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April 12, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Employee Benefits Jobs

Part Time On Call Retirement Planning Consultant
for Transamerica Retirement Solutions in CA, MO, NC, NY, UT

Entry Level Loan & Distribution Specialist
for Scholz, Klein & Friends Enlightened Retirement Group, Inc. in TX

Retirement Communications Specialist
for CBIZ Insurance Services, Inc. in MD

Compensation Analyst:
for Verisight, Inc. in IL, MN, WI

Senior Paralegal Specialist - Employee Benefits
for University of California Office of the President in CA

Director, Retirement Key Account Management
for Prudential in TX

Pension Risk Transfer Relationship Management
for Prudential in NJ, NY

401K Administrator
for CPEhr in CA

Enrolled Actuary
for CPEhr in CA

Retirement Plan Services Participant Communications Manager
for T. Rowe Price in MD

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Webcasts and Conferences

401(k) Essentials Plus Series
Nationwide on April 18, 2013 presented by McKay Hochman Co., Inc.

Becoming an Effective Human Resources Business Partner
Nationwide on May 15, 2013 presented by Thompson Interactive

TeleHealth In The Workplace Webinar
Nationwide on April 16, 2013 presented by Oswald

Designated Roth Accounts and Roth Conversions
Nationwide on April 18, 2013 presented by McKay Hochman Co., Inc.

View All Webcasts and Conferences


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[Guidance Overview]

CCIIO Provides Ins and Outs of Filing Annual Medical Loss Ratio Reports
"Issuers will file MLR data reports using the MLR module of CMS' online Health Insurance Oversight System (HIOS). To access the HIOS MLR module, all users will first need to register with CMS' Enterprise Portal. Once user access requests are processed, the authorized individuals will receive user account information and instructions for accessing the MLR module in HIOS." (Wolters Kluwer Law & Business)


[Advert.]

3rd Annual Prevention & Wellness Congress May 16-17, Santa Monica, CA

Sponsored by World Congress

Prepare to challenge the way you think about wellness and reposition your program by doing away with what you know doesn't work. Wellness 3.0 means reaching beyond the employee and impacting dependants and communities too. Promo Code BLINK3 for $300 off.


[Guidance Overview]

What is 'Affordable Health Care Coverage' Under ACA?
"Affordability is germane to several of the [ACA]'s provisions: [1] Assessable payments under the Act's employer shared responsibility rules can be avoided if the employer makes an offer of coverage that is, among other things, 'affordable'; [2] Low-income individuals can qualify for subsidized health insurance coverage in order to make coverage 'affordable'; and [3] The tax penalty imposed on individuals for failing to obtain health insurance coverage is waived where coverage is not 'affordable.' The test for affordability differs, however, for each provision." (Mintz Levin)

OPM Proposes Extending Federal Employees' Health Benefits to Same-Gender and Opposite-Sex Domestic Partners
"The Obama administration has proposed to expand the Federal Employees Health Benefits Program to domestic partners -- including both opposite- and same-gender couples -- as part of sweeping changes to the program. The Office of Personnel Management announced its proposals at a congressional hearing ... saying the initiatives would improve efficiency and help recruit a better workforce while saving $8.4 billion over ten years." (GovExec.com)

Insurance Providers Debate Health Plans for Federal Workers
"Two leading health-insurance providers squared off during congressional testimony Thursday, debating whether the government should allow more plans to participate in the $47 billion health-benefits program for federal employees.... United Healthcare asserted that adding more plans to the mix would increase competition and help keep premium costs in check.... Blue Cross Blue Shield, which covers more than 60 percent of the federal workforce as the sole provider of the program's government-wide 'service benefit plan,' ... is concerned that smaller providers will cherry-pick low-cost regions, ultimately driving up premiums for the nationwide plans." (The Washington Post)

CMS Official: We Really Do See the Role of the Navigator and Agent and Broker as Different
"'They are not making recommendations, they're not selling,' [Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight,] said about Navigators. 'Some things are the same; they will [both] provide education and inform people about options available to them. But I think you go to an agent because you want to ask the agent sort of the bottom-line question, "what do you think I should do?" And if a Navigator is asked that question they're going to say "I can't tell you what to do."'" (Employee Benefit Adviser)

ACA Medicaid Expansion Analyzed by Cost Burden to Patients
"States with the largest shares of low-income people who have high medical cost burdens would benefit the most from expanding their Medicaid programs under the health system reform law ... [but] not all of the states with the biggest shares of poor individuals with high cost burdens have decided to do so. Louisiana and Mississippi, for example, the states with the second- and third-highest share of these individuals, respectively, have no plans to expand their programs next year." (American Medical News)

Wait for Obamacare Price Tags Could Be Months
"Last week Vermont became the first state to provide a glimpse of how expensive individual health insurance might be under the [ACA].... But rate disclosure elsewhere may take a while. In many states the deadlines for filing proposed plans aren't until late May. And some states with early deadlines have no plans to publish results as quickly." (Kaiser Health News)

Groups Seek to Fast-Track Efforts to Curb Costs, Boost Quality
"Five veteran health care leaders ... outlined an ambitious set of recommendations aimed at slowing rising costs, focused mainly on changing the way America pays for health care. Many of the ideas draw on existing efforts, such as accelerating Medicare's efforts to pay for quality rather than just quantity of care.... One proposal would offer financial carrots to states: Voluntarily find ways to slow rising health care costs without cutting coverage or services -- and share in any savings gleaned by Medicare, Medicaid and other government programs." (Kaiser Health News)

U.S. House Hearing: 'The Federal Employees Health Benefit Program: Is It a Good Value for Federal Employees?'
Hearing held April 11, 2013. Links to testimony by Jonathan Foley, Director, Planning and Policy Analysis, U.S. Office of Personnel Management; William A. Breskin, Vice President of Government Programs, Blue Cross and Blue Shield Association; Thomas C. Choate, Chief Growth Officer, UnitedHealthcare; Mark Merritt, President and CEO, Pharmaceutical Care Management Association; and Jacqueline Simon, Public Policy Director, American Federation of Government Employees. (U.S. House of Representatives, Committee on Oversight and Government Reform)

2012 Study of State Employee Health Benefits (PDF)
"Among medical plans in which employees pay some of the premium cost, the percentage of total costs paid by employees did not change significantly from 2011 to 2012, remaining at 19 percent for employee-only coverage and 24 percent for family coverage for preferred provider organization ... The total premium cost paid by both employees and the states increased between 2011 and 2012.... Average monthly employee premium contributions for HDHP/CDHPs were roughly half the cost of the premiums for PPOs/POS plans for employee-only coverage and 57 percent of the cost of family coverage.... Overall, annual deductibles increased between 2011 and 2012." (Segal)

Considerations for Medicaid Expansion Through Health Insurance Exchange Coverage (PDF)
"[HHS] has indicated that, as a test of effectiveness, it will consider approving a limited number of proposals to cover Medicaid beneficiaries through commercial market plans. HHS will only consider approving proposals that meet [certain] criteria ... The [article] outlines several financial considerations with the proposal to utilize the healthcare exchanges for the Medicaid expansion populations." (Milliman)

No Obligation by Administrator During Appeal to Disclose New Medical Opinions That Merely Supplement Earlier Opinions
"Under ERISA, '[a]fter the administrator denies the claim, the administrator must provide the claimant with notice of the decision' and 'relevant documents generated or relied upon during the initial claims determination [and] prior to or at the outset of an administrative appeal.' Thereafter the claimant must be provided with a 'full and fair opportunity' to appeal the decision internally ... Where the results of additional tests and reviews do not provide a new basis for terminating the plaintiff's benefits, but merely supplement its initial reasoning there is no requirement to disclose that information until at or after the appeal is denied." [Lee v. Hartford Life & Accident Insurance Company, 2013 WL 794061 (D.D.C. Mar. 5, 2013] (Lane Powell PC)

Most Employers Plan to Continue Offering Health Coverage
"Although the large majority of [employers in a recent survey] said they plan to retain their employees' health benefits, 47.4% predicted that the ACA would raise their costs by 1% to 4%, and 16.8% of respondents estimated that their costs would increase by more than 10%.... According to [a second] study, 159 million people had such coverage in 2011, down by 11.5 million from 2000." (California Healthline)

The ACA: Like Building the Plane While Learning to Fly It
"[There is] a common set of core issues and business questions that many biopharmaceutical manufacturer executives are finding themselves left to deal with as they begin planning for 2014. What is an ACO and how will we as an organization define them? ... Does my organization want to engage with ACOs? ... How does my organization want to engage with ACOs? ... How do I measure success of my engagement with ACOs?" (HealthLeaders InterStudy)

Obamacare Architect Jay Rockefeller: It's 'Beyond Comprehension'
"West Virginia Democratic Sen. Jay Rockefeller, one of the towering architects of Obamacare, on Tuesday openly criticized program managers for not moving quickly enough to build the system, warning that if it gets off to a bumpy start it will just get worse. Decrying the Patient Protection and Affordable Care Act as way too complex, he warned the acting Medicare director that Obamacare is 'so complicated and if it isn't done right the first time, it will just simply get worse.'" (The Examiner)

Here's What Humana's CEO Has to Say About the Future of Health Insurance
"The shift, from defined-benefit to defined-contribution plans, is exactly what happened when 401k retirement accounts replaced pensions. [Bruce Broussard, CEO of Humana Inc.] figures that change will take a decade to kick in fully. Corporations will increasingly use wellness offerings, he said, to differentiate themselves in recruiting." (Business Courier)

Fact Check on Health Insurance Administrative Costs: Low and Lower
"According to historical government data going back to the 1960s, the portion of premiums allocated to health plans' administrative costs has been consistent for decades and in 2011 was among the lowest in recent years, despite the fact that health plans have been incurring new compliance and regulatory costs related to the health care reform law. National Health Expenditure data show that, on average, only 3.9% of the annual growth in health spending from 1989-2010 was attributable to private health insurance administrative costs." (America's Health Insurance Plans)

Doctors Told They Must Drive Health System Change
"Doctors are the only people who can drive the change in healthcare delivery that's needed to save the country from a financial crisis [said Ezekiel Emanuel, MD, PhD, chair of medical ethics and health policy at the University of Pennsylvania in Philadelphia] ... [T]he U.S.'s healthcare spending last year -- $2.87 trillion -- makes it equivalent to the fifth largest economy in the world. 'We spend more on healthcare in this country than the 66 million French spend on everything in their society,' he said." (MedPage Today)

Strengthening Affordability and Quality in America's Health Care System
"[K]ey health care stakeholders from the insurance, hospital, physician, business, and consumer sectors ... worked together to reach consensus about what is needed to control costs and improve quality. The five recommendations from this group, the Partnership for Sustainable Health Care, align incentives to transform care delivery and strengthen the infrastructure needed to achieve improved savings and health outcomes." (Robert Wood Johnson Foundation)

Fear Over Obamacare Age Rating Not Supported
"[N]ationwide analysis revealed that premiums increase 260% on average for 63 year-olds versus 23 year-olds, an amount that is well under the 300% limit imposed by the Affordable Care Act. Consequently, for most states the new premium limit related to age is unlikely to cause significant premium increases on the new Affordable Care Act health plans (as compared to existing health coverage)." (HealthPocket)

U.S. House Hearing: 'Working Families Flexibility Act of 2013'
Video of subcommittee hearing on April 11, 2013. Includes links to testimony by various interested individuals. (Subcommittee on Workforce Protections, Committee on Education & the Workforce, U.S. House of Representatives)

Health Care Costs: A State-by-State Comparison
"Health-care spending in the U.S. averaged $6,815 per person in 2009. But that figure varies significantly across the country, for reasons that go beyond the relative healthiness, or unhealthiness, of residents in each state." (The Wall Street Journal)

Senate Hearing: 'A New, Open Marketplace: The Effect of Guaranteed Issue and New Rating Rules'
Video of full committee hearing on April 11, 2013. Includes links to testimony by Gary Cohen, Director, CCIIO; Kevin Counihan, CEO, Connecticut Health Insurance Marketplace; Sabrina Corlette, Research Professor and Project Director, Georgetown Health Policy Institute, Center on Health Insurance Reform; Stacy Cook, Carroll, Iowa; and Chris Carlson, Principal and Consulting Actuary, Oliver Wyman Consulting. (Committee on Health, Education, Labor & Pensions, U.S. Senate)

Expanding Medicaid May Actually Be Good for Business in Some States
"When business owners discuss the Affordable Care Act, they tend to fixate on the pay-or-play mandate that will require firms with 50 or more full-time employees to offer health coverage or pay penalties. What they might not know is that they may be able offset new costs by taking advantage of another controversial aspect of the law: the expansion of Medicaid. But only if they live in the right place." (Inc.)

[Opinion]

Chronic Care at Walgreens? Why (Not)?
"A one-stop shop for toothpaste, prescription drugs, and a diabetes diagnosis? The retail clinic phenomenon has its appeal: it allows patients convenience and better access to care through longer hours and more locations than our health care system now provides." (The Health Care Blog)

[Opinion]

The Reason Health Care Is So Expensive: Insurance Companies
"[T]he arrangement that accounts for much of the difference between health spending in the U.S. and other places ... is the enormous administrative overhead costs that come from lodging health-care reimbursement in the hands of insurance companies that have no incentive to perform their role efficiently as payment intermediaries.... Because [insurance companies who act as self-funded plan administrators] are paid a fixed percentage of the claims they administer, they have no incentive to hold down costs. Worse than that, they have no incentives to do their jobs with even a modicum of competence." (Bloomberg BusinessWeek)

Benefits in General; Executive Compensation

Creditors Can Reach Benefits under Top Hat Plan, District Court Rules
"After recognizing that the Plan was exempt from ERISA's anti-alienation provision mandate, the [federal district court in Maryland] went on to address whether the terms of the Plan controlled over Maryland's garnishment laws by virtue of ERISA's preemption section 514. In holding in favor of the creditor, the Court ... [ruled] that ERISA did not preempt state garnishment laws that simply provided a procedural device for enforcing a judgment. As to the Participant's argument that garnishment would violate the terms of the Plan, the Court held that the creditor's rights were not subject to the terms of the Plan[.]" [Sposato v. First Mariner Bank, 2013 WL 1308582 (D. Md. Mar. 29, 2013)] (Womble Carlyle)

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