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May 20, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Assistant Vice President, Pension
for Associated Third Party Administrators in CA

Health Benefits Analyst
for The Segal Company in CT

Relationship Manager - Corporate Retirement Plans
for Plancorp, LLC in MO

Service Account Manager
for Administrative Systems, LLC (ASI) in CA

Retirement Services Consultant
for CUNA Mutual Group in WI

DB/DC 401(k) Administrator
for Nicholas Pension Consultants in CA

401k Sales
for National Qualified Plan Provider in ANY STATE, CA, OR, WA

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Webcasts and Conferences

Executive Compensation in ESOP Companies
August 20, 2013 WEBCAST
(National Center for Employee Ownership)

The Ongoing S Corp ESOP: Traps for Unwary
August 27, 2013 WEBCAST
(National Center for Employee Ownership)

Understanding the Health Insurance Marketplace
June 13, 2013 WEBCAST
(Centers for Medicare & Medicaid Services (CMS))

"What to Expect from a DOL Audit"
May 23, 2013 in IL
(Great Lakes NIPA Study Group)

International Equity Compensation
August 28, 2013 WEBCAST
(National Center for Employee Ownership)

Health Insurance Marketplace 101
June 5, 2013 WEBCAST
(Centers for Medicare & Medicaid Services (CMS))

First Look: bswift 2013 Wellness & Benefits Benchmarking Study
June 19, 2013 WEBCAST
(Employee Benefit News)

"Fundamentals of 401(k) and Other Qualified Plans" - a 3-day Seminar, Atlanta
June 19, 2013 in GA
(SunGard Relius)

View All Webcasts and Conferences


[Official Guidance]

Text of CMS Letter to State Medicaid Directors on Facilitating Medicaid Enrollment and Renewal in 2014 (PDF)
"This letter describes five specific targeted enrollment strategies and provides guidance for states interested in adopting them: [1] Implementing the early adoption of Modified Adjusted Gross Income-based rules; [2] Extending the Medicaid renewal period so that renewals that would otherwise occur during the first quarter of calendar year 2014 ... occur later; [3] Enrolling individuals into Medicaid based on Supplemental Nutrition Assistance Program (SNAP) eligibility; [4] Enrolling parents into Medicaid based on children's income eligibility; and [5] Adopting 12-month continuous eligibility for parents and other adults." (Centers for Medicare & Medicaid Services)


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[Official Guidance]

Text of CMS Interim Final Rule on Pre-Existing Condition Insurance Plan Program
"This interim final rule with comment period sets the payment rates for covered services furnished to individuals enrolled in the Pre-Existing Condition Insurance Plan (PCIP) program administered directly by HHS beginning with covered services furnished on June 15, 2013. This interim final rule also prohibits facilities and providers who, with respect to dates of service beginning on June 15, 2013, accept payment for most covered services furnished to an enrollee in the federally-administered PCIP from charging the enrollee an amount greater than the enrollee's out-of-pocket cost for the covered service as calculated by the plan." (Centers for Medicare & Medicaid Services)

[Official Guidance]

Text of CMS Final Reg on Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare Prescription Drug Benefit Programs
"This final rule implements new medical loss ratio (MLR) requirements for the Medicare Advantage Program and the Medicare Prescription Drug Benefit Program established under the Patient Protection and Affordable Care Act.... For the most part, this final rule incorporates the provisions of the proposed rule." [118 pages, including a 50-page discussion of the comments submitted to CMS on the proposed rule.] (Centers for Medicare & Medicaid Services)

[Guidance Overview]

Tri-Agency FAQs Address Annual Limit Waivers, Provider Selection, Clinical Trials and Transparency Notices (PDF)
"Nongrandfathered plans must disclose to HHS and make available to the public certain information including (but not limited to): Claims payments practices; Data on enrollment/disenrollment; Data on the number of claims denied; and Information on cost-sharing and out-of-network coverage.... The guidance clarified that this requirement (originally effective in 2014) will be delayed at least one year, until 2015. The requirement will only become effective after the agencies issue further guidance." (Seyfarth Shaw LLP)

Health Spending Slowdown Shows Signs It Will Stick
"Insurance benefit design changes, slower introduction of new drugs and technology, and improved physician efficiency are among the factors that researchers cited to explain the recent slowdown in the growth of health spending in the United States. Although spending rates historically have shot back up after such slow periods, some studies suggested that flatline growth might continue even as the nation's economy keeps recovering." (American Medical News)


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Considering the Spousal Surcharge
"One of the ways employers are looking to contain healthcare costs is by levying surcharges on spouses who opt for coverage through their partners' insurance policies. This strategy may be effective, but HR must carefully communicate the reasons for these changes and prepare for employee pushback." (Human Resource Executive Online)

With High Deductible Health Plans, It Pays To Shop Around For Care
"Proponents of high-deductible plans say consumers will make more cost-conscious health care choices if they have to spend more of their own money. According to [one] analysis ... consumers in such plans cut their medical spending by between 5 and 14 percent. But results were mixed on whether they cut back only on unnecessary care or on treatment that was needed." (Kaiser Health News)

The Evolving Roles of Emergency Departments
"Rising use of [emergency departments (EDs)], particularly by patients who do not have reliable access to primary care, has led insurers and policymakers to focus on the high cost of 'nonurgent' ED visits. This has distracted attention from more important and consequential trends, including the growing use of EDs as diagnostic centers, the increasingly prominent role EDs play as the major entry point for unscheduled hospital admissions, and the potential role EDs may be playing in limiting growth of preventable hospital admissions." (RAND Corporation)

Michigan Employers Report Cost of Providing Health Care Growing at 4%, Lowest Rate in Ten Years (PDF)
"For the second consecutive year, 25% of participants report no cost increase at all.... Compared to 12% of employers nationally, 30% of Michigan employers require a surcharge or exclude spouses who are eligible for coverage from other sources. Wellness plans continue to evolve with 36% of employers tying incentives to achievement of a health goal[.]" (McGraw Wentworth)

Trends in Medigap Coverage and Enrollment, 2012
"In 2012, most Medicare beneficiaries with a standardized Medigap policy had Plan F (53 percent). Plan C, the second most popular plan, had 13 percent of the Medigap standardized plan market. Plans F and C cover 100 percent of the deductibles and coinsurance not covered by Medicare.... Enrollment in Plan N, which includes cost-sharing of up to $20 for physician office visits and up to $50 for certain emergency room visits (waived in certain circumstances), grew by 35 percent between December 2011 and December 2012, and was the most popular of the newer standardized plans." (America's Health Insurance Plans)

Employer Assessment and Premium Charges Set to Finance Vermont Health Insurance Exchange
"The [Vermont] state Senate [has voted] to place a charge on health insurance premiums and extend an employer assessment to pay for the operation of the state's new health insurance marketplace, called Vermont Health Connect. Senate bill 152, which began this legislative session as a streamlining of the state's health insurance rate review process, has become the vehicle for financing the operation of the insurance exchange." (VTdigger.org)

When Medicare Launched, Nobody Had Any Clue Whether It Would Work
"Medicare is, these days, an incredibly popular program. Americans overwhelmingly oppose cutting it. No politician would consider repealing it. Most think providing health insurance to all Americans over 65 is worth the both the trouble and the cost. This was not always true. Back in 1966, as Medicare was just about to launch, nobody knew whether the new program would provide benefits to millions or fail completely. Sound familiar?" (The Washington Post)

Feds Make It Easier for States to Enroll Poor Under Health Law
"Allowing adults to stay in the program when their income changes is a 'big deal,' said Alan Weil, executive director for the National Academy for State Health Policy. He said it was likely to reduce the large number of people churning in and out of the program, which interferes with their ability to get care. Thirty-two states now use this option for children." (Kaiser Health News)

A Data Trove Now Guides Drug Company Pitches
"The research firm IMS Health has tracked information about which drugs doctors prescribe since the 1990s, and over the last decade, the list of available information has expanded to include insurance claims data, which yields a trove of intelligence about patients' medical diagnoses and insurance coverage. Additional details about patients, including income, education and ethnicity, can also be available." (The New York Times; subscription may be required)

Broker Breached Fiduciary Duty by Failing to Explain Interaction of Stop-Loss and Self-Funded Health Plan Coverage
"Apart from providing benefit consulting services to the Employer, the Broker had a long-standing and close relationship with the Employer as its agent for various other types of insurance coverage.... A federal district court in Alabama held that (i) the Broker was a fiduciary of the Employer based on the long-standing, close advisory relationship between the two parties; and (ii) the Broker breached its fiduciary duty by failing to adequately explain to the Employer how the stop-loss coverage interfaced with the Plan's lifetime maximum and the means by which the Employer could cap its total liability." [Express Oil Change, LLC v. ANB Insurance Services, Inc., No. CV-10-BE-0263-KOB (N.D. Ala. Mar. 27, 2013)] (Haynes and Boone, LLP)

Two Insurers May See Surge in Medicare Advantage Enrollments
"Medicare Advantage plans for the elderly and disabled will swell to 21 million participants by fiscal 2023 from 14 million this year, the Congressional Budget Office said yesterday in its annual review of the federal budget. The CBO didn't explain the revision from its previous estimate that enrollment would fall to 11 million[.]" (Bloomberg)

How Much Big Insurance Paid a Small-Business Group to Fight a Premium Tax
"The nation's leading health insurance industry group gave $850,000 to a top small-business trade association as part of a campaign to repeal a key provision of President Obama's health care law ... America's Health Insurance Plans cut the six-figure check to the National Federation of Independent Business as part of a partnership aimed at blocking a tax on health care premiums that goes into effect next year and will cost insurers roughly $100 billion over the next decade." (NationalJournal)

Health Care in Retirement Probably Costs More Than You Think
"F[A] couple, both 65, retiring in 2013 would probably need $220,000 to cover health-care expenses if the husband lives to 82 and the wife to 85, the average life expectancies.... The estimate does not include [nursing home] costs. It applies to retirees with traditional Medicare insurance coverage ... [and] assumes that an individual does not have employer-provided retiree health-care coverage." (Michelle Singletary, in The Washington Post)

Actual Knowledge of Employee's Disability Insufficient to Extend COBRA Coverage When Plan's Notice Procedures Were Not Followed
"The employer in this case was spared potentially costly medical expenses at least in part because it had adopted, and apparently informed the qualified beneficiary of, such procedures. Without reasonable procedures, plans may be bound by oral or informal notices from covered employees and qualified beneficiaries, even if notice is given to individuals within the employer's or insurer's organization who do not ordinarily handle COBRA administration." [Rayle v. Wood County Hosp., 2013 WL 1654898 (N.D. Ohio 2013)] (Thomson Reuters / EBIA)

Two States Say 2014 Obamacare Insurance Costs on Low Side
"As of Thursday, nine insurers had notified the Washington Healthplanfinder, the state's online marketplace, of their intent to offer 57 plans -- with different deductibles, premiums and coverage options to individuals and families.... 'We were pleasantly surprised at how great the rates look,' said Washington exchange spokesman Michael Marchand. 'After subsidies many people will pay even less, and they'll get more benefits' than are offered in many current policies." (Reuters via Yahoo News)


This Week's Reasons to Repeal Obamacare
"There are plenty of reasons to repeal Obamacare, especially before its most egregious provisions begin next year, and just this week a few more were added to the list: Small businesses really don't like it.... Huge premium increases projected.... Parts of the law are already failing.... Unrealistic funding promises." (The Heritage Foundation)


Taking off the Hospital Cost Blindfold: New Information Brings Answers and More Questions
"[T]wo big events recently were a giant step toward public access to information. First, Medicare released hospital cost data for 3,000 hospitals across the country. Now consumers can see how hospital fees compare on the top 100 most common reasons for hospitalization, based on an impressive 7 million discharge events ... Perhaps even more important, [HHS] announced that hospitals will now be required to release cost data." (The Institute for HealthCare Consumerism)

Benefits in General; Executive Compensation

Key Issues in the IRS Audit Report on Tax-Exempts and Reasonable Compensation (PDF)
"Key areas of IRS interest include: The role of the board or compensation committee in determining the peer group and selecting survey sources; Whether the organization has a compensation policy; Whether all items of compensation (such as country clubs and personal auto use) are appropriately included in income." (Towers Watson)

Baker & McKenzie Compensation and Benefits Quarterly Update
Articles include: PBGC Issues Proposed Rule on Reportable Events; HIPAA Final Rule Issued; Time to Review Medical Plans in Light of Supreme Court Decision; New PPACA Guidance on Expat Plans; FATCA and FBAR Compliance Deadlines Approaching for 2013; IRS Prevails on Application of Section 409A to Discounted Stock Options; Federal District Court Reinforces that Typical Equity Plans are not Subject to ERISA; Target Stock Option Deductions May No Longer Be Available to Acquiring Corporations; Same-Gender Marriage, DOMA and Employee Benefits. (Baker & McKenzie)

Executive Compensation Calendar: When Should You Work on Specific Projects?
"Polls and surveys usually show June and July as the slowest months of any compensation professional's year. This is especially true for those who focus on executive compensation. This post lays out when you may want to focus on some of the high priority executive compensation topics that must be tackled every year. You may find that making your June and July just a little busier, will make December through March so much easier." (PayScale)

Press Releases

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