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August 29, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Account Manager
Northwestern Benefit Corporation of Georgia
in GA

Plan Administrator
Nationwide Financial
in OH

Conversion, Data Specialist
The Newport Group
in NC

Conversion Specialist
The Newport Group
in NC

Senior Counsel
Baltimore City Fire and Police Employees' Retirement System
in MD

401(k) Relationship Manager
Leading Financial Services Firm
in CA

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Webcasts and Conferences

Health & Benefits Leadership Conference
March 17, 2014 in NV
(Human Resource Executive Magazine)

Eligibility and Participation
September 25, 2013 WEBCAST
(McKay Hochman Co., Inc.)

Ethics Case Studies Two
September 25, 2013 WEBCAST
(McKay Hochman Co., Inc.)

Health Care Reform for Employers: Now What?
November 20, 2013 in CT
(Lorman Education Services)

Advanced Cross-Tested Plans: Adding More Tools - Charlotte
September 26, 2013 in NC
(SunGard Relius)

View All Webcasts and Conferences


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

Text of CMS Health Insurance Marketplace Navigator Standard Operating Procedures Manual (PDF)
217 pages. Excerpt: "[This manual] is an instructional guide intended for Navigator Program grantees. This manual also contains standard operating procedures that detail the required Navigator activities.... The instructions and information included in this manual provide guidance on the consumer assistance process for the Individual and the [SHOP] Marketplaces, which includes the following procedures: Preparing, completing, and updating health coverage applications; Reviewing eligibility determinations for enrollment in health coverage; Enrolling in health coverage; Renewing health coverage eligibility and enrollment; and Completing exemption and appeal requests." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


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[Official Guidance]

Text of CMS Final Regs on ACA Program Integrity: Exchange, SHOP, and Eligibility Appeals
300 pages. Excerpt: "[T]his final rule outlines Exchange standards with respect to eligibility appeals, agents and brokers, privacy and security, issuer direct enrollment, and the handling of consumer cases. It also sets forth standards with respect to a State's operation of the Exchange and Small Business Health Options Program (SHOP). It generally is finalizing previously proposed policies without change." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Official Guidance]

Text of CCIIO Fact Sheet on Program Integrity Final Rule for Exchanges, SHOP, Eligibility Appeals: Safeguarding Federal Funds and Furthering Consumer Protection
"Key policies in the final rule include: Oversight of QHP Issuers in Federally-facilitated Marketplace.... Oversight and Monitoring of Privacy and Security Requirements... Consumer Protections for Payment and Application Assistance... Individual Eligibility Appeals... Employer Appeals in the Individual Market... Small Business Health Options Program (SHOP) Eligibility Appeals... Flexibility for States... Exchanges, SHOP, Eligibility Appeals: Safeguarding Federal Funds and Furthering Consumer Protection." (Center for Consumer Information & Insurance Oversight, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Official Guidance]

Text of OPM Proposed Regs on Compensatory Time Off for Religious Observances and Other Miscellaneous Changes (PDF)
"The U.S. Office of Personnel Management is issuing proposed regulations to amend its current regulations on compensatory time off for religious observances. The proposal would clarify employee and agency responsibilities, provide timeframes for earning and using religious compensatory time off, and define key terms. In addition, we are making other miscellaneous changes in the pay and leave area." (U.S. Office of Personnel Management)  

[Official Guidance]

Text of IRS Notice of Hearing Cancellation on Computation of, and Rules Relating to, Medical Loss Ratio (PDF)
"This document cancels a public hearing on proposed regulations that provide guidance to Blue Cross and Blue Shield organizations, and certain other health care organizations, on computing and applying the medical loss ratio added to the Internal Revenue Code by the Patient Protection and Affordable Care Act.... The public hearing originally scheduled for September 17, 2013 at 10 a.m. is cancelled." (Internal Revenue Service)  


[Advert.]

National Business Coalition on Health Annual Conference

Sponsored by National Business Coalition on Health

Register now for the National Business Coalition on Health's (NBCH) 17th Annual Conference, November 18-20, 2013 in Scottsdale, AZ to gain insight and learn best practices for improving health and transforming health care.



[Official Guidance]

Text of OPM Memo to Chief Human Capital Officers on the ACA and the Health Insurance Marketplace
"This memorandum provides information about some of the tools OPM is using to educate its employees about the ACA. In addition, OPM has developed [Q&As] to address concerns your employees may have about the impact of the ACA on the Federal Employees Health Benefits Program (FEHBP) ... so that you will have the information you need to respond to FEHBP questions that may arise in connection with any ACA educational activities you conduct." (U.S. Office of Personnel Management)  

[Guidance Overview]

The Forgotten Employees: How a Treasury Oversight Will Impact Employers Wishing to Utilize the Look-Back Measurement Method
"The issue that is unclear is whether an employer can have a segment of its workforce average 29 hours of service during the initial measurement period with no employee accumulating 30 or more hours of service during the initial measurement period. If an employer is able to use the look-back measurement method for this segment of its workforce despite no single employee being classified as a full-time employee during the initial measurement period, the employer would gain value by being able to adjust an employee's hours to match changes in demand throughout the year." (Moulder Law)  

[Guidance Overview]

States Tweak Conversion Coverage and Mini-COBRA Laws in Preparation for ACA
"With respect to policies providing coverage for the ACA's 'essential benefits', [Oregon's mini-COBRA] law is clarified to provide that mini-COBRA coverage must be offered in the same manner as provided to other certificate holders under the group health insurance policy.... [Colorado] amendments include eliminating the state's conversion coverage laws and requiring guaranteed issue coverage beginning in 2014.... Utah ... will, effective January 1, 2014, repeal both its conversion coverage law and the Utah NetCarePlans.... Georgia has revised its conversion coverage laws to provide that upon the availability of guaranteed issue coverage under ACA beginning in 2014, insurers are no longer required to offer conversion coverage." (Wolters Kluwer Law & Business)  

[Guidance Overview]

FAQs on Grandfathered Health Plans for Consumers
"[C]onsumers should know the status of their plans since that may determine whether they are eligible for certain protections and benefits created by the health law. For example, an employee at a large company may wonder why his job-based insurance doesn't include the free preventive services he's heard about. Or someone who purchases her own coverage may wonder whether she will be eligible for broader benefits when new insurance marketplaces open next fall. To answer those questions, you must understand the status of your plan and how grandfathering works." (Kaiser Health News)  

Seventh Circuit Says Request for Leave to Attend Overseas Family Funeral May Require Religious Accommodation
"Two written requests from an employee for unpaid leave to attend funeral rites for his father in Africa created a genuine issue of material fact as to whether the employer received notice of the religious nature of the request for purposes of accommodation under Title VII of the Civil Rights Act, the Seventh Circuit Court of Appeals in Chicago has ruled.... The Court described three factors to consider when determining whether a belief is in fact 'religious' for purpose of Title VII: '(1) the belief necessitating the accommodation must actually be religious, (2) that the religious belief must be sincerely held, and (3) accommodation of the sincerely held belief must not impose an undue hardship.'" [Adeyeye v. Heartland Sweeteners, LLC, No. 12-3820 (7th Cir. July 31, 2013)] (Jackson Lewis LLP)  

When an Employee Returns from FMLA Leave, What Does Same or Equivalent Position Actually Mean?
"Remember those oppressive words [in the FMLA regulations]: the new position must be 'virtually identical' to the former position, and it must maintain the same privileges, perquisites ('perks') and status.... The [Sixth Circuit] refused to dismiss [an employee's claim], finding that the new position: 1) did not offer the same career advancement; 2) did not require a similar level of education and training; 3) increased her clerical duties; and 4) did not allow her to utilize her legal skills. As a result, it found that a jury could decide that the new position was not equivalent under the FMLA." [Crawford v. JPMorgan Chase and Company, No. 12-3698 (6th Cir. Aug. 6, 2013)] (FMLA Insights)  

Prepaid Debit Cards Allowed as Health Insurance Payment
"Rules released by [HHS] said insurers participating in new health-insurance exchanges set to open in October would be required to accept payment from consumers in several different forms, including prepaid debit cards, cashier's checks and money orders, as well as paper checks and bank-account transfers. Insurers won't be required to accept cash. A move to allow payment by prepaid card had been backed by consumer advocates, who said they wanted to ensure access to coverage for 'unbanked' Americans, and by card giants such as MasterCard Inc." (The Wall Street Journal; subscription may be required)  

As Rates Soar, Small Business Owners Pass Along More Health Care Costs to Employees
"[T]he number of firms offering health care plans has held fairly steady in the past few years, but as prices have continued to climb, employers, particularly those at small businesses, are asking workers to pay much more for their care.... [F]or the first time since ... 1999, a majority of workers covered by a small employer (58 percent) now pay deductibles of more than $1,000, up from just 21 percent in 2007.... The average deductible for workers at small firms (those with more than two employees but less than 200) was $1,715, nearly double the $884 deductible paid by workers at large businesses." (The Washington Post; subscription may be required)  

Census Bureau Releases Health Insurance Coverage Estimates for All Counties
"The estimates show the number of people with and without health insurance for all states and each of the nation's roughly 3,140 counties. The statistics are provided by broad age group, sex, race and Hispanic origin, and at income levels that reflect thresholds for state and federal assistance programs. The data can be used to assess annual changes in health insurance coverage from 2008 through 2011." (U.S. Census Bureau)  

The ACA and Health Insurance Markets: Simulating the Effects of Regulation
"[The ACA] will lead to an increase in insurance coverage and higher enrollment in the nongroup market. However, data limitations and uncertainties about insurer behavior make estimates uncertain, particularly when considering outcomes for the nongroup market. They find that the law has little effect on small group premiums and find large variation in the effects for nongroup premiums across states. The analysis suggests that comparisons of average premiums with and without the Affordable Care Act may overstate the potential for premium increases." (RAND Corporation)  

ACA Implications for State Network Adequacy Standards
"Network adequacy refers to a health plan's ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all and other health care services included under the terms of the contract. Taken together with the Essential Health Benefits (EHB) package ... network adequacy standards will determine what care is covered and how easily it can be obtained. States have taken different approaches in regulating the adequacy of health plan networks.... This brief explores some of the discrepancies that can arise with varying network adequacy standards and provides examples of how some states have resolved such issues." (Robert Wood Johnson Foundation)  

BlueCross BlueShield Plans Want Quality Improvement Activities in Loss Ratio
"BlueCross BlueShield [BCBS] plans should be allowed to include expenses for quality improvement activities (QIAs) in calculating their medical loss ratios (MLRs) that are used to determine rebates to consumers, the Blue Cross and Blue Shield Association said in an comment letter to the [IRS]..... Nonprofit BCBS plans must meet an 85 percent threshold because their tax treatment differs from for-profit health insurers. In the proposed rule the IRS did not allow for the inclusion of QIAs for BCBS plans[.]" (Bloomberg BNA)  

Many U.S. Adults Don't Understand Basic Health Insurance Terms
"More than half of respondents (51%) could not accurately identify at least one of the following terms: premium, deductible, and copay, according to a [recent] telephone survey ... Forty-one percent of respondents said they are not at all knowledgeable about the [ACA], and another 48% said they are somewhat knowledgeable." (Journal of Accountancy)  

Employers See Obamacare Options for Part-Time Workers, COBRA Purchasers
"Two in five employers, or 41 percent, of the respondents said they believe COBRA 'plan participants might find public exchanges to be the most cost effective option.' ... [A]bout one in four, or 26 percent, of employers believed workers who retire before age 65 ... might choose to purchase coverage on exchanges. This comes as more and more employers increase the cost of retiree coverage or drop it all together in the face of rising costs. In addition, one in five employers, or 20 percent, said part-time workers may opt for public exchanges." (Forbes)  

Obamacare's Architects Reap Windfall as Washington Lobbyists
"The voracious need for lobbying help in dealing with ObamaCare has created a price premium for lobbyists who had first-hand experience in crafting or debating the law. Experts say that those able to fetch the highest salaries have come from [HHS] or committees with oversight power over healthcare. Demand for ObamaCare insiders is even higher now that major pieces of the law, including the healthcare exchanges and individual insurance mandate, are being set up through a slew of complicated federal regulations." (The Hill)  

[Opinion]

Obama's Affordable Care Act Looking a Bit Unaffordable
"Whether the quality of care in the new market is comparable to private offerings remains to be seen. But one thing is clear: The cost of care in the new market doesn't stack up. A single wage earner must make less than $20,000 to see his or her current premiums drop or stay the same under Obamacare ... That's equivalent to approximately 34 percent of all single workers in the U.S. seeing any benefit in the new system." (Government Executive)  

[Opinion]

Statement by Sen. Lamar Alexander on the Administration's Delay in Signing Insurer Agreements for ACA Federal Exchange
"I've been warning that a train wreck is coming with this law, but the truth is that no train wreck has ever had this many warning signs. The avalanche of last-minute delays should make every American anxious about the quality of the health care they'll be able to purchase in October and the security of the information they'll have to provide[.]" (Committee on Health, Education, Labor and Pensions, U.S. Senate)  

Benefits in General; Executive Compensation

Reinhart Employee Benefits Update, August 2013 (PDF)
Topics include: PBGC Issues Proposed Regulations Regarding Premiums and Payments; DOL Allows Employers to Delay Distribution of the 2013 Participant Fee Disclosure; IRS Releases Static Mortality Tables for 2014-15; DOL Amends Definition of "Ratings Agency" for Purposes of Plan Investment in Asset-Backed and Mortgage-Backed Securities; HHS Releases Final Exchange Verification Rules; HHS Continues to Take Steps to Help Ensure Consumer Protections; and Court Orders Employer to Pay $1.8 Million Fine for Failure to Provide COBRA Notice. (Reinhart Boerner Van Deuren s.c.)  

Payroll Departments to Face Burdensome Tax Requirements for Same-Sex Spouses After DOMA Decision
"Applying the laws of an employee's resident state when determining the tax value of same-sex employee benefits for federal tax purposes would 'be a nightmare' for payroll departments because most states do not recognize same-sex marriages ... Following the laws of the state where the marriage occurred would be easier, though still burdensome because the employer would have to determine what constitutes marriage[.]" (Bloomberg BNA)  

Pay Ratio Rules are Coming
"If you are in the simplest of all situations-- that is, no employees outside of the U.S., no part-timers, no seasonal employees, no equity compensation, no defined benefit plans and no perquisites, your job is easy. CEO compensation and that of other employees is going to look a lot like W-2.... Oh, you're not in that simplest of all situations? It's going to be more complicated then. You will be faced with the exciting prospect of currency conversions, actuarial present value calculations, Black-Scholes calculations, gathering of data from multiple payroll feeds, and determination of the value of other benefits on which you usually don't place a price tag." (Benefits and Compensation with John Lowell)  

U.S. Top Executive Compensation Report, 2013 Edition
"Between the last two years, total cash compensation increased in 17 out of 22 industries, a positive change compared to only 13 in the 2009-2010 period. However, four industries saw declines in total cash pay, up from two in 2011. Total compensation changed positively in 20 of 22 industries, another contrast to the 2009-2010 period when in 12 industries, the median change in total compensation was negative." (The Conference Board; free registration required to view full report)  

Disclosure Lessons from the 2013 Proxy Season
"The 2013 proxy season brought several kinds of changes to compensation proxy disclosure practices.... [C]ontinuing the strong trend from the 2012 proxy season and foreshadowing what we expect to see in 2014, many more companies provided more disclosure about the alignment of their pay with the company's performance, with many companies providing more information regarding peer group determinations and changes, as well as utilizing supplemental disclosures of 'realized' or 'realizable' pay to measure such alignment." (The Conference Board)  

[Opinion]

A Simple Solution That Made a Hard Problem More Difficult
"Congressional leaders, in their rage against ever-rising executive compensation and income inequality, have created more murkiness. The irony is that it all came out of such a simple-sounding idea: requiring that the pay of a company's chief executive be compared to the median salary of its employees. Carrying out the law may well result in costs that are just as obscene as the pay it is disclosing." (The New York Times; subscription may be required)  

Press Releases

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Burnham Benefits Insurance Services Inc.

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