DB/DC Retirement Plan Sales Consultant/Account Manager
for USI Consulting Group in NY

Senior Data Specialist, Client Transition
for Prudential in IA

Plan Document Project Coordinator
for Pension Consulting Firm in AL, AZ, LA, NM, OK, TX

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Why and How Does the Department of Labor Target Retirement Plans for Investigation?
June 27, 2013 in CA
(No. Calif. Chapter of Certified Employee Benefits Specialists (ISCEBS))

Health Benefits Laws Compliance Assistance Seminar
June 26, 2013 in OR
(U.S. Department of Labor, Employee Benefits Security Administration (EBSA))

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[Official Guidance]

IRS Chief Counsel Memorandum AM2013-002: PCOR Fees Are Deductible (PDF)
"The [Patient Centered Outcomes Research Trust Fund (PCOR)] fee is required to be paid by any issuer or sponsor of specified health insurance policies for each policy year ending after September 30, 2012, and before October 1, 2019. There are no exceptions to this rule.... The required PCOR fee will be an ordinary and necessary business expense paid or incurred in carrying on a trade or business and, therefore, will be deductible under Section 162." [May 31, 2013] (Internal Revenue Service)

[Advert.]

DATAIR's FlexPlus System – Makes Administration Profitable

Proposals, Testing, Claims Processing, Debit Cards and more!
Plus CafeDocs/SPDs and 5500s/SARs
(888) 328-2474   Sales@DATAIR.com   www.DATAIR.com

[Guidance Overview]

Who Is a Variable Hour Employee Under the ACA?
"While employees who are expected to work on relatively short-term, intermittent assignments clearly will qualify for variable hour status under the proposed examples, it is not clear at what point the length of an expected assignment will not qualify as variable hour -- in which case the look-back approach would not apply.... [T]he American Staffing Association (ASA) has submitted comments urging the adoption of a special safe harbor rule for employers with unusually high historical employee turnover. Under the proposal, employees of firms, such as temporary staffing firms, with historical (not expected) annual employee turnover of at least 100% would be presumed to be variable hour employees." (Mintz Levin)

[Guidance Overview]

Final SHOP Regulations Delay Employee Choice and Premium Aggregation Features, Shorten Special Enrollment Periods
"Citing new premium rating rules for 2014 that significantly reform rating practices in many states and were only finalized in February ..., insurers have expressed concern that implementing the SHOP employee-choice feature would complicate SHOP QHP pricing. According to the preamble, the delay has been prompted by this, along with insurer comments suggesting that making systems and operational changes required for SHOP enrollment and premium aggregation would compete with efforts to prepare for participation in the Exchanges." (Thomson Reuters / EBIA)

Fourth Circuit Reverses District Court and Trend, Says Death from Driving While Intoxicated Is an 'Accident'
"The reversal at the Fourth Circuit illustrates again the struggle to define the word 'accident,' in a situation involving a driver who intentionally becomes highly intoxicated and intentionally drives, knowing the inherent dangers, yet probably does not intend to crash, sustain injury and/or perish.... As did ... the District Court below, the Fourth Circuit Court of Appeals explored a spectrum of interpretations of the word 'accident.'" (Womble Carlyle)

Failure to Provide Additional Leave as ADA Accommodation Could Prove Costly to Employers
"If it's going to take you two months to offer the position to a candidate ... it will be difficult to show that it is an undue hardship to grant the two month leave of absence.... The easier it is for a temp employee to fill the position, the longer the leave typically needs to be.... [T]he more fungible the position, the longer the leave needs to be.... [If the employee] asks a third, fourth or fifth time for additional leave, don't be afraid to ask the employee's physician to explain why the additional leave did not allow the employee to come back to work when he/she said the employee would." (FMLA Insights)

The Future of Health Insurance for Uninsured Americans: Only 19 Percent Say They'll Sign On for 2014
"64 percent of the uninsured say they haven't decided whether they will buy health insurance by Jan. 1, 2014, as required by the [ACA] ... Only 19 percent said they will get coverage by the deadline, while 10 percent said they plan to stay uninsured and pay the penalty, which in 2014 is the greater of $95 or one percent of income for an adult." (InsuranceQuotes.com)

Next Employee Benefit Fortress to Fall: Employee Health Insurance
"The evolution in health care coverage looks a lot like the migration from traditional pensions to employee-financed 401(k) plans that occurred over the past three decades. But the health care evolution -- one might call it a revolution -- is occurring at a much faster pace. A recent [survey] found that only 26% of respondents are very confident that their organization will offer health care benefits 10 years from now." (Investment News; free registration required)

How Obamacare's Markets Are Shaping Up
"[T]here is widespread geographic variation in how many plans want to participate in the exchanges.... One big question about Obamacare is whether ... the new marketplace lets one of the non-dominant plans gain a bit of stronger footing in its market share. The numbers we have so far can't really tell us whether that will happen." (The Washington Post)

Federal Budget Cuts Cost Nonprofits a Sliver of Their Health Care Payments
"[C]ertain small non-profits nationwide will see an 8.7 percent cut in a federal tax credit they have received since 2010 for providing health care insurance for their employees.... [A]utomatic federal budget cuts ... that took effect March 1 ... trimmed those credits for nonprofits ... Instead of nonprofits getting back 25 percent of their premium payments, they're receiving up to 16.3 percent, after the reduction is applied. For-profit small employers still get the full credit." (Wisconsin State Journal)

Five Steps to Prepare for ACA Compliance in 2014 and Beyond
"[1] Ensure Ongoing Compliance With Current Mandates.... [2] Ensure All Required Notifications are Sent Each Year.... [3] Be Aware of all ACA-Related Fees... [4] Determine Impact of 'Pay or Play' Rules.... [5] Determine Other Options to Consider for 2014 and Beyond." (Polsinelli, P.C., in Ingram's Magazine)

The Math of State Medicaid Expansion (PDF)
"[E]xtending federal subsidies to the poorest population could somewhat blunt the effect of a state's non-expansion decision and slightly increase the number of individuals covered. And while a regulatory change that allows states to only partially expand Medicaid to the poorest residents (those with incomes at or below the federal poverty level) would shift some state costs to the federal government, this policy would have little effect on the number of people covered." (RAND Corporation)

The Medicare Trustees Report in Perspective
"[A]nnual estimates of [Medicare Part A] solvency since 1990 have ranged from four years to 28 years, averaging 13.6 years. So this year's projection falls just below the 24-year average.... While payroll taxes will remain relatively constant as a share of GDP, other relatively minor sources of [Part A] financing will increase slightly, but not enough to cover the projected growth in spending. As a result, the projected [Part A] deficit (the difference between income and outgo) is projected to increase from 0.31 percent of GDP in 2012 to 0.57 percent in 2087, and will average 0.52 percent of GDP over the next 75 years." (Lee Goldberg in Health Affairs)

Court Awards Over $5 Million for Breach of Fiduciary Duty by TPA of Self-Insured Health Plans
"Following a detailed review of internal and external TPA communications regarding the disputed fees, the court determined that the TPA provided misleading information about its administration of the plans and the cost of its services. The court ruled that the TPA violated its fiduciary duty of loyalty by intentionally concealing fees with the intent to deceive the plan sponsors and by supplying false information for Form 5500 filings." [Hi-Lex Controls Inc. v. Blue Cross & Blue Shield of Michigan, 2013 WL 2285453 (E.D. Mich. 2013)] (Thomson Reuters / EBIA)

[Opinion]

Flawed Analysis Is at Root of Erroneous Conclusion That Medical Loss Ratio Rules Led to $1.9 billion in Lower Premiums
"Because the health insurers missed their pricing objectives -- they priced too high a trend rate in 2010 and thereby charged too much ... the 2010 MLR ended up being a comparably low 78% ... By 2011 and 2012, the individual health insurers began to understand something had changed and therefore began to moderate their trend projections and effectively gave back the extra pricing cushion they found themselves with in 2010. Therefore, the MLR rose -- to 83% by 2012." (Health Care Policy and Marketplace Review)

[Opinion]

What is the Future State of Health Care Delivery?
"Starting with these rules to create an informed high-level future state, entities can develop a contextual set of road map milestones along the journey that are specific to their situation. This gap analysis process provides the basis to arbitrate priorities within an entity and their related resource trade-off allocations." (Jim Hansen in The Health Care Blog)

[Opinion]

Retiree Health Benefits and Obamacare Collide
"States that offer extremely generous health benefits for government retirees, and which have little to no pre-funding for those benefits, could choose to move their retirees into the [ACA]'s new exchanges.... For these states, the exchanges offer a chance to shore up their finances and relieve state taxpayers of some of the looming burden of financing all those retirees. It could be a huge opportunity for states and localities in desperate need of fixing their long-term finances, and one that they should seriously consider in the coming months." (David M. Walker in The Health Care Blog)

[Opinion]

The Culprits Behind High U.S. Health Care Prices: Employers
"[W]ho bears the blame for this chaotic, private-sector price system. The only fair answer is: American employers. Who else could it be? ... Alas, in their self-appointed role as purchasing agents in health care, American employers have arguably become the sloppiest purchasers of health care anywhere in the world. The chaotic price system for health care is one manifestation of that sloppiness." (Uwe E. Reinhardt in The New York Times; subscription may be required)

[Opinion]

Text of Four Senators' Letter Asking HHS to Investigate Report That California May Be 'Concealing Details' of Health Exchange Contracts Awarded Using Federal Dollars
"[T]he May 9, 2013, Associated Press story entitled 'Calif. exchange granted secrecy' states that California may 'keep all contracts private for a year and the amounts paid secret indefinitely.' We see no reason why a state that has been awarded nearly $910 million in federal taxpayer dollars should not disclose how that money is being spent once a contract is finalized." (Committee on Health, Education, Labor & Pensions, U.S. Senate)

Need More Time Off from Work? Just Buy It
"[Nine] percent of employers allowed workers to cash out unused vacation time. Five percent let employees purchase additional vacation days through a payroll deduction. An additional 7 percent allowed employees to donate vacation time to a general pool that can be used by other workers.... The cost is usually one week's salary, prorated over the course of the year. Employees often have to decide whether to participate during an annual fall enrollment process and it becomes part of their benefits for the upcoming year." (Fox News)

2013 Say on Pay Voting Results as of June 7, 2013
"2,183 companies have held Say on Pay votes in 2013. 42 companies have failed with an average 59% 'Against' vote ... 72% of companies have received a greater than 90% 'For' vote." (Steven Hall & Partners)

ERISA Does Not Protect Top-Hat Plan Benefits from Garnishment
"[B]ecause top-hat plans are designated for HCEs, they are exempt from certain ERISA protections, including anti-alienation, Judge Catherine C. Blake reminds in her ruling on the plaintiff's claim. This finding especially applies to creditors not party to the anti-alienation protection agreement that may exist as a contract between plan sponsor and participant." [Sposato v. First Mariner Bank, No. 1:2012-cv-01569 (D. Md. Mar. 28, 2013)] (Thompson SmartHR Manager)

Aon Hewitt Partners with Catalyst for Payment Reform to Develop Strategies for Achieving Higher-Value Health Care in the U.S.
Aon Hewitt

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