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June 25, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Outside Retirement Plan Sales Consultant
for The Online 401(k) in TX

Benefits Attorney
for New York City Law Firm in NY

DCIO / Retirement (Internal) Intermediary Sales Consultant
for T. Rowe Price in MD

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Webcasts and Conferences

"Fundamentals of 401(k) and Other Qualified Plans" - a 3-day Seminar, Chicago
July 24, 2013 in IL
(SunGard Relius)

Toto, We Aren’t in Kansas Anymore… 409(p) Anti-Abuse Testing
July 18, 2013 WEBCAST
(National Institute of Pension Administrators)

What Every Benefit Consultant in TPA Needs to Know About Healthcare Reform
August 20, 2013 WEBCAST
(National Institute of Pension Administrators)

Exchange Notices: Are You Prepared? -- Teleconference
July 10, 2013 WEBCAST
(Employers Council on Flexible Compensation (ECFC))

IRS Tax Forum
July 9, 2013 in FL
(Internal Revenue Service (IRS))

IRS Tax Forum
July 30, 2013 in TX
(Internal Revenue Service (IRS))

Case Study: Serigraph — The Company that Solved Healthcare -- Webinar
June 27, 2013 WEBCAST
(Corporate Research Group)

Wouldn't It Be Nice -- Webinar
July 9, 2013 WEBCAST
(Conrad Siegel Actuaries)

Strategies for Small Group Employers -- Recorded Webinar
July 10, 2013 WEBCAST

Shifting Challenges: Mental Health in the ACA Era
July 2, 2013 in DC
(Alliance for Health Reform)

View All Webcasts and Conferences


Sibelius Says HHS Will Engage in 'Rate Negotiation' with Insurers on Federally-Run Exchanges
"The federal government is taking a more active role than expected in selecting plans for ObamaCare's new insurance exchanges, Health and Human Services Secretary Kathleen Sebelius said ... She contrasted the negotiations with state laws that accept all policies at all prices. 'We intend to do rate negotiation and make sure that the plans are going to offer consumers the best possible choices, as opposed to the law in some states ... where a company comes in with the plan rates and you take what you get,' Sebelius said.... The federal government doesn't have the authority to block premium increases or prevent companies from entering the federal exchange as long as they meet standards set out in the law. Those limitations could hinder the department's effort to negotiate with insurers." (The Hill)


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.

Be Careful With Your Life Insurance Enrollments
"Courts [after Amara] are now more likely to find remedies for ... enrollment errors. A recent decision from the federal District Court in Virginia ... held that an employer breached its fiduciary duty when it allowed an employee to enroll in the company's life insurance plan, encouraging him to believe he was eligible for benefits, when the employer knew or should have known that he was not eligible to enroll in the plan.... The court did not decide damages for the employee's family.... [The] employer is now potentially liable for the amount of the insurance that the employee thought he had in place." [Lewis v. Kratos, No. :12-cv-01012 (E.D. Va. June 11, 2013)] (Leonard, Street and Deinard)

Employers Test Plans That Cap Health Costs
"Hoping to cut medical costs, employers are experimenting with a new way to pay for health care, telling workers that their company health plan will pay only a fixed amount for a given test or procedure, like a CT scan or knee replacement. Employees who choose a doctor or hospital that charges more are responsible for paying the additional amount themselves. Although it is in the early stages, the strategy is gaining in popularity and there is some evidence that it has persuaded expensive hospitals to lower their prices." (The New York Times; subscription may be required)

Explicit Plan Terms Allow Self-Insured Plan to Recover Medical Benefits Paid to Employee Post-McCutchen
"The court rejected the defendants' argument that the 'make-whole doctrine,' which would prevent the employee from paying monies from his personal injury recovery until he was 'fully compensated for his injuries,' limited the plan's right to recovery, reasoning that the explicit terms of the plan 'unambiguously foreclose[d] the application of the make-whole doctrine.'" [Quest Diagnostics v. Bomani, No. 11-CV-00951 (D. Conn. June 19, 2013)] (Proskauer's ERISA Practice Center Blog)

Is a Private Exchange Right for Your Organization? (Part 2)
Infographic. Excerpt: "Private exchanges: top three ways employees will benefit. 1. Employees will have broad choices ... 2. Employees gain consistent access to education and decision-support tools to help them make good choices.... 3. Employees will have more flexibility to create their own benefit portfolios." (Mercer)

National Report Card on Medication Adherence (PDF)
"The score can range from 0 (non-adherence on all nine [measured] behaviors) to 100 (perfect adherence). The average score is 79 (C+).... [J]ust 24 percent earn an A grade for being completely adherent. An additional 24 percent [report] one non-adherent behavior out of nine (a grade of B). Twenty percent earn a grade of C and 16 percent a D for being somewhat non-adherent, with two or three such behaviors in the past year, respectively. The remaining 15 percent -- one in seven adults with chronic conditions -- are largely non-adherent, with four or more such behaviors, an F grade." (National Community Pharmacists Association)

[Guidance Overview]

Aetna Health Reform Weekly, June 17, 2013
"A record 14.4 million seniors are now enrolled in private Medicare plans despite fears that payment rate changes required under the [ACA] would hurt enrollments. Additionally, the continued growth in enrollments came despite a decline in the number of plans available. The popularity of Medicare Advantage speaks to the value seniors find in the private coverage option. But the authors of the research warn that the full impact of the ACA cuts has not been felt yet and that the changes could still disrupt the market." (Aetna)

As Hospitals Buy Physician Practices, Costs Rise, Medicare Report Finds
"A 15-minute evaluation visit nets $72.50 in a doctor's office -- $58 paid by Medicare and a $14.50 patient co-pay. But as a hospital outpatient evaluation, that same visit is worth 70 percent more, or a total of $123.38. Perhaps not surprisingly, the panel reported a 9 percent increase in the number of these evaluations performed through hospital visits between 2010 and 2011. And the rise in outpatient echocardiograms was even greater." (Tampa Bay Times)

$200 Billion Annual Opportunity from Using Medicines More Responsibly
"Patients not adhering to their doctors' medication guidance experienced complications that led to an estimated $105 billion in annual avoidable healthcare costs.... The largest avoidable impact is seen in diabetes, where such delays increased outpatient visits and hospitalizations.... Some signs of improvement are evident in the responsible use of antibiotics.... Many efforts are underway to address the underlying causes of avoidable spending and to improve medication use." (IMS Institute for Healthcare Informatics)

Massage Therapists, Chiropractors Wrote Unauthorized Drug Prescriptions -- But Medicare Paid
"In 2009, massage therapists, athletic trainers, chiropractors and other professionals wrote hundreds of thousands of drug prescriptions without the authority to do so. In some cases these were controlled substances like oxycodone, but Medicare Part D, which covers prescription drugs, paid for them anyway.... Through the private insurers that contract as Medicare Part D providers, the total came to $5.4 million for 72,552 of these prescriptions nationwide." (ABC News)

CBO Presentation: Offsetting Effects of Prescription Drug Use on Medicare's Spending for Medical Services (PDF)
12 presentation slides. Topics include: [1] Why did CBO revisit the effect of changes in drug use on medical service use? [2] How does the use of prescription drugs affect medical spending? [3] Methodology and methodological issues to consider; [4] Literature and results; [5] Example of applying the medical-drug 'offset.'" (Congressional Budget Office)

CBO Presentation: Understanding CBO's Medicaid Coverage Projections under the ACA (PDF)
15 presentation slides. "CBO usually updates its baseline projections 3 times a year and categorizes all changes as due to: changes in law, changes in the economic forecast, technical changes from new information, data, regulations, and changes in modeling assumptions.... When outcomes are uncertain, CBO considers a range of possible outcomes and aims for a projection that lies in the middle of the distribution of those outcomes. CBO carefully monitors new developments and incorporates new information, data, and research that will enhance its projections. CBO pays close attention to states' decisions on extending Medicaid coverage." (Congressional Budget Office)

CBO Presentation: Competition and Bids in Medicare's Prescription Drug Program (PDF)
13 presentation slides. Summary: "Beneficiaries place weight on the premium and tend to migrate toward low-premium plans. The design of the program generally motivates plan sponsors to submit low bids. The market has experienced a net exit of plan sponsors since 2007, which has generally allowed bids to increase slightly. Some rules of the program reduce the incentive for plan sponsors to submit low bids." (Congressional Budget Office)

CBO Presentation: Costs under Medicare's Prescription Drug Benefit and a Comparison with the Cost of Drugs under Medicaid Fee-for-Service (PDF)
23 presentation slides. Topics include: [1] Background on Medicare Part D; [2] Comparing actual Part D costs to CBO's original estimate; [3] Growth in Part D drug costs and plan payments; [4] Comparing costs of drugs under Part D and Medicaid Fee-for-Service. (Congressional Budget Office)


Health Data De-Identification: Getting It Right
"De-identification of health data can be an important tool for protecting privacy while still preserving the utility of health data for analytic purposes. But the ability of de-identification to meet both of these goals depends in large part on the deployment of effective health data de-identification methodologies. There are distressingly few resources (and only a handful of experts) available to health data researchers and health data stewards to help them understand -- and effectively implement -- health data de-identification methodologies." (Center for Democracy & Technology)


Deloitte Health Care Reform Memo, June 24, 2013
"The business practices of our industry are increasingly an open book. Deals between parties will be scrutinized and likely made public. We are a high profile industry whether we like it or not.... Going forward, educating consumers will be a vital consideration in our business practices.... With health care consuming a fourth of federal and state budgets, elected officials and policymakers will, of necessity, pay closer attention: not just about expenditures, about everything!" (Deloitte)


EBRI's Puzzling Study of CDHP Effects on Healthcare Costs
"There was a substantial first-year dip in discretionary services among the people who were switched to a CDHP.... The study authors seemed concerned about the use of preventive screening, but these charts show that the CDHP enrollees had a higher use of screening services than the PPO enrollees in the last three years of the study period. Perhaps the authors should be more concerned about why PPO enrollees had such a dramatic reduction in their use of screening services over the years of the study." (John Goodman's Health Policy Blog)

Benefits in General; Executive Compensation

[Official Guidance]

Text of DOL FAQs for Participants and Beneficiaries Following the Oklahoma Tornado
22 Q&As, including: "Q2: My employer's place of business is closed. I cannot locate my plan administrator. Who do I contact to file a claim for benefits or to obtain other documents such as certificates of prior coverage, or replacement identification documents? ... Q7: My employer did not pay my insurance premium. May I pay the premium to continue my coverage? Q8: I had COBRA coverage prior to the Oklahoma tornado. The location I was sending my COBRA premium to is closed. Where do I send my premium? ... Q13: How can I make changes in the way my 401(k) plan account is invested if it was affected by the events of the Oklahoma tornado? ... Q14: Can I get money out of my retirement plan if I need financial assistance to help me at this time? ... Q20: If my employer faces economic difficulties as a result of the events of the Oklahoma tornado, can my employer terminate my retirement plan, and if so, what happens to my benefits? ... Q21: All of the records concerning my employment with the retirement plan sponsor and my participation in the retirement plan were destroyed as a result of the events of the Oklahoma tornado. What do I do?" (Employee Benefits Security Administration, U.S. Department of Labor)

NAIC Proposals: Another Wakeup Call on Pay Disclosures, Especially for Mutual Insurers
"Outside boards at many large mutual insurers have asked management to develop pro-forma versions of both the Compensation Discussion and Analysis and the compensation tables routinely required of public companies by the SEC.... Mutual insurers that have yet to go down this path will likely have an added incentive to do so, given recent pay disclosure proposals issued by the National Association of Insurance Commissioners (NAIC). Mutual insurers may need to pay special attention to the NAIC proposals as they contemplate requirements for pay disclosure that are directionally similar to those required for public companies." (Towers Watson)

Press Releases

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