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June 19, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

401K Administrator
for Farmer & Betts in OR, WA

Retirement Plan Relationship Manager
for Full Service Employee Benefits Consultant/ Broker in DC, VA

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Webcasts and Conferences

Employee Plan Fix-It Programs and How to Use Them (NY CLE Program)
July 16, 2013 in NY
(Osler, Hoskin & Harcourt LLP)

What Every Retirement Practitioner Should Know About IRA's -- Web Seminar
July 11, 2013 WEBCAST
(SunGard Relius)

In-Plan Retirement Income Solutions: Understanding Participant Interest -- Webinar
June 27, 2013 WEBCAST
(Transamerica Retirement Services)

In-Plan Roth Conversions -- Webcast
June 27, 2013 WEBCAST
(American Society of Pension Professionals & Actuaries (ASPPA))

Advanced Required Minimum Distributions -- Web Seminar
July 16, 2013 WEBCAST
(SunGard Relius)

Western Benefits Conference
July 21, 2013 in CA
(American Society of Pension Professionals & Actuaries (ASPPA))

Finding Lost Pension Plans -- Recorded Webinar
June 18, 2013 WEBCAST
(Pension Rights Center)

View All Webcasts and Conferences


[Official Guidance]

Text of CMS Guidance on State Alternative Applications for Health Coverage (PDF)
"[The April 3] application, in both its paper and online versions, will be the sole application used by the Federally-facilitated Marketplace to facilitate eligibility determinations and enrollment in health coverage. State-based Marketplaces, as well as Medicaid and CHIP agencies, may choose to use the model single, streamlined application, or may develop an alternative single, streamlined application that is approved by CMS.... States may submit for approval an alternative application that can be tailored to accommodate state preferences and policies, while also reflecting the general principles of the model application and complying with the applicable provision of law ... This section outlines the parameters for creating an alternative application and also identifies areas where a formal approval of modifications to the model application is not needed." [The document is dated June 18, 2013.] (Center for Consumer Information & Insurance Oversight, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)


ftwilliam.com, TAG Data, CCH and Aspen Publisher's Customer Conference

Sponsored by ftwilliam.com

Join us August 4-6 and learn from industry specialists! We'll cover hot topics including Coverage & Testing, TPA Workflow, Advanced Plan Design and much more! Make sure to drop in on our hands-on product training sessions with fellow TPAs.

[Guidance Overview]

PCORI and Reinsurance Fees: Keeping Them Straight (PDF)
"While the PCORI Fee and the Reinsurance Fee are both calculated based upon the number of 'covered lives' under a plan and use similar methodologies for counting those lives, there are significant differences between the two fees, such as the amount of the fee, due date, payment method, and treatment of individuals covered by retiree medical plans." (Groom Law Group)

[Guidance Overview]

A Primer on 'Low-Cost' Group Health Plans
"On one side are those who claim that low-cost plans are patently abusive and will shortly be banned altogether; on the other are those who claim that these plans are a panacea. Neither side is correct. Far from being abusive, low-cost plans fit squarely into the [ACA]'s statutory scheme; and far from being a panacea, they leave adopting employers exposed to penalties that, while for the most part, are not as severe as those that apply where no coverage is offered, can still be significant." (Mintz Levin)

Seventh Circuit Makes Damages More Available for Employees Given Wrong Information About Benefits
"In a concurring opinion, Circuit Judge Daniel Manion cautioned that the Supreme Court's decision in Cigna v. Amara did not mean that monetary relief would always be an appropriate equitable remedy under ERISA 502(a)(3), but instead held that surcharge could be an appropriate equitable remedy under the right circumstances. Accordingly, Judge Manion advised the district court to ensure that surcharge would be an appropriate equitable remedy given the facts of the case." (McDermott Will & Emery)

Seventh Circuit Finds Expanded ERISA Remedies Available in Fiduciary Breach Claims
"Applying Amara, the Seventh Circuit concluded that monetary compensation is not automatically considered legal rather than equitable for Section 502(a)(3) purposes. Rather, the participant could seek make-whole money damages as an equitable remedy under ERISA Section 502(a)(3) if the participant can demonstrate that: [1] The plan breached its fiduciary duty to the participant. [2] The breach caused the participant damages." [Kenseth v. Dean Health Plan, Inc., 2013 WL 2991466 (7th Cir. June 13, 2013)] (Practical Law Company)


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.

CalPERS Committee Recommends 3% Increase in Health Premiums for 2014
"The California Public Employees' Retirement System's (CalPERS) Pension and Health Benefits Committee (PHBC) today recommended the Board of Administration approve a 2014 health care package that would raise overall premiums next year by an average of 3 percent for the Pension Fund's nearly 1.3 million health program members, the lowest average increase since 1998. The rate is lower than the 9.6 percent increase in 2013. If the full Board approves the new premium rates, they will take effect January 1, 2014." (California Public Employees' Retirement System)

Health Insurance Exchanges Falling Behind Schedule
"The Government Accountability Office said federal and state health officials still have major work to complete, offering its most cautious comments to date about the Obama administration's ability to bring the centerpiece of its signature law to fruition." (The Wall Street Journal; subscription may be required)

GAO Report on Status of CMS Efforts to Establish Federally Facilitated Health Insurance Exchanges
"CMS completed many activities necessary to establish FFEs by October 1, 2013, although many remain to be completed and some were behind schedule. CMS issued numerous regulations and guidance and took steps to establish processes and data systems necessary to operate the exchanges. The activities remaining cross the core exchange functional areas of eligibility and enrollment, plan management, and consumer assistance.... Though the system used to submit applications for QHP certification was operational during the anticipated time frame, several key tasks regarding plan management, including certification of QHPs and inclusion of QHP information on the exchange websites, remain to be completed.... CMS is also depending on the states to implement specific FFE exchange functions, and CMS data show that many state activities remained to be completed and some were behind schedule." (U.S. Government Accountability Office)

GAO Report on Status of Federal and State Efforts to Establish Health Insurance Exchanges for Small Businesses
"Much progress has been made, but much remains to be accomplished by CMS and states within a relatively short amount of time. CMS's timelines for the remaining key activities provide a roadmap for completion; however, factors such as the still-evolving scope of CMS's required activities in each state and the many activities yet to be completed -- some close to the start of enrollment -- could suggest the potential for future challenges. And while missed interim deadlines may not affect implementation, additional missed deadlines could do so. CMS said it is working on strategies in each state to address contingencies. Whether CMS's contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined." (U.S. Government Accountability Office)

Kaiser Family Foundation's Online Calculator for ACA Premium Subsidies
"This tool illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges (or 'Marketplaces') created by the [ACA].... With this calculator, you can enter different income levels, ages, and family sizes to get an estimate of your eligibility for subsidies and how much you could spend on health insurance. As premiums and eligibility requirements may vary, contact your state's Medicaid office or exchange with enrollment questions." (Kaiser Family Foundation)

Healthcare Costs 'An Abomination' Says Senate Finance Committee Chair
"The Senate Finance Committee spent more than two hours Wednesday discussing the relationship between healthcare costs and transparency with a panel of witnesses ... Sen. Max Baucus (D-MT), committee chair, closed the hearing with a request for specific recommendations from both the witnesses and 'anyone watching this hearing. It's an abomination that we pay about 60% more for healthcare in this country than the next most expensive country. Something's not quite right there. Market forces have a tough time in this area.'" (HealthLeaders Media)

Evolving Dynamics of Exchange Implementation
"[T]here is a lot of variety in the types of exchanges that will open next year. As of June 1, 2013: Sixteen states and the District of Columbia chose to establish a state-based exchange.... Thirty-three states chose to default to a federally facilitated exchange.... Seven states chose to pursue a state partnership exchange.... Seven states chose to pursue the marketplace plan management option.... Nineteen states have not opted for a formal role in exchange operations.... One state chose to pursue a bifurcated model." (The Commonwealth Fund)

Kaiser Health Tracking Poll, June 2013
"Among the public overall, 87 percent say it is 'very important' to them personally to have health insurance, 88 percent describe health insurance as 'something I need,' and two-thirds (68 percent) say insurance is worth the money it costs. Even among younger adults -- a group that many have speculated may be resistant to getting coverage under the ACA -- more than seven in ten rate having health insurance as 'very important,' and similar shares feel it is something they need and that it is worth the money. Overall, just a quarter of those ages 18-30 feel they are healthy enough to go without insurance." (Kaiser Family Foundation)

'Enroll America' Sets Private Outreach for Obamacare Sign-Up
"The group, which has strong ties to the Obama administration and the healthcare industry, announced plans for more than 50 events in 18 states, including California, Florida and Texas, as part of its 'Get Covered America' campaign. The events include canvassing neighborhoods and speeches at churches and other local venues to explain the need for health insurance, particularly among younger people, whose participation could determine whether 'Obamacare' succeeds or fails." (Reuters)

Health Law Won't Bring Prices Down for Patients
"Joined by a panel of health policy experts at the hearing to explore ways to make health pricing more transparent, [journalist Steven Brill] said that while he views efforts to disseminate prices for health services to consumers favorably, he believes that increasing transparency has its limits. '[Transparency] starts the conversation about prices that we didn't have in the debate over Obamacare. It's only a start,' Brill said. 'Obamacare does nothing about these prices. Nothing to solve the problem -- Zero.'" (Kaiser Health News)

District Court Issues Mixed Rulings in Retirees' Challenge to Increased Health Care Premiums
"Judge Janet B. Arterton ruled that, because the health benefits in question were not vested under the terms of the relevant plans and contracts, the retirees could not maintain their challenge to their former employer's altered method for calculating its portion of the retirees' premium payments. However, Arterton allowed the retirees to go forward with their claim that the employer committed fiduciary breach by failing to inform them of the changed calculation method." [Connecticut Independent Utility Workers Local 12924 v. Connecticut Natural Gas Corp., No. 3:12-cv-00961-JBA (D. Conn. June 14, 2013).] (Bloomberg BNA)

ACA and Self-Insurance for Small Employers (PDF)
"[M]any employers are considering an early switch to self-insurance prior to the 2014 effective date. This will help employers to not only take advantage of favorable incentives in ACA to exempt self-insurance from many requirements imposed on insurers, but also to avoid many of the ACA's costly benefit mandates and requirements.... 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)

Proposed Rules Clarify Health Plan Liability for Reinsurance Program Contributions
"The proposed regulations would amend the definition of contributing entity to clarify that a self-insured health plan includes a group health plan that is partially insured and self-insured, but only if the insured coverage is not major medical coverage (regardless of whether the self-insured coverage is major medical coverage)." (Practical Law Company)

Initial Bronze Plan Filings Reveal Higher Out-of-Pocket Costs
"Based on a review of 9,727 health plans in the current individual and family health insurance market, copayments were the most common form of cost-sharing for doctor visits and they averaged $28. In comparison, doctor visit copayments average $41 for Bronze Plans within the rate filings, an increase of 46% over current levels. The lowest Bronze Plan copayment for a doctor visit was $15 and the highest was $60." (HealthPocket)


Unfinished Fiscal Fix -- But the Cliff Is Still There
"There is ... a litany of other taxes, penalties and fees introduced in the ACA ... [that] could legitimately be brought to bear by Republicans in addressing the fiscal cliff problem ... inasmuch as they, like the Medicare taxes, have been designed to hit high bracket businesses and individuals, by reason of being (i) targeted at big businesses (viz., medical device makers, pharmaceutical manufacturers, and health insurance companies), or (ii) drafted with specific thresholds based on size of business payrolls or on individuals' income levels, as regards health insurance or self-insurance mandates imposed on businesses, or relating to insurance that individuals must purchase for themselves or their families, or (iii) imposed on the purchase of a specific luxury health item colloquially called a 'Cadillac insurance plan.'" (Alvin D. Lurie, Esq. on BenefitsLink.com)


Can Avik Roy and Ezra Klein Find Common Ground on Obamacare? [Video]
Forbes bloger and Manhattan Institute fellow Avik Roy discusses Obamacare with Washington Post blogger ("Wonktalk") Ezra Klein, including the "rate shock" controversy. The video is approximately 45 minutes long. (The Washington Post)


Mistakes Almost Everyone Makes in Thinking about Health Care
"[I]n a single New York Times editorial -- comparing U.S. and Swedish health care -- [Robert Frank] manages to repeat just about every major misconception about health economics that you are likely to run into.... [T]he real cost of health care is the value of the alternative uses of the real resources that are used to produce that care. So an alternative to adding up questionable monetary totals is to count real resources. And on that score, the picture looks very different." (John Goodman's Health Policy Blog)


GAO Confirms Obamacare Implementation Behind Schedule, Facing Challenges
"'What the GAO found is what most Americans have known all along: this law isn't ready for primetime and come October millions of Americans and small businesses are going to be the ones suffering the consequences,' said [Senate Finance Committee Ranking Member Orrin Hatch (R-Utah)]. 'We're less than four months away from open enrollment for the ObamaCare exchanges, but the programs' details have more holes in it than Swiss cheese, and this Administration still wants to guarantee that the exchanges will provide insurance coverage to millions of Americans? Give me break.'" (Committee on Oversight and Government Reform, U.S. House of Representatives)


Text of Answers to Actuarial Questions Posed by Congressional Representatives at Hearing on ACA Premiums (PDF)
"[1] Are premium estimates calculated assuming that all people will sign up for coverage or that some will not obtain coverage? ... [2] Will consumers in eastern North Carolina get better value from their insurance premiums under the [ACA]? ... [3] Can you describe some of the additional benefits insurance plans may offer to my constituents due to consumer protections under the [ACA]?" (Cori Uccello, Senior Health Fellow, American Academy of Actuaries)

Benefits in General; Executive Compensation

[Guidance Overview]

New York Adopts Final Regulations Limiting Executive Compensation for State-funded Service Providers
"The limit applies to executive compensation paid to covered executives. The regulations define covered executive as a compensated director, trustee, managing partner, officer or key employee whose: [1] Salary and/or benefits, in whole or in part, are administrative expenses (generally expenses authorized under agency rules that are incurred in connection with overall management and overhead and cannot be attributed to the provision of program services). [2] Executive compensation during the reporting period exceeds $199,000." (Practical Law Company)

Ruminations on Terminations in the Age of Long-Term Performance Plans
"[P]erformance-based [long-term incentive ('LTI') plans] made up 38% of the senior executive LTI mix in 2012, versus 30% in 2010. While this shift is targeted at aligning senior executive pay with shareholder outcomes, it should prompt a fundamental review of LTI award terms. In most cases, the terms of the LTI grants ... have not been changed to reflect the growing prominence of performance-based LTI, subtle differences in award timing and the increased emphasis on long-term performance." (Towers Watson)

Press Releases

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