EmployeeBenefitsJobs.com logo BenefitsLink.com logo

BenefitsLink Health & Welfare Plans Newsletter

September 12, 2013          Get Retirement News  |  Advertise
         Past Issues  |  Search

Employee Benefits Jobs

Part Time On Call Retirement Planning Consultant
Transamerica Retirement Solutions
in AR, CA, GA, HI, MO, NJ, NY, UT

Daily Processing Distribution Client Service Associate
Alliance Benefit Group of Houston, Inc.
in TX

Employee Benefits Administrator
The National Bank & Trust Company (NB&T)
in IL

Trading & Corrections Associate
ASPire Financial Services LLC
in FL

Post Your Job

View All Jobs

RSS feed for jobs RSS Feed: All Jobs

Webcasts and Conferences

2013 Fall Forum - Las Vegas
November 18, 2013 in NV

Health Reform - Beyond the Basics: Determining Household Size for Medicaid and Premium Tax Credits
September 25, 2013 WEBCAST
(Center on Budget and Policy Priorities)

19th Annual Funniest Celebrity Contest: Fundraiser for Pension Rights Center
September 25, 2013 in DC
(Pension Rights Center)

Compensation Data Bank (CDB) Executive Survey Results
September 17, 2013 WEBCAST
(Towers Watson)

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 DOL Frequently Asked Question on Notice of Coverage Options
"Q: Can an employer be fined for failing to provide employees with notice about the Affordable Care Act's new Health Insurance Marketplace? A: No. If your company is covered by the Fair Labor Standards Act, it should provide a written notice to its employees about the Health Insurance Marketplace by October 1, 2013, but there is no fine or penalty under the law for failing to provide the notice." (U.S. Department of Labor)  


DATAIR's FlexPlus System Makes Administration Profitable

Sponsored by DATAIR Employee Benefit Systems, Inc.

Proposals, Testing, Claims Processing, Debit Cards and more!
Plus CafeDocs/SPDs and 5500s/SARs
(888) 328-2474Sales@DATAIR.comwww.DATAIR.com

[Guidance Overview]

Notice of Exchange Penalties: DOL FAQ Says There Aren't Any, But Timely Compliance is Key
"This information, at this late date, is more confusing than it is helpful to employers who have already invested significant resources in preparing to deliver the Notice of Exchange. The wording of the FAQ says that employers 'should' rather than 'must' provide the Notice, which is misleading ... Particularly for employers with pre-existing group health plans, the Notice of Exchange potentially could be viewed by the DOL as within the scope of the employer's required disclosures to participants and thus within the scope of an ERISA audit[.]" (E is for ERISA)  

[Guidance Overview]

All Employers Face October 1 ACA Deadline
"Employers should pay close attention to these notice requirements to avoid common pitfalls, including: [1] My insurance provider is taking care of the notice requirement for me. Be careful! Employers are required to send the notice to all employees.... [2] I just looked at the DOL model notice, and we don't have time to fill out individualized information for every employee. Don't worry! The individualized information requested on page 3 of the DOL model notice for employers who offer health coverage is optional.... [3] I'm sure this requirement doesn't apply to my small company.... [T]he requirement applies to nearly all employers, large or small." (Fisher & Phillips LLP)  

[Guidance Overview]

Proposed Regs on ACA Information Reporting Expand Form W-2 Role
"The proposed rules also would eliminate the need for employers to make full-time and part-time determinations for employees if adequate coverage is offered to all potentially full-time employees and would spare employers from reporting the cost of coverage to employees under certain circumstances." (Bloomberg BNA)  

[Guidance Overview]

Health Policy Brief: Excise Tax on 'Cadillac' Plans
"Although the excise tax does not take effect for another four years, many employers are already scaling back their health benefit offerings or increasing workers' deductibles and copays to avoid paying the tax.... It's not yet clear how widely the excise tax will be felt by both employers and consumers. This brief explains the tax, its current and projected effects, and what's next in the debate as the tax moves toward full implementation in 2018." (Health Affairs Blog)  

Text of HHS Rate Review Annual Report, September 2013 (PDF)
"[T]he rate review process saved consumers approximately $1.2 billion on their premiums when compared to the amount initially requested by insurers. These savings accrued to 6.8 million people.... [In] the small group market, the average rate increase request declined by 19 percent (from 5.8 percent to 4.7 percent), saving consumers an estimated $866 million after rate review. This is in addition to the $500 million in medical loss ratio rebates for 2012, for a total $1.7 billion in savings in 2012.... [I]nsurers were much less likely to submit requests for rate increases of 10 percent or more in 2012 than in previous years, and it is likely that this change in issuer behavior is a result of the [ACA] policy that requires requests for increases of 10 percent or more to be justified and reviewed." (U.S. Department of Health and Human Services)  

Penn State Faculty Senate Debates Wellness Plan as University Defends Steps Taken
"Under Penn State's new employee wellness program, a health risk assessment questionnaire asks female employees if they plan to get pregnant in the next year. If the employee doesn't want to disclose that and opts out of completing the assessment, she'll incur a $100 fee each month. That's $1,200 over the course of the year.... Highmark representatives, promised the information would be safe because they are bound by federal privacy rules to assure that. Further, they said, the information will not be given to anyone, such as Penn State itself or a third party, such as an advertising or marketing company." (Centre Daily Times)  

Fifth Circuit Says Attorney's Disability Case 'Does Not Have a Leg to Stand On' After Scorned Boyfriend Provides Emails
"[The court held that] Unum did not abuse its discretion by considering emails (from the scorned boyfriend) because Unum: (a) identified evidence it received (emails and travel documents etc.) that supported the decision to deny benefits; (b) considered Truitt's rebuttal evidence that the emails had been hacked; [and] (c) addressed Truitt's objections to the emails, finding no evidence the emails had been manipulated or tampered with. The emails appeared authentic and reliable." [Truitt v. UNUM Life Ins. Co. of America, No. 12-50142 (5th Cir. Sept. 6, 2013)] (Lane Powell PC)  

The Expanding Ranks of the Disabled
"New guidelines from the American Medical Association consider obesity to be a disease, which means the majority of working Americans could now be classified as disabled. That may make HR departments responsible for their employees in a whole new way.... While there currently is no federal law prohibiting discrimination against obese individuals, the AMA's recent announcement could bring about legislative changes that could affect the way employers deal with overweight employees. Some experts also fear that companies might face more disability-related lawsuits as a result." (Human Resource Executive Online)  

Data Hub Readiness Questioned by House Subcommittee
"Rep. Patrick Meehan (R-PA), who chairs the Subcommittee on Cyber Security, Infrastructure Protection, and Security Technologies for the House Homeland Security Committee, disparaged the administration's claims. 'Just last month we were told that [it] wouldn't be ready until the end of Sept. 30. Now lo and behold [security testing] was completed on Sept. 6 and it's ready to go?' He added incredulously, 'this is an agency [Department of Health & Human Services] that for three months failed to meet a single deadline.'" (HealthLeaders Media)  

Health Insurance Sales Hit the Mall
"[F]or the first time, insurers are fiercely competing to attract individual consumers and turning to traditional retail marketing techniques to do so, luring them into stores with special events and using splashy advertising. As any retailer knows, they have the greatest chance of converting shoppers to customers once they have them in their retail locations or on their sites." (USA TODAY)  

Advocates to Launch an LGBT-Specific Obamacare Campaign
"The LGBT community is more likely to lack health insurance coverage than heterosexuals. Particularly, [Kellan Baker, associate director for the LGBT Research and Communications Project at the Center for American Progress] thinks that reaching the LGBT community will be a tougher sell -- and one that requires more targeted messaging than other outreach campaigns will be able to provide.... [F]ocus groups showed a lot of skepticism from transgendered people that the health plans on the new marketplaces would meet their health care needs. And there was concern that, even if they called up the plan to find out, the person on the other end would likely have no idea." (Sarah Kliff in The Washington Post; subscription may be required)  

Unions' Misgivings on Obamacare Burst Into View
"While praising the overall legislation, the delegates overwhelmingly passed a sharply worded resolution that demanded changes to some of its regulations ... The resolution asserts that the law, by offering tax credits to workers seeking insurance from for-profit and other companies in the exchanges, will place some responsible employers at a competitive disadvantage and destabilize the employment-based health care system." (The New York Times; subscription may be required)  

Rhode Island to Study Moving City, Town Retirees to Obamacare
"Cranston Mayor Allan Fung said it's too soon to tell whether Rhode Island's Obamacare marketplace, known as HealthSource RI, could be an option for cities and towns trying to get control of their retiree health costs. He suggested it could be an uphill battle because the benefits were often spelled out in workers' union contracts.... Underfunded pension plans have garnered most of the headlines in Rhode Island in recent years, but the cost of providing ever-pricier health care to retirees could place a larger financial burden on cities in the long run." (WPRI.com)  

'Peers' Seen Easing Mental Health Worker Shortage
"Research shows that by using peer specialists, states can save mental health money by reducing hospitalizations and other emergency interventions. And people with mental illness who are helped by peers tend to experience more thorough and longer-lasting recoveries." (Kaiser Health News)  

GAO Report on Dental Services: Information on Coverage, Payments, and Fee Variation
"This report describes (1) trends in coverage for, and use of, dental services; (2) trends in payments by individuals and other payers for dental services; and (3) the extent to which dental fees vary between and within selected communities across the nation." (U.S. Government Accountability Office)  

Obamacare Insurance CO-OPs at the Starting Gate
"They have rented offices and zero customers. All their capital is borrowed. They're trying to sign the kind of expensive, chronically ill individuals that insurers have avoided for decades. In three weeks they face mighty competitors with a hundred times the resources. But the 24 insurance-company startups created by the [ACA] say they're ready to battle the establishment, stay in business and change health care." (Kaiser Health News)  

Obamacare Created 22 New CO-OPs, But Can They Succeed?
"Nonprofits in 24 states have received over $2 billion in federal loans to essentially start new health insurance products from scratch.... [Consumer Operated and Oriented Plans (CO-OPs)] leaders readily acknowledge that, going forward, setting prices is probably the most difficult part of their job. Usually, health insurance plans look at data from previous years to figure out what to charge consumers.... But these [CO-OPs] are brand-new. They can rely on general medical trends and hire actuaries, but they don't have their own premium collection data to fall back on." (Sarah Kliff in The Washington Post; subscription may be required)  


Plaintiffs Ask D.C. District Court for Preliminary Injunction to Stop ACA Premium Subsidies for Insurance Purchased Through Federal Exchanges
"[A]ttorneys for the Halbig plaintiffs [have] filed a motion for a preliminary injunction, requested a hearing on that motion before October 1, and filed a second motion also seeking to expedite the case. The first motion requests: 'an Order enjoining [the government], pending resolution of the litigation, from applying the IRS regulations extending eligibility for premium assistance subsidies under the [ACA] to individuals who purchase health coverage through Exchanges established by the federal government.' If the court grants that request, ObamaCare implementation will come to a screeching halt." (Cato Institute)  


DOL Says No Penalty for Failing to Provide October 1 Notice
"[The author's] experience with the federal laws and the enforcement of said laws by federal agencies is that when things say 'shall' and 'must,' there are penalties when you don't do them. So when the DOL now takes the position that it is not a 'shall' or 'must' scenario, but rather only a 'should' and 'even if you don't we won't punish you' proposition, [it gets] suspicious. But ... this [also] confirms what [the author has said] since the beginning about PPACA compliance for employers. It is all about your risk tolerance." (Fox Rothschild LLP)  


What You'll Really Pay for Health Care
"Imagine if your auto insurance worked the way your health insurance does. For years, you probably would have paid a fixed monthly premium plus, say, $20 every time you took your car to the body shop, regardless of whether you got an oil change or your entire engine replaced. Now, your plan has switched, and in addition to premium payments you're responsible for the first few thousand dollars of bodywork each year. And here's an extra wrinkle: The mechanic won't tell you how much you owe until after your car has been serviced. That pretty much sums up the state of affairs with health insurance today for millions of people in the U.S." (MarketWatch)  


Report Shows Why Obamacare Is Not Needed
"According to Commonwealth's own survey data, fewer than one in 10 (9 percent) of Americans were always uninsured during the period 2011-2012. Among adults with incomes above 133 percent of the poverty level (just under $15,000 for a single person), only one in 20 (5 percent) Americans lacked health insurance for all of 2011 and 2012." (John Goodman's Health Policy Blog)  


Will the ACA Obviate the Need for Employer-Sponsored Insurance?
"The majority of studies suggest that the impact of ACA on employers' decisions regarding the continuation of their employee health benefit programs will be relatively modest initially. Examples that predict more extreme shifts ... are often based on narrow assumptions. In this case the assumption is that quite modest differences in net costs of plans offered through the exchanges compared with employer-sponsored plans could cause large shifts from employers to the exchanges.That ignores a great many other considerations that enter the employers' action plans." (Physicians for a National Health Program [PNHP])  

Benefits in General; Executive Compensation

Text of Second Circuit Ruling on Award of Attorney's Fees Under ERISA After Settlement During Litigation (PDF)
"The present case raises the question, in part, that the Supreme Court did not resolve in Hardt: what must a party achieve or obtain to show some degree of success on the merits [that will support a grant of attorney's fees].... [In] evaluating ERISA fee applications, the catalyst theory remains a viable means of showing that judicial action in some way spurred one party to provide another party with relief, potentially amounting to success on the merits.... Where, however, the parties already have received a tentative analysis of their legal claims within the context of summary judgment, a party may be able to show that the court's discussion of the pending claims resulted in the party obtaining relief. This is in line with the underlying policy considerations of ERISA that we are to construe broadly." [Scarangella v. Group Health, Inc. et al., No. 12-2750-cv (2nd Cir. Sept. 10, 2013)] (U.S. Court of Appeals for the Second Circuit)  

Supreme Court Set to Weigh in on When a Cause of Action Accrues Under ERISA
"The Supreme Court accepted certiorari in this case to resolve the split in the circuits. Heimeshoff argues that plans should not be allowed to impose a limitations period that begins before the claimant exhausts administrative remedies and is able to file suit because doing so could potentially allow the limitations period to waste away while the claimant is going through the plan's administrative review process, forcing participants into a 'Catch-22' of having to file an ERISA lawsuit before they have exhausted their administrative remedies as required by law." (Benefits Bryan Cave)  

Press Releases

Connect   LinkedIn   Twitter   Facebook
BenefitsLink.com, Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
Phone (407) 644-4146
Fax (407) 644-2151

Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

Copyright © 2013 BenefitsLink.com, Inc. -- but feel free to forward this newsletter without further permission from us, if you do not modify the newsletter in any way (including this lower portion).

All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

Links to Web sites other than those owned by BenefitsLink.com, Inc. are offered as a service to readers. The editorial staff of BenefitsLink.com, Inc. was not involved in their production and is not responsible for their content.

Useful links: