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April 19, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Employee Benefits Jobs

Vice President, Investment Advisory Services
for Sapers & Wallack, Inc. in MA

Voluntary Benefits Support Specialist
for Northwestern Benefit Corporation of Georgia in GA

Manager, Client Services
for The Newport Group in NC

Staff Attorney (Announcement No.: 20130226)
for DC Retirement Board in DC

Defined Contribution - Client Service Associate
for Milliman in CO, TX

Project Manager - Benefits Administration
for Publix Super Markets, Inc. in FL

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Webcasts and Conferences

Smoking Discrimination in the Workplace: On and Off the Clock
Nationwide on May 21, 2013 presented by Lorman Education Services

Department of Labor Legislative and Regulatory Update with Phyllis Borzi Webinar
Nationwide on May 6, 2013 presented by Worldwide Employee Benefits Network (WEB)

Conflicted Fiduciaries: Successful Management of ERISA's Permitted Dual Obligations Fiduciaries
Nationwide on May 16, 2013 presented by ABA Joint Committee on Employee Benefits

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[Official Guidance]

Text of CMS Notice on Early Retiree Reinsurance Program in Preparation for Jan. 1, 2014 Sunset Date
"This notice sets forth termination dates for several processes under the Early Retiree Reinsurance Program (ERRP) in preparation for the January 1, 2014 program sunset date. These operational processes, which involve plan sponsors and other parties, include: the submission of changes to information in a plan sponsor's ERRP application; the reporting of plan sponsor change of ownership; the submission of reimbursement requests; the reporting and correction of data inaccuracies; and the request for reopenings of reimbursement determinations." (Centers for Medicare & Medicaid Services)


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]

Final HIPAA Omnibus Rules Require Attention
"[C]overed entities and business associates will likely find more incidents of reportable breaches. In each instance, they will need to decide whether to ... provide notice of the breach without undertaking a risk assessment, or to undertake an objective risk assessment, considering the following factors ... [1] What was the nature and extent of PHI involved ... [2] Who was the unauthorized person ... [3] Was the PHI actually acquired or viewed? [4] What is the extent to which the risk has been mitigated?" (Kilpatrick Townsend)

[Guidance Overview]

Update: New Hires and Counting Hours for Play-or-Pay Purposes
"[The authors] have concluded that the correct reading of the regulations is reflected in Q8-10 ... The good news is: we don't think there is a hole in the play or pay regulations! However, this reading of the rules results in [certain new hires] not getting coverage for more than two full years!" (Benefits Bryan Cave)

[Guidance Overview]

What Self-Funded Group Health Plans Should Know About Fees Under the Transitional Reinsurance Program
"Your plan must submit its first annual enrollment counts to HHS by November 15, 2014. HHS will notify your plan of the required contribution within 30 days or by December 15, whichever is later. The plan will have 30 days to remit the fee. The estimated fee for each enrollee for 2014 is $63 ($5.25 per month). The IRS has indicated that the payment is a permissible plan expense under ERISA and is deductible as a business expense." (Bloomberg BNA)

Have You Checked Your Plan's Subrogation and Reimbursement Provisions Lately?
"Some plan sponsors might be inclined to amend their plans' reimbursement provisions to prohibit application of the common fund doctrine (which is certainly a reasonable strategy for responding to the US Airways case). However, we recommend considering whether this strategy dissuades plan participants from seeking recovery at all, thus putting the onus of seeking recovery (and paying all of the attorney's fees) on the plan. Plaintiffs' attorneys may be less likely to represent plan participants in injury cases if they understand that the participant might be required to turn over most or all of the participant's recovery to an employee benefit plan." (Quarles & Brady LLP)

Supreme Court Forbids Rewrite of ERISA Plan
"The supremacy of a written ERISA-governed plan still reigns as the U.S. Supreme Court reversed the ruling of an appellate court which had held that a court in equity can ignore unambiguous subrogation reimbursement language, and simply rewrite the terms of an ERISA-governed plan in line with its own ideas of what was 'fair and equitable.'" [McCutchen v U.S. Airways] (Fisher & Phillips LLP)

Analysis of the McCutchen Decision: If the Agreement Governs, the Agreement Governs
"Foreclosing the common-fund rule would mean that McCutchen 'in effect . . . [paid] for the privilege of serving as US Airways' collection agent.' In the majority's view, 'McCutchen would not have foreseen that result when he signed on to the plan.' ... The dissent ... contends that McCutchen conceded that the terms of the plan require 'full reimbursement,' without any contribution by the airline to attorney's fees and expenses. Therefore, the dissent argues, '[t]he Court ... has no business deploying against petitioner an argument that was neither preserved ... nor fairly included within the question presented.'" (SCOTUSblog)

High Court Issues Half-Victory for ERISA Plan Administrators, Reinforcing Importance of Clear Plan Terms (PDF)
"Plan sponsors and administrators should not only confirm that their reimbursement provisions clearly address who will cover (or share in) the costs of recovery, but they should also take a hard look at all plan provisions and fill in any gaps where the plan may be silent or ambiguous." [McCutchen v. U.S.Airways] (Alston & Bird)

Despite Win, UnitedHealth Criticizes Medicare Rates, Considers Pruning Its Business
"'We did not expect the fastest growing, most popular and most effective Medicare benefit option serving America's seniors to be underfunded to this extent in 2014,' [UnitedHealth Group CEO Stephen Hemsley said.] UnitedHealth's Medicare Advantage business, he added, 'will likely experience market exits as well as in market membership contraction as we reshape Medicare networks and benefits to respond to the continuing underfunding of this program.'" (Kaiser Health News)

NYC to Seek New Provider for Revamped $6 Billion Health Care Program, to Include Discounts for Wellness Participation
"New York City will seek a new provider for its $6 billion health-insurance plan that would require workers to pay premiums for the first time, with discounts for participating in wellness programs, Deputy Mayor Caswell Holloway said. ... [W]orkers who agree to participate in preventive health measures -- such as not smoking, exercising and getting yearly medical examinations -- [would] pay either no premium or a minimal amount, Holloway said." (Bloomberg)

Legislation Would Eliminate FSA 'Use It or Lose It' Rule
"This bipartisan legislation lowers costs associated with medical care by making it easier for Americans to plan and save for their health-care needs using FSAs. The legislation makes FSAs easier to use by eliminating a government regulation forcing workers to forfeit all of their remaining FSA funds to an employer at the end of the year. One in four FSA participants suffers forfeitures every year. This bureaucratic rule discourages millions of individuals from benefiting from FSAs." (U.S. Rep. Charles W. Boustany, R-La.)

Managing Disability Risks in an Environment of Individual Responsibility
"[L]ong term disability insurance is increasingly important to ensure that the individual maintain a certain level of financial security during the disability period without having to use their retirement savings to finance non-retirement expenditures. The Council received repeated testimony on the fact that far too many employees significantly underestimate and underappreciate the risk of becoming disabled.... In addition, witnesses noted that because employers have limited resources to provide employee benefits, many employers offer other competing benefits that are in greater demand by the employees." (ERISA Advisory Council)

Administrative Law Judges Sue Social Security Administration Over Case 'Quotas'
"Judges struggling to handle a surge of disability cases sometimes award benefits they might otherwise deny in order to clear cases faster so they can meet quotas imposed by the Social Security Administration, according to a lawsuit filed by the union representing the agency's administrative law judges.... 'Many administrative law judges find themselves pressured to grant more claims than they otherwise would because a decision awarding benefits is less complex and time-consuming than a decision which denies benefits,' [said the president of an association of administration law judges]." (WWBT-TV NBC)

Bipartisan Center Offers Plan to Reduce Health Spending
"The plan offers more than 50 recommendations that would cut the federal deficit by about $560 billion over the next decade. About $300 billion of those savings would come from Medicare. The document makes a variety of recommendations to change how health care is delivered and financed in both the public and private sectors." (Kaiser Health News)

A Bipartisan Rx for Patient-Centered Care and System-wide Cost Containment
"Our policies would engage both beneficiaries and providers with incentives to pursue a more coordinated, accountable, and sustainable health care system. These recommendations span four broad categories: 1. Improve and Enhance Medicare to Incent Quality and Care Coordination; 2. Reform Tax Policy and Clarify Consolidation Rules to Encourage Greater Efficiency and Competition; 3. Prioritize Quality, Prevention, and Wellness; and 4. Incent and Empower States to Improve Care and Constrain Costs Through Delivery, Payment, Workforce, and Liability Reform. Our recommendations would improve how health care is delivered and financed in both the public and private sectors." (Bipartisan Policy Center)

Arkansas' Unusual Medicaid Pledge: 'The Program Is Not an Entitlement Program.'
"The Arkansas state legislature has officially passed legislation to use Medicaid expansion dollars to buy private insurance for some 250,000 state residents. The bill used to do so contains one of the more unusual provisions [the author has] ever seen in health-care legislation. It requires those enrolling in the Medicaid expansion to acknowledge that they're not enrolling in an entitlement program." (Sarah Kliff, in The Washington Post)

Consolidation in Health Plan and Hospital Markets: Implications for Hospital Prices (PDF)
"Key findings: [1] Most hospitals do not operate in markets with only a few dominant health plans. [2] In most markets, hospital concentration exceeds health plan concentration. [3] Hospital prices are higher in more concentrated hospital markets. [4] Hospital prices in the most concentrated health plan markets are approximately 12 percent lower than in more competitive health plan markets." (Robert Wood Johnson Foundation)

Consumer Assistance in Health Reform, April 2013 (PDF)
"The ACA seeks to expand coverage and to promote competition among health insurers in order to control costs. Achieving these goals depends on consumers ' ability to actively and effectively participate in health coverage in ways they do not today. This brief outlines the needs for consumer assistance that people will have and the resources available under the ACA to address them, and identifies implementation issues that may impact the effectiveness of consumer assistance." (Kaiser Family Foundation)

Navigator and In-Person Assistance Programs: A Snapshot of State Programs, April 2013 (PDF)
"Many of the 17 states and the District of Columbia that are running their own Exchanges are moving forward with establishing Navigator and IPA programs.... Although similar in many aspects, key differences are emerging across the programs reflecting the flexibility states have to tailor these programs to meet specific needs. This brief discusses some of the key policy decisions states are making and briefly describes these programs in a handful of states." (Kaiser Family Foundation)

McCutchen Ruling Calls for Scrutiny of ERISA-Covered Health Plan Terms
"This decision represents a victory and a reminder. The McCutchen ruling ... strongly affirmed the principle that clear plan terms prevail over plan participants' equitable defenses ... But it also reminded plans that when less-than-perfect plan language is used, courts can insert a beneficiary's 'equitable' rules as gap filler." (Thompson SmartHR Manager)

Consider Limiting Work Calls to Employees on FMLA Leave
"The U.S. District Court for the Northern District of Ohio recently found that there indeed is a limit to how much an employer should make work-related contacts with an employee on leave.... There are reasonable and defensible amounts of contact for an employer to make with an employee on leave -- but sometimes the contact can go too far." [Vess v. Select Medical Corp., No. 3:11 CV 2549 (N.D. Ohio Mar. 15, 2013)] (Thompson SmartHR Manager)

Illinois Employee Health Plan Is More than $1 Billion Behind on Payments to Health Care Providers
"Doctors have to wait as long as a year after they provide health care to a state worker before they're reimbursed by the state.... [T]he insurance backlog totals $1.6 billion now -- and could jump another $200 million by the summer.... Illinois is charged interest when it takes longer than 90 days to pay a bill." (University of Illinois, Springfield)

Strengthening the Capacity for Health Care Delivery Transformation in Rural Colorado Communities (PDF)
"The region's experience with health IT ... offers insights on how community stakeholders can help spread health information exchange to improve care coordination among local 'medical neighborhoods' of health care providers. Early results indicate increased provision of preventive and chronic care, improved workflow and teamwork in physician practices, and enhanced capability to prepare for health care delivery and payment reforms" (The Commonwealth Fund)

Health Coverage for the Hispanic Population Today and Under the ACA (PDF)
"Despite the growing size of the Hispanic population, many Hispanics continue to face disparities in health coverage and care, and they have the highest uninsured rate among racial/ethnic groups, with nearly one in three lacking coverage.... Many uninsured Hispanics could benefit from [the ACA's coverage] expansions. Ensuring that they successfully enroll in coverage and access needed care will be key to improving care for Hispanics and promoting greater equity in health care." (Kaiser Family Foundation)

How Will Consumers Navigate New Health Care Options? [Video]
"Many health care consumers still don't know how the [ACA] will affect them, or what their coverage options may be.... [A recent forum] explored those concerns, and considered the importance of hands-on assistance to help consumers understand their options. The role of the states and the federal government, and the resources available under ACA, were also examined." (Robert Wood Johnson Foundation)

Obamacare 'Uninsured Penalty' of $95 Won't Make Consumers Buy Health Insurance
"When asked 'Will the $95 IRS penalty motivate you to shop this October for an Obamacare health plan?' nearly two-thirds of consumers surveyed answered 'No.' Only 8% of those surveyed answered 'Yes.' The $95 tax penalty proved as ineffective for younger respondents as it was for survey respondents as a whole." (HealthPocket)

DOL Lawsuit Highlights Simple Reality: Employers Who Ignore FMLA Regulations Face Severe Consequences
"The DOL's FY 2014 budget calls for more resources dedicated for FMLA enforcement, and the DOL's solicitor's office already has indicated we will see an increased number of FMLA lawsuits filed by the government in the time ahead. Moreover, as we see in this case, the DOL will not hesitate to seek a broad range of damages -- even reinstatement -- where appropriate. This reality makes it critical that employers self audit their FMLA policies, practices, and forms to ensure compliance with the FMLA and its regulations." (FMLA Insights)


Health Insurance Premium Subsidies: How Far Will They Go?
"Subsidies do NOT lower the underlying premium.... Millions of Americans are not eligible for subsidies and, for those that are eligible, the subsidy amount declines significantly as incomes rise.... Many individuals who receive subsidies will still pay more for their premiums than they do today.... As premiums increase, many younger, healthier people may wait to purchase coverage until they need it-- driving up costs for everyone else." (America's Health Insurance Plans)


Republican Congressman's Letter to Senator Baucus About Obamacare 'Train Wreck'
"Secretary Sebelius's implementation of the law is certainly flawed, but the policy process produced a law that could not possibly be implemented successfully. As legislators, it is our responsibility to write bills that clearly explain our meaning and have achievable goals. By your own admission, this law is a disaster." (U.S. Rep. Mike Pompeo, R-Kans)


The Future of the Affordable Care Act: A Debate on Its Effects
"The [ACA] contains elements on which there is broad agreement. The current fee-for-service system needs to be replaced. So do certain current practices of insurance companies that are both understandable and deplorable ... The tax breaks for employer financed health care need to be curbed or eliminated.... [But] even if overhead expenses are reduced ... and even if administration were perfect ... a lot of people are going to have high-voltage sticker shock. And what that means in turn is that the exchanges may face nasty adverse selection problems, boosting premiums still more.... [And] real errors will be made. This law is complicated. People don't understand it." (Henry J. Aaron, via Brookings)


How to Build a Better Healthcare System
"The four of us came together to change the conversation around how to improve health care and constrain cost growth. What we learned is that, until better care is prioritized over more care, our nation will continue to face a problem with health-care costs. The good news is that, through thoughtful policy, health-care practitioners can be encouraged through rewards to focus far more on what is best for their patients and less on the number of tests and procedures they can order. The even better news is that such a health-care vision can not only produce better care but also cost less." (Tom Daschle, Bill Frist, Pete Domenici and Alice Rivlin, in The Washington Post)


How the MLR Requirement Could Increase Health Insurance Premiums and Insurer Profits at Taxpayer Expense (PDF)
"The goal of this provision is to encourage insurers to restrain administrative costs, and also to limit their profit.... However, the ill-designed structure of the MLR provision may actually have the opposite effect, for two reasons: First, it is likely to require higher average annual premiums (averaged over several years) for insurers to meet state solvency requirements. Second, it might end up rewarding who raise premiums." (American Action Forum)

Benefits in General; Executive Compensation

Retirement and Medical Benefits: Which Employees of Private Employers Have Both?
"This article uses March 2012 National Compensation Survey (NCS) data to examine private industry workers' access to medical benefits, retirement benefits, and combinations of the two benefits, by major occupation group, wage category, part-time and full-time status, union and nonunion status, and establishment size. The study finds notable differences in the patterns of access to medical and retirement benefits -- separately, and in combination -- among the various worker groups." (U.S. Bureau of Labor Statistics)

Are Compensation-Related Shareholder Proposals Primed for Comeback?
"An early review of proposals filed for 2013 shareholder meetings ... shows year-over-year growth ... Based on early filings, the majority of the 2013 proposals are concentrated in two areas: [1] Stock-retention proposals seeking the adoption of 'hold until retirement' policies requiring executives to retain a portion of stock received through equity grants until retirement (as defined by the company) [2] Proposals to limit automatic acceleration of vesting of equity upon a change in control." (Towers Watson)

BenefitsLink Turns 18
April 19 marks the 18th anniversary of the very first BenefitsLink newsletter. We're happy to still be here, working to bring you timely news and information every weekday. Dave, Lois and Holly send a big thank you to all of our readers and friends! (BenefitsLink.com)

Press Releases

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David Rhett Baker, J.D., Editor and Publisher
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