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April 8, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Employee Benefits Jobs

DC Administrator
for Matthews, Gold, Kennedy & Snow in AZ

Senior Benefits Consultant
for Hub International Midwest Limited in IL

DB CSM Team Manager
for J.P. Morgan in IL

Assistant Vice President, Director Retirement Benefit Plans
for TJX Companies in MA

Onboarding/New Client Implementation Associate
for The Benefit Practice in CT

Director, Performance Planning and Analysis (Pension Risk Transfer Service Delivery)
for Prudential in PA

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Webcasts and Conferences

"Form 5500 Workshop 2013: Issues and Answers" - Appleton
in Wisconsin on May 7, 2013 presented by SunGard Relius

"Form 5500 Workshop 2013: Issues and Answers" - Detroit
in Michigan on May 7, 2013 presented by SunGard Relius

"Form 5500 Workshop 2013: Issues and Answers" - Bloomington
in Illinois on May 9, 2013 presented by SunGard Relius

View All Webcasts and Conferences

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[Official Guidance]

Text of CCIIO Letter to Issuers on Federally-facilitated and State Partnership Exchanges (PDF)
"This Letter provides issuers seeking to offer Qualified Health Plans (QHPs) in Federally-facilitated Exchanges (FFE) and Federally-facilitated SHOPs (FF-SHOP), including State Partnership Exchanges, with operational and technical guidance to help them successfully participate in Exchanges.... State Plan Management Partnership Exchanges have some flexibility to apply certification standards and adjust processes." (Centers for Medicare & Medicaid Services)


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[Guidance Overview]

How to Claim the Small Business Health Care Tax Credit
"To qualify for the credit, you must meet the following criteria: [1] You must cover at least 50 percent of the cost of single (not family) health care coverage for each of your employees. [2] You must have fewer than 25 full-time equivalent employees (two half-time workers count as one full-timer). [3] Those employees must have average wages of less than $50,000 a year." (U.S. Small Business Administration)

[Guidance Overview]

HIPAA Compliance Update for Employee Benefit Plans
"Health plan sponsors will want to review and revise, as necessary, the following to comply with the new rules ... [1] Business Associate Relationships and Agreements; [2] Policies and Procedures; [3] Security Assessment and Breach Notification; [4] Plan Risk Analysis -- Security; [5] Plan Document and SPD; [6] Notice of Privacy Practices; [7] Individual Authorization for Use and Disclosure of PHI; [8] Workforce Training[.]" (Drinker Biddle)

[Guidance Overview]

Guidance Released on 90-Day Waiting Period for Health Coverage
"If a group health plan conditions eligibility on any employee's (part time or full time) having completed a number of 'cumulative hours of service,' the plan will not be deemed as designed to avoid compliance with the 90-day waiting period limitation if the cumulative hours of service does not exceed 1,200 hours.... The same individual must not be subject to multiple eligibility requirements annually ... Other conditions for eligibility (i.e., those that are not based solely on the lapse of a time period, such as compensation) are generally permissible unless the condition is designed to avoid compliance with the 90-day waiting period limitation." (Healthcare Town Hall)

[Guidance Overview]

Stop-Loss Insurers Excluded as Health Exchange Navigators
"Generally, the health reform law provided that Navigators are not to be health insurance issuers or related entities, or receive direct or indirect compensation from any issuer in connection with the enrollment in an exchange plan. The proposed rules would take this a step further by applying this exclusion to stop-loss insurers or their subsidiaries." (Thompson SmartHR Manager)


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]

Enhanced Penalties and Stiffer Enforcement for HIPAA Violations
"Note that the penalties assessed against a covered entity or business associate may well exceed $1.5 million if multiple HIPAA requirements have been violated because each category of violation may be counted separately (in addition to counting multiple violations of the same provision). Importantly, the Final Rule provides an affirmative defense for any violation in tier 1 (unknown and 'unknowable' violations) and tier 2 (violations due to 'reasonable cause') if the violation is corrected within 30 days of the date the covered entity or business associate learned or should have learned of the violation." (Verrill Dana LLP)

[Guidance Overview]

Employees Could See Their SHOP Exchange Choices Delayed Until 2015
"[T]he proposed rule would provide a transitional policy for plan years beginning on or after January 1, 2014, and before January 1, 2015. For these plans, a SHOP would not be required to permit qualified employers to offer employees a choice of QHPs at a single level of coverage. It would have the option to do so, however." (Wolters Kluwer Law & Business)

[Guidance Overview]

HHS Releases Final Letter to Issuers on Federally Facilitated and State Partnership Exchanges
"The topics covered by the issuer letter are virtually identical to those covered by the proposed letter.... This does not mean, however, that nothing has changed ... CMS omits this prediction that plans that do not meet ECP standards might not be certified, suggesting even greater flexibility on inclusion of ECPs beyond its already remarkably generous policy.... Again the final letter omits language from the proposed letter stating that it will be difficult for issuers that do not meet minimum expectations to meet regulatory compliance standards in favor of language promising to take into account factors and circumstances in evaluating compliance." (Health Affairs)

[Guidance Overview]

A Healthy Choice for America's Small Businesses
"Beginning in 2014, small business owners will have access to a Marketplace -- which opens for enrollment on October 1st -- that will allow them to make side-by-side comparisons to find a plan that fits their budget and that's right for their businesses and employees. Each Marketplace will operate a Small Business Health Options Program, or SHOP, focused just on small businesses, where employers will be able to choose from a range of affordable plans to offer their employees.... Although [there have been] claims that the opening of our SHOP marketplaces will be delayed, this is not the case -- these marketplaces will open for enrollment, as planned, on the first of October." (U.S. Small Business Administration)

[Guidance Overview]

HHS Issues Proposed Regs on Standards for Exchange Navigators
"Navigators must have expertise in eligibility and enrollment rules and procedures, but may not actually make eligibility determinations and may not select qualified health plans (QHPs) for consumers or enroll applicants into QHPs. Given the complexity of health care reform, potential QHP purchasers are likely to rely on Navigators for assistance, at least until they have some experience with the Exchange. Separate rules are being considered for another group of information providers -- certified application counselors -- who are not funded through an Exchange. And, of course, it will be interesting to see how these Navigator rules dovetail with much anticipated regulations for brokers." (Thomson Reuters / EBIA)

[Guidance Overview]

HHS Offers Guidance for Vision and Other Ancillary Insurance Products Offered Through an Exchange
"It seems natural that a state may want to use its Exchange website to promote other programs and a seamless experience for consumers. But as these FAQs explain, federal funds may not be commingled with state funds for non-Exchange programs. In addition to the obvious issues with funding, the FAQs also highlight concerns that an Exchange may confuse enrollees by adding non-QHP plans that are not eligible for premium tax credits and cost-sharing reductions." (Thomson Reuters / EBIA)

Universities in the Hot Seat Over Health Care
"[W]hat is considered 'reasonable' [for counting hours of adjunct faculty] to university officials (say, crediting three hours of service for every hour taught) is quite different from how professional organizations representing adjunct faculty define reasonable (they'd like the hours of credit to be greater). Depending on how you count, it could result in hundreds of thousands of dollars in additional costs to university health plans if several more adjuncts become eligible for coverage." (Idaho Business Review)

In Obamacare, Online Insurance Brokers See Potential Windfall
"The online brokers want millions of new insurance customers to be able to use those subsidies to buy health coverage through their Web sites, rather than shop exclusively on the new exchanges being set up by states and the federal government. For that to happen, states will have to agree to partner with these privately-run firms. While a handful of states are considering the option, none has yet adopted it." (The Washington Post)

Alabama Won't Enforce Federal Health Care Rules
"[Alabama Gov. Robert] Bentley wrote a letter to federal officials last month saying Washington, rather than state regulators in Montgomery, should be responsible for ensuring that insurance policies sold in Alabama comply with the federal law's requirements such as covering people with pre-existing health conditions ... Bentley spokeswoman Jennifer Ardis said the governor doesn't believe state insurance officials have the authority to enforce the federal provisions. She said the cost of enforcement is also unclear." (Tuscaloosa News)

Many Independent Pharmacies are Price-Competitive, Comparison Finds
"Some consumers may assume national chain pharmacies universally offer the best deal on prescription drugs because of their purchasing power, potential economies of scale, etc. After calling around more than 200 pharmacies to compare the 'cash price' or cost of five popular drugs outside of health insurance coverage, the results suggest what community pharmacists have said all along: don't overlook independent pharmacies." (National Community Pharmacists Association)

Some Small Businesses Opt to Drop Health Plans and Pay Penalty Instead
"Mr. Levi currently spends about $140,000 a year on insurance premiums to cover 25 managerial staff at his business ... Under the new law, he will have to offer insurance to all of his 102 full-time employees starting in January. Assuming all of them take the coverage, Mr. Levi says the cost of premiums could exceed $500,000. 'I've never made a profit in any year of the company that has surpassed that amount,' says Mr. Levi, 62 years old. 'I don't make enough money.' He says it makes more sense to drop insurance entirely and pay a penalty of about $144,000." (The Wall Street Journal)

Worries Mount About Enrolling Consumers In Federally-Run Insurance Exchanges
"When President Lyndon B. Johnson wanted to enroll seniors for the new Medicare program he had just signed into law, the story goes that his administration sent out workers on dog sleds to reach people in the remote Alaskan tundra.... The plan to insure as many as 27 million Americans under the federal health law beginning this fall will be the biggest expansion of health coverage since that launch." (Kaiser Health News)

Tip to Wall Street on Medicare Rates Draws Scrutiny
"Senator Charles E. Grassley said he will investigate how an investor services firm specializing in so-called political intelligence got early word of a Medicare-rate decision that led to a surge in health insurer stocks. At issue is a private e-mail from the Washington research firm Height Analytics LLC to its Wall Street clients that Medicare rates, scheduled to drop under a preliminary decision, would increase instead." (Bloomberg)

Developments of Interest to Sponsors of Multiemployer Health Plans, Second Quarter 2013 (PDF)
Articles include: Trend and CPI; ACA Proposed Regs on Employer Shared Responsibility; What Health Plan Sponsors Are Doing to Manage Costs: Selected Strategies; Key Trends, Developments and Statistics. (Segal)

'Obamageddon' for Massachusetts Employers
"As of April 5, the Massachusetts DOI must notify HHS of our intentions to 'unmerge' our group health plans from our individual market. Failure to do so will mandate that all Massachusetts employers under 100 employees be priced and treated like a single person entity." (William Gallagher Associates)

Employers Adopt Stricter Wellness Policies in Face of Surging Costs
"Faced with rising health care costs, employers are adopting stricter policies to keep workers healthy. Failure to comply with those measures could hurt employees' wallets.... [O]ften these new policies require employees to share personal health information, something critics say is both unfair and an invasion of privacy.... [C]ompanies argue that the new policies not only help cut costs, but also contribute to the overall well being of their workforces." (The Huffington Post)

10 Workplace Wellness Tips for IT Managers
"Techies have a unique approach to life -- and your employee wellness program needs to reflect that.... 1. Your main goal is creativity.... 2. Think long-haul.... 3. Watch the ergonomics like a hawk.... 4. Think of physical activity as a reboot.... 5. Provide healthy food.... 6. Embrace your inner geek... 7. Keep things interesting.... 8. Watch the stress.... 9. Bump up the serendipity.... 10. Think beyond the office." (Tech Republic)

Insurers' Efforts to Delay Health Law Compliance Could Affect Premiums, Benefits for Millions
"Regulators in some states are trying to prevent insurers from getting around the health law by extending potentially cheaper, but more limited policies for another year, but other states are giving the firms leeway.... How many insurers are pursuing the strategy is unknown. But if a significant number extend their old policies, it could affect the cost of health insurance and scope of benefits for millions of people who buy their own policies rather than getting them through their jobs." (Kaiser Health News)

Factors Affecting Self-Funding by Small Employers
"Policy experts predict that small employers, especially those with younger and healthier employees, will increasingly establish 'self-funded' health plans, leaving the traditional fully insured market to obtain lower premiums and avoid market reforms under the [ACA].... [T]his paper describes factors that may influence whether and how extensively this change occurs. It also shows that states have minimal data on this potentially growing market[.]" (Urban Institute)

Insurers Balk at High Facility Fees for Freestanding Emergency Rooms
"[T]his relatively new type of care delivery comes with hefty price tags. Treatments for a chest cold and breathing problems, for example, can cost $2,000, including about $1,500 in 'facility fees.' Insurers, including Aetna and Humana, are concerned that freestanding ERs aren't justified in charging such facility fees and claim they aren't being transparent about the reasons behind the fees." (FierceHealthPayer)

BLS Survey: Employment-Based Health Benefits in Small and Large Private Establishments
"In March, 2012, 57 percent of private sector establishments employing 1-49 workers ('the smallest establishments') offered health benefits to at least some workers; in contrast, 94 percent of establishments employing 500 workers or more ('the largest establishments') offered health benefits. The data are similar for the proportion of workers offered benefits. In the smallest establishments, 54 percent of workers are offered health care benefits and in the largest establishments, 90 percent of workers are offered such benefits." (U.S. Bureau of Labor Statistics)

Addressing Racial and Ethnic Disparities in Health Care
"About 30 percent of Hispanic and 20 percent of black Americans lack a usual source of health care compared with less than 16 percent of whites. Hispanic children are nearly three times as likely as non-Hispanic white children to have no usual source of health care. African Americans and Hispanic Americans are far more likely to rely on hospitals or clinics for their usual source of care than are white Americans (16 and 13 percent, respectively, vs. 8 percent)." (Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services)

DOL's Third Annual Report to Congress Improves Accuracy of Identification of Self-Insured Health Plans Based on Form 5500 Data
"The 2013 report is based on 2010 data and thus it necessarily lags behind the most current trends. But it provides a useful breakdown of health plans by size, industry, and funding mechanism. It also examines the use of stop-loss insurance ... (although those figures may be understated as well, since the Form 5500 does not require reporting of stop-loss insurance when purchased by the employer rather than the plan)." (Thomson Reuters / EBIA)


Look Out, Below! The Obamacare Chaos Is Coming
"Most supporters of Obamacare embraced it because of a principled belief that everyone should have access to essential healthcare. But even the ... CBO admits that after 10 years of implementation, Obamacare will still leave 30 million uninsured. [Here is] why that is a woeful underestimate." (Forbes)


John Goodman: 'Why Don't the Republicans Have a Vision for Health Reform?'
"One reason the Republicans can't agree on what to do about health care is that the people who advise them don't agree.... [T]he conservative think tanks have been all over the map in their recommendations. There is simply no agreed upon vision for health care among those on the right of the political spectrum." (John Goodman in Health Affairs)


Uwe Reinhardt: A Response to John Goodman about the Republican Vision for Health Reform
"There actually is a current Republican vision. It has been expressed through the House budget resolution. I agree with Goodman, though, that in the past Republicans, John Goodman included, did offer visions on U.S. health care that differ sharply from the one expressed by the House and are worth considering." (Uwe E. Reinhardt in Health Affairs)


Reports of the Small Business Exchange's Death Are Greatly Exaggerated
"When the exchanges open in 2014, employers will still be able to contribute a set amount to their employees' health premiums through the SHOP exchange. But under a newly-proposed rule -- the rule that's attracted all the attention -- small business employers on the federal exchange will pick just one plan for all of their workers rather than letting each worker pick their own plan.... The reasons for disappointment are obvious: Employers thought they would be able to offer their employees a range of health plans and now, in some states, they won't have that option, at least at the outset." (The Washington Post)


Comments by Galen Institute to HHS on Proposed Contraceptive Mandate Regs
"The attempt by this tortured regulation to find an accommodation to the coverage mandate shows the extraordinary difficulty -- indeed impossibility -- of attempting to go around the constitutionally-protected right to religious liberty. The only way to ensure that employers' rights are protected is to eliminate the underlying requirement that they provide contraceptive coverage. The exceptions contemplated by the [proposed regulations] are insufficient to counteract the intrusions on personal liberty created by the coverage mandate." (Galen Institute)


A Model for Health Care Reform: Would You Guess Medicare Part D?
"Not only is Part D popular; it is also cost effective. It has cost 30 percent less than originally estimated. Premiums are an average of half the price originally estimated. Meanwhile, price controls are estimated to increase drug costs by 40 percent. Clearly, they are not the answer to cutting Medicare costs. Think for a moment. If Part D is so successful, why aren't we using it as a model for the rest of Medicare?" (The Health Care Blog)


Who Are These Guys? Why the PCORI Picks Matter a Lot More Than You Probably Realize
"PCORI isn't a church, where all are created equal in the eyes of God, but a politically created, politically governed, controversial dispenser of a very large amount of money that a host of interest groups would like to control. PCORI staff chose the panel members in part by looking at their affiliations, and those connections (or lack of them) should be an immediate part of the public record when the appointments are announced. By being vague, PCORI obfuscates political and power relationships and makes it more difficult for the public and industry stakeholders to either approve of or criticize those choices." (The Health Care Blog)

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