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May 10, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Transition/Conversion Manager
for OneAmerica Financial Partners in IN

Pension Administration Project Manager
for Aon Hewitt in IL, TX

Retirement Plan Administrator
for Retirement Plan Services, LLC in IA, MO

Qualified Retirement Plan Compliance Leader
for Polycomp Administrative Services, Inc. in CA

Sales Administrative Coord
for The Standard in TX

Pension Administrator
for Actuaries Unlimited, Inc. in CA

Plan Administrator
for Rapidly Growing 401(k) Third Party Administration and Recordkeeping Firm in PA

Plan Administrator/Consultant
for Independent Retirement Consulting, LLC in OR

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Webcasts and Conferences


[Official Guidance]

Text of CMS FAQs on Small Business Health Options Program (SHOP)-Only Marketplace (PDF)
"Q1: May a State operate only a Small Business Health Options Program (SHOP) while the individual market Marketplace is operated as a Federally-facilitated Marketplace (FFM)? ... Q2: Can any State elect to operate a State-based SHOP in 2014? ... Q3: Will the requirements for a State to operate a State-based SHOP while the individual market Marketplace is operated as a FFM be different for 2015? ... Q5: [sic] If a State elects to operate a State-based SHOP only, will the State be required to operate a Navigator program for the SHOP? If so, are the requirements for the State-based SHOP-only Navigator programs the same?" (Centers for Medicare & Medicaid Services)


Are you ready for the changes coming to employer-sponsored healthcare?

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50+ workshops led by benefits experts prepare you for the challenges of complying with ACA, containing costs, understanding exchanges and more. Exclusively for employers. Earn 16 HRCI recertification credits. Register by May 13 and save $100!

[Official Guidance]

Text of IRS Notice of Proposed Rulemaking and Public Hearing on Computation of, and Rules Relating To, Medical Loss Ratio
"This document contains proposed regulations that provide guidance to Blue Cross and Blue Shield organizations, and certain other health care organizations, on computing and applying the medical loss ratio added to the Internal Revenue Code by the [ACA]. This document also contains a request for comments and provides notice of a public hearing on these proposed regulations." (Internal Revenue Service)

[Guidance Overview]

Is Your Health Plan 'Affordable?'
"Wellness programs are subject to a myriad of requirements but, if you have a compliant wellness program, you may provide a discounted rate of employee contributions to those benefits-eligible employees who choose to participate in your wellness program.... [F]or purposes of determining affordability, you must use the contribution rate applicable to employees who decline participation in any wellness programs. In other words, you must ignore any premium discount that employees may get when they participate in your wellness program.... The regulations, if finalized as proposed, would apply in 2015." (Vorys, Sater, Seymour and Pease LLP)

[Guidance Overview]

Agencies Issue Updated Summary of Benefits and Coverage Template, and Extend Enforcement Relief (PDF)
"It appears that any employer-sponsored health coverage, other than coverage that consists of 'HIPAA-excepted benefits' (e.g., limited-scope dental or vision coverage, if offered separately), will be considered minimum essential coverage.... While plans may continue to furnish partial SBCs if there are multiple insurers, benefits described in a partial SBC may not satisfy the 60% minimum value standard, even though the overall plan does. Additional guidance on how to handle partial SBCs would be helpful." (Buck Consultants)

[Guidance Overview]

What Executives and Boards Need to Know About Health Care Reform
"[W]hile many leaders are waiting to make decisions, the window for communicating with employees will not be open for long. Over the next few months, leaders must engage employees in an open discussion about how potential changes may affect them, their pocketbooks and their families. So in addition to the company's decision about play or pay and workforce structure, companies should be talking to their employees about their responsibility for health insurance (the individual mandate), understanding the public and private exchanges, and Medicaid eligibility." (Towers Watson)

[Guidance Overview]

Implementing Health Reform: Employer Coverage Option Notices
"Employers must provide the notice if they are subject to the FLSA. The FLSA applies generally to employers who employ one or more employees and have a volume of at least $500,000 in annual business. It also applies to specific listed types of employers. Employers must provide the notice to each employee, including part time employees." (Timothy Jost in Health Affairs)

[Guidance Overview]

The Labor, Employment and Benefits Law Implications of the ACA: Are You Prepared? (PDF)
"While the requirements of the 'play-or-pay' penalty itself have received the attention of many employers, how this and other provisions in the ACA could implicate other aspects of employment, labor and benefits law may be overlooked. From wellness programs to whistleblower protections, this paper examines the broader impact of healthcare reform law on workplace policy." (Littler Mendelson P.C.)

[Guidance Overview]

DOL Issues Eagerly Anticipated Guidance on Marketplace Notice Requirement (PDF)
"Unlike the Summary of Benefits and Coverage (SBC), the guidance does not include a requirement to provide the notice in alternate languages. The DOL does not indicate its intention to provide the model notice template in other languages.... It is welcome news that the model notices are not state-specific or employee-specific. Employers who offer different health plans to different groups of employees, however, may need to prepare multiple not ices and coordinate the distribution." (Buck Consultants)

[Guidance Overview]

OCR and HIPAA Privacy Update
"OCR confirmed informally that the 6-month compliance deadline was in fact meant to apply to all changes, including those affecting Business Associate Agreements. Thus, Business Associate Agreements entered into between January 25, 2013 and September 23, 2013 are not required to be updated for the final regulations until September 23, 2013. However, from a practical perspective covered entities and business associates would probably want to enter into an already updated agreement during that time period, rather than entering into an old agreement, and then having to update it a few months later (i.e., by September 23, 2013)." (Kilpatrick Townsend)

[Guidance Overview]

Staffing Agencies and Common Law Employees: Who is Responsible for Offering Health Coverage?
"Given the myriad of factors used to determine who an employee's common law employer is, it is imperative that employers currently utilizing the services of a staffing agency clarify who will be responsible for providing coverage to workers working more than 30 hours per week. With the use of the common law employer rules, many companies may have more employees than they currently realize and this could affect how they determine their size for the pay or play penalty, as well as to which employees they offer coverage if they have more than 50 full-time employees." (Hill, Chesson & Woody)

EEOC Urged to Align Wellness Standards With HIPAA/ACA Rules
"EEOC members acknowledged the need for additional guidance on wellness incentives, but no such clarification seems imminent. 'It is the commission's duty to let the regulated community and all stakeholders know what our positions are,' said Commissioner Victoria Lipnic. 'We haven't given that kind of certainty.'" (Thompson SmartHR Manager)

Statements and Testimony at May 8 EEOC Meeting on Wellness Programs Under Federal Equal Employment Opportunity Laws
At the link appear statements and testimony submitted to the Commission, as well as video of the meeting. (Transcript to follow.) The Commission will hold open the May 8, 2013 Commission meeting record for 15 days, and invites audience members, as well as other members of the public, to submit written comments on any issues or matters discussed at the meeting." (Equal Employment Opportunity Commission)

Want to Know How Much Your Hospital Charges? Find Out Here
"By now you've certainly had time to read through Medicare's 163,000-line spreadsheet that lists thousands of hospitals' prices for the 100 most common procedures, right? Never fear: The very smart folks in [the Washington Post] graphics department have turned that big pile of data into an easily searchable database. You can look up your own hospital and compare it to other ones nearby." (The Washington Post)

Hospital Billing Varies Widely -- But Quality Has Nothing To Do With It
"[The hospital] charges have almost nothing to do with what hospitals get paid. Medicare doesn't pay charges, Medicaid doesn't pay charges, and health plans don't pay charges. Every one of these entities gets a discount from charges, and those discounts are highly diverse as well, creating another layer of irrationality in the pricing scheme. Worst of all, the only patients expected to pay these nonsensically variant hospital charges are the unfortunate people who have no coverage at all." (Leah Binder in Forbes)

Federal Agency Says It's on Track to Make Health Exchanges Work
"The federal government has met its deadlines, tested its system and collected insurance plan information critical to rolling out the 2010 health care law ... despite the rumors of train wrecks, delays and bare-bones health care exchanges rocking Washington. White House and [HHS] officials working on implementing the plan say the exchanges will be up and running for enrollment by Oct. 1. They spoke on condition of anonymity because they were not authorized to speak publicly about internal meetings." (USA TODAY)

Four States That Snubbed Health Law Gaining Jobs From It
"Up to 9,000 jobs are expected to be created at call centers to support the new federally run marketplaces. [An HHS] spokeswoman said some of them will be added to existing Medicare call centers in Phoenix, Chester, Va., Lawrence, Kan., and Tampa, Fla. -- all states with Republican leaders who oppose the law." (Kaiser Health News)

By Overwhelming Vote, New York City Council Passes Paid Sick Day Law
"Highlights include: Employers with at least 15 employees and employers with at least 1 domestic worker must provide employees with paid sick time ... each calendar year.... Employees, other than domestic workers, may begin using accrued time after the 120th calendar day of employment 'reasonable' minimum increment of use of up to 4 hours." (Jackson Lewis LLP)

Study Points to Declining Cost Curve for U.S. Medicines in 2012
"Total spending on U.S. medicines fell 3.5 percent on a real per capita basis in 2012 and the use of healthcare services overall declined for the second consecutive year ... [T]otal dollars spent on medications in the U.S. reached $325.8 billion last year, or real per capita spending of $898, down $33 from 2011." (IMS Institute for Healthcare Informatics)

It's Called the Affordable Care Act, So People Will Judge Its Success Based on Premiums
"[A recent poll asked] consumers which is the most important issue for determining whether Obamacare fails or succeeds.... [P]remium affordability is the number one factor at thirty-eight percent of respondents. The only response that came close to this option is the percent of people uninsured at thirty percent. Three other choices ... came in the vicinity of ten percent each." (HealthPocket)

How Will Premiums Change Under the ACA? (PDF)
"Premium changes due to ACA health insurance market reform rules will vary across states and individuals and will reflect many factors, including: [1] The effectiveness of the individual mandate and premium subsidies at attracting low-cost enrollees, [2] New benefit requirements which may increase plan generosity but reduce out-of-pocket costs, [3] Employer offer decisions and the demographics and health status of any employees shifting to coverage in the individual market, [4] How each state's current issue and rating rules compare to those beginning in 2014, and [5] Each individual's demographic characteristics and health status (and income when determining premiums net of subsidies)." (American Academy of Actuaries)

House Committee Hearing on the Fee on Health Insurance: Impact on Small Businesses
"On Thursday May 9 2013 the Committee on Small Business Subcommittee on Health and Technology held a hearing titled, The Health Insurance Fee: Impact on Small Businesses.... The purpose of the hearing was to provide an opportunity to examine the economic effects of the fee on small businesses." [At the link are the Chairman's opening statement, witness lists, and testimony.] (Committee on Small Business Subcommittee on Health and Technology, U.S. House of Representatives)


Oregon's Medicaid Lottery: A Participant's View
"Q: How did lacking insurance affect your medical care? A: ... You're always telling them, 'No, no, no, this is the only thing I want.' ... You have this resistance all the time, because doctors and nurses look at you with these big soft eyes and say, 'But it would be so important to know your level of cardiac health, I'm really concerned. I'm sure the doctor there will work out something and make payment arrangements.' And it sounds so good and you do it and it never works out. The discount isn't there or you fill out something wrong and all of a sudden you have a $300 bill in collections. So you have to make sure none of that happens to you." (Kaiser Health News)


American Health Care as a Source of Humor
"[This week, CMS] delivered a giant spreadsheet on hospital charges and payments. The spreadsheet has data in 65,536 rows and 12 columns. It covers, for each of more than 3,000 hospitals, charges and payments for the 100 most frequently billed inpatient cases, along with the average covered charges hypothetically billed by those hospitals for those cases. The distribution of this giant spreadsheet instantly brought headlines in major daily publications, telling the world that billing charges for a given case vary widely among hospitals even within one city. Really? Why was this news?" (Uwe Reinhardt in The New York Times)


Text of NFIB Testimony on the Fee on Health Insurance: Impact on Small Businesses (PDF)
"The Congressional Budget Office (CBO) explicitly asserted that this tax/fee/surcharge 'would be largely passed through to consumers in the form of higher premiums for private coverage'.... The tax has a number of oddities and one of them raises a major equity and competitive issue for smaller firms. The tax falls almost exclusively on small businesses. Their larger competitors have no equivalent obligation. Small businesses, therefore, are asked to absorb a significant share of the financial load of the program while placing them in a less competitive position to do so." (National Federation of Independent Business)


Text of Center on Budget and Policy Priorities Testimony on the Fee on Health Insurance
"All things considered, CBO estimates that health reform will slightly reduce premiums for employer-sponsored health insurance in the near term.... Claims that the health insurance tax in particular, or health reform in general, will kill jobs are unfounded. CBO foresees a small net reduction in labor supply, primarily because some people who now work mainly to obtain health insurance will choose to retire earlier or work somewhat less, not because employers will eliminate jobs." (Center on Budget and Policy Priorities)

Benefits in General; Executive Compensation

Health Care Concerns & Retirement Planning (PDF)
"In 2012, 45 percent of individuals reported that medical expenses were extremely important when it came to planning for retirement, and 26 percent reported that they were very important ... Moreover, the percentage of individuals reporting that medical expenses were extremely important when it came to planning for retirement increased from 27 percent in 2003 to 45 percent in last year's [survey]." (EBRI)

Proskauer ERISA Litigation Newsletter, May 2013
Articles include: [1] U.S. Supreme Court Provides Defendants With More Ammunition for Defeating Class Certification by Requiring Classwide Proof of Damages; [2] District Court Limits the Collection of Withdrawal Liability Against Private Equity Funds; [3] Monetary Damages Potentially Available For Inadequate Disclosure; [4] U.S. Supreme Court Rules That Plan Terms Trump Equitable Defense; and [5] U.S. Supreme Court Agrees To Hear Case On ERISA Statute of Limitations. (Proskauer Rose LLP)

Best Laid Plans Gone Awry: Practices for Rule 10b5-1 Trading Plans
"[I]nvestigations have been initiated by U.S. Attorney's Offices and the SEC into possible abuses by corporate executives of such plans... Companies and their boards of directors should review and strengthen their insider trading policies concerning Rule 10b5-1 trading plans. Such measures will raise the likelihood that the plan will be successful as a defense, the company's insider trading policy will be deemed rigorous by regulators and governmental entities and more favorable directors' and officers' (D&O) insurance policy terms and premiums will be available due to a reduced risk profile." (Pillsbury Winthrop Shaw Pittman LLP)

Press Releases

Robert Wood Johnson Foundation and United Health Foundation Award $700,000 in Community Health Grants to National Business Coalition on Health Members
Robert Wood Johnson Foundation, United Health Foundation and National Business Coalition on Health

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