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July 30, 2013          Get Retirement News  |  Advertise
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Retirement Education Specialist
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Webcasts and Conferences

Health Care Reform for Employers: Now What? - Annapolis, MD
October 15, 2013 in MD
(Lorman Education Services)

2013 Regulatory Update
August 6, 2013 WEBCAST
(Multnomah Group)

Health Insurance Marketplace Training: Becoming a Certified Application Counselor Organization -- Webcast
July 31, 2013 WEBCAST
(Centers for Medicare & Medicaid Services (CMS))

Health Insurance Marketplace Training: Becoming a Certified Application Counselor Organization -- Webcast
August 1, 2013 WEBCAST
(Centers for Medicare & Medicaid Services (CMS))

Health Insurance Marketplace Training: Becoming a Certified Application Counselor Organization -- Webcast
August 5, 2013 WEBCAST
(Centers for Medicare & Medicaid Services (CMS))

Health Insurance Marketplace Training: Becoming a Certified Application Counselor Organization -- Webcast
August 7, 2013 WEBCAST
(Centers for Medicare & Medicaid Services (CMS))

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[Guidance Overview]

California Implements 60-Day Cap on Eligibility Waiting Periods
"California Assembly Bill 1083 ... brings California law governing group health insurance products and HMOs, into conformity with insurance market reforms and other provisions of the [ACA]. AB 1083 varies in some respects from the ACA. Perhaps the most notable difference is in the maximum eligibility waiting period for group health plan participation, which the ACA sets as no more than 90 days after hire.... The new provisions setting forth the 60-day limit take effect January 1, 2014 and will be applied to 'plan' years beginning on or after that date." (E is for ERISA)  

Containing Health Care Costs: Recent Progress and Remaining Challenges
"There are promising signs that federal programs and policies, as well as aggressive private sector activities, have helped to curb cost growth in Medicare and overall health expenditures. However, even if we continue to reduce the growth of health care costs and improve overall value, demographic trends and constrained state and local budgets will drive health and retirement spending toward an even larger share of the economy.... We must make difficult decisions in the coming years to encourage system-wide cost containment and sustainable health care transformation." (Brookings)  

Seventh Circuit Explains How Insurers Can Be Sued Directly for Benefits Under ERISA
"The court recognized that ... [b]enefits are a plan obligation [and a] claim for ERISA benefits ordinarily should be brought against the plan itself. The court added, however, that an ERISA claim for benefits must be brought against the party having an obligation to pay, and that these 'obligors' are therefore proper defendants in an ERISA claim to recover plan benefits. For an insured ERISA health plan, in which the plan's insurer decides eligibility and benefits questions and pays claims, an ERISA claim for benefits against the insurer is therefore permissible." (Practical Law Company)  

Unclean Hands Doctrine No Defense to Disability Plan's Reimbursement Action, Court Rules
"A long-term disability plan participant cannot use the equitable doctrine of unclean hands to defeat the plan administrator's counterclaim for reimbursement of allegedly overpaid benefits ... [The judge] also concluded that the plan administrator's reimbursement action sought appropriate equitable relief as allowed by Section 502(a)(3) of [ERISA]." [(Makoul v. Prudential Ins. Co. of America, No. 1:12-cv-01240 (N.D. Ill. July 25, 2013).] (Bloomberg BNA)  

As ACA Implementation Continues, Consumer Health Care Cost Growth Has Slowed
"Prices for personal consumption expenditures (PCE) on health care goods and services rose just 1.1 percent over the twelve months ending in May 2013, the slowest rate of increase in nearly 50 years. The slowdown in PCE health care inflation has been widespread, with important contributions from two large components: hospital and nursing home services (which comprise 42 percent of total health care expenditures) and outpatient services (which comprise 34 percent of total health care expenditures)." (The White House Blog)  

Stop the Presses: A Disease Management Program Worked!
"However, the nonprofit Iowa Chronic Care Consortium (ICCC) apparently can execute a [disease management] program. They reduced total diabetes events by 6% in the rural counties they targeted. This success supports a hypothesis that in rural (presumably underserved) areas, disease management fulfills a critical clinical gap: it provides enough basic support that otherwise would not be provided even to those who actively seek it to reduce near-term complications and exacerbations." (The Health Care Blog)  

Contraceptive Coverage Litigation Moving Toward Supreme Court
"[T]hirty-five cases have been filed by for-profit employers that object to the contraceptive mandate. Thirty of these cases have resulted in court decisions, primarily on preliminary injunctive relief or injunctions pending appeal. Twenty-three court decisions, including cases decided by the Seventh, Eighth, and Tenth Circuit Courts of Appeal, have ruled for the employer. Seven cases, including cases decided by the Third and Sixth Circuit Courts of Appeal, have ruled against employers." (Timothy Jost in Health Affairs)  

Small Advisory Firms Could Qualify for 50% Tax Credit on 2014 Health Care Costs
"To qualify for the tax credit, average annual wages must be $50,000 or less and the employer must contribute at least half of the self-only premiums for their employees. The average wage calculation does not include the owner, a partner or family members ... A similar health care tax credit of up to 35% has been available to business owners since 2010 and about 360,000 firms took advantage of it in 2011[.]" (Investment News; free registration required)  

New Jersey Employers Must Provide Unpaid Leave to Victims of Domestic Violence under New Law
"The NJ SAFE Act contains a posting requirement, civil penalties for violations, availability of injunctive relief, and a private cause of action for any violation of the Act (in which a litigant may recover lost wages, benefits, costs, and attorney's fees). Claims for harassment, retaliation or discrimination because of the use of or entitlement to leave under the statute are covered." (Jackson Lewis LLP)  

ML Strategies Health Care Reform Update, July 29, 2013 (PDF)
Update on developments in federal and state health care reform legislation and regulations, including summaries of recent announcements and regulatory activity by HHS, CCIIO, IRS and CMS. (ML Strategies, LLC)  

Expanding Options for Employers in Next-Generation Private Exchanges
"The segments employers will need to examine separately include active employees, COBRA participants, pre-Medicare-eligible retirees, Medicare-eligible retirees, and seasonal and part-time workers. By choosing to treat one or more of these segments differently, employers have the ability to improve their plan's performance and provide each segment with a solution that delivers the best value." (Towers Watson)  

WellPoint Program Lets Employers Name Their Price for Doctors
"Physicians collecting from WellPoint-insured patients who haven't met their deductible or have a co-pay might have one more reason to send them a bill -- to collect the difference between the price the insurer has negotiated with the doctor, and what the employer is willing to pay. WellPoint plans to launch a program in 2014 in which self-insured companies can determine what they will pay for certain procedures. WellPoint would present a price range to the employer based on what has been negotiated with doctors. Then the company would determine the maximum price it's willing to pay." (American Medical News)  

Is the ACA Really a Hidden Jobs Killer?
"[The ACA] does provide a clear incentive to reduce workers' hours below 30 per week and many employers claim to be making such reductions in hours. This issue brief looks at data from the Current Population Survey and finds only a small number (0.6 percent of the workforce) of workers report working just below the 30-hour cutoff in the range of 26-29 hours per week. Furthermore, the number of workers who fall in this category was actually lower in 2013 than in 2012, the year before the sanctions would have applied." (Center for Economic and Policy Research)  

The Changing Culture of Health and Wellness Initiatives
"The top five things they believe companies should start doing -- if they haven't already -- is: [1] Offer healthy options in vending machines and cafeterias if the employer has them onsite. HR executives can consider subsidizing the healthy meal of the day. [2] Take steps to address unnecessary stressors at work. [Tom] Emerick says 'stress literally makes people sick.' [3] Address defective work processes as an initial methodology to reduce workplace stress. [4] When things go wrong, counsel managers to focus on process improvement instead of blaming employees for errors made. [5] Design worksites to include open, clean and well-lit work areas, clean restrooms and soothing break rooms." (Human Resource Executive Online)  


How the Obamacare 'Honor System' Will Encourage Fraud
"Those who should never have received an income-based subsidy -- because their income exceeds 400 percent [of the Federal Poverty Level (FPL)] -- will have to repay the full amount of the subsidy they received. However, those with incomes under 400 percent FPL -- who qualify for some level of subsidy, just not as much as they actually received -- will only have to pay back up to $2,500 of the difference between the subsidies they actually received and the subsidies they should have received. It's this loophole that will encourage fraud -- because individuals can gain more in benefits than they will have to repay, by understating their income." (The Heritage Foundation)  


The Question of Taxing Employer-Provided Health Insurance
"According to the Congressional Budget Office, the health insurance exclusion will reduce federal revenue by $248 billion this year, including lost income and payroll taxes. That is equal to 1.5 percent of the gross domestic product -- more than the federal government spends for interest on the public debt." (The New York Times; subscription may be required)  


Obamacare Spin 101: How to Make Premiums Seem Really Cheap -- or Insanely Expensive
"[H]ealth premiums are complex. Comparisons to other information can make rates seem like a bargain-basement deal or an outrageous ask. It all depends on which health-care adventure you choose." (Sarah Kliff in The Washington Post; subscription may be required)  


Obamacare's Employer Mandate Delay Creates Two Big Problems
"Although greeted as a relief by many, the move actually raises two significant problems for businesses and taxpayers during Obamacare's roll-out. First, the delay implies that Congressional Budget Office (CBO) scores of government health spending will become even less realistic than they currently are. Second, employers who take advantage of the delay will be on very shaky legal grounds.... It will be even harder to impose the employer mandate after a year of relief than it is now." (Forbes)  


Deloitte Health Care Reform Memo, July 29, 2013
"[I]nsurance against health costs is a permanent fixture in the U.S. health care ecosystem. Some insurance companies will shift their focus from employers to individuals and government purchasers, some will globalize and diversify, some will monetize their claims data around costs and clinical transactions and some will be absorbed by the sector's consolidation binge. But the sector's not going away." (Paul Keckley, Deloitte Center for Health Solutions)  

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