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

Document Consultant
for Verisight, Inc. in CA, MN

Executive Benefits/Non-Qualified Relationship Manager
for Wells Fargo in NC

Retirement Account Manager
for Benefits Resource Group in OH

Product Analyst
for Guardian Life Insurance Company of America in NY, PA

Qualified Retirement Plans Consultant/Relationship Manager
for First American Bank in IL

Director of Communications
for Unite Here Health in IL

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Webcasts and Conferences

"Advanced Cross-Tested Plans: Adding More Tools," 12 Cities
September 11, 2013 in MO
(SunGard Relius)

Annual Conference 2013
October 27, 2013 in LA
(American Council of Life Insurers)

Inside the Beltway - Free Audiocast
September 12, 2013 WEBCAST
(Drinker Biddle & Reath LLP)

IRC Section 105(h) Testing and Design Alternatives 2013 -- OnDemand Webinar
September 4, 2013 WEBCAST
(Lorman Education Services)

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  LinkedIn   Twitter   Facebook Hand-picked links to the web's best news articles,
official guidance, jobs, webcasts and more.
[Official Guidance]

Text of CMS Fact Sheet for Consumers: How to Protect Yourself from Fraud in the Health Insurance Marketplace (PDF)
"Your best protection against fraud is you! Starting October 1, 2013, you can apply for health insurance through the Health Insurance Marketplace, on HealthCare.gov. A few simple things can protect you from fraud, while getting you the coverage you need. [1] Be informed.... [2] Protect your private health care and financial information.... [3] Ask questions and verify the answers you get." (Centers for Medicare & Medicaid Services)  


[Advert.]

Interaction of Health Care Reform with Other Laws: What Employers and Advisors Need to Know

Sponsored by Lorman and BenefitsLink

This live webinar is critical for employers, counsel and HR professionals to understand and deal with the effects of PPACA on employer obligations and systems. September 18. Registration discount for BenefitsLink readers.



[Official Guidance]

Text of HHS Inspector General Report: Most Critical Access Hospitals Do Not Meet Medicare's Location Requirements (PDF)
"The Critical Access Hospital (CAH) certification was created to ensure that rural beneficiaries are able to access hospital services. Medicare reimburses CAHs at 101 percent of their reasonable costs, rather than at the rates set by prospective payment systems or fee schedules.... Nearly two-thirds of CAHs would not meet the location requirements if required to re-enroll. The vast majority of these CAHs would not meet the distance requirement. CMS does not have the authority to decertify most of these CAHs... However, if CMS were authorized to reassess whether all CAHs should maintain their certifications and concluded that some should be decertified, Medicare and beneficiaries could realize substantial savings. If CMS had decertified CAHs that were 15 or fewer miles from their nearest hospitals in 2011, Medicare and beneficiaries would have saved $449 million." (Office of Inspector General, Department of Health and Human Services)  

[Guidance Overview]

Wait, Another Delay? the Truth About Out of Pocket Costs in 2014
"The 'delay' recent news articles reference are an acknowledgment by the DOL that many 'plans may utilize multiple service providers to help administer benefits' ... Recognizing this additional compliance challenge, the Departments will consider the out-of-pocket maximum requirement to be met if each individual separate policy complies." (Hill, Chesson & Woody)  

[Guidance Overview]

ACA Delay on Out-Of-Pocket Caps Is Old News, So Why the Fuss Now?
"The news about the one-year postponement actually came about in February of this year ... Keep in mind, however, that the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) does not allow group health plans to apply separate out-of-pocket maximums to mental health or substance use disorder benefits separately from the maximum established for medical/surgical benefits. Also, consumers are perhaps not aware that this one-year 'transitional period' does not apply to insurance obtained through the state exchanges/marketplaces, where a single out-of-pocket maximum will apply." (Wolters Kluwer Health Reform Talk)  

[Guidance Overview]

Massachusetts Wellness Tax Credit for Small Employers
"The state of Massachusetts unveiled a wellness incentive program for small employers, called the 'MA Wellness Tax Credit'. Under this program, businesses with 200 or fewer employees, the majority of whom must work in MA, may apply for a Wellness Tax Credit of up to 25% of the costs associated with implementing a certified wellness program up to a maximum credit of $10,000 in a taxable year.... The credit will be issued on a first come first serve basis, so it is important to get your applications in now. All applications must be received by December 31, 2013 to qualify." (William Gallagher Associates)  

The Price of Public Health Care Insurance in Canada
"In 2013, the estimated average payment for public health care insurance will range from $3,387 to $11,381 for Canadian families ... For the average Canadian family, between 2003 and 2013 the cost of public health care insurance increased more than 1.5 times faster than the cost of shelter and clothing, more than twice as fast as food, and nearly 1.5 times faster than average income. The 10 percent of Canadian families with the lowest incomes will pay an average of about $482 for public health care insurance in 2013." (National Center for Policy Analysis)  

Penn State Employees Protest Wellness Program
"Pennsylvania State University employees are protesting a new wellness program that requires them to provide detailed health information or pay penalties that can total $1,200 a year, in an unusually public backlash against an increasingly common employer practice. An online petition calling for the program to be canceled ... has gathered more than 2,000 signatures. [An] Associate professor ... has called publicly, in a letter on a faculty-group website and in a column for a local newspaper, for university employees to resist the initiative through steps such as giving 'nonsense' answers to a health questionnaire. Both professors have raised concerns about privacy and said the effort is coercive." (The Wall Street Journal; subscription may be required)  

Plan Sponsor Open Enrollment Communication Checklist
"Mercer's open enrollment communication checklist contains five specific steps for plan sponsors to consider: [1] Communicate the impact of health care reform ... [2] Promote the role of wellness initiatives within an overall health benefits program ... [3] Use online and mobile strategies for more convenient access to information and tools ... [4] Empower your employees to become informed consumers ... [5] Anticipate questions to avoid being overwhelmed with calls[.]" (Mercer and Directors & Boards)  

Employer Gives More Than (It Thought) It Bargained For
"M&G (and predecessor employers) had negotiated various collective bargaining agreements with the plaintiffs' union. It also negotiated 'cap' letters that placed a cap on M&G's health care contributions. It was not erroneous to find that these cap letters did not apply to plaintiffs' union, even though they may have been part of some master agreements with other locals.... Using standard contract interpretation principles, Judge Cole affirmed the lower court's finding that the parties intended for plaintiffs' retiree health benefits to vest under the various agreements. These vested benefits could not be bargained away without the retiree's permission." (Seyfarth Shaw LLP)  

Federal Courts Divided on Contraceptive Coverage Mandate (PDF)
"More than three dozen reported lawsuits have been filed by for-profit employers to challenge on religious grounds an [ACA] mandate that requires certain health plans to cover contraceptives without cost-sharing.... Two recent cases from the U.S. Courts of Appeals have created a split among the federal circuit courts on whether a for-profit business can challenge ACA's contraceptive coverage mandate on religious grounds.... [This] makes it more likely that the U.S. Supreme Court will ultimately review the constitutionality of the contraceptive coverage mandate." (Pilot Employee Benefits)  

Health Law Likely to Spur TV-Ad Bonanza
"The television industry is anticipating an advertising bonanza related to the rollout of the federal health overhaul, with as much as $1 billion expected to be spent on ads by insurers alone ... States including California, Illinois and Colorado are already running commercial spots to promote the online exchanges they are launching on Oct. 1 to allow people to buy coverage ... Making a big marketing push to individual consumers will be a shift for many insurers that mainly sell their plans through employers." (The Wall Street Journal; subscription may be required)  

Feds Award $67 Million In Grants To Help Consumers Navigate The Health Law
"Hospitals, universities, Indian tribes, patient advocacy groups and local food banks were among organizations awarded $67 million in federal grants Thursday to help people sign up for coverage in new online health insurance marketplaces that open for enrollment Oct. 1. Planned Parenthood, the United Way and the National Urban League are some of the best known organizations among the 105 awarded 'navigator' grants in 34 states that will rely on the federal government to operate all or part of their marketplaces." (Kaiser Health News)  

[Opinion]

Pioneer ACOs' Disappointing First Year
"What was irritating about the Pioneer spin is it treated the ACO as if it were a brand new idea with growing pains. This studiously ignores a burned out Conestoga wagon pushed to the side of the trail: the Physician Group Practice {PGP] demonstration CMS conducted from 2005-2010. The PGP demo tested essentially the same idea -- provider bonuses for meeting spending reduction and quality improvement targets for attributed Medicare patients. The pattern of arrow holes and burn marks on the PGP wagon closely resemble those from the Pioneer's first year, strongly suggesting more troubles ahead for the hardy, surviving Pioneers." (Timothy Jost in Health Affairs)  

[Opinion]

Preparing for 2014: Questions for Opponents of Obamacare
"Although ObamaCare's opponents have overwhelmingly succeeded in convincing society of the law's drawbacks, it is not at all clear that society is ready to accept a more free-market alternative reform. Indeed, some of the approaches used against ObamaCare might have unintended consequences that will appear in 2014, the law's first fully operational year, which would make repealing and replacing ObamaCare extremely difficult." (John Goodman's Health Policy Blog)  

Benefits in General; Executive Compensation

Deconstructing DOMA: DOL Takes Its First Step Toward Extended Rights for Same-Sex Spouses
"At present, it is the states that remain at the helm of defining rights for same-sex couples. But, it sounds as though the Obama Administration is just getting started asserting its authority to extend such rights. Armed with Windsor, the feds very well may try to take control.... While the DOL's guidance did not expand FMLA leave eligibility to same-sex married couples who live in states that do not recognize same-sex marriage, it seems that extension by the DOL is not out of the question for the future." (BakerHostetler)  

'Hell or High Water' -- or Fraud
"When Marsh Supermarkets fired [Don Marsh] in 2006 -- after learning of his misuse of company expense accounts -- it told him that the termination was 'without cause.' The supermarket chain soon developed a case of buyer's (firer's?) remorse, and claimed that it had been 'snookered' into firing Marsh 'without cause.' ... The court agreed with Marsh that once the company had terminated him 'without cause,' his termination benefits were vested and non-forfeitable, and could not be limited by general equitable principles under ERISA.... Further, because ERISA includes a fee-shifting provision for a prevailing party and Marsh prevailed on the ERISA issues, the court ordered the company to pay his fees for litigating those claims." (Zuckerman Spaeder LLP)  

Summary of 2013 Proxy Vote Results: Majority of Say-on-Pay Proposals Approved (PDF)
"Approximately 98% of [say-on-pay (SOP)] proposals were approved by shareholders of Russell 3000 and S&P 500 companies. Over 75% of Russell 3000 companies' SOP proposals received greater than 90% shareholder support.... Of the 271 Russell 3000 companies whose SOP proposals received a negative vote recommendation from ISS, only 47 (or 17.3%) of these companies' SOP proposals were voted down by shareholders. However, a negative ISS vote recommendation, on average, depressed favorable shareholder votes by nearly 30%." (Meridian Compensation Partners, LLC)  

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