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April 17, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Employee Benefits Jobs

Senior Client Development Officer
for COUNTRY Financial in AZ, NV, OR, WA

Client Relationship Consultant
for Gallagher Benefit Services, Inc. in OH

401K Administrator
for Farmer & Betts in OR

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Webcasts and Conferences

What You Need to Know About the IRS Final 401(k) Questionnaire Report and Next Steps Phone Forum
Nationwide on May 13, 2013 presented by Internal Revenue Service (IRS)

Start Early to Take Charge of Your Financial Future - A Webcast for College Seniors and Young Workers
Nationwide on April 30, 2013 presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

Health Care Challenges Facing North Carolina's Workers and Job Creators Field Hearing
in North Carolina on April 30, 2013 presented by U.S. House Education and the Workforce Committee

Plan Sponsor Basics: 401(k) Plan Issues Recorded Webcast
Nationwide on May 8, 2013 presented by Morgan Lewis & Bockius LLP

View All Webcasts and Conferences

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[Guidance Overview]

Governmental Health Plans Face New Fee for 2014-2016
"An exception ... from the reinsurance contribution requirement applies to health insurance coverage that is not part of an issuer's commercial book of business. However, the regulations do not treat a governmental health plan as automatically being noncommercial." (Calhoun Law Group)


The Latest on Current Legislation Impacting Your Benefit Plans

Sponsored by IFEBP (International Foundation of Employee Benefit Plans)

From election implications to health care reform, attend the Washington Legislative Update, May 20-21 in Washington, DC, to hear from Washington insiders on the regulations, policy initiatives and proposed legislation that impact your benefit plans.

[Guidance Overview]

2014 Final Call Letter: CMS Raises MA Rates, Foreshadows Changes
"The Final Call Letter addresses a wide variety of issues that will affect all parties involved in Medicare Advantage and Medicare Part D arrangements, including plans, beneficiaries, providers, and administrative services entities, such as pharmacy benefit managers.... CMS also provides insight into program modifications it is considering for CY 2015." (Mintz Levin)

[Guidance Overview]

Cloud Storage Providers Storing Protected Health Information May Be Obligated to Comply with HIPAA Regs
"The newly released rule may give cause for alarm among many technology companies that provide services to health-related businesses. Many such businesses historically have given little thought to whether or not their customers were covered entities under HIPAA. Or, because they did not have access to any PHI, they believed the HIPAA rules did not apply. Under the omnibus rule, however, whether an entity actually accesses the PHI is irrelevant to HHS's determination of whether an entity is a business associate." (Wilson Sonsini Goodrich & Rosati)

[Guidance Overview]

Proposed IRS Regs Provide Guidance on Employer Shared Responsibility Rules (PDF)
"The no coverage penalty (for failing to offer coverage to full-time employees) will not apply if coverage is offered to at least 95% of full-time employees (rather than 100%) allowing some room for error or strategic planning. Thus, an employer may intentionally exclude up to 5% of full-time employees and still avoid the no coverage penalty. The proposed regulations clarify that the offer of coverage must include dependent children under age 26. Coverage is not required to include spouses." (Drinker Biddle)

Supreme Court Upholds Health Plan's Contractual Language on Right to Reimbursement
"Although in this particular instance the court [in a split decision] limited the plan's reimbursement right because of a perceived ambiguity in the plan's terms relating to attorney's fees, the court unanimously ruled that a clearly drafted reimbursement clause will trump all equitable defenses. Thus, if properly drafted, a reimbursement clause will allow a plan to recover the full amount of the medical costs it paid, without qualification." (Society for Human Resource Management)


Successful webinars: get in, get to the point, and get out.

Sponsored by Gross Strategic Marketing

A memorable webinar adheres to a simple but powerful philosophy: get in, get to the point, and get out. Unless your webinar is intended explicitly for continuing-education credits, then presentation and delivery quality really matter.

What Does the McCutchen Decision Mean for Health Plan Sponsors?
"[H]ealth care plan sponsors can write provisions regarding reimbursement from recovery, and participants who accept payment of expenses under those conditions are expected to honor the agreement. The decision also leaves plan sponsors with a decision to make regarding whether to explicitly disclaim the common-fund doctrine in their plan documents." (Porter Wright Morris & Arthur LLP)

Supreme Court Addresses Health Plan Reimbursement Dispute
"[I]n a footnote, the Supreme Court pointed out that the reimbursement language litigated in this dispute came from the plan's summary plan description, rather than from the plan itself. The footnote does not indicate how application of the actual plan language (which was not made available until the case reached the Supreme Court) might have affected the outcome." (Practical Law Company)

OK, So ERISA Plan Terms Control -- But to What Extent?
"McCutchen and Heimeshoff are important because they test the bedrock ERISA principle that ERISA plan terms control in ERISA Litigation. They test whether the question 'what does the plan say' should be the first inquiry when an employer or fiduciary receives word that it, he or she has been sued." (Seyfarth Shaw LLP)

Supreme Court Addresses ERISA Equitable Remedies under 502(a)(3)
"The message for plan sponsors is clear: be sure to draft clearly and thoroughly because the ERISA plan document will control. As a corollary, plan sponsors should beware of relying on summary plan descriptions to fill gaps, although the Supreme Court's decision opens the door for interpreting contractual gaps by reference to 'the best indication of the parties' intent.'" (ERISACloud.com)

Second Circuit Upholds Health Plan's Right to Reimbursement Despite Commingling or Expenditure by Participant
"The Second Circuit ... [found] there need not be a 'literal segregation' of the funds over which the plan seeks reimbursement, so long as the plan has identified the funds from which it seeks reimbursement. Furthermore, the court agreed with the majority that dissipation of the funds does not prevent the plan from obtaining reimbursement because the plan's 'equitable lien' over the funds attached as soon as the third-party recovery came into existence, and the funds were at that point in the participant's possession." [Thurber v. Aetna Life Insurance Co., No. 12-370 (2d Cir. Mar. 13, 2013)] (Littler Mendelson LLC)

Supreme Court Agrees to Hear Case on ERISA Statute of Limitations
"The Supreme Court agreed to address the following question: 'When should a statute of limitations accrue for judicial review of an ERISA disability adverse benefit determination?' ... [T]he reasoning of the Second Circuit appears to be more consistent with the enforcement of a contractual statute of limitations period since, absent the ability to establish an early accrual date of the claim, any effort to shorten the limitations period would yield little benefit." [Heimeshoff v. Hartford Life & Accident Insurance Co., No. 12-729, (U.S., cert. granted Apr. 15, 2013)] (Proskauer's ERISA Practice Section Blog)

[Guidance Overview]

ML Strategies Health Care Reform Update, April 15, 2013 (PDF)
Update on developments in federal and state health care reform legislation and regulations, including summaries of recent announcements and regulatory activity by HHS, CCIIO, IRS and CMS. (ML Strategies, LLC)

House Committee Approves Bill to Allow Employees to Take Comp Time in Lieu of Cash Pay for Working Overtime
"As approved by the committee, [the Working Families Flexibility Act of 2013] will: [1] Allow employers to offer employees a choice between cash wages and comp time for overtime hours worked.... [2] Protect employees by requiring the employer and the employee to complete a written agreement to use comp time.... [3] Retain all existing employee protections in current law, including the 40 hour work week and how overtime compensation is accrued.... [4] Allow employees to accrue up to 160 hours of comp time each year." (Committee on Education & the Workforce, U.S. House of Representatives)

Roofers Union Calls for Repeal of Obama Health Law
"Organized labor was instrumental in getting the Affordable Care Act passed in 2010, but more recently has voiced concerns that the law could lead members to lose their existing health plans. The United Union of Roofers, Waterproofers and Allied Workers is believed to be the first union to initially support the law and later call for its repeal." (Wall Street Journal, via U.S. House Ways and Means Committee Chairman David Camp)

Goal of Illinois Online Health Exchange Marketplace: User Friendly
"[Illinois] officials have worked with Enroll UX 2014, a public-private partnership among eight national and state health care foundations, the federal government and 11 participating states, to create a model for state websites that is intended to make searching for insurance streamlined and user-friendly. With the new website, applicants will create a user account, complete one streamlined application of personal information and be matched with programs to help make the insurance more affordable." (Medill Reports -- Chicago)

GOP Fast-Tracks Bill to Use Redirect ACA Funds to Pre-Existing Conditions Insurance Plan
"The Obama administration suspended enrollment in the PCIP earlier this year, citing cost concerns. Republicans want to take money from the Affordable Care Act's public and preventive health efforts to keep the plan open through the end of the year." (The Hill)

ACA's Expansion of Coverage for Addiction Treatment Could Overwhelm Facilities
"Only 1 cent of every health care dollar in the United States goes toward addiction, and few alcoholics and drug addicts receive treatment. One huge barrier, according to many experts, has been a lack of health insurance. But that barrier crumbles in less than a year.... [when] 3 million to 5 million people with drug and alcohol problems -- from homeless drug addicts to working moms who drink too much -- suddenly will become eligible for insurance coverage under the new health care overhaul." (Associated Press)

Hospitals Profit from Surgical Errors
"Hospitals make money from their own mistakes because insurers pay them for the longer stays and extra care that patients need to treat surgical complications that could have been prevented, a new study finds. Changing the payment system, to stop rewarding poor care, may help to bring down surgical complication rates, the researchers say. If the system does not change, hospitals have little incentive to improve: in fact, some will wind up losing money if they take better care of patients." (The New York Times)

Reasons Why Social Security Findings Could Be Rejected by ERISA Claims Administrator
"The claimant seeking long term disability benefits under your ERISA Plan was found to be disabled by the Social Security Administration. Does that automatically mean the claimant is entitled to disability benefits under the ERISA Plan? No, but you must explain why you are taking a position different from the Social Security Administration.... [D]isability findings by the Social Security Administration involve different evaluative criteria, and give lots of weight to a claimant's subjective complaints." (Lane Powell PC)

Wisconsin Court Of Appeal Allows City of Milwaukee to Modify Health Plan; Collective Bargaining Not Required
"The [Wisconsin] Court of Appeals firmly and unequivocally concluded that employers of public safety employees may unilaterally determine health insurance plan design, to include deductibles, co-pays and maximum-out-of-pocket costs, as well as the funding mechanisms associated with the plan design (such as a high-deductible HSA, HRA, Flexible Savings Account, etc.).... [Wisconsin] Act 10 prohibited bargaining over 'health insurance plan design,' but [the parties had] disagreed over the definition of that term." [Milwaukee Police Association vs. City of Milwaukee, No. 2011CV15086 (Wisc. Ct. App. Apr. 16, 2013)] (von Briesen & Roper, s.c.)

Text of Wisconsin Court of Appeals Decision on Public Safety Employee Health Benefits
"It would make no sense for the legislature to have granted to the City and other municipal employers the unilateral right to design and select health-care-coverage plans irrespective of the 'impact' the 'design and selection' has 'on the wages, hours, and conditions of employment of the public safety employee,' but require bargaining on what the Association calls the 'direct result' on the public-safety employee's finances." (Wisconsin Court of Appeals)

Maximize Your Company's Health Plan Investment with a Strong Communications Strategy (PDF)
"[E]mployers are carefully evaluating their current benefits and searching for strategies to improve or maintain them without increasing costs. While these strategies may be in workers' best interest, many employers lack the resources to adequately inform them about the benefits that can keep them healthy, protect them from future health risks, and ensure financial stability for their families." (Colonial Life)

Seventh Annual Prudential Study of Employee Benefits: Today & Beyond (PDF)
"While the fate of health care reform loomed large this year, brokers, employers, and employees were also grappling with a slowly recovering economy -- three years after the Great Recession officially ended. This report examines five topics, identifying key trends within each area: the economy; health care reform; wellness programs; voluntary benefits; and technology." (Prudential Retirement)

BLS Survey: Employee Contributions to Medical Care Benefits Costs
"In March 2012, across all private sector employers, 82 percent of workers who received medical care benefits were required to share in the cost of single coverage and 91 percent of workers were required to share in the cost of family coverage. The smallest establishments (those employing 1-49 workers) were more likely to provide single coverage at no cost to the employee; 25 percent of workers at the smallest establishments received such coverage for free. Free coverage was less likely among the largest establishments (establishments with 500 or more workers); 13 percent of workers at these establishments received single coverage at no cost." (U.S. Bureau of Labor Statistics)

Text of Letter from Senators Requesting Feedback from Health IT Stakeholders and General Public About HITECH Implementation
"Unfortunately, it is unclear whether the HITECH Act has expanded the use of health IT in a meaningful, effective way... We hope stakeholders can provide information about the areas of concern we have identified, any additional areas of concern, and potential solutions to improve HITECH implementation. We ask that feedback be sent to HealthITCommentPeriod@thune.senate.gov by May 16, 2013." (Senators John Thune (R-S.D.), Lamar Alexander (R-Tenn.), Pat Roberts (R-Kan.), Richard Burr (R-N.C.), Tom Coburn (R-Okla.), and Mike Enzi (R-Wyo.))

Text of Letter from Senators to HHS Secretary Requesting Data on Implementation of HITECH
"[W]e have significant concerns with the implementation of the HITECH Act to date ... We respectfully ask that ... you provide a detailed written plan ... to ensure that health IT taxpayer investments today are sound and result in a safe, secure, interoperable health IT system in the future. Specifically, please address your plans to achieve interoperability, control billing costs, prevent waste and abuse, protect patient privacy, and ensure the program is sustainable." (Senators John Thune (R-S.D.), Lamar Alexander (R-Tenn.), Pat Roberts (R-Kan.), Richard Burr (R-N.C.), Tom Coburn (R-Okla.), and Mike Enzi (R-Wyo.))

Reboot: Re-Examining the Strategies Needed to Successfully Adopt Health IT
"The key implementation deficiencies can be summed up in five points: Lack of Clear Path Toward Interoperability.... Increased Costs.... Lack of Oversight.... Patient Privacy at Risk. ... Program Sustainability." (Senators John Thune (R-S.D.), Lamar Alexander (R-Tenn.), Pat Roberts (R-Kan.), Richard Burr (R-N.C.), Tom Coburn (R-Okla.), and Mike Enzi (R-Wyo.))


David Balto: Antitrust and Monopolies Are Key to Health Care Costs
"Antitrust principles prefer the greatest level of competition and a lack of integration. The greatest rivalry will lead to the best allocation of resources, and hopefully to the lowest prices. At the same time, health care reform attempts to grapple with the current disaggregation in the market which often serves as an impediment to the greatest efficiency, realign incentives, better control utilization, and establish strong consumer incentives." (David Balto, in U.S.News & World Report)


A Response to David Balto: Why Coordination is Key to a Sustainable Health Care System, Not Antitrust
"Provider coordination can be accomplished in many ways, and often does not require mergers or problematic forms of integration. The cost to consumers of the vast amount of consolidation that has occurred in provider markets has been well documented in economic studies for years and in powerful news stories more recently. Health care reform, and the need for more coordination of care, does not mean that the antitrust laws need to be bent, twisted, or contorted with respect to health care markets." (America's Health Insurance Plans)


In Florida, Insurance Expansion May Be Choice Between Cat Food and Steak
"While Gov. Rick Scott and the Florida Senate have put forward Medicaid expansion plans that attempt to cover 1 million uninsured residents through private insurance, Florida House Republicans responded with Florida Health Choices Plus -- not so much a proposal for reducing the state's high uninsured rate, but rather a 46-page treatise on why private insurance is better than Medicaid." (HealthLeaders InterStudy)


Out of Order, Out of Time: The State of the Nation's Health Workforce, 2013 (PDF)
"We are running out of time as the need to address health workforce issues becomes even more urgent. Dramatic growth in our aging population, coupled with the sizeable increase of newly insured persons in 2014 as a result of the ACA, will strain a healthcare delivery system already struggling under the weight of its current load." (Association of Academic Health Centers)


Indexed Health Care: An Evolving Health Policy Proposal
"After indexing [Medicare Advantage] costs to GDP growth, the next steps should be to progressively convert Medicare from fee-for-service to prepaid capitated payments, and to index Medicare and all federal health care expenditures -- including tax expenditures -- to GDP growth. The private health care sector must be persuaded to move from FFS to capitated payments." (Timothy Jost in Health Affairs)


ERIC Welcomes U.S. Supreme Court Ruling in ERISA Equitable Remedies Case
"'The high court appears to have agreed with the basic analysis and argument put forward by ERIC and other trade associations that equitable rules cannot override the clear terms of a plan,' said ERIC President & CEO Scott Macey. 'Had the Third Circuit ruling been allowed to stand, you would have seen an influx of litigation from participants using equitable defense claims to rewrite the clear terms of a plan, and thus undermine the principles of ERISA[.]'" (The ERISA Industry Committee)

Benefits in General; Executive Compensation

[Guidance Overview]

Deadline Approaches for Amending Compensation Committee Charters
"By July 1, affected companies must comply with recent amendments to the listing rules of the NYSE and NASDAQ relating to compensation committees.... [R]ules of both the NYSE and NASDAQ have exemptions from some of the new criteria for controlled companies, smaller reporting companies and foreign private issuers, asset-backed issuers, limited partnerships, and management investment companies. Smaller reporting companies and foreign private issuers should review these exemptions to determine whether they need to amend their compensation committee charters." (Morgan Lewis)

Summary of Administration Budget Proposals That Affect Benefits and Employment (PDF)
9 pages. Excerpt: "Why study proposals? Whether enacted or not in a current session, they reveal the thinking of those in power and give strong hints on how to plan for the future. [This article] summarizes the Administration proposals which will directly affect retirement savings, employee benefit plans, executive compensation, and the workplace." (Davis, Malm & D'Agostine P.C.)

GAO Evaluates IRS Website and Finds Long-Term Strategy Needed to Improve Interactive Services
"U.S. taxpayers visited the IRS's website over 375 million times during 2012. IRS officials noted there are over 110,000 web pages and downloadable documents plus some basic interactive tools, such as calculators, on IRS.gov. In December 2011, GAO reported that taxpayers benefit from the increased web services, and IRS could realize substantial savings by transferring taxpayers away from costly telephone interactions." (U.S. Government Accountability Office)

Addressing Sections 280G and 4999 in Executive Employment Agreements
"These provisions ... generally impose a 20% excise tax on, and deny the employer a tax deduction for, certain payments and benefits provided in connection with a change in control of a corporation.... [Links in this article provide] a sampling of recent executive employment agreements ... with summaries of their respective provisions addressing IRC Sections 280G and 4999." (Practical Law Company)

Press Releases

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