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July 5, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Senior Benefit Advisor
for ThinkHR Corporation in CA

Retirement Services Manager
for District of Columbia Retirement Board in DC

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Webcasts and Conferences

Voluntary Fiduciary Correction Program Workshop -- Free
August 21, 2013 in MO
(Employee Benefits Security Administration (EBSA), U.S. Department of Labor)

Recent DOL Enforcement Initiatives & ERISA Supreme Court Update
August 11, 2013 in CA
(ABA Joint Committee on Employee Benefits)

How Does the DOMA Decision Affect My Employee Benefit Plans? -- Webcast
July 10, 2013 WEBCAST
(International Foundation of Employee Benefit Plans)

Employee Benefit Plans - 2013 Plan Sponsor Update -- Webcast
July 11, 2013 WEBCAST
(PricewaterhouseCoopers LLP)

Turbo Charge Your EAP Program: Addressing Hardship Through Effective Collaboration
July 31, 2013 WEBCAST
(TrainHR)

View All Webcasts and Conferences



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[Official Guidance]

Text of Final CMS Regs on Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment
606 pages. "This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules ... This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.... [T]his final rule provides notice that we are considering, for purposes of the initial open enrollment period for enrollment in a Qualified Health Plan through the Exchange, whether various provisions of the Medicaid and CHIP regulations should be effective October 1, 2013, or whether a later effective date is appropriate. In this final rule, we do not address all of the proposed regulatory changes to 42 CFR parts 431, 435 and 457. We are focusing on those changes that are most needed to implement the changes made by the [ACA] starting in 2014. We intend to address certain of the other provisions in future rulemaking." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)


[Advert.]

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[Official Guidance]

Health Coverage Tax Credit Newsletter, July 2013 (PDF)
"The legislation that authorizes the Health Coverage Tax Credit (HCTC) expires on January 1, 2014 and the tax credit will no longer be available. There is no indication from Congress that the HCTC will be extended. The HCTC Program does not have the authority to transition HCTC participants into any other federal health program." (Internal Revenue Service)

[Guidance Overview]

Final ACA Regs Issued on Exemption of Contraceptive Coverage by Religious Employers, Including Student Enrollees and Their Dependents
"The applicability date of these final regulations, with the exception of the amendments to the religious employer exemption, apply to group health plans and health insurance issuers for plan years beginning on or after January 1, 2014. The amendments to the religious employer exemption apply to group health plans and health insurance issuers for plan years beginning on or after August 1, 2013. The final regulations retain the definition of a religious employer, modify the accommodations provided for eligible organizations that object to contraception coverage on religious grounds, and describe how contraceptives will be provided and paid for under both a fully insured and a self-insured group health plan." (McDermott Will & Emery)

[Guidance Overview]

Play or Pay Rules Delayed Until 2015
"Though the Treasury urged employers to maintain or expand health coverage during what they referred to as the '2014 transition period,' there will be no risk of penalties to an employer under the ACA in the 2014 Plan Year for failure to offer minimum essential coverage that is affordable to an adequate number of employees and their dependents... Individual subsidies will presumably still be available, even though they are tied to whether the individual was offered affordable employer-paid coverage." (Davis Wright Tremaine LLP)

[Guidance Overview]

Administration Delays Until 2015 Large Employer Shared Responsibility Requirements, Reporting and Tax Penalties (PDF)
"Importantly, the Department said its actions do not affect employees' access to the premium tax credits available under the ACA, although without employers reporting on who they provide coverage to, it is hard to see how the government will know which individuals qualify for a tax credit. Without more, this suggests that the Department intends that marketplaces for individuals will still be available January 1, 2014. It also suggests that most Americans will still have to obtain health benefits coverage or pay the individual tax. It is not clear if the notice employers are required to send to all employees by October 1, 2013 advising them of the marketplaces will still be required." (Dickinson Wright)

[Guidance Overview]

Employer Health Care Mandate and Reporting Requirements Delayed Until 2015
"Employers who were planning to expand coverage to new classes of employees or dependents, or change cost-sharing structures to comply with affordability requirements, can postpone implementation of those changes for up to a year.... Employers may wish to voluntarily comply with the new IRS reporting requirements beginning in 2014 in order to start data collection, and to develop and test IT systems before penalties can be imposed for reporting errors." (Nixon Peabody LLP)

[Guidance Overview]

Federal District Court Blocks Michigan Law Eliminating Health Benefits for Domestic Partners of Public Employees
"The Act did not by its terms make reference to gay or lesbian employees. Nevertheless, Judge Lawson found that, 'The historical background and legislative history of the Act demonstrate that it was motivated by animus against gay men and lesbians.' The decision relied in part on the Supreme Court's recent decision in United States v. Windsor, which struck down the provision of the federal Defense of Marriage Act which had precluded federal recognition of same-sex marriages." (Calhoun Law Group)

California Says Employer Mandate Delay Won't Affect Health Care Exchange
"Covered California, the state's new health insurance exchange, said it remains on track to start enrollment for consumers Oct. 1. 'This has virtually no impact on Covered California and the enrollment of millions of Californians eligible for subsidized coverage,' said Peter Lee, executive director of Covered California. 'This doesn't change our job. The fact that individuals are eligible for a subsidy or not has nothing to do with whether an employer pays a penalty[.]'" (Los Angeles Times)

Delay in Obamacare Requirement Puts Onus on the Honor System
"[W]ithout the reporting requirements of the employer mandate in 2014, 'the exchanges and the IRS will not be able to verify whether someone's coverage is unaffordable' and thus whether the person is eligible for subsidies, said law professor Timothy Jost of Washington and Lee School of Law in Lexington, Virginia. That leaves it up to individual consumers to be honest about what they do, or do not, qualify for." (Reuters)

'I Wish We Had One More Year:' States Are Struggling to Launch Obamacare on Time
"Although the states are promising to provide new marketplaces for individuals to compare and buy health insurance plans, the Web portals will be a bare-bones version of what was initially envisioned.... 'In 2011, there was this "we're going to save the world" mentality,' said Rebecca Pearce, executive director of the Maryland Health Benefit Exchange. 'In 2013, it focuses more on how do we deliver on the requirements of the law.'" (The Washington Post)

National Health Plans, Designed To Spur Competition, May Be Unavailable In Some States Next Year
"OPM has declined to name the insurers or states under consideration, but the White House says there will be national plans in at least 31 states. Blue Cross Blue Shield plans are expected to be one of the multi-state plans, raising questions about whether that will really result in greater competition since they are already in every state and dominate some individual markets." (Kaiser Health News)

District Court Finds No Duty of Plan Administrator to Consider Evidence Submitted After Denial of Administrative Appeal (PDF)
"[T]he Plan gave Plaintiff only one appeal of MetLife's adverse benefits determination, and that review was all that was required under ERISA as well.... That appeal was when Plaintiff had both the right and the opportunity to furnish whatever evidence she desired to support her claim. While Plaintiff concedes that MetLife provided that appeal, she urges that ERISA also imposes a continuing duty on MetLife to consider all of the additional evidence she later furnished.... In essence, [Plaintiff] ... seeks to have the court order MetLife to re consider Plaintiff's claim in light of the evidence that she failed to timely submit and which MetLife had no legal obligation to consider, under either the terms of the Plan or ERISA itself. The court declines to do so." [Blair v. Metropolitan Life, No. 12-1776 (N.D. Ala. June 28, 2013) (U.S. District Court, Northern District of Alabama)

Most U.S. Health Spending Is Exploding, But Not for Mental Health
"Mental health spending, both public and private, was about $150 billion in 2009, more than double its level in inflation-adjusted terms in 1986 ... But the overall economy also about doubled during that time. As a result, direct mental health spending has remained roughly 1 percent of the economy since 1986, while total health spending climbed from about 10 percent of gross domestic product in 1986 to nearly 17 percent in 2009." (The New York Times; subscription may be required)

U.S. Supreme Court to Opine on the Use of Contractual Limitation Periods in ERISA Plans
"Federal courts have generally enforced contractual limitation periods for benefit claims as long as they are made known to participants and beneficiaries and are not 'manifestly unreasonable.' The courts are less consistent in enforcing contractual accrual provisions. The Supreme Court recently granted certiorari ... to resolve the circuit split on the question of '[w]hen should a statue of limitations accrue for judicial review of an ERISA disability adverse benefit determination?'" (Proskauer's ERISA Practice Center)

Second Circuit Finds Subjective Evidence Worth Its Weight in Disability Claim
"How do you handle a claim supported only by 'subjective' evidence? Can you reject the claim outright? No. You must weigh the subjective evidence.... This case also stands for the interesting proposition that a claimant with a history of 'hard work' may be more credible[.]" [Miles v. Principal Life Insurance Company, No. 12-152-cv (2nd Cir. June 26, 2013)] (Lane Powell PC)

Loosening the PTO Rules
"With all the rhetoric around the benefits of establishing more flexible-work arrangements for employees, it's somewhat surprising that the number of companies taking creative approaches to workers' paid vacation time is as low as it is.... [O]nly 5 percent allow employees to buy more vacation time through payroll deductions and only 7 percent allow them to donate unused vacation days to a companywide kitty or to specific individuals. What's more, those figures don't seem to be trending up or down." (Human Resource Executive Online)

Text of Letter to HHS Seeking Small Business Insurance Coverage Clarification (PDF)
"The State of Vermont and the District of Columbia [have] proposed a requirement that would force all individuals and small business to purchase coverage through [their] Exchange[s]. We are concerned that these proposals will result in less consumer choice and higher costs for many businesses and individuals. We are also concerned that the mandatory small business requirement conflicts with the text of PPACA that requires participation in the Exchange to be voluntary." (Committee on Oversight and Government Reform, U.S. House of Representatives)

Round-Up of State Action on ACA Implementation
"Currently, 16 states and the District of Columbia intend to operate a state-based marketplace, while the remaining 34 states will have a federally facilitated marketplace. Seven of these 34 states will conduct plan management activities and/or consumer assistance and outreach functions in a state-federal partnership model. Another seven of the 34 will conduct plan management activities only, and one, Utah, will operate the small-business marketplace while the federal government operates the individual marketplace. Here is a list of recent state and federal activity." (The Commonwealth Fund)

[Opinion]

Blows to Obama's Healthcare Law Pile Up, Cutting Its Sweep
"The law was designed to extend insurance to most of the 50 million Americans who lack coverage. But when the main features of the law go live Jan. 1, the share of those people set to remain uninsured is bigger than the proportion set to gain coverage. That raises the prospect of a long battle to make the law work as its supporters intended, and the likelihood that opponents will dismiss it as a costly failure." (The Wall Street Journal; subscription may be required)

[Opinion]

Medicare Analysis Confirms Some 'Preferred Pharmacy' Drug Plans are Costlier to Plan Sponsors than Traditional Benefit Designs
"In analyzing 2012 prescription drug claims in the Medicare Part D drug benefit, CMS finds that 'prices are sometimes higher in certain preferred networks,' compared to traditional plans offering patients greater choice ... There is a simple solution to this problem ... Allow any legitimate pharmacy provider that is willing to accept a health plan's terms and conditions, including reimbursement, to participate in that plan's network, whether it is a preferred network or a traditional one." (National Community Pharmacists Association)

[Opinion]

White House Delays Employer Mandate, But What About Rules Burdening Small Employers?
"The administration did not delay the many new requirements facing employers who choose to offer health insurance in the small group market -- employers with less than 50 workers.... While small employers are not required to offer coverage, if they do they come under that large number of new essential health benefit mandates and group rating rules that won't apply to large employers. These small group requirements are expected to increase the cost of small group coverage by an average of 15% -- with wide variation by state and the average age of the group." (The Health Care Blog)

[Opinion]

The Massive Costs of the Latest Obamacare Waiver
"The Congressional Budget Office (CBO) estimated in May that the employer mandate would raise $10 billion in revenue in its first year.... That $10 billion in employer mandate revenue projected for fiscal year 2015 will almost certainly disappear. Then there's the separate question of whether, when, and how employers will drop their health insurance plans and dump their workers on the exchanges." (The Heritage Foundation)

[Opinion]

Employer Penalties Do Not Drive Healthcare Coverage
"[T]here is very little in the ACA that changes the incentives facing employers that already offer coverage to their workers, and fully 96 percent of employers with 50 or more workers already offer today. Competition for labor, the fact that most employees get greater value from the tax exclusion for employer sponsored insurance than they would from exchange-based subsidies, and the introduction of a requirement for individuals to obtain coverage or pay a penalty themselves, are the major factors that will keep the lion's share of employers continuing to do just what they do today with no requirements in place to do so." (Urban Institute)

Benefits in General; Executive Compensation

[Guidance Overview]

Benefit Issues in Puerto Rico: Impact of the ACA, ERISA and the PBGC
"The most controversial parts of the ACA do not apply in Puerto Rico. These are the so-called 'pay-or-play' employer mandate and individual minimum essential coverage mandate.... The status of PBGC coverage for Puerto Rico defined benefit plans is one that has been the subject of review and analysis by the PBGC for quite some time.... PBGC may now consider the affirmative election to be a prerequisite before a Puerto Rico based plan is subject to Title IV of ERISA." (Proskauer's ERISA Practice Center)

[Guidance Overview]

What Federal Recognition of Same-Sex Marriage Means for Employee Benefits
"Many plans were drafted to specifically incorporate the DOMA definition of spouse to avoid any confusion regarding the treatment of same-sex spouses under the terms of the plan. Therefore, plan documents will need to be reviewed to determine if the DOMA definition of spouse is reflected. If it is, an amendment to the plan may be required. With respect to qualified retirement plans, any required amendment generally will need to be adopted by the last day of the current plan year, unless the IRS provides for a delayed amendment due date." (Bond, Schoeneck & King, PLLC)

Impact of the Supreme Court's DOMA Decision on Employee Benefit Plans
"The Supreme Court did not disturb the provisions of DOMA that allow states to refuse to recognize same-gender marriages performed under the laws of other states.... This will present particular challenges to employee benefit plans maintained by multistate employers.... The Supreme Court's decision has left us with many questions, some of which can be answered by the regulators, others of which will be sorted out, if at all, by the courts. Set out [in this article] are some of the most pressing questions for employer-sponsored employee benefit plans:" (Mintz Levin)

DOL Semiannual Regulatory Agenda, Spring 2013
Lists upcoming regulatory projects for DOL, including EBSA. (U.S. Department of Labor)

[Opinion]

Retirees' Medical Bills Are Bringing Down Detroit
"Pension and retiree-health-care obligations make up the bulk of the city's unsecured debt, and their costs are rising rapidly. The emergency manager, Kevyn Orr, is right that Detroit must reduce its retirement-related debt to secure its future, but he has to be more specific about his target. Cutting retiree health care ... should take priority over pensions." (Bloomberg)

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