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June 14, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Client Relations
for Alliance Benefit Group in MI

Daily Operations Associate
for Alliance Benefit Group of Michigan in MI

Manager, Conversions
for The Newport Group in NC

Employee Benefits & Tax Attorney
for Porter Wright Morris & Arthur LLP in OH

Actuarial Consultant
for TPA/actuarial consulting firm in Chicago northern suburbs in IL

Retirement Services Program Director
for Nationwide Insurance in NM

Retirement Services Program Director
for Nationwide Insurance in AL

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Webcasts and Conferences

Phone Forum for FICA Replacement Plans
June 27, 2013 WEBCAST
(Internal Revenue Service (IRS))

ERISA Litigation Congress
September 9, 2013 in NY
(Momentum Events Group)

Texas Business Group on Health 2013 Regional Health Benefits Forum: Houston
July 16, 2013 in TX
(Texas Business Group on Health)

Texas Business Group on Health 2013 Regional Health Benefits Forum: San Antonio
August 21, 2013 in TX
(Texas Business Group on Health)

Texas Business Group on Health 2013 Regional Health Benefits Forum: Austin
August 22, 2013 in TX
(Texas Business Group on Health)

2013 Executive Benefits Forum
September 26, 2013 in TX
(SouthWest Benefits Association)

View All Webcasts and Conferences


 

[Guidance Overview]

Temporary Employees and the ACA Play-or-Pay Rules
"Because of the business need for temporary workers, it may not be practical to make these temporary workers company employees or to offer them coverage under your company's health plan. In that case, your strategy may be to assume that these temps will be treated as your common-law employees but to try and limit the risk that these workers will expose you to employer responsibility penalties. This strategy revolves around making sure that your contract with the staffing agency requires it to offer affordable coverage to these workers ... [and] to report these workers to the IRS as the staffing agency's employees." (Warner Norcross & Judd LLP)


[Advert.]

Executive Forum on Employee Health & Wellness Clinics -July 24-26, Chicago, IL

Sponsored by World Congress

Join the industry experts and thought leaders for the leading event strictly dedicated to improving the health, productivity, and engagement of employees through the on-site health and wellness clinic! Save $300 with promo code BLINK3.


[Guidance Overview]

DOL Issues Temporary Guidance on the Exchange Notice (PDF)
"The notice requires certain employer-specific data. However, employee-specific data is optional. Employers will also welcome the fact that the notice directs the employee to one website. Because that site will direct employees to the applicable Marketplace, multistate employers do not need to worry about directing employees to different state Marketplaces." (McGraw Wentworth)

[Guidance Overview]

DOL Issues Model Notices of Marketplace Coverage Options
"A Notice does not have to be provided to dependents or former employees even if they continue to have coverage (for example, through COBRA or retiree benefits).... Notices may be delivered by first-class mail. They may also be delivered electronically if the employee can effectively access electronic documents at his worksite and the use of the employer's electronic information system is an integral part of his job." (Clifton Budd & DeMaria, LLP)

State-Level Progress in Implementation of Federally Facilitated Exchanges
"Two of the three states are actively engaged in their exchange's development, although some stakeholders noted they need more information from the government to complete the exchange and prepare themselves in a timely manner. State Departments of Insurance view the regulations and their role in the exchanges as a continuation of their work pre-reform. States are at different stages of readiness ... Consumer assistance programs will need to be created to help people navigate the exchange, although clearing political hurdles will be a challenge in the acquisition of federal funds to pay for such programs." (Robert Wood Johnson Foundation)

Reduce Self-Insured Plan Expenses: Pursue Third-Party Reimbursement
"[S]ponsors of employer health and other self-insured plans may maximize their right to third-party reimbursements by keeping these four things in mind: [1] Reimbursement rights are generally limited to self-insured plans.... [2] Auto accident defendants and insurers aren't the only sources of reimbursement.... [3] Clear, Comprehensive Plan Language.... [4] Clear, Consistent SPD Language." (Warner Norcross & Judd LLP)

Firms Are Loath to Harm Staff to Curb Health Care Act Costs
"Looming requirements under the [ACA] are set to jack up health-care costs for many companies next year, but the companies who plan to make changes as a result to offset some of those costs are reluctant to take drastic steps that could negatively affect their workers.... Only 45% of 113 companies surveyed ... said they are making changes or likely will, while the remaining 55% are taking a wait-and-see approach ... But of that 45%, only a handful said they expect to ask any full-time employees to shift to part-time, use more contract workers or discontinue employer-sponsored coverage for some or all active full-time employees." (The Wall Street Journal; subscription may be required)

In or Out? Most Companies Say They'll Continue Health Care Benefits
"97 percent of the 131 respondents said they'll continue offering health-care coverage to employees. In addition, 58 percent of the companies that will continue with coverage said their insurance plans won't change significantly.... Some respondents pointed out that dropping coverage and paying the penalties might save them money, but really isn't an option if they want to remain competitive." (Warner Norcross & Judd LLP)

Court Upholds $3.8 Million Arbitration Award Against VEBA
"The court concluded that, by failing to participate in the arbitration, the administrator waived its right to raise its arguments on both procedural (as to internal appeal requirements) and substantive (as to interpretation of the plan's documents or benefit calculations) matters in court." [Langlais v. PennMont Benefits Serv., Inc., 2013 WL 2450752 (3d Cir. 2013); 2012 WL 2849414 (E.D. Pa. 2012)] (Thomson Reuters / EBIA)

Consumer 'Driven' Benefit Plans?
"Over the last several years, the trend in employment-based retirement plans has been to put in place structures to make more decisions for workers through the expansion of automatic enrollment plan designs. At the same time, the trend in employment-based health plans has been to look for ways to better manage costs, while providing workers more choice, and flexibility in those choices, by looking to so-called consumer-driven health plans, or CDHPs." (Nevin Adams via EBRI)

Patient Reviews Suggest Mail Order Doesn't Deliver
"Consumer surveys consistently rank mail order pharmacies much lower in overall patient satisfaction than their retail counterparts. [The NCPA] recently documented patient testimonials for their independent pharmacy, and also launched a companion feature of patient experiences with mail order, entitled 'Mail Order Doesn't Deliver'.... [T]hese companion features allow readers to contrast consumer experiences between these two pharmacy options." (National Community Pharmacists Association)

Seventh Circuit Permits Equitable Relief for Fiduciary Breach When Incorrect Coverage Information Provided by Call Center
"[After Cigna v. Amara, we] can now comfortably say that if [the participant] is able to demonstrate a breach of fiduciary duty ... and if she can show that the breach caused her damages, she may seek an appropriate equitable remedy including make-whole relief in the form of money damages.... If the plan documents are clear and the fiduciary has appropriately trained staff to field inquiries, a fiduciary will not be held liable if a ministerial, non-fiduciary agent has given incomplete or mistaken advice to an insured.... But if the documents are ambiguous or incomplete on a recurring topic, a fiduciary may be liable for mistakes that representatives make in answering questions on that subject." [Kenseth v. Dean Health Plan, No. 11-1560 (7th Cir. June 13, 2013)] (U.S. Court of Appeals for the Seventh Circuit via Bloomberg Law)

MLR Bill Introduced in House But Faces Steep Climb to Passage
"A broker-friendly bill to combat the financial impact of the medical loss ratio requirements contained in the [ACA] was filed in the U.S. House of Representatives Wednesday. A bi-partisan team of Representatives Mike Rogers (R-Mich.) and John Barrow (D-Ga.) are sponsoring the Access to Professional Health Insurance Advisors Act of 2013, known as the MLR bill, in an effort to relieve compensation restraints for health insurance brokers and agents." (Employee Benefit Adviser)

Wellness Programs: Are They on Life Support? Responding to the Final Regulations (PDF)
22 presentation slides. Excerpt: "Wellness programs are becoming far more prevalent, and encompassing far more designs, than 5-10 years ago.... Spider's web of legal considerations and issues can snare the simplest of wellness programs ... A single changed design element can significantly raise, or lower, legal risks." (Morgan Lewis)

California Insurance Chief Wants to Bar Anthem from Selling Small Business Coverage
"In California and a handful of other states, the marketplaces do not have to accept every insurer that applies, but will choose from among applicants. [California Insurance Commissioner Dave Jones] said Anthem had raised rates more than 17 percent in the past year for small business customers. While he does not have the power to reject rate increases, the federal health law says state insurance commissioners can recommend that the marketplaces ... can exclude insurers with a pattern of excessive premium increases." (Kaiser Health News)

Health Care Solutions: Putting Smaller Employers in the Driver's Seat
"Smaller employers' inability to obtain useful, readily available data has allowed premiums to go uncontested far too long. Premiums have risen 131 percent during the past 10 years. In contrast, wages have grown 38 percent, and inflation is up 28 percent ... What's surprising is that most health insurance brokers have not suggested self-funding to clients as a way to gain transparency. This simple solution can help smaller businesses better manage medical costs." (CNBC)

Hearing on the 2013 Medicare Trustees Report
"[The] House Ways and Means Health Subcommittee ... will hold a hearing on the recently released 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. This hearing will allow the Subcommittee to focus specifically on the Medicare program's financial status and changes from the Trustees previous reports. The Subcommittee will hear testimony from Medicare's two public trustees. The hearing will take place on Thursday, June 20, 2013[.]" (Health Subcommittee, Committee on Ways and Means, U.S. House of Representatives)

CBO Analysis of S. 534, National Association of Registered Agents and Brokers Reform Act of 2013
"S. 534 would establish the National Association of Registered Agents and Brokers (NARAB) and authorize it to license producers of insurance (mostly agents and brokers) to operate in multiple states.... Under the bill, insurance producers that join the NARAB would be able to obtain a license to act as a producer in any state other than their home state by meeting the NARAB's eligibility requirements and paying certain fees. CBO estimates that enacting S. 534 would increase revenues by $490 million and increase direct spending by $483 million[.]" (Congressional Budget Office)

Hatch, Rubio Announce Bill to Strengthen, Expand HSAs, FSAs
"[T]he legislation will: [1] allow a husband and wife to make catch-up contributions to the same HSA; [2] remove the onerous new restrictions on the use of HSA and FSA dollars for the purchase of over-the-counter drugs; [3] clarify the use of prescription drugs as preventive care that will not be subject to an HSA-eligible plan deductible; ... [4] promote wellness by expanding the definition of qualified medical expenses to encourage more exercise and better nutrition; [5] allow seniors enrolled in Medicare Part A to continue contributing to their HSAs; and [6] allow for the purchase of low-premium health insurance and long-term care insurance with HSA dollars." (Committee on Finance, U.S. Senate)

Text of S. 1031: Family and Retirement Health Investment Act of 2013 (Introduced Version)
"To amend the Internal Revenue Code of 1986 to improve access to health care through expanded health savings accounts, and for other purposes." [Also introduced in the House as H.R. 2194.] (U.S. Senate)

[Opinion]

Insurance Exchanges Under Obamacare: Roadblocks to Enrollment and a Waste of Millions in Taxpayer Money?
"eHealthInsurance.com -- along with smaller websites providing similar services -- is, in virtually all respects, an existing healthcare exchange and has operated as such for long before the [ACA] introduced the concept of the health insurance exchange into the vernacular of national health care policy.... [It] only stands to reason that the newly formed state health insurance exchanges would be flocking to these privately operated, experienced exchanges to give the state organizations a solid 'leg up' in getting their programs up and running, right? Not so much." (Rick Ungar in Forbes)

[Opinion]

Why Does Kaiser Have the Highest Premiums in the California Exchange?
"By Kaiser setting premiums higher, this initial influx of less healthy but more expensive patients would be diverted to competing plans because of the attraction of their lower premiums.... Since Kaiser realizes that they have not only dominant market share but also a stable group of satisfied patients who do not want any disruption in their care, they know that they can charge a little bit more for their plans since patients are willing to pay the modest differences to avoid such disruptions." (Physicians for a National Health Program)

Benefits in General; Executive Compensation

[Official Guidance]

Text of DOL Compliance Guidance for Employee Benefit Plans in Wake of Oklahoma Tornado
"The guidance provided in this statement applies to employee benefit plans, plan sponsors and service providers to such employers, located in one of the counties that have been identified as covered disaster areas because of the devastation caused by the Oklahoma tornado that occurred on May 20, 2013.... The relief provided under this announcement is in addition to the Form 5500 Annual Return/Report filing relief already provided by the IRS [and includes] Participant Contributions and Loan Repayments... ERISA Disclosures... ERISA Group Health Plan Compliance Guidance[.]" (Employee Benefits Security Administration, U.S. Department of Labor)

Retirees and City of Stockton Reach Tentative Agreement on Pension and Health Benefits
"Under the deal with some 1,100 retired employees -- Stockton's largest group of unsecured creditors -- the city will pay a lump sum of $5.1 million to reflect the loss of their health benefits in retirement and leave their current pension benefits intact.... Details of how the money will be divided weren't immediately available. Nothing is final until the city settles its bankruptcy in total, which also includes striking deals with a majority of its Wall Street creditors." (Recordnet.com)

Government Asks Supreme Court to Reject Quality Stores Ruling that Exempts Severance Pay from FICA Taxes
"The 26-page petition sets forth the IRS' long standing position that severance payments are subject to employment taxes, following the broad definition of 'wages' ... IRS emphasized the importance of getting a 'final answer' on the proper tax treatment of these payments that employers have struggled with for decades -- with 11 substantial similar cases pending, 2400 administrative refund claims pending, and over a $1 billion at stake, not to mention the impact on Social Security benefits, which are contingent on the outcome as well." (Groom Law Group)

Cypen & Cypen Newsletter for June 13, 2013
Article titles include: [1] BNY Mellon Pension Summary; [2] 2013 Income Study Is Bad News for Most Americans; [3] Implications of Long-term Pay Freezes for States, Localities; and [4] Status of the Social Security and Medicare Programs. (Cypen & Cypen)

Press Releases

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