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June 11, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Senior Relationship Manager
for T. Rowe Price in MD

Retirement Account Manager
for Benefits Resource Group in OH

Business Analyst
for Chesapeake Benefit Partners in MD

Senior Regulatory Reporting Specialist
for TD Ameritrade in CA, CO

401(K) Participant Recordkeeper #7476
for Johnson Financial Group in WI

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Webcasts and Conferences

"Fundamentals of 401(k) and Other Qualified Plans" - a 3-day Seminar, Minneapolis
July 10, 2013 in MN
(SunGard Relius)

The Future of Employer-Sponsored Insurance (Archived Webcast)
June 25, 2013 WEBCAST
(National Institute for Health Care Management Foundation)

View All Webcasts and Conferences


 

[Guidance Overview]

HHS Finalizes SHOP Special Enrollment Periods Under ACA
"The final rule provides that a qualified employee or dependent of a qualified employee who has obtained coverage through the SHOP has 30 days from the date of most of the triggering events to select a QHP. Additionally, a qualified employee or dependent of a qualified employee who has lost eligibility for Medicaid or CHIP coverage, or who has become eligible for state premium assistance under a Medicaid or CHIP program, is eligible for a special enrollment period in a SHOP and has 60 days from the date of the triggering event to select a QHP." (Wolters Kluwer Law & Business)


[Advert.]

Leadership Summit on Health Insurance Exchanges (HIXs)

Sponsored by World Congress

Timely information focused on leveraging current "knowns" and progress to derive practical strategies for successful future participation in HIXs. Join us July 15-17 in Arlington, VA.


[Guidance Overview]

Final Wellness Regulations Expand Employer Compliance Duties
"[T]he most significant change [made by] the final regulations [is to] treat certain wellness programs that formerly were classed as 'participatory-only' programs as 'health contingent' programs that must meet five criteria designed to permit individuals with health limitations to still qualify for the wellness reward. Examples include walking programs or other programs that do not require that employees attain a specific result, but that do require their physical participation or other activity that may be ruled out by health issues." (E is for ERISA)

ACA and Self-Insurance for Small Employers (PDF)
"With major, disruptive changes looming in the U.S. health insurance system, many employers and their brokers are taking a closer look at the self-insurance alternative not only as a strategic move in light of the uncertainty in the insurance marketplace, but also as a more effective way to mitigate health risk and manage their health plans in the long run. This report discusses ACA's new federal benefit mandates and distinguishes their impact on insured vs. self-insured plans, tracks positive trends in self-insurance for employers of all sizes and outlines a new model for data-driven self-funding programs[.]" (Healthcare Performance Management Institute)

Drunk Driving Death is an 'Accident': The Importance of Accurate Plan Language
"The key for the Court was that the plan did not define 'accident' in the policy, nor did it exclude from coverage events where it was reasonably foreseeable that injury would occur. Arguably driving while intoxicated makes injury more foreseeable than driving sober, but it cannot be said that injury is 'substantially certain' to occur. Also, because the policy did not provide the carrier with discretionary authority to interpret plan terms, it left the court open to apply a de novo review of the determination." (Fox Rothschild LLP)

Federal Rule Allows Higher Out-Of-Pocket Spending For One Year
"Although all non-grandfathered plans will have to cap the amount that consumers pay out-of-pocket for major medical expenses, if health plans use more than one company to administer their benefits... consumers may face separate caps next year, or no cap on their pharmacy spending at all.... So a plan with a separate cap on pharmacy benefits can keep it as long as the limits don't exceed the new maximum. Plans with no drug spending limit -- the norm, according to experts -- don't have to cap members' out-of-pocket spending at all." (Kaiser Health News)


[Advert.]

ACI's Defending and Managing Employment Discrimination Litigation, 7/31 - 8/1, NY

Sponsored by ACI (American Conference Institute)

The premier employment discrimination litigation conference returns for a fourth year -- more in-house counsel client presence, more government regulators and enforcers, and top federal and state jurists actively involved in these cases. Discount Code BEN200.


Providing Workplace Wellness Centers Could Backfire for Occasional Users
"Participants were split into low, below-average, above average and high users. Low users attended less than once every two weeks and high users two or three times a week....Among high users, the percentage increased from 59.4 to 80.4 percent [but] was no improvement in physical quality-of-life scores among the lowest use group and the number of low users reporting a high mental quality of life decreased from 51.4 to 34.5 percent.... [P]articipants in wellness programs often have unrealistic expectations and become discouraged when they don't immediately reach their goals. If participants understand that motivation can fluctuate due to life circumstances, it could help." (Center for Advancing Health)

Wagner Law Group Legal Updates in ERISA, Employee Benefits & Human Resources, June 2013
Articles include: [1] DOL Releases PPACA and HIPAA Self-Compliance Tools; [2] HHS Issues Final Regulations Implementing Provisions of the HITECH Act; [3] DOL Updates Delinquent Filer Voluntary Compliance Program; [4] HHS Issues Final Regulations on PPACA's Transitional Reinsurance Fees; [5] Individual Shared Responsibility Penalty; and [6] DOL Issues Guidance on PPACA Exchange Notices. (The Wagner Law Group)

ML Strategies Health Care Reform Update, June 10, 2013 (PDF)
Update on developments in federal and state health care reform legislation and regulations, including summaries of recent announcements and regulatory activity by HHS, CCIIO, IRS and CMS. (ML Strategies, LLC)

ACA Could Encourage Early Retirement
"Retiree health coverage has its strongest effects at ages 62 through 64. Coverage that includes an employer contribution is associated with a 6.3 percentage point (36.2 percent) increase in the probability of turnover at age 62; a 7.7 percentage point (48.8 percent) increase in the probability of turnover at age 63; and a 5.5 percentage point (38.0 percent) increase in the probability of turnover at age 64. Conditional on working at age 57, such coverage reduces the expected retirement age by almost three months and reduces the total number of person-years worked between ages 58 and 64 by 5.6 percent." (National Center for Policy Analysis)

Cutting Health Care for Special Needs Children
"[O]ut-of-pocket spending on children with special health care needs in families with private health insurance decreased during the recession from 2007 to 2009, dipping from $774 to $626. To put this decrease in spending in context, in 2008, while children with special health care needs only composed about 17.9 percent of all children, they represented about 47.6 percent of all health care expenditures for children." (The Century Foundation)

Rising Health Care Costs Grow as Top Concern for Manufacturers
"82.2 percent of manufacturers identified rising health care and insurance costs as their top challenge, an increase from 74.0 percent in the previous survey." (National Association of Manufacturers)

Costs of Medical and Prescription Drug Benefits Continue to Rise for Central Pennsylvania Employees and Families (PDF)
"88 percent of the companies who responded now require employees to share in the cost of their health premiums. Results from a similar survey in 2009 found that 77 percent of employees shared in the cost of their health premiums ... In line with national surveys, the most common type of plan offered continues to be the preferred provider organization (PPO) ... Central PA lags significantly with 11 percent in QHDHP compared with 26 percent nationally." (Conrad Siegel Actuaries)

Brand Name Drugs Drive Up Medicare Spending
"Comparing Medicare enrollees and those on the U.S. Department of Veterans Affairs (VA) health plan, researchers found that Medicare beneficiaries were up to three times more likely than VA patients to choose higher-cost brand name drugs over generic brands ... Physicians in the VA system follow an approval process that requires them to try the generic drug before they prescribe a patient the brand-named version. The system also limits their providers' interactions with pharmaceutical representatives[.]" (Kaiser Health News)

South Koreans, Argentines Most Satisfied with Health Care
"[P]atients in South Korea, Argentina and Japan are the most satisfied with their medical care ... [and] gave top grades for improvements in their national healthcare system since 2008, along with residents of Belgium and Australia, which rounded out the top five nations. At the other end of the spectrum, patients in Sweden, France, Italy, Hungary and Spain were the least satisfied with their health services and experiences among the 15 countries studied." (Reuters)

The Effect of Medicare Advantage on Hospital Admissions and Mortality
"The sharp difference in payment rates [in Metropolitan Statistical Areas with populations of 250,000 or more] creates a greater incentive for plans to increase the generosity of benefits and therefore enroll more beneficiaries in [Medicare Advantage (MA)] in counties just above versus just below the cutoff. We find that the expansion of MA on this margin reduces beneficiaries' rates of hospitalization and mortality." (National Bureau of Economic Research)

States, Employers Junking Obamacare Online Calculators
"Two online health calculators designed by federal officials to help states and employers comply with Obamacare mandates are riddled with so many flaws that users are abandoning them ... Users say the calculators -- one used by state officials, the other by private employers -- too often are confusing, produce contradictory results, do not reflect real world conditions, and use old data. The problem is so acute that several states are weighing whether or not to create their own calculators." (The Examiner)

Patient Engagement Will 'Vastly' Improve Health Care
"U.S. Chief Technology Officer Todd Park emphasized the importance of federal efforts to engage patients in their own healthcare.... Park, who previously served as CTO for the U.S. Department of Health & Human Services, spoke at length about the evolution of the Blue Button, which gives patients easy access to their medical records. He said that to date, more than 88 million Americans have taken advantage of the Blue Button, a number he said is expected to grow to 115 million by the end of the year." (FierceHealthIT)

Background Check Bill in California May Affect Exchange Deadline
"Covered California board members say the timely rollout of the health insurance exchange relies heavily on two bills in the state Legislature spelling out the details of hiring 20,000 health reform workers.... Health policy experts and civil rights groups are taking issue with the provision in the bill prohibiting the state from hiring new employees with a felony conviction, arguing that it violates potential employees' equal opportunity employment rights." (Kitsap Sun)

[Opinion]

Text of Letter to HHS Requesting Clarification and Guidance on HIPAA/HITECH Final Rule on Refill Reminder Programs (PDF)
"[The authors] are concerned that language in the preamble to the Final Rule ... [will] jeopardize the sending of refill reminders. Specifically, [they] request that OCR issue additional guidance that: [1] Makes clear that when pharmacies enter into business associate relationships with third parties in order to carry out their refill reminder programs, such relationships do not automatically trigger a patient authorization requirement; and [2] Clarifies that permissible 'reasonable in amount' payment for such medication adherence programs explicitly includes all reasonable direct and indirect costs related to them." (Center for Democracy & Technology)

[Opinion]

Deloitte Health Care Reform Memo, June 10, 2013
"On the surface, a fairly straightforward idea that can be interpreted as: individuals who enjoy a state of health void of major problems. But a deeper look prompts a litany of questions -- what's the right balance between physical and mental health, what's the role of spirituality, is wellness absence of symptoms of a disease or state of mind, and so on.... [T]he trade literature is inconsistent about exactly the right combination of activities that constitute a comprehensive wellness program. It may be complicated and costly if not deciphered appropriately." (Deloitte)

[Opinion]

What States Could Do to Protect Their Citizens If Obamacare Collapses
"The following are a few among many state policy ideas that states could pursue and put them ahead of the reform curve: Assess insurance rating rules and benefit mandates.... Extend portability of coverage to individually owned policies.... Expand access through the harmonization of state rules.... Integrate choice and competition in Medicaid.... Adopt medical liability reforms.... Remove certificate of need restrictions." (The Heritage Foundation)

[Opinion]

Good News For Health Insurance Consumers in the District of Columbia
"[T]he Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2013 sets forth key standards for health plans that insurers want to sell in the D.C. Exchange ... providing significant consumer protections and value to District residents. In addition, the bill transitions the current individual and small group insurance markets into a single unified market that the D.C. Exchange will oversee.... The District joins Vermont as the only two jurisdictions with state-run unified health insurance marketplaces." (Center on Budget and Policy Priorities)

Benefits in General; Executive Compensation

List of Companies That Have Failed Say on Pay in 2013
"2,228 companies have held Say on Pay votes in 2013; 45 companies have failed with an average 59% 'Against' vote ... Six companies have failed previous votes." [Includes a list of the 45 companies and their voting results.] (Steven Hall & Partners)

Is It Time to Reevaluate the Role (and Pay) of the Lead Director?
"So far this year, 47 S&P 500 companies have faced shareholder votes to create an independent board chair, up from 44 last year and 26 two years ago. But, while the number of shareholder proposals coming to a vote has increased, average support for these proposals has dropped from 35% last year to 28% so far in 2013." (Towers Watson)

Press Releases

Nominations Open for EBRIís 2013 Lillywhite Award
Employee Benefit Research Institute (EBRI)

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