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October 14, 2013          Get Retirement News  |  Advertise
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[Official Guidance]

CMS Opens Comment Period on ACA Application Forms for Exemption from Minimum Coverage Requirements
"The data collection and reporting requirements are critical to the basic ability of Exchanges to determine eligibility for and issue certificates of exemption, and will also assist Exchanges, HHS, and IRS in ensuring program integrity and quality improvement." [Click here for a ZIP file with the proposed application forms plus the 25-page supporting statement by CMS.] (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


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[Guidance Overview]

CMS Addresses Insurer Questions on Employer Premiums and Contributions in FF-SHOP
"Although directed at insurers, these FAQs provide some practical details and examples of how to calculate premiums and contributions for employers considering participating in an FF-SHOP. With FF-SHOP coverage scheduled to begin January 1, 2014 for enrollments completed by December 15, 2013, the FAQs are essential reading for those interested in FF-SHOP coverage." (Thomson Reuters / EBIA)  

[Guidance Overview]

DOL Stepping Up Enforcement of ACA Through Plan Audits: Are You Prepared?
"The type of information being requested by the DOL varies depending on whether your group health plan is claiming grandfathered status.... [P]lan sponsors should: [1] Routinely conduct compliance audits of their plans. [2] Maintain in one designated location all signed plan documents and amendments, committee or board resolutions and minutes addressing issues relating to the plans, service provider and insurance contracts, participant communications, summary plan descriptions, and required employee notices under ACA and other federal mandates, including the Women's Health and Cancer Rights Act and HIPAA; and [3] Document, document, document[.]" (McKenna Long & Aldridge LLP)  

Obamacare Deductibles May Cause Sticker Shock
"To promote the Oct. 1 debut of the exchanges ... Obama administration and Illinois officials touted the lower-than-expected monthly premiums that would make insurance more affordable for millions of Americans. But a Tribune analysis shows that 21 of the 22 lowest-priced plans offered on the Illinois health insurance exchange for Cook County have annual deductibles of more than $4,000 for an individual and $8,000 for family coverage." (Chicago Tribune via Physicians for a National Health Program [PNHP])  

Employers Push Health Care Savings Accounts; Consumer Groups Wary
"In the last six years, the number of workers covered by these health savings account plans has quadrupled, from 5 percent in 2007 to 20 percent this year ... It's part of sweeping trend toward 'consumer-driven' health care, an approach that government and employers are embracing as a way to tamp down health care costs by encouraging individuals to be more in control of their health care behaviors and choices." (Sacramento Bee)  

Why Some Virginia Health Plans Cost So Much
"[A] Virginia consumer considering so-called gastric bypass or bariatric surgery will have to pay up to $1,500-a-month more for plans that cover the surgery. Consumers in Maryland, by contrast, could buy any policy in the marketplace -- and for dramatically less than the Virginia rider plans -- and be covered for bariatric surgery since that state requires all plans to pay for it.... State laws vary, with some having fewer than 20 mandates and others, like Maryland, having more than double that number." (Kaiser Health News)  

CMS Operational Manual Details Enrollment Processes for Federally Facilitated Exchanges
"The manual, which also describes the processes for special enrollments, coverage cancellations, and coverage terminations, will be of interest to agents, brokers, and similar advisors assisting individuals and employers to enroll in coverage through FFEs and FF-SHOPs. Unfortunately, ambiguities remain." (Thomson Reuters / EBIA)  

Citing Procedural Missteps and Conflict of Interest, Court Reverses Insurer's Denial and Imposes Penalties for Failure to Provide Internal Guidelines
"While the decision itself is very fact-specific, the lessons to be learned from the insurer's procedural missteps are universal. Not only insurers, but also self-insured plan sponsors and TPAs deciding claims and appeals should be careful to adopt, follow, and document a compliant claims and appeals process.... [D]enial letters should reference plan provisions (or internal rules where applicable) and explain why any contrary evidence has been disregarded or distinguished." [Butler v. United Healthcare of Tenn., Inc., 2013 WL 5488644 (E.D. Tenn. 2013)] (Thomson Reuters / EBIA)  

Glitches on Health Insurance Exchanges Prompt Increased Interest in Paper Applications
"The dead-tree version of health insurance enrollment is turning out to be surprisingly popular. Unable to use new government insurance Web sites that have been plagued by technological problems, those tasked with helping the uninsured sign up for health coverage are bypassing the sites altogether, relying instead on old-fashioned paper applications. It is a slow and labor-intensive substitute for what was supposed to be a snappy online application[.]" (The Washington Post; subscription may be required)  

Employer Failed to Show It Would Have Fired Employee for Work Issues and Faking Need for FMLA Leave
"Although the lower court found it persuasive that Chevron had begun the disciplinary process before the employee applied for FMLA leave, the Fifth Circuit found the company's claim that it would have fired him based on his absences and poor performance 'disingenuous and contradicted by the evidence.' ... [T]here was no indication [the company] was considering further discipline for his prior absences and performance. Rather, it gave him a final warning, implying he had another chance to keep his job." [Ion v. Chevron USA, Inc., No. 12-60682 (5th Cir. Sep. 26, 2013)] (Wolters Kluwer Law & Business)  

From the Start, Signs of Trouble at Federally-Run Exchanges
"One person familiar with the system's development said that the project was now roughly 70 percent of the way toward operating properly, but that predictions varied on when the remaining 30 percent would be done. 'I've heard as little as two weeks or as much as a couple of months,' that person said. Others warned that the fixes themselves were creating new problems, and said that the full extent of the problems might not be known because so many consumers had been stymied at the first step in the application process." (The New York Times; subscription may be required)  

Aetna Tests Personalized Lifestyle Therapy on Employees
"Over the next year about 500 Aetna employees who fit the risk profile for metabolic syndrome will be given online health surveys and saliva genetic tests, separated based on genes linked with obesity, appetite, and behavior, and then receive personalized coaching therapies ... The pilot is aiming to eventually lead to improvements in the individuals' health, as measured by biometric screenings before and after the program." (Healthcare Payer News)  

How Many People Have Signed Up for Health Insurance on the Federal Exchanges?
"For some reason the system is enrolling, unenrolling, enrolling again, and so forth the same person. This has been going on for a few days for many of the enrollments being sent to the health plans.... [The] health plans worry some of these very few enrollments really don't exist. The reconciliation system, that reconciles enrollment between the feds and the health plans, is not working and hasn't even been tested yet." (Health Care Policy and Marketplace Review)  

Eight Costly Benefits Mistakes Employees Will Make During Fall Open Enrollment Season
"If your employer-provided coverage is expensive or not comprehensive, definitely look at the exchanges. If you have coverage through a large employer, that's probably the better deal, but not necessarily.... [T]wo-earner spouses who each have employer-provided healthcare benefits have extra work to do comparing various scenarios, including surcharges, which gets more complicated if there are kids." (Forbes)  

Doctors, Patients Scramble to Determine Effects of UnitedHealthcare Cutting Doctor Network
"UnitedHealthcare plans to eliminate 810 primary-care physicians and 1,440 specialists from its Medicare Advantage network in Connecticut next year ... A UnitedHealthcare executive denied that the insurer was targeting doctors who are most expensive to the system." (Hartford Courant)  

[Opinion]

Five Thoughts on the Obamacare Disaster
"[1] So far, the [ACA]'s launch has been a failure. Not 'troubled.' Not 'glitchy.' A failure.... [2] Are there problems behind the problems? ... We're far from knowing what the fail rate is for those people trying to take that final step of purchasing a plan. [3] What didn't the White House know and when didn't they know it? ... [4] One thing has gone abundantly right for the [ACA]: The Republican Party.... [5] This isn't about politics." (Ezra Klein in The Washington Post; subscription may be required)  

[Opinion]

Paying for the ACA: A Field Guide
"The inattention to the financing of the ACA by the public, the media, and even Republicans is a testament to the skill of its drafters. The benefits of the ACA are highly visible, the costs are concealed." (The Health Care Blog)  

[Opinion]

Mileposts Remain for Health Care Law
"The Oct. 1 rollout was interesting, instructive and not all that important. Over the next year or so, there are at least four crucial benchmarks: [1] Dec. 15: That's when we will know if the computer glitches have been fixed and whether the administration has adequately promoted the law in preparation for Jan. 1, when coverage of the uninsured begins.... [2] April 1: The [CBO] estimates that seven million Americans will sign up in the first three months.... [3] A year from now ... insurance rates, which factor in risks and likely costs, will probably come down.... [4] January 2015:... [T]he partisan pressure might subside after the 2014 election." (The New York Times; subscription may be required)  

[Opinion]

What's the Deal with the Exchanges?
"People are unlikely to go through all these applications until they have a pretty good idea of what it is they are applying for. It is like being expected to fill out an application for a car loan without having any idea of the cars that are available. Plus, many of the web site visitors aren't potential buyers at all. They may be reporters, or researchers, or just the public curious to see how its tax dollars are being spent. All are required to fill out the same forms before they can see any actual insurance products." (John Goodman's Health Policy Blog)  

Benefits in General; Executive Compensation

Opening Up the Courthouse Door: The Second Circuit Weighs In on Exhaustion of Administrative Remedies (PDF)
"As we move more and more into a world in which employees ... are the ones responsible for their retirements, and in many instances for much of the cost and even management of their health benefits, the competency of plan operations becomes more and more central to our, as well as courts', thinking about ERISA plans, responsibilities, and liabilities. This is becoming an explicit and literal concern ... with legal doctrines governing ERISA litigation moving towards a framework in which problems with competence can more readily be remedied through the court system." (Stephen Rosenberg of The McCormack Firm, LLC, via Journal of Pension Benefits)  

A Preview of Key Executive Compensation Issues for the 2014 Proxy Season: Results of ISS' 2013-2014 Policy Survey
"In contrast with last year's survey which focused on numerous executive compensation topics (e.g. peer group selection, measuring pay including granted vs. realizable pay, pay for failure, and executives' and/or board members' pledging of company stock), this year's survey concentrated on broader high-level corporate governance themes including board responsiveness, director tenure/rotation and director assessment, with the primary executive compensation survey questions relating to equity plan evaluations." (Steven Hall & Partners)  

The Importance of Commenting on the Proposed CEO Pay Ratio Rules
"In [a recent speech, SEC Chair Mary Jo] White recognized the importance of disclosure to investors, but stated that disclosure which strayed beyond the SEC's core purposes could lead to information overload which would harm investors. She also noted that certain Congressional mandates appeared more directed at exerting societal pressures on companies to change their behavior rather than at disclosing financial information to inform investment decisions.... Companies ... should not assume that the final rules could not be more burdensome than the proposed rules and need to support what the SEC has done, as well as suggest improvements." (The Conference Board)  

2013 'Say on Pay' Voting Results
"3,011 companies have held Say on Pay votes in 2013. 60 companies have failed with an average 60% 'Against' vote. Ten companies have failed previous votes. 71% of companies have received a greater than 90% 'For' vote. Average vote among all companies: 90% 'For' vote 8% 'Against' vote 2% Abstentions." (Steven Hall & Partners)  

SEC's Pay Ratio Proposal: Costs, Complexities, and Contradictions
"Several companies discussed their preliminary thoughts on compliance, with the conclusion being that some companies have centralized data that may be useful in identifying the median employee, but only if the SEC permits sufficient flexibility in how 'reasonable estimates' are obtained. One company [indicated] that to have precise data across all databases by implementing a global HRIS system, it would take $9 million and as long as eight years." (HR Policy Association)  

How Does Retiree Health Insurance Influence Public Sector Employee Saving?
"[T]his paper utilizes a unique data file on three baseline cohorts from the Health and Retirement Study to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. We find that most full-time public sector employees who anticipate receiving employer-provided health insurance coverage in retirement save less than their private sector uncovered counterparts." (National Bureau of Economic Research [NBER])  

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