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July 16, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

DB/DC 401(k) Administrator
for Nicholas Pension Consultants in CA

Retirement Plan Administrator
for Altman & Cronin Benefit Consultants, LLC in CA

Pension Administrator
for Cornerstone Group in RI

Retirement Plan Sales Officer
for Heartland Financial USA, Inc. in AZ, CO, IA, IL, KS, MN, MT, NM, WI

Pension Benefits Specialist
for City of Lakeland in FL

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Webcasts and Conferences

Are You Keeping Your Client's Health Information Secure? -- Recorded Webinar
July 31, 2013 WEBCAST
(Nixon Peabody LLP)

FREE Webinar: "If I Were in Your Shoes: Best Practices for Running a Successful and Compliant Retirement Plan"
August 27, 2013 WEBCAST
(University Conference Services)

Health Care Reform for Employers: Now What? - Liverpool NY
September 18, 2013 in NY
(Lorman Education Services)

Health Care Reform for Employers: Now What? - Gaithersburg MD
September 19, 2013 in MD
(Lorman Education Services)

Health Care Reform for Employers: Now What? - Lexington KY
September 20, 2013 in KY
(Lorman Education Services)

IRS and DOL Corrective Procedures
August 15, 2013 in FL
(ASPPA Benefits Council of Central Florida)

View All Webcasts and Conferences

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[Guidance Overview]

July 31 Deadline Looms for Payment of CER Fees to Fund the Patient-Centered Outcomes Research Trust (PDF)
"If you use a wrap plan document and file a single Form 5500 for a plan that includes all of your health and welfare benefits, using the 5500 method to estimate the number of covered lives may significantly increase the number of covered lives (and thus, the fee). For example, if all employees receive employer-provided basic life coverage, the number of participants would include all employees, not just those enrolled in medical coverage.... The first CER Fee for the 2012 calendar year is due by July 31, 2013. IRS has issued a modified Form 720 with which to accommodate CER Fees in the near future." (Alston & Bird)


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]

Plan Ahead to Look Back: Implications of the Delay of the Pay or Play Penalties
"You can take a moment to reevaluate your chosen strategies and decide how best to use the one-year reprieve. The decision may be to forge ahead so as to use 2014 as a dry run (test systems and fix glitches) in preparation for the application of the pay or play penalties in 2015. Or, you may decide to hold off on implementing changes so as to avoid 2014 expenses and sequential adjustments of systems as governmental requirements evolve. Still, given the significant likelihood that the IRS will go forward with a look-back measurement method of identifying full-time employees (potentially without transitional rules) in 2015, you may want to try cumulating hours of variable-hour employees in a measurement period ending in 2014." (Vorys)

[Guidance Overview]

Philadelphia Offers Tax Credits for Health Benefits Provided to Same-Sex Partners (PDF)
"Philadelphia recently became the first U.S. city to offer employers tax incentives for making health benefits available to employees' same-sex partners and their children. Additional tax credits are available to employers for providing health insurance coverage for transgender care.... Employers should consider whether to expand their current health offerings to take advantage of the new tax credits, which are available for the 2013 tax year[.]" (Buck Consultants)

[Guidance Overview]

Flowchart Describes Rules for Employer Responsibility Under the ACA
"The Affordable Care Act does not require businesses to provide health benefits to their workers, but larger employers face penalties starting if they don't make affordable coverage available. Enforcement of those penalties will begin in 2015, a year later than originally scheduled. This simple flowchart illustrates how those employer responsibilities work." (Kaiser Family Foundation)

[Guidance Overview]

Maryland Enacts Leave Law for Family of Armed Service Members
"Effective October 1, 2013, Maryland employers must provide employees with one day of unpaid leave to be used on the day the employee's 'immediate family member' is leaving for or returning from active military duty outside the United States as a member of the armed forces. 'Immediate family member' is defined as the employee's spouse (including a same-sex spouse), parent, stepparent, child, stepchild or sibling." (Jackson Lewis LLP)

Fourth Circuit Finds Health Care Reform's Employer Mandate Is Valid Under Commerce Clause
"The Fourth Circuit affirmed the district court's judgment, holding that: The plaintiffs have standing to challenge the employer mandate, and the court has jurisdiction to hear the challenge. In light of the Supreme Court's decision in NFIB, the employer mandate is a valid exercise of Congress' authority under the Commerce Clause. The employer mandate's payment is a constitutional tax under Congress' taxing power. The employer and individual mandates do not violate the First Amendment or the [Religious Freedom and Restoration Act]." (Practical Law Company)

Some State Marketplaces Opt Not to Charge Smokers More for Premiums
"Under the [ACA], health insurers are allowed to charge smokers 50 percent higher premiums than nonsmokers for new policies sold to individuals and small employer groups. States have the option to reduce or eliminate the variation in rates, however, and six states and the District have opted not to charge smokers more, according to [HHS]. A few others have limited the premium differential to less than 50 percent." (Kaiser Health News)

Delayed Affordable Care Act Rules Ease Pressure on Employers
"Employers face an open enrollment period for 2014 under far less pressure because of a one-year delay of potential employer penalties under the [ACA] ... Despite the delay ... employers subject to ACA's health coverage provisions still must provide information about affordability and minimum value requirements that apply to employer-provided health care coverage ... But 'the pressure is off' for a year in terms of employers being subject to excise tax penalties for having full-time employees who receive subsidized coverage in one of ACA's health insurance marketplaces[.]" (Bloomberg BNA)

U.S. Health Spending as a Share of GDP
"[T]he historical trend since 1965 is roughly on a linear path, increasing by 4 percentage points each 15 years ... At this rate, the share would reach 20 percent in 2020, 28 percent in 2050, and 40 percent by 2095. And yes, health spending would reach 100 percent of GDP in about 310 years! ... What macro variable might we examine for clues as to the longer term path of this line and its possible leveling-off point?" (Altarum Institute)

Is Your Employee Paying a Deception Service to Provide a Fake Doctor's Note or FMLA Certification?
"[T]here are many tools available to employers to weed out these tall tales: [1] ask questions of the employee up front to determine whether FMLA might apply; [2] require completion of a leave of absence form that the employee (not the fake doctor) must complete; [3] authenticate and/or clarify the FMLA certification so that you can confirm that the health care provider and reasons for leave are legit; [4] where you have reason to doubt the FMLA certification, use the second and third opinion process; and [5] where an employee's return to work is a question mark and the information from the employee is fishy, [consider] an independent medical examination." (FMLA Insights)

No Veto: Massachusetts Employer Mandate to be Canceled for 2014 Despite Delay in ACA Employer Mandate
"Discussing his decision not to veto despite the ACA delay, the Governor expressed his belief that in Massachusetts, where there is near-universal coverage already, employers who have adopted health insurance programs after half a dozen years of robust regulatory enforcement -- in lieu of paying Fair Share Contributions and as a tool to attract and retain employees -- will maintain these insurance offerings until the federal employer mandate's new effective date despite the absence of the preexisting regulatory requirements." (Seyfarth Shaw LLP)

Reshaping the Health Care Experience: What's Next for Employers? What's Now?
"Employers that choose to continue offering employee health benefits will need to focus on two goals for their plans: viability and affordability. Decisions you make on how you will play in health care will have an impact on your organization's brand, how you will attract and retain employees, the health and productivity of your employees, and how you organize and deploy your workforce. With the excise tax looming, many organizations are increasingly adopting cost-reduction strategies they may have been reluctant to leverage before health care reform." (Towers Watson)

Labor Unions Say Obamacare Will 'Shatter' Health Benefits, Cause 'Nightmare Scenarios'
"[U]nions are waking up to the fact that Obamacare is heavily disruptive to the health benefits of their members. [Recently], representatives of three of the nation's largest unions fired off a letter to Harry Reid and Nancy Pelosi, warning that Obamacare would 'shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class.'" (Forbes)

Health Insurance Coming Into Reach for Many
"Many Americans still don't realize the ACA is coming into effect, including 6 out of 10 low-income workers who especially stand to benefit, according to a study by the Kaiser Family Foundation. Many mistakenly believe the law has been overturned and few have any idea how they are to go about purchasing health insurance from the online exchanges being set up in each state -- or that the federal government intends to help many of them pay for it. But many efforts are being made to simplify the process of buying insurance and to make the exchanges as user-friendly as possible." (The New York Times; free registration required)

Mixed Results in Healthcare Pilot Plan Under ACA
"Lowering health-care costs is tougher than improving the quality of care, according to first-year results from a key pilot program under the federal health law. All of the 32 health systems in the so-called Pioneer Accountable Care Organization program improved patient care on quality measures such as cancer screenings and controlling blood pressure ... But only 18 of the 32 managed to lower costs for the Medicare patients they treated -- a major goal of the effort." (The Wall Street Journal; subscription may be required)

Kentucky's Rush Into Medicaid Managed Care Is Cautionary Tale for Other States
"Ever since Kentucky rapidly shifted patients from traditional Medicaid to private health plans that manage their care for a set price, problems have been widespread. Patients complain of being denied treatment or forced to travel long distances to find a doctor or hospital in their plan's network. Advocates for the mentally ill argue the care system for them has deteriorated. And hospitals and doctors say health plans have denied or delayed payments. Experts warn that what happened in Kentucky should be a cautionary tale for other states that rush to switch large numbers of people in Medicaid[.]" (Kaiser Health News)

What Types of Hospitals Have High Charge-to-Reimbursement Ratios?
"While the difference between charges and reimbursement rates is well known, little has been written about the characteristics of hospitals associated with these factors.... Hospitals that charge more tend to be affiliated with a hospital system, located in urban areas, and investor-owned, while hospitals that charge less tend to be small, unaffiliated, government-owned entities located in rural areas." (Health Affairs)

CBO Cost Estimate for H.R. 2667, Authority for Mandate Delay Act
"H.R. 2667 would delay for one year certain reporting requirements as well as penalties for certain large employers that do not offer 'affordable' health insurance coverage to their employees (as affordability is defined in the [ACA]).... Because H.R. 2667 essentially codifies the Administration's recent announcement, CBO and the staff of the Joint Committee on Taxation (JCT) estimate that enacting H.R. 2667 would not affect direct spending or revenues. Therefore, pay-as-you-go procedures do not apply. CBO and JCT have not yet completed an analysis of the impact that the Administration's July 2, 2013, announcement and other recently issued final rules will have on spending and revenues under current law. That analysis will be released soon." (Congressional Budget Office)


Deloitte Health Care Reform Memo, July 15, 2013
"in the long term, shifting responsibility to individual employees to manage their health while gauging how the health market will shake out as a result of the ACA. What's it mean going forward? It means health care will be a central theme in board rooms and management meetings for employers large and small.... It means human resource professionals will become health care experts, moving well beyond benefits management to assess and recommend bold changes linked to the company's long- term goals for its workforce and competitiveness. And it means employers are paying attention to the ACA with an eye beyond penalties and compliance to their role in shaping the new normal." (Deloitte)


It's No Contest: The Employer Mandate Has Far Less Effect on Coverage and Costs Than the Individual Mandate (PDF)
"While a delay of one year in the implementation of the employer mandate will not have a discernible effect on coverage or government spending on insurance, delaying the individual mandate would undermine a critical component of the coverage expansion in the ACA. Combined with the Medicaid expansion, insurance market reforms, and subsidies to assist those with modest incomes to purchase private insurance through the health insurance exchanges, the ACA's individual responsibility requirement provides stability to insurance pools and financial access to adequate coverage for a broad swath of the population disadvantaged by the prior system." (Urban Institute)


Health Insurers Will Continue to Skirt Eligibility Requirements
"Although insurers can no longer reject applicants who fail medical underwriting standards, they have learned to selectively market their plans to healthier populations, and they will continue to do so. They intensify their targeting to younger, healthier individuals while avoiding marketing to higher cost individuals. As [a recent Wall Street Journal] article indicates, an industry has arisen to help insurers select their targets for marketing, based on the health of selected groups or on the average health in geographical regions (ZIP Codes). This adds yet more administrative costs to our system already tremendously overburdened with administrative waste." (Physicians for a National Health Program)

Benefits in General; Executive Compensation

[Guidance Overview]

Top 10 Summary Plan Description Issues Beyond the ERISA Regs
"[1] Firestone Language.... [2] Exhaustion Requirements.... [3] Forum Selection Clause.... [4] Modification of the ERISA Rights Statement.... [5] Time Limit for Filing a Lawsuit.... [6] Subrogation and Reimbursement Language.... [7] Incorporation of Securities Filing.... [8] SPD Disclaimer.... [9] Allocation of Fees.... [10] Circular 230." (Proskauer's ERISA Practice Center)

[Guidance Overview]

Upcoming Deadlines for Puerto Rico Retirement and Welfare Plans (PDF)
Topics in this article include: Due Date to Comply with PR Treasury Annual Filing Requirement for Trusts Funding Calendar Year Puerto Rico Tax Qualified Retirement Plans is July 31st -- Automatic Extension is Available; Puerto Rico Retirement and Certain Welfare Benefit Plans Must Also File IRS Forms 5500 and 8955-SSA; and Puerto Rico Plans are Subject to ERISA's Fee Disclosure Notice Requirements. (Groom Law Group)

Press Releases

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