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BenefitsLink Health & Welfare Plans Newsletter

June 12, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Client Service Representative
for Associated Pension Consultants in CA

Retirement Plans Administrator
for Vectren Corporation in IN

Defined Contribution Specialist
for United Retirement Plan Consultants in CA

Director Retirement Plan Services
for First Savings - Retirement Services in PA

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Webcasts and Conferences

Countdown to 2014 Offering Health Care Coverage to Employees: Who, What, How, and When?
June 27, 2013 WEBCAST
(Hinshaw & Culbertson LLP)

403(b) Summit: Synergize to (b)uild your (b)usiness
June 23, 2013 in IL
(National Tax Sheltered Accounts Association)

View All Webcasts and Conferences


[Guidance Overview]

Get Ready: PCORI Fees May Be Due By July 31
"PCORI will be funded by fees paid by health insurance issuers and employers who sponsor self-insured group health plans. Most plans must begin paying this fee by July 31, 2013.... If an employer sponsors more than one self-insured arrangement, those arrangements may be treated as a single plan for purposes of calculating the PCORI fee, but only if the plans have the same plan year." (Poyner Spruill LLP)


Earn Your Certificate in Benefit Plan Administration

Sponsored by IFEBP (International Foundation of Employee Benefit Plans)

Learn the skills to successfully manage employee benefit plans. The Certificate in Benefit Plan Administration program covers a variety of areas including risk management, HR, communication, technology, finance and the legal climate. Register Now.

[Guidance Overview]

Agency Trio Issues Final Regulations on Wellness Programs
"The final regulations recognize that a reasonable alternative standard could be an activity-only program or an outcome-based wellness program, in itself, which will be required to follow all the same rules of the programs. For example, if the initial reasonable alternative is an activity-only program, the plan must provide further reasonable alternatives to any individual who has a medical condition that precludes them from participating, and if the initial alternative is an outcome-based program, the plan must provide a reasonable alternative to every individual without regard to health status. The final regulations do recognize that this could lead to a never-ending cycle of reasonable alternatives and special rules are provided to prevent such occurrence." (Troutman Sanders)

[Guidance Overview]

Wellness Program Final Rules Increase Maximum Rewards But Include Significant New Requirements
"The final regulation paves the way for employers to significantly expand the financial incentives offered as part of a wellness program to encourage plan participants and beneficiaries to maintain, or to pursue changes in, their health status and health-related behaviors. Employer plan sponsors will need to incorporate into any health-contingent wellness programs the revised requirements for maintaining legal compliance." (Towers Watson)

Employee Who Voluntarily Resigned Had No Claim of FMLA Interference
"The appellate court recognized that an employer's knowledge of an employee's prior medical history may be relevant to determining whether an employee gave adequate notice to invoke FMLA rights in a particular instance. However, in the case before the court, there is nothing that indicates NES had reason to interpret Miles's statement that she was not coming back to work as an indication she was requesting leave for a serious health condition." [Miles v. Nashville Elec. Serv., No. 12-6028 (6th Cir. May 19, 2013)] (Jackson Lewis LLP)

Colorado Family Care Act Signed into Law
"[In] addition to the leave that an employee is entitled to the under the FMLA, an eligible Colorado employee is now also entitled to up to 12 weeks of unpaid leave in a 12-month period to care for a person with a serious health condition who is the employee's partner via a civil union under Colorado's newly-enacted civil union law, or the employee's domestic partner as registered in the employee's residential municipality or as recognized by the employer. The law will go into effect on August 7, 2013 ... unless a referendum petition is filed before that date." (Fisher & Phillips LLP)


IRC Section 105(h) Testing and Design Alternatives June 24, 2013

Sponsored by Lorman and BenefitsLink

This live audio conference will examine the nondiscrimination rules under Section 105(h) that apply to self-funded health plans, and comparable rules under the Affordable Care Act that apply to insured plans. Registration discount for BenefitsLink readers.

2014 Draws Closer: Employer Plans for Dealing with Health Care Reform Evolving
"A new survey of nearly 900 employers ... found that employers have upped their estimates of the cost impact of the ACA. In 2011, 25% of survey respondents expected the law would have little or no impact on cost (adding less than 1%). In 2013, only 9% expect to get off so easily. And now 19% of respondents expect cost to rise significantly (by 5% or more), compared to just 15% in 2011." (Mercer)

Health Insurers Report Increased Enrollment in 2012
"Leading U.S. health insurers realized an aggregate membership increase of 5.6 million from 2011 to 2012 ... [T]he top seven companies analyzed enrolled 135.7 million medical members, which represents approximately 52 percent of the estimated 260.2 million people with health insurance in the United States. The leaders saw significant gains in Medicare and Medicaid business while commercial enrollment growth was slight." (InsuranceNewsNet.com)

Consumer Health Experts Attack 'Calcified Hairball' System of Care
"Most companies view their wellness programs as a means to employee retention, rather than a vehicle to reduce costs. The most important objective, from the point of view of the company that's paying for them, is keeping employees happy and engaged. Financial incentives -- either rewards, such as paying for adherence, or punishments, such as penalizing for failure to use a wellness offering, are a disturbingly effective way to drive behavior change, but the resultant change isn't durable, and lasts only as long as the financial incentives persist." (David Shaywitz in Forbes)

HHS Inspector General Finds Room for Savings in Medicare
"A review of rates on 20 of the most common lab tests showed Medicare paid $910 million more than it would have if it had paid the rates of some state Medicaid plans and private insurers, according to the report by the [HHS] Office of Inspector General. Medicare pays a set rate for lab tests and is restricted by law from negotiating lower rates.... Medicare paid anywhere from 18% to 44% more than state Medicaid plans or private insurers on lab fees." (The Wall Street Journal; subscription may be required)

Colorado Offers Exchange 'Assister' Money To Many Groups
"One of the 16 states that is setting up its own online insurance marketplace, Colorado ... named 58 organizations it's selected to form its 'assistance network' to help residents sign up for health coverage on the exchange. But no organization is getting all the money it applied for, and it's unclear how many will accept the grants they've been offered. That may mean gaps in reaching all corners of the state, or specifically targeted populations, such as refugees, rural Latinos, or the disabled." (Kaiser Health News)

Sweden Leading the World in Allowing Private Companies to Run Publicly Funded Hospitals
"Saint Goran's hospital is one of the glories of the Swedish welfare state. It is also a laboratory for applying business principles to the public sector. The hospital is run by a private company, Capio, which in turn is run by a consortium of private-equity funds ... The doctors and nurses are Capio employees, answerable to a boss and a board. Doctors talk enthusiastically about 'the Toyota model of production' and 'harnessing innovation' to cut costs. Welcome to health care in post-ideological Sweden." (The Economist)

Pent-Up Demand for Medical Care Threatens to Inflate Premiums
"[M]ore than one out of four respondents answered that they would see the doctor more frequently and an additional 15% answered that they would get a medical procedure they had put off. In total, 42% of respondents' answers indicated a higher use of medical services if their health insurance coverage improved. These results suggest that insurance premiums in the second year of Obamacare, 2015, may experience a temporary rise due to the pent-up demand for medical procedures being addressed in 2014." (HealthPocket)


The Wellness Game: Employers Become the New Parents
"Like so many other behaviors that animate the phrase 'personal responsibility', in the face of economic and demographic tumult we have decided to pass the buck on them in our homes, neighborhoods, schools, and churches. We now want employers to handle them, and health-contingent wellness is the final step in the ascendancy of the employer as the new parent.... This is not why most people start businesses (unless, of course, you're a wellness vendor)." (The Health Care Blog)


How Health Insurance Exchanges Will Drastically Affect Career and Retirement Decisions
"Deciding where to work will no longer need to be tied to the availability of health insurance, freeing clients to make job changes, start new businesses, or simply retire before age 65 Medicare eligibility, without worrying about how they'll get access to health insurance. How many clients would still be working where they are today if health insurance availability was guaranteed regardless of where (or whether) they worked?" (Nerd's Eye View)


What the New York Times Doesn't Know About Medicaid Under Health Reform
"Let's see -- there are about 50 million uninsured ... mostly living in states that are not expanding Medicaid ... and as a result there will be 3.6 million who don't get insured ... And ... 3.6 divided by 50 ... is 7.2%. Hmmm. Only 7.2 percent of the uninsured will fail to get insurance because half the states don't expand Medicaid? We could fail to insure that many just by bureaucratic snafus alone.... It turns out that below 100 percent of poverty, people who are not eligible for Medicaid will not be entitled to subsidized insurance in the health insurance exchanges." (John Goodman's Health Policy Blog)


Examinations of Health Care Overlook Mergers
"Our anguished search for ways to slow runaway health spending has so far mostly focused on how to eliminate waste ... What is missing from the stampede of policy innovation is something to tackle one of the best-known causes of high costs in the book: excessive market concentration.... Merger activity has jumped in anticipation of the law?s coming fully into effect.... To 'bend the curve' of health care costs downward, their leverage must stop growing." (Eduardo Porter in The New York Times; subscription may be required)


Will 'Too Big to Fail' Come to Health Care?
"[W]hile experts argue about over-consolidation versus integration, an irreversible 'cycle of consolidation' exists in some markets that may be impossible to undo; as doctors and hospitals form larger organizations and federal and state budget pressures continue to constrain Medicare and other public program payments, providers will use their increased market power to demand large price increases from health insurers and employers." (The Health Care Blog)

Benefits in General; Executive Compensation

BLS Report of Employer Costs for Employee Compensation, March 2013
"Wages and salaries averaged $21.50 per hour worked and accounted for 69.1 percent of these costs, while benefits averaged $9.59 and accounted for the remaining 30.9 percent.... Private industry employer costs for paid leave averaged $2.01 per hour worked (6.9 percent of total compensation), supplemental pay averaged 81 cents (2.8 percent), insurance benefits averaged $2.40 (8.2 percent), retirement and savings averaged $1.06 (3.6 percent), and legally required benefits averaged $2.39 (8.2 percent)." (U.S. Bureau of Labor Statistics)

Senator Portman, Representative Boustany Introduce Enrolled Agents Credential Act
"U.S. Senator Rob Portman (R-Ohio) and Congressman Charles Boustany (R-La.-03) today introduced the Enrolled Agents Credential Act, legislation to ensure that individuals, families, and businesses across the country are able to identify and access trained specialists to assist them in filing their taxes.... This bill would clarify that Enrolled Agents may use and display their credential when advertising their services and representing their clients." (U.S. Rep. Charles W. Boustany, R-La.)

Has Another Wave of 'Say-On-Pay' Litigation Come to an End?
"As the 2013 proxy season kicked off, there was a great deal of speculation among public companies, their counsel, and commentators over whether the say-on-pay injunction challenges would continue.... There remained the possibility that alleged say-on-pay disclosure deficiencies might be tacked onto subsequent complaints over these equity incentive provisions. However, not only did this not occur, but no injunctive lawsuits materialized -- challenging say-on-pay or equity incentive plans. Indeed, no companies appear to have been targeted for say-on-pay injunctive suits in advance of annual meetings during the 2013 proxy season." (Haynes and Boone, LLP)

New York State Regulations Restricting Provider Executive Compensation Finally Become Final
"The Final Regulations make only minor revisions to the proposed regulations ..., retain the same basic limits on executive compensation, and do not change the effective date (July 1, 2013) or the implementation date of the regulatory limits (for most providers, January 1, 2014).... [The] latest Assessment of Public Comments provides no other guidance on the following, still outstanding issues: [1] exactly what types of government funding will be considered 'State funds' or 'State-authorized payments'; [2] what will be the format and content for the EO#38 Disclosure Form; and [3] what will be the format and content for waiver applications." (Cadwalader via Mondaq; free registration required)

Sixth Circuit Tentatively Rejects Agreement with Acquirer to Cancel Top-Hat Plan Benefits
"After the sale closed, Metaldyne informed the participants that it had invalidated the Plan. The participants filed multiple lawsuits against Heartland and the two Metaldyne board members who were Heartland principals, including this one in Michigan state court.... [T]he court did not decide the merits of the participants' claim that Heartland and two of its principals had tortuously interfered with the plaintiff/participants' contractual relationship. It only decided that the claim was not preempted by ERISA and, therefore, the participants could continue with their state court claims at trial." [Gardner v. Heartland Industrial Partners, LP, No. 11-2327 (6th Cir. May 10, 2013)] (Winston & Strawn LLP)

Press Releases

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