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May 31, 2013          Get Retirement News  |  Advertise
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Operations Specialist
for Well Established and Successful Company in TN

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Webcasts and Conferences

RMD Intricacy
July 31, 2013 WEBCAST
(McKay Hochman Co., Inc.)

National Health Care Reform
August 23, 2013 in MA
(Lorman Education Services)

Health Care Reform for Employers: Now What?
August 28, 2013 in CA
(Lorman Education Services)

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[Official Guidance]

Text of 2013 Medicare Trustees Report (PDF)
"The estimated depletion date for the HI trust fund is 2026, 2 years later than was shown in last year's report. As in past years, the Trustees have determined that the fund is not adequately financed over the next 10 years. HI taxable earnings in 2012 were slightly lower than last year's estimate.... Growth in HI expenditures has averaged 5.6 percent annually over the last 5 years and is projected to average 3.7 percent over the next 5 years.... The difference between Medicare's total outlays and its "dedicated financing sources" reaches an estimated 45 percent of outlays in fiscal year 2013, the first year of the projection." (The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds)


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[Official Guidance]

Text of Final Regs on Establishment of Exchanges and Qualified Health Plans; Small Business Health Options Program
"[T]his final rule amends the special enrollment period for the SHOP to 30 days for most applicable triggering events, so that it aligns with the special enrollment periods for the group market established by [HIPAA].... For plan years beginning on or after January 1, 2014 and before January 1, 2015, a SHOP will not be required to permit qualified employers to offer their qualified employees a choice of QHPs at a single level of coverage, but will have the option of doing so. Federally-facilitated SHOPs (FF-SHOPs) will not exercise this option, but will instead allow employers to choose a single QHP from the choices available in FF-SHOP to offer their qualified employees." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)

[Official Guidance]

Text of CMS Q&A on Requirement That Issuers of Certain Health Insurance Coverage Sold As Fixed Indemnity Insurance Submit an Annual Medical Loss Ratio (MLR) Report (PDF)
"Question #61: Must an issuer of plans that the issuer had categorized as 'fixed indemnity' policies, but which in fact fail to satisfy the criteria for fixed indemnity policies described in the Affordable Care Act Implementation FAQs, Set 11, Question and Answer #7 (January 24, 2013), report the medical loss ratio (MLR) experience of those plans to the Secretary for the 2012 reporting year? Answer #61: No. Issuers do not need to report the experience of these policies for the 2012 MLR reporting year." [Technical Guidance CCIIO 2013-0002] (Centers for Medicare & Medicaid Services)

[Guidance Overview]

ACA Definitions of Essential Health Benefit Package, AV and MV (PDF)
"For a non-applicable large employer interested in a non-grandfathered small group policy or an individual interested in coverage through an Exchange, beginning in 2014, all [Qualified Health Plans] will offer [Essential Health Benefits (EHBs)]. Through the standardization of the coverage tiers and the application of actuarial value standards, the plans will be subject to cost-sharing limits and a de minimis variation of +/- 2 percentage points. Small employers and individuals are expected to be able to compare health plans and costs in a more straight forward manner. For applicable large employers, none of the EHB Package applies. Instead, the health insurance offered must meet the MV and affordability guidelines established in order for an employer to not be subject to [penalties]." (Chao & Company, Ltd.)

[Guidance Overview]

Agencies Release Final Rule on Employer Wellness Programs
"The final rule subdivides health contingent wellness programs into activity-only wellness programs and outcome-based wellness programs, 'to make it clearer to whom a plan or issuer is required to provide a reasonable alternative standard.' The final rule also clarifies the scope of the existing HIPAA and ACA rules governing wellness programs and sets forth 'criteria for an affirmative defense that can be used by plans and issuers in response to a claim that the plan or issuer discriminated under the HIPAA nondiscrimination provisions.'" (Littler)

[Guidance Overview]

Is Promoting Good Health Bad for Business?
"Participation in a workplace wellness program can reduce an employee's health insurance premium cost by 30% next year. That is likely to be a significant impact if all the rumors of skyrocketing insurances rates predicted for next year are true. But before an employer rushes to put a wellness program in place, careful attention should be paid to the ACA nondiscrimination wellness rules AND the existing Americans with Disabilities Act (ADA). Looking to one and not the other can trip up an employer with the best intentions." (Hill, Chesson & Woody)

[Guidance Overview]

Final Rule Provides Wellness Incentive Guidance
"The new rule supports workplace health promotion and prevention as a means to reduce the burden of chronic illness, improve health and limit growth of health care costs, while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status.... The rule allows plans to use reasonable methods to apportion rewards among family members including, for instance, when one family member fails to qualify for the reward but other family members do." (Society for Human Resource Management)

[Guidance Overview]

Get Ready for Sweeping Changes in HIPAA Privacy Regulations (PDF)
"The business associate agreement can play a key role in framing and documenting the intentions of the covered entity and business associate, which may be useful in analyzing whether the parties intended the business associate to be an 'agent' of the covered entity.... Entities that have dual roles, such as a business associate that enters into agreements with both covered entities and subcontractors, may want two different templates... It is important to note that the breach is treated as discovered by the covered entity at the time the workforce member or other agent has knowledge of the breach." (Groom Law Group via Bloomberg BNA Pension & Benefits Daily)

Medicare Trustees Report Shows Reduced Cost Growth, Longer Medicare Solvency
"The Medicare Trustees today projected that the trust fund that finances Medicare's hospital insurance coverage will remain solvent until 2026, two years beyond what was projected in last year's report.... A number of factors have contributed to the improved outlook, including lower-than-expected Part A spending in 2012, and lower projected Medicare Advantage program costs. Recent data from the Medicare Advantage program indicate that certain provisions of the Affordable Care Act will help reduce the growth of spending in this program by more than was previously projected. Partially offsetting these lower spending projections are somewhat lower projected levels of tax revenue." (Centers for Medicare & Medicaid Services)

Feds Deal a Blow to Wellness Programs
"[T]he new regulations ... eliminate the physician-certification requirement for outcome-based programs. Any participant who does not meet an initial standard for getting the reward or avoiding the penalty -- for instance, having a body mass index (BMI) under 30 at the program's launch and then staying under that threshold for a year -- can simply opt for the alternative standard." (CFO.com)

Wellness Rules Released: It's Time to Pay More for Your Bad Habits
"The magic phrase used throughout the guidelines is 'reasonable alternative standard,' in that rewards and programs should be designed for each employee based on 'all the relevant facts and circumstances'.... While the guidelines are meant to improve public health, regulators are careful to not discriminate against those with health conditions that may keep them from exercising." (Healthline)

Impact Analyses in Six States of the ACA
"[This study by Milliman addresses] the potential impact of the [ACA] on current premium rates for individual and group comprehensive medical insurance plans in Arizona, Florida, Illinois, New Jersey, Ohio, and Wisconsin. [It] includes the potential impact of the following ACA provisions on premium rates and rate structures for the individual market in these six states: [1] Minimum benefit coverage (i.e., essential health benefits). [2] Maximum and specified levels of member cost sharing, or metallic tiers. [3] Premium rating restrictions regarding gender, variation by age, health status, and other insured characteristics. [4] Guaranteed issue requirements without preexisting condition limitations in the individual market. [5] Federal premium subsidies (prepaid tax credits) for low-income individuals purchasing coverage on individual exchanges. [6] ACA-related taxes and fees. Our analysis for the small group market was limited to the impact of the elimination of health status ranges and the introduction of the new ACA-related taxes and fees." (Center Forward)

ACA Improves Incentives for Entrepreneurship and Self-Employment
"New research estimates that the number of self-employed Americans will be 1.5 million higher in 2014 because of the [ACA]. Beginning next year, access to high-quality, subsidized health insurance coverage will no longer be exclusively tied to employment, which could lead people to pursue their own businesses as self-employed entrepreneurs." (Urban Institute via Robert Wood Johnson Foundation)

Four Benefits of 'Bare-Bones' Insurance Plans
"If low-benefit plans catch on, they will have a number of important ramifications. First, the real losers will be businesses employing between 50 and 100 workers. Those who employ fewer than 50 will be exempt from penalties. Moving from 49 to 50 employees will be more costly on a per-worker basis than moving from 49 to 100." (MarketWatch.com)

Why Health Insurance Policies are Being Cancelled
"Despite the promise that 'If you like the plan you are in, you can keep it,' the AP reports that plans are being cancelled all over the country because of ObamaCare. One insurer explains it this way: ... almost every policy on the street today in the individual and small group markets is not legal for one reason or another[.]" (John Goodman's Health Policy Blog)

Premiums Could Rise an Average of 40 Percent Under Obamacare
"The survey of premiums in six states found that premiums could increase most significantly for young, healthy men. Premiums will rise for people who currently purchase bare-bones plans with high deductibles and meager coverage. They'll be forced to upgrade to policies that must offer at least a certain level of coverage." (The Hill)

Hospitals Struggle to Get Workers to Wash Their Hands
"With drug-resistant superbugs on the rise ... and with hospital-acquired infections costing $30 billion and leading to nearly 100,000 patient deaths a year, hospitals are willing to try almost anything to reduce the risk of transmission.... [T]he incentive to do something is strong: under new federal rules, hospitals will lose Medicare money when patients get preventable infections." (The New York Times; subscription may be required)

More Than 100 Insurers Sign Up for Obama Health Care Exchanges
"The administration did not provide a state-by-state breakdown. Officials, who spoke on condition of anonymity, said some markets now dominated by one or two insurers may not see significant change....Healthcare analysts cautioned that competition alone would not guarantee affordable rates or convenience." (Reuters)

Are Obamacare's Exchanges Competitive? Here's What the Experts Say.
"One of the first tests of President Obama's health-care overhaul is whether enough companies sign up to create competition and deliver lower prices on government-run insurance marketplaces.... [T]he administration said that more than 120 health-care plans had applied to sell in the 19 state insurance exchanges that the government will run. The White House claimed victory, arguing that the turnout ensures there will be robust competition to hold down costs." (The Washington Post)

UnitedHealth Spurns Obama Exchanges as Rules Stall Profit
"The insurers' reluctance has become clearer as states release details for the marketplaces ... UnitedHealth, Cigna Corp. and Aetna Inc. were absent from the list last week when California announced the companies chosen to sell in its exchange. All three decided not to bid. The conservatism 'has probably been the biggest surprise' as the health law moves toward Jan. 1, ... [said] Milton Johnson, the chief financial officer at HCA Holdings Inc., the biggest U.S. hospital chain[.]" (Bloomberg)

Enrollment and Spending in the Early Retiree Reinsurance and Pre-existing Condition Insurance Plan Programs
"GAO was asked to provide updated information on ERRP and PCIP spending. This report describes the current status of ERRP and PCIP enrollment and spending as well as projected PCIP spending and how CCIIO is ensuring that program funding is sufficient through 2013." (U.S. Government Accountability Office)

Seven States' Actions to Establish Exchanges under ACA
"Despite some challenges, the seven selected states in GAO's review reported they have taken actions to create exchanges, which they expect will be ready for enrollment by the deadline of October 1, 2013.... Two states have decided that their exchanges will have the authority to actively select which qualified health plans may participate in the exchange, while the remaining five states will allow all qualified health plans to participate in the exchange." (U.S. Government Accountability Office)

Increased Post-Reform Consolidation Transformed Massachusetts Health System
"Health plans may encounter financial instability after major regulatory changes are enacted, the data suggests. While the new enrollment in Massachusetts led to higher combined revenues across the state's largest health plans, profits varied widely in the years following enactment of the law, HRI found. Providers in Massachusetts have experienced more subtle financial effects: profit margins leveled out." (PricewaterhouseCoopers)

Valuing Good Health in Oregon:The Costs and Benefits of Earned Sick Days (PDF)
"Annually, Oregon employers are expected to expend about $107 million in providing new earned sick days for employees. This cost of the law for employers ... is equivalent in size to a $0.21 per hour increase in wages for employees receiving new leave, or about $7.17 per week for covered workers ... Providing new earned sick days is expected to yield benefits of $118 million annually for employers, ... a wage equivalent of a savings of $0.23 per hour, or about $7.90 per week for covered workers[.]" (Institute for Women's Policy Research)

What to Tell Your Employees About Health Care Reform -- and When
"Focus on what matters now. Don't overwhelm employees with what happens four years from now or random 'What if?' scenarios.... Plan for ongoing communication. Don't pile it all on at once. And don't think that one time is going to fix everything.... Do the work to make this simple for your employees.... This stuff is complicated, confusing and full of nuance. You need to be the source of clear, simple, unbiased information. Use social media, videos, tools, examples and real stories to make this come to life." (Benz Communications)

Most State Exchange Markets Looking Competitive
"As more states show their cards on health exchange participation, their hands seem to match their existing insurance markets. New Hampshire has only has one insurer ... planning to participate in the exchange, not surprising given Anthem's dominance there. California has 13, Minnesota has nine and even Georgia's federally facilitated exchange will include seven carriers. Colorado's exchange had to fight for its existence back in 2011, and from those struggles, a healthy exchange market has emerged. Colorado landed 11 plans[.]" (HealthLeaders InterStudy)


The Cost Curve Is Bending, But Does Obamacare Deserve the Credit?
"Harvard University scholars David Cutler and Nikhil Sahni calculate that if [recent] numbers hold over the next decade, the government will save up to $770 billion, employers will save up to $430 annually on each covered worker and households will spend up to $290 less on annual health costs. 'Slow health care spending growth might thus bring much-needed relief throughout the economy,' they write. Ah, that pesky 'might.' Here's the catch: The curve is bending, but we don't really know why, and we don't know if it'll stay bent." (The Washington Post)


Scoring Health Care
"[W]ith the [ACA] about to steer millions of newly-insured Americans into marketplaces known as exchanges, government and industry need to collect and distribute real-time patient feedback that offers viable quality and experience comparisons. Patients' yeas or nays already add up in this era of value. The ACA has shifted reimbursement policies toward quality, moving from fee-for-service to outcomes-based payment.... For consumers, however, word of mouth still trumps reviews and ratings[.]" (Kelly Barnes in Health Affairs Blog)


Affordable Care Act Increases Insurance Choices
"in 2012 just one or two different insurance companies dominated the individual insurance market in most states -- in 29 states, one insurer covered more than 50% of all enrollees in the individual insurance market. In 11 states, the largest two issuers covered 85% or more of the individual market.... In the states with early data, an estimated 80 percent of the people who will enroll in the Marketplace will have five or more different insurance companies to choose from, instead of just one or two. On average, issuers plan to offer more than 15 qualified health plans per state[.]" (The White House Blog)


The Truth About Medicaid Reform
"Medicaid patients experience significantly more deaths, longer hospitalizations and more serious complications from major surgery, cancers, heart disease, interventional procedures, transplants and AIDS than equivalent patients with the same illnesses and same health status but with private insurance ... Medicaid outcomes are so shamefully poor that, when comparing patients with the same risk factors and same health status, Medicaid patients at times even fared worse than those with no insurance at all." (Scott W. Atlas in USA TODAY)

Benefits in General; Executive Compensation

Does New PCAOB Proposal Really Eliminate the Risk of Auditor Involvement in Executive Compensation Design?
"[T]he re-proposed rule has not changed that much and ... audit firms will still be confronted with having to determine if certain pay structures create more potential incentives for fraudulent behavior than others. According to the [Public Company Accounting Oversight Board], however, the new rule clarifies 'that the auditor's procedures would not require the auditor to make any determination regarding the reasonableness of compensation arrangements or recommendations regarding compensation arrangements'[.]" (Towers Watson)

Press Releases

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