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July 29, 2013          Get Retirement News  |  Advertise
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401(k) Administrator
for G & C Pensions in NY

401(k) Administrator
for The Pension Service, Inc. in CT

Retirement Plan Administrator
for United Retirement Plan Consultants in MD, PA

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for United Retirement Plan Consultants in MD, PA

New Business Conversion Specialist
for TPA for 401(k) and Employer-Sponsored Retirement Plans in CA

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Webcasts and Conferences

The SAFE Retirement Act of 2013 A Boost for the Private Retirement System -- Webcast
September 24, 2013 WEBCAST
(American Society of Pension Professionals & Actuaries (ASPPA))

ERISA Assets: QPAM and INHAM Audit Legal Requirements and Best Practices -- Webinar
September 10, 2013 WEBCAST
(Strafford)

11th Annual ERISA Update
October 17, 2013 in WA
(ASPPA Benefits Council of Great Northwest)

View All Webcasts and Conferences


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[Guidance Overview]

New NYC Law Requires Employers to Provide Earned Sick Leave
"In order to earn sick time, an employee must work within New York City, have been employed for at least four months and have worked for more than 80 hours in a calendar year with the employer. Temporary and part-time employees are, likewise, entitled to earn sick time if they meet these minimum requirements." (Wolff Samson)  


[Advert.]

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Third Circuit Ruling Creates Split on Contraception Coverage Mandate
"Creating a direct split among federal appeals courts and thus enhancing chances that the Supreme Court will take on the issue, the Third Circuit Court ruled ... that a family-owned, profit-making business cannot challenge on religious grounds the new federal health care law's mandate of birth control health insurance for its workers. The two-to-one decision by the Philadelphia-based court conflicts with a recent ruling by the Denver-based Tenth Circuit Court.... [T]he Third Circuit panel declared that 'for-profit, secular corporations cannot engage in religious exercise' even though they are operated by religiously devout owners." [Conestoga Wood Specialties Corp. v. Health and Human Services Department, No. 13-1144 (3rd Cir. July 26, 2013)] (SCOTUSblog)  

Text of Third Circuit Decision in Conestoga v. Sebelius, Upholding Contraceptive Mandate (PDF)
96 pages. Excerpt: "[T]he purpose of the Free Exercise Clause 'is to secure religious liberty in the individual by prohibiting any invasions thereof by civil authority.' ... And as the District Court aptly noted in its opinion, '[r]eligious belief takes shape within the minds and hearts of individuals, and its protection is one of the more uniquely 'human' rights provided by the Constitution.' We do not see how a for-profit 'artificial being, invisible, intangible, and existing only in contemplation of law,' that was created to make money could exercise such an inherently 'human' right." [Conestoga v. Sebelius, No. 13-1144 (3rd Cir. July 26, 2013)] (U.S. District Court for the Western District of Oklahoma)  

Futility Is Not in the Eye of the Beholder, But Depends on the Facts
"[T]he dividing line between when to require exhaustion and when to allow an exception should be fact based: when a claimant simply alleges the elements needed to establish an exception, exhaustion should be strictly enforced, but an exception should be allowed where the plaintiff can demonstrate that the factual elements of a particular exception exist." [Algandoz-Betancourt v. Sedgwick Claims Management Services, Inc., No. 12-1147 (D.P.R. July 11, 2013)] (Stephen Rosenberg of The McCormack Firm, LLC)  

Text of Seventh Circuit Case Allowing ERISA Claim for Benefits Against Wisconsin Health Insurers Over Chiropractic Coverage (PDF)
The three-judge panel determined that ERISA did not preclude the bringing of suit under ERISA section 1132(a)(1)(B) by several employer-sponsored health plan participants directly against six health insurance companies rather than the employers, when the plans are "insurance-based" and the insurance companies "decided all eligibility questions and owes the benefits." The participant claimed the insurance policies illegally applied co-payment requirements to chiropractic care under Wisconsin law. The court examined the Wisconsin law and found the policies were in conformance, however, so the district court's denial of the claim was affirmed. A claim for breach of fiduciary duty under ERISA was rejected as being inapplicable to the insurance companies. [Larson v. UnitedHealthcare Insurance Company, et al., No. 12-1256 (7th Cir. July 26, 2013)] (United States Court of Appeals for the Seventh Circuit)  

IRS Employee Union: We Don't Want Obamacare
"The union leaders are providing members with a form letter to send to congressmen that says, 'I am very concerned about legislation that has been introduced by Congressman Dave Camp to push federal employees out of the Federal Employees Health Benefits Program and into the insurance exchanges established under the Affordable Care Act.'" (National Center for Policy Analysis)  

Detroit Looks to Health Insurance Exchanges to Ease Costs
"As Detroit enters the federal bankruptcy process, the city is proposing a controversial plan for paring some of the $5.7 billion it owes in retiree health costs: pushing many of those too young to qualify for Medicare out of city-run coverage and into the new insurance markets that will soon be operating under the Obama health care law.... Similar proposals that could shift public sector retirees into the new insurance markets, called exchanges, are already being planned or contemplated in places like Chicago; Sheboygan County, Wis.; and Stockton, Calif." (The New York Times; subscription may be required)  

Medicare Pioneer ACOs Save Money But Lose Physicians
"Physicians in nine large groups have dropped out of Medicare's pioneer accountable care organization initiative after just one year of participation, but health policy officials and doctors leading ACO groups said they are not turning their backs on coordinating care for beneficiaries. The 32 pioneer ACOs cut costs for Medicare by 0.3% in 2012 while similar patient populations outside of the initiative experienced spending increases of 0.8%." (American Medical News)  

Promoting Health Insurance Exchange with No Help from Texas Officials
"Of the more than 6.3 million uninsured Texans -- the state has the country's highest rate of uninsured residents -- almost half will be eligible to buy insurance through the federal exchange ... The Texas Department of Insurance has made no extra effort to publicize the federal exchange, said John Greeley, an agency spokesman. In 2010, it conducted a federally financed campaign about health insurance options but has done nothing comparable since, he said, adding that those with questions could use the department's Web site or telephone service." (The New York Times; subscription may be required)  

Maryland Regulators Slash Rates for Obamacare Insurance Policies
"In some cases, the final premiums were cut by a third for the Maryland Health Connection exchange, pleasing advocates of affordable coverage but prompting others to question whether such low prices can be sustained. Regulators reduced prices for all nine carriers filing to sell policies in the marketplace.... Under the revised prices, monthly premiums for a 25-year-old nonsmoker buying a lower-benefit 'bronze plan' in the Baltimore area will range from $131 to $237. For a 50-year-old Baltimore nonsmoker buying a higher-benefit silver plan, prices go from $267 to $470 per month." (Kaiser Health News)  

Privacy and Security in the ACA's Data Hub
"Although the system is called the data hub, it is not a repository of information but rather a 'routing tool.' When an individual enrolls in a health insurance marketplace, her application information is processed through the hub in three steps.... The health insurance marketplaces will be able to verify eligibility by communicating with one secure portal administered by CMS instead of having to establish their own secure connections to SSA, [Department of Homeland Security] and IRS databases." (Center for Democracy & Technology)  

WellPoint Could See $20 Billion Revenue Boost from ACA
"Growth opportunities created by the reform law are 'more compelling than we have seen in several years' WellPoint CEO Joseph Swedish told analysts ... The insurer projected that expanding Medicaid and selling plans on exchanges could help increase its revenue from $70 billion to $90 billion." (FierceHealthPayer)  

Take a Health Plan and Call Me in the Morning: Pharmacies Plan Obamacare Pitch
"Major pharmacy chains are preparing plans for promoting the [ACA] and educating consumers about their options under the health law overhaul. Part of it has to do with customer service: If patients turn up at the pharmacy counter with questions, it would behoove pharmacists to have answers. But it's not a completely altruistic effort, as higher insured rates make it easier for pharmacy customers to pay for their prescriptions." (The Washington Post; subscription may be required)  

Kathleen Sebelius on Obamacare's 'Very Tight' Deadlines
"How is it going to go on Oct. 1? ... [W]e are testing all of the data systems like crazy to try and make sure that information can flow easily through the system. I'm sure there will be operational challenges in the opening of the markets, but I think we're trying to build in redundancies and be able to respond very rapidly. And really we see Oct. 1 as the beginning of the campaign that really lasts for six months." (The Washington Post; subscription may be required)  

House Oversight Committee to Hold July 31 Hearing on IRS Obamacare Rule
"IRS and Treasury have not been able to provide the Committees with detailed information about the factors considered by IRS and Treasury that expanded the availability of PPACA's tax credits to federal exchanges ... Legal experts at the Congressional Research Service have stated that the IRS rule seems to go against the health law and is 'contradictory to clear congressional intent.' The rule, which adds hundreds of billions of dollars in new and unauthorized federal spending, is currently the subject of two lawsuits challenging its legality. Individuals involved in the legal challenges will be among the hearing witnesses." (Committee on Oversight and Government Reform, U.S. House of Representatives)  

[Opinion]

Republican and Democratic Approaches to Health Reform: Is There a Dime's Worth of Difference?
"There are basically three criteria by which to judge a public policy: efficiency, equity and liberty. To what degree does the policy allow us to achieve a social objective at minimum cost? (Efficiency) To what degree does the policy treat people fairly? (Equity) And to what degree does it leave individuals free to make their own decisions? (Liberty) With respect to efficiency ... I see the Republican and Democratic approaches as different as night and day." (John Goodman's Health Policy Blog)  

[Opinion]

Tobacco Users Will Increase the Bill for Taxpayers
"[I]t is clear the people eligible for the premium tax credit program will be heavily populated by tobacco users. States that do not allow insurers to adjust premiums for tobacco use will be doing a disservice to taxpayers in every State as the taxpayers will ultimately be responsible for funding the premium tax credit program which will be significantly impacted by the States that restrict insurers from adjusting premium prices for tobacco use." (Moulder Law)  

[Opinion]

Think Messaging Will Change Opinions on Obamacare? Think Again.
"Public support for health-care reform declined markedly during the first year or so of Obama's presidency, at the same time that Republicans were ramping up their attacks on the legislation.... Signing up people, not shifting public opinion, is the aim of the Obama administration's latest efforts. But after five years of debate, it is clear that public opinion on the Affordable Care Act is unmoved by catchy slogans alone." (The Washington Post; subscription may be required)  

Benefits in General; Executive Compensation

Tightening Incentive Plan Performance Criteria a Top Priority for Both HR and Finance Executives
"Finance executives are less likely than HR execs to view executive incentive programs as appropriately structured to discourage excessive risk-taking. Almost three-quarters (74%) of the HR executives believe their executive incentives effectively discourage excessive risk-taking, compared to only 58% of the Finance executives surveyed, possibly reflecting HR leaders' deeper appreciation for the behavioral implications of incentives or maybe Finance leaders' greater sensitivity to the risk implications." (Towers Watson)  

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