations released by the U.S. Department of Health and Human Services." (Treasury & Risk)

Administration Delays SHOP Health Exchanges -- Small Businesses Disappointed
"The law calls for a new insurance marketplace specifically for small businesses, starting next year. But in most states, employers will not be able to get what Congress intended: the option to provide workers with a choice of health plans. They will instead be limited to a single plan. ... The choice option, already available to many big businesses, was supposed to become available to small employers in January. But administration officials said they would delay it until 2015 in the 33 states where the federal government will be running insurance markets known as exchanges. And they will delay the requirement for other states as well.... The administration cited 'operational challenges' as a reason for the delay." (The New York Times)

Who Uses Out-of-Office Benefits More?
"[O]nly 37 percent of women regularly use employee benefits designed to help them meet demands outside the office, compared to 42 percent of men.... only 38 percent of women regularly use flexible-work arrangements, compared to 42 percent of men.... [O]ne-third of all working Americans (33 percent) say work interfering during personal or family time has a significant impact on their level of work stress and one in four report that job demands interfere with their ability to fulfill family or home responsibilities." (Human Resource Executive Online)

Don't Take an Exchange at Face Value -- Kick the Tires
"When employers interact with exchanges, they need everything consumers need -- and a lot more: A proven, end-to-end technology foundation ... Reports for managing health benefits, population by population ... Data to manage and workforce health and wellness ... Benefit advisors to manage the questions their in-house HR departments cannot ... Individual tracking capabilities that synch with eligibility for federal subsidies ... Funds and claims management tools ... A great interface." (ExtendHealth)

The First ACA Exchange Rates Are Out: Vermont
"Vermont became the first state to publish proposed rates for its exchange. The single coverage rates average between $365.76 per month for bronze coverage up through $609.47 for platinum coverage. Family rates average between $1,027.78 and $1,712.61. These averages are measured based on the options available under each level of coverage, so it might be that some coverage levels cost more or less depending on the option selected." (Fox Rothschild LLP)

Employers Turn to Fines to Force Participation in Wellness Programs
"While sticks are growing in popularity, a new study shows that carrots still remain the main strategy for employers trying to pry medical information from employees or to get them to participate in wellness programs. [A recent survey] of nearly 800 large and mid-sized employers in the U.S. found that only 5 percent are utilizing a consequence while 79 percent are offering incentives in the form of rewards. Another 16 percent are offering a mix of both..... Nearly 60 percent of respondents ... said they plan to impose consequences on participants who do not take appropriate actions for improving their health." (HealthLeaders InterStudy)

Factors Affecting Individual Premiums Rates in 2014 for California (PDF)
"We categorize the expected changes in average premiums into four components. The first three affect the premiums charged by the carrier, and the fourth affect the member's contribution to these premiums. [1] Trend from 2013 to 2014: 9.0% average increase to premium ... [2] Affordable Care Act Market Changes: 14.0% average increase to premium ... [3] Buying More Coverage: 16.9% average increase to premium, offset by reductions to consumer out-of-pocket ... [4] Premium Tax Credits and Cost Sharing Subsidies: Impact depends on income level." (Milliman, for Covered California)


The Confused Debate Over Obamacare and Insurance Premiums
"Vermont's insurers didn't have to change their products because their products were already very good. In other states, some of the insurance products will have to be upgraded, as they're stingier. But Obamacare will help people pay for the better insurance. Comparing the two isn't just comparing the cost of apples to the cost of oranges. It's comparing the cost of apples to somebody taking you out to dinner." (The Washington Post)


HHS Secretary Doesn't Understand What Insurance Is
"[HHS] Secretary Kathleen Sebelius [recently] said some of what passes for health insurance today is so skimpy it can't be compared to the comprehensive coverage available under the law. 'Some of these folks have very high catastrophic plans that don't pay for anything unless you get hit by a bus,' she said. 'They're really mortgage protection, not health insurance.' ... Sebelius' response is apparently that catastrophic insurance isn't really insurance at all -- which is exactly backwards. Catastrophic coverage is 'true insurance'. Coverage of routine, predictable services is not insurance at all; it's a spectacularly inefficient prepayment plan." (The Daily Beast)


Deloitte Health Care Reform Memo, April 1, 2013
"Medicare is expensive and how it's spent is uneven: 10 percent of its enrollees represent 63 percent of the expenditures, and the 5 percent who die each year account for 30 percent of its costs often involving intensive care that extends lives with no hope of recovery ... So a solution to Medicare spending will necessarily require difficult discussions in our society about how we treat should treat our seniors to provide evidence-based, cost effective care, and how at the end of their lives we should support families as they navigate death that's dignified and appropriate." (Deloitte)


Text of U.S. Chamber of Commerce Comments to CMS on Proposed Regs for Establishment of Exchanges and Qualified Health Plans; Small Business Health Options Program (PDF)
"First and foremost, the Chamber remains hopeful that SHOPs will offer small businesses a new avenue to access, compare, and ultimately provide employer-sponsored coverage to their employees. If restrictions are placed on employers, or options are taken away from them, this new conduit through which small businesses may offer employer-sponsored coverage will be of little or no value to employers, or by extension, their employees. In addition to these policy concerns, we also believe the restrictions as to how an employer offers coverage through a SHOP, regardless of the exchange model, violates the PPACA." (U.S. Chamber of Commerce)


Health Care Reform Bites Small Business in Massachusetts
"The untold story of the Massachusetts reform is that the small business community has been paying more for health insurance since the commonwealth's 2006 reform merged sicker individuals into the same risk pool.... Now the future looks even bleaker for small business. Not only will their highest-in-the-nation premiums go up because of these new regulations, but they will be paying on average $8,000 per family, per plan more in taxes over the next ten years." (Forbes)


Last Chance: If Private Insurance System Flunks the ACA, Single Payer Is Next
"The Patient Protection and Affordable Care Act should be seen as what it is: One last opportunity for the private health insurance market to prove that it can offer a service that covers the millions of Americans who were previously left out, at a cost that we -- as individuals, employers and taxpayers -- can afford. If that is a goal beyond the grasp of the existing system, then it needs to be finally swept aside in favor of something that will meet those needs." (The Salt Lake Tribune)

Benefits in General; Executive Compensation

Happy National Employee Benefits Day
"National Employee Benefits Day acknowledges trustees, administrators, corporate benefits practitioners and professional advisors for your dedication to providing quality benefits and the important role you play in your colleagues' well-being. This year, National Employee Benefits Day focuses on the Affordable Care Act (ACA). We encourage you to use the day to ensure you are informed and compliant on the latest regulations and to address your employees' questions." (International Foundation of Employee Benefit Plans)

Colorado Governor Signs Civil Unions Into Law
"Colorado will recognize civil unions entered into by same-gender and opposite-sex couples, granting rights afforded to traditionally married couples ... Colorado health plans 'issued, delivered, or renewed or after January 1, 2014' will be required to treat a partner in a civil union and a marriage the same. This means that if a Colorado employer offers health insurance to the spouse of an employee, the employer must also offer health insurance for the partner in a civil union.... If a group health plan is self-insured, it will not be governed by state law ... Under a Colorado public retirement system, civil union partners will now be entitled to any survivor benefits provided to spouses under public sector pension plans." (Holland & Hart)

[Guidance Overview]

Insurer Executive Compensation Regulations Released
"Employers who utilize captives for health coverage will need to determine how the proposed regulations will apply to the employer's captive and the other subsidiaries and affiliates in its controlled group. It may also be possible to fall within the 2-percent de minimis exception." (Kilpatrick Townsend)

Delaware Federal Court Dismisses Say-on-Pay Case (PDF)
"In evaluating the plaintiff's claims, the court found that [1] The Dodd-Frank Act explicitly prohibits construing a negative say on pay vote as 'overruling' a Board's compensation decision or altering the directors' fiduciary duties ... [2] Plaintiff's 'selective' characterization of the company's compensation philosophy as 'pay for performance' excluded other goals discussed in the company's proxy statement[.]" (Meridian Compensation Partners, LLC)

Executive Compensation 2012 Year in Review and Implications for 2013 and Beyond (PDF)
"Market observations through two years under [Say on Pay ('SOP')]: [1] Most companies continue to obtain majority shareholder support for their SOP proposals. For companies that passed in 2012, the average shareholder support was 92%. [2] The number of failing companies increased 52% year-over-year (38 in 2011; 58 in 2012). 2011 success did not guarantee positive 2012 results.... [3] Failure to receive support from proxy advisors ... may not result in failed SOP votes, but significantly impacts shareholder support levels , e.g., generally greater than 20%." (Frederic W. Cook & Co., Inc.)

Press Releases

CEFEX Renews 19 Registrations
Centre for Fiduciary Excellence (CEFEX)

BenefitsLink.com, Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
Phone (407) 644-4146
Fax (407) 644-2151

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

Copyright © 2013 BenefitsLink.com, Inc. but feel free to forward this newsletter if done without modification in any way.

All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

Links to Web sites other than those owned by BenefitsLink.com, Inc. are offered as a service to readers. The editorial staff of BenefitsLink.com, Inc. was not involved in their production and is not responsible for their content.

Useful links: