[Guidance Overview]
Government Agencies Propose Regulations on 90-Day Waiting Period for Health Plans
"Compliance with either the August 2012 guidance or these proposed regulations will constitute compliance with the PPACA's 90-day waiting period limitation, at least through 2014. Health plan provisions that base eligibility on performance are generally considered substantive eligibility provisions that are outside the 90-day waiting period limitation. Under the PPACA, the 90-day waiting period includes weekends and holidays."
(Towers Watson)
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RAND Study Says 'Workplace Wellness' Fails Bottom Line, Waistlines
"According to a report by researchers at the RAND Corp, programs that try to get employees to become healthier and reduce medical costs have only a modest effect.... The report found, for instance, that people who participate in such programs lose an average of only one pound a year for three years. In addition, participation 'was not associated with significant reductions in total cholesterol level.' And while there is some evidence that smoking-cessation programs work, they do so only 'in the short term.'"
(Reuters)
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California Didn't Have 'Rate Shock' But California Isn't Like Most Other States
"When California created the country's first-ever health insurance exchange, way back in November 2010, it ... decided that it would act as an 'active purchaser' that would select a small number of health plans allowed to sell on the California exchange.... In an active purchaser exchange, health plans know that they're competing against others for the chance to access millions of customers with tax subsidies. That could easily effect the bids that they submit, the ones they hope will get them into the new marketplace. That's the dynamic in California, but not in most other states."
(The Washington Post)
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NYC Latest to Embrace Paid Sick Leave
"The act requires all private businesses, except those with less than 15 employees, to offer at least five paid sick days each year to employees. Businesses with less than 15 employees are required to offer five sick days, but they don't need to be paid.... [But NYC] lawmakers included a 'reverse trigger' in the legislation. It would delay the implementation of the law in the event of a decline in the city's economy, as determined by the Federal Reserve Bank of New York."
(HRBenefits Alert)
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Play or Pay: Special Transition Rules for Fiscal Year Plans
"If the employer qualifies for the first transition rule, its compliance obligations will only be delayed for certain of its employees; other employees can trigger penalties. If the employer qualifies for the second transition rule, transition relief has the potential to apply with respect to a broader spectrum of employees.... Relief is available on an entity-by-entity basis. In other words, each entity in your controlled group needs to qualify independently for relief."
(Benefits Bryan Cave)
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Renew Early? Pay Later?
"[L]et's be clear about one fact: this does not get an employer out of play or pay. The employer mandate rules specifically say that a plan year can only be changed for a valid business purpose and that, in this case, avoiding the shared responsibility tax is not a valid business purpose. Renewing early is (assuming other legal niceties are satisfied) a change in plan year."
(Benefits Bryan Cave)
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One Strategy for Health Law Costs: Self Insure
"UnitedHealth Group Inc. and Humana Inc. will begin offering smaller employers -- including firms with as few as 10 members in UnitedHealth's case -- the option of so-called self-insurance in some markets later this year ... For small businesses, being self-insured would let them avoid new requirements under the law that call for traditional small group plans to include richer benefits, such as mental-health and maternity care. Self-insured companies can also avoid changes to pricing rules that could increase costs for groups of healthy workers."
(The Wall Street Journal; subscription may be required)
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Two of Five Adults Younger Than 65 Fear They Can't Afford Health Care
"Forty-three percent of adults ages 19 to 64 reported that cost prevented them from going to the doctor or filling prescriptions ... 79% of young adults in 2012 were insured, compared with 69% in 2010. The increase means that 3.4 million more people ages 19 to 25 got health care coverage.... 30% of adults ages 19 to 64 were uninsured at some point in 2012. An additional 16% were underinsured, meaning out-of-pocket expenses exceeded at least 10% of income[.]"
(American Medical News)
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High-End Health Plans Scale Back to Avoid 'Cadillac Tax'
"Companies ... are beginning to scale back the more generous health benefits they have traditionally offered and to look harder for ways to bring down the overall cost of care. In a way, the changes are right in line with the administration's plan: To encourage employers to move away from plans that insulate workers from the cost of care and often lead to excessive procedures and tests, and galvanize employers to try to control ever-increasing medical costs. But the tax remains one of the law's most controversial provisions."
(The New York Times; subscription may be required)
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Political Intelligence Firms Set Up Investor Meetings at White House
"Wall Street investors hungry for advance information on upcoming federal health-care decisions repeatedly held private discussions with Obama administration officials, including a top White House adviser helping to implement the [ACA].... Hedge fund executives and other investors are increasingly interested in the timing and nature of health-policy decisions in Washington because they directly affect the profits and stock prices of pharmaceutical, insurance, hospital and managed-care companies."
(The Washington Post)
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New York Archdiocese Reluctantly Paying for Birth Control
"The Archdiocese of New York has previously acknowledged that some local Catholic institutions offer health insurance plans that include contraceptive drugs to comply with state law; now, it is also acknowledging that the archdiocese's own money is used to pay for a union health plan that covers contraception and even abortion for workers at its affiliated nursing homes and clinics. 'We provide the services under protest,' said Joseph Zwilling, a spokesman for the Archdiocese of New York."
(The New York Times; subscription may be required)
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Obamacare Insurance Won't Cover Weight-Loss Surgery In Many States
"In more than two dozen states, obesity treatments -- including intensive weight loss counseling, drugs and surgery -- won't have to be covered in plans sold on the exchanges. Some of these states -- Alabama, Louisiana, Arkansas, Texas and Mississippi -- have the highest obesity rates in the nation, according to the Centers for Disease Control."
(Kaiser Health News)
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District Court Finds Concealment of Administrative Fees for Self-Insured Plan Breaches Fiduciary Duties and Triggers 6-Year Statute of Limitations (PDF)
"[Blue Cross and Blue Shield of Michigan] also violated its fiduciary duty ... to disclose information to the Plaintiffs about its compensation, which necessarily included information about the Disputed Fees, even if [the plan sponsor] did not make a specific request for information.... BCBSM determined its own administrative fees by acting unilaterally with respect to the Disputed Fee; this type of self-dealing is a per se breach of [ERISA] Section 1106(b)(1).... Plaintiffs prove that BCBSM actively concealed their knowing misrepresentations and omissions in the contract documents in order to allay Plaintiffs' suspicion and prevent inquiry into Disputed Fees. [T]hey are entitled to damages from 1994 through 2011." [Hi-Lex Controls v. Blue Cross and Blue Shield of Michigan, No. 11-12557 (E.D. Mich. May 23, 2013)]
(U.S. District Court, Eastern District Michigan)
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Rhode Island Health Insurers Seek Double-Digit Premium Hikes
"Blue Cross Blue Shield of Rhode Island, the state's dominant insurer, has proposed an average increase of 18 percent for individuals and nearly 15 percent for small groups. UnitedHealthcare of New England is seeking a hike of nearly 18 percent for its small group HMO plan and 13 percent for its preferred provider plan. Tufts Health Plan wants an average increase of 10 percent and 11 percent, respectively, for those plans."
(Associated Press via InsuranceNewsNet.com)
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Don't Blame the ACA: Trend Toward Part-Time Workers Began in 2007
"In the wake of the recent economic recession the percentage of workers employed part-time has been rising since 2007, increasing from 16.7 percent to 22.2 percent in 2011.... Between 2007 and 2011, full-time workers experienced a 2.8 percent reduction in the likelihood of having coverage from their own jobs, while part-time workers suffered a 15.7 percent decline."
(Wolters Kluwer Law & Business)
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[Opinion]
Everything You Know About Employers and Obamacare Is Wrong
"[P]eople simply misunderstand why employers offer health-care benefits. They're not doing it as a favor to employees. And they're not doing it because anyone is making them.... Employers offer health insurance because employees demand it. If you're an employer who doesn't offer insurance and your competitors do, you'll lose out on the most talented workers."
(Ezra Klien in The Washington Post)
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[Opinion]
GE's Wellness Program: Bright Shining Light or Dim Bulb?
"Health-contingent workplace wellness, the two-time darling of federal legislation codified in both [HIPAA and the ACA], is now plagued by doubts about effectiveness and validity that are inexorably grinding away its legitimacy. This puts employers, particularly large employers who have committed to it so vocally and visibly, in an awkward spot."
(The Health Care Blog)
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[Opinion]
Text of Comments by U.S. Chamber of Commerce to EEOC on Wellness Programs (PDF)
"Although some exceptions permit incentives for employees to meet certain health standards, such incentives are commonly part of carefully constructed and heavily monitored and regulated wellness programs that are already not permitted to discriminate on the basis of a health factor (e.g., disability). We urge the EEOC, therefore, to do nothing to expand the current regulatory scheme."
(U.S. Chamber of Commerce)
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Benefits in General; Executive Compensation
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[Guidance Overview]
Compensation Committee and Compensation Committee Advisers Listing Standards
"By July 1, 2013, the compensation committee of a company must assess the independence of every compensation consultant, legal counsel or any other adviser ... to the committee.... After July 1, 2013, the compensation committee must assess the independence of advisers before their selection and must evaluate the independence of existing advisers annually. Although compensation committees are required to evaluate the independence of advisers, neither listing exchange requires that advisers actually be independent."
(Haynes and Boone, LLP)
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Real-Life Examples of Simple, Low-Cost Work/Life Efforts
"Studies show that work/life programs can help improve employee engagement and productivity. But you may believe effective strategies are expensive and require a big-business budget. Not true. Some larger and midsize employers have created innovative, low-cost work/life practices that even small businesses can adopt."
(Business Management Daily; free registration required)
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Senate Finance Committee Lists Possible Tax Reform Provisions
"[T]he paper recognizes that the tax code plays an important role in individual economic security by encouraging retirement savings and making employer provided healthcare more affordable. However, these protections written into the code also are some of the greatest tax expenditures and an easy target for tax reform.... [This article lists] some of the recommendations made in the paper[.]"
(Schneider Downs)
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Press Releases
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