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July 23, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

PT Benefit Enroller Specialist - English and/or Bilingual
for Total Benefit Concepts in ANY STATE

Installation Coordinator
for Ascensus in MN, PA

401k Client Relationship Manager
for Burnham Gibson Financial Group, Inc. in CA

ERISA Attorney / Assistant General Counsel
for Transamerica in IA

Benefits Tax Associate
for Boutique Benefits Firm in DC

for Saunders Financial in FL

Recordkeeping Team Leader
for Verisight, Inc. in CA

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Webcasts and Conferences

Evaluating Your Third-Party Administrator: Are You Getting What You're Paying For? -- Webinar
August 14, 2013 WEBCAST
(Lorman Education Services)

Webcast: PPA DC Restatements - What to Expect
August 27, 2013 WEBCAST
(National Institute of Pension Administrators)

Getting It Right - Know Your Fiduciary Responsibilities Webcast
August 7, 2013 WEBCAST
(Employee Benefits Security Administration (EBSA), U.S. Department of Labor)

Unraveling DOMA: How the Supreme Court's Windsor Decision Affects your Employee Benefit Plans -- Recorded Webinar
August 5, 2013 WEBCAST
(Nixon Peabody LLP)

View All Webcasts and Conferences

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[Guidance Overview]

PCOR Fees under Health Care Reform Due Next Week: July 31
"[S]elf-insured plans and insurance policies that provide only excepted benefits under Section 9832(c) of the Internal Revenue Code (IRC) (including limited-scope dental and vision benefits and most health FSAs) are not subject to PCOR fees. Also, self-insured plans and policies that are limited to employee assistance programs, disease management programs or wellness programs are not subject to PCOR fees if these programs do not provide significant benefits in the nature of medical care or treatment[.]" (Practical Law Company)


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]

Employer Checklist for ACA Compliance
"Employers must distribute notices to employees by October 1, 2013, and thereafter to new employees upon hire, regarding the existence of the Exchanges ... and related information on the employee's coverage options.... Employers that need to determine whether they will be subject to the employer mandate in 2015 (50 or more full-time or full-time equivalent employees in 2014) will need to record employee hours in 2014. [In 2014, employers] will need to count employees and record hours over the applicable measurement period to determine which employees are eligible for coverage offers effective January 1, 2015, under the employer mandate." (HighRoads)

Benefits Brokers Uneasy About Their Role As Health Care Change Looms
"Nearly half of the more than 300 insurance brokers polled in [a recent survey] said they are considering leaving the marketplace. But the vast majority of them -- 85% -- also say their clients are not ready for the impending changes under the [ACA]. Meanwhile, 55% percent of 1,884 employers said they've done absolutely nothing to prepare for the health care reform law's impacts. What's more, the study revealed that 75% of employees surveyed say they are relying on their employer to educate them on changes to their health benefit plans stemming from the reform law." (Business Insurance; free registration required)

Under Obamacare, Small Business Owners Will Take Big 'HIT' in 2014
"Several small business owners told Congress they don't know how they will stay afloat when the [ACA]'s Health Insurance Tax (HIT) raises insurance premiums by as much as $500 per employee in 2014. The business owners, who have covered 100 percent of their employees' insurance premiums in the past, said that with the HIT, they will struggle to offer any health care coverage at all." (CNS News)

Developments on the State Exchanges, Weeks of July 8 and 15
"This [article] includes news on rate proposals, outreach programs, participating insurers, promotional campaigns and the HHS report on rates on the individual and group markets. The State Exchange Table continues to provide the latest information on carrier participation and plan rates as they occur." (ExtendHealth)


11th Annual Value Based Care Congress - August 5-6 - Boston, MA

Sponsored by World Congress

Top visionaries and thought leaders discuss incentives, pay-for-performance, bundled payments, global reimbursement strategies, physician/hospital alignment, accountable care organizations, and measurement to improve the delivery of care.

Hospitals Are Quitting a Key Obamacare Cost-Control Program
"The [ACA] includes 45 separate provisions meant to reduce the cost of health care. It's a 'kitchen sink' approach: Trying lots of different demonstrations and hoping that, between the 45, a few prove especially successful. This, however, can prove an administrative nightmare for hospitals, especially when it means managing a completely new system for a relatively small number of patients." (Sarah Kliff in The Washington Post)

Which Employees Get Health Benefits?
"For both retirement benefits as well as paid sick leave and vacations, workers at larger private or government enterprises continue to have more access than their counterparts at smaller operations.... The latest findings continue a long-time trend. The take-up and access rates seldom change by more than a percentage point year-to-year[.]" (The Wall Street Journal; subscription may be required)

ERISA and Contractual Limitations Provisions: 'Don't Worry, Be Happy'
"Does telling a claimant that you 'will be happy to reconsider the claim' waive a contractual limitations provision? No.... It was not fatal that the SPD failed to disclose applicable time limits for judicial review.... Unum did not have to prove what was in the administrative file to rebut Plaintiff's equitable tolling defense.... 'When an adverse benefit determination is justified in the first instance and later denials are premised on the initial reason, there has been a 'full and fair review' that satisfies [the regulations].'" [Engleson v. Unum Life Insurance Company of America, 2013 WL 3336741 (6th Cir. July 3, 2013)] (Lane Powell PC)

Hobby Lobby Wins Temporary Relief from Birth Control Mandate
"Friday's decision means that the government must decide how to appeal a recent decision by the 10th Circuit, which said Hobby Lobby is likely to succeed on the merits of its case against the mandate. Lawyers for the Obama administration could either appeal the ruling to the Supreme Court or seek a final judgment at the district level." (The Hill)

27 Ways Obamacare Increases Your Health Insurance Premium
"Item 1 explains the $8 billion in new taxes that insurers must pay the federal government in 2014, an amount that increases through 2018 and then applies in all of the years to come.... Item 10 explains that patients will pay an estimated $2.3 billion more for prescription drugs.... Item 17 is the $25 million in transitional reinsurance program fees.... Item 19 covers the limit on the waiting period for enrollment into employer plans.... Item 22 is the slacker mandate, the requirement that 'children' up to age 26 must be covered by family policies." (John Goodman's Health Policy Blog)

Senators, House Republican Committee Leaders Press Administration to Release All Health Insurance Premiums Data
"According to an administration source, insurers are being informed whether their rates are similar to other insurers. These negotiations have been conducted behind closed doors, without assurances that a fair process has been observed or that the negotiations will result in better insurance products for consumers.... Open enrollment on the exchanges will begin October 1, 2013. Delaying the release of premium information until September will only serve to limit the amount of time individuals and families have to budget for the substantially higher insurance costs many will face." (Committee on Health, Education, Labor and Pensions, U.S. Senate)

Clarifying the Next Step on Hobby Lobby Contraception Dispute
"The dispute in an Oklahoma case over the contraception mandate in the new federal health care law would go directly to the Supreme Court, rather than go back to a federal appeals court, under an arrangement made by Justice Department lawyers late last week ... As a result, the government must decide by September 25 if it is going to take to the Supreme Court the case of Hobby Lobby v. Sebelius.... That would make the Hobby Lobby case the first to reach the Justices, among the more than sixty lawsuits that have been filed around the country by both profit-making businesses and non-profit institutions that object to the birth-control mandate as a violation of their religious beliefs." (SCOTUSblog)

Baffled Consumers Seek Help Understanding Medical Bills as Rising Costs Vary Widely Among Hospitals
"Until recently, [one patient's] doctor charged about $500 for a treatment, with Medicare paying $216.82. Her share, once she met a small annual deductible, was $50.70 for the treatment plus $60 for her 40 mg dose of gamma globulin. In January, she went to the same doctor in the same office for the same treatment. This time the bill was a whopping $19,235.07. Medicare paid $2,623.16. Her share: $655.80. The staggering increase wasn't the result of some technological breakthrough or new medical complication. Rather, her hematologist sold his practice to Nyack Hospital." (lohud.com)


Your Employer's Wellness Program Is Bad For Your Health
"Encouraged by the [ACA], our employers have started -- there's no other way to put this -- 'playing doctor.' But it turns out there is a reason real doctors go to medical school -- to learn real medicine. Most employers know so little about real medicine that if, instead of your own human resource department, your own physician dispensed this advice, he or she could lose their license. If you value your health, you should ignore much of what these programs tell you, beyond giving up smoking, eating better, and exercising more." (AOL Jobs)


Three Reasons Why Accountable Care Organizations Are Not Likely to Go Away
"[Accountable Care Organizations (ACOs)] aren't likely to fade from prominence in health care reform anytime soon for three reasons: [Fee-for-service (FFS)] payments are a vestige of the past.... Health insurance plans are building an important new market in providing ACO services to providers.... Hospitals and doctors recognize reality: per capita health care spending will shrink, FFS is going away and sophisticated actuarial modeling and analytic capabilities are necessary to navigate risk.... ACOs are here to stay, but their maturity will be an important story to follow. The key questions for the doctors and hospitals are straightforward." (Deloitte)


The Troubling Rise of Expensive Freestanding Emergency Rooms
"As a business model, these freestanding ERs seem like a boon for whoever owns them. One article cites that ER reimbursement for a sprained ankle can be $700, three or four times what it would cost at an urgent care or primary care clinic.... What the rise of free-standing ERs actually points to, however, are more pressing problems nationwide: people's dissatisfaction with the care they receive at urgent care and primary care facilities, and the need for more education about when an ER visit is necessary." (The Century Foundation)

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