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October 17, 2013          Get Retirement News  |  Advertise
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Choosing the “Right” Retirement Plan
October 22, 2013 WEBCAST

ERISA Workshop 2013 - Denver
November 14, 2013 in CO
(SunGard Relius)

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official guidance, jobs, webcasts and more.
[Official Guidance]

Text of Federal Data Services Hub Employer Group Business Service Definition (DOC)
26 pages. Excerpt: "This document describes the service interactions, assumptions, activities, constraints, process flow, and data elements for the Employer Group Service.... The FF-SHOP uses the Employer Group Service to transmit group request information to the Issuer through the Hub.... During the life of the employer group, any update to group-level information triggers transmission of updated group information via the Employer Group Service.... The Hub conducts all communication between the FF-SHOP and Issuers." (Office of Information Services, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


Gain a fresh outlook from benefits leaders ahead of the curve

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It's a new era in employee benefits. Gain direct insight, innovative practices and new ideas from executives at leading organizations such as BP America, Cargill, Marriott, Twitter, Walgreens and more. Learn more.

[Guidance Overview]

Government Shutdown, Debt Ceiling Deal Includes One ACA Provision
"The change to the health care law ... sets up a new requirement that the eligibility of people who receive cost-sharing reductions under Section 1402 of the Patient Protection and Affordable Care Act, P.L. 111-148, or the health insurance premium tax credit under Sec. 36B, be verified.... [HHS] must ensure that health insurance exchanges verify that individuals applying for the credit or cost-sharing reductions are eligible and must certify to Congress that the exchanges are verifying eligibility. The secretary is required to report to Congress by Jan. 1, 2014, what procedures exchanges are using to verify eligibility." (Journal of Accountancy)  

[Guidance Overview]

CMS FAQs Address Federally-Facilitated SHOP Premiums, Contributions
"CMS expects that employers would have the information necessary to perform the calculations for composite rating (i.e., dates of birth) only for their employees, and not for their employees' dependents.... For this reason, the FF-SHOPs are able to accommodate composite rating for employees only. Premiums for employees' dependents will be determined on an individual rating basis." (Wolters Kluwer Law & Business Health Reform Talk)  

Employer-Sponsored Health Insurance: Recent Trends and Future Directions (PDF)
28 pages. Excerpt: "It is all but certain that employers will continue to shift a greater portion of health benefit costs to employees and tighten eligibility rules for dependents.... The evolution of ongoing market trends and the impact of the new changes brought by the ACA both may be affected by ... trends toward self-insurance by smaller employers, the long-term viability of the public exchanges, state decisions about Medicaid expansion, legal challenges to the payment of subsidies on certain public exchanges and possible changes to the tax treatment of [employer-sponsored insurance] premiums." (National Institute for Health Care Management)  

Health Insurance Buying Power: Public Marketplaces vs. Private Exchanges
"Despite the fact that private exchanges offer so many solutions for certain employers, there is an undeniable layer of bureaucracy that exists in this approach. In addition, it's hardly an exact science. Employers need to be aware of some of the pitfalls of offering coverage through a private exchange, not the least of which is that it may take some time for a well-crafted model to emerge." (William Gallagher Associates)  


IRS COBRA Audit Guidelines - November 7 Webinar

Sponsored by Lorman and BenefitsLink

At this live webinar, we will explore the impact of the IRS' COBRA Audit Guidelines issued in 2012, and how they can be used as a roadmap for COBRA compliance. Registration discount for BenefitsLink readers.

GINA Author, Large Employers at Odds Over Genetic Data in Wellness Programs
"The chief architect of the Genetic Information Nondiscrimination Act [GINA] is asking the [EEOC] to investigate the use of genetic data in wellness programs and offer compliance guidance -- while large employers are hoping for more flexibility in tying incentives to genetic screening. Representative Louise Slaughter, a New York Democrat representing greater Rochester, urged the EEOC to take up the issue after controversy ensued from Penn State University's now-cancelled plans to require employees to undergo health risk assessments or else pay $100 extra in monthly premiums." (Healthcare Payer News)  

Analysis Shows Lowest U.S. Health Care Cost Increases in More Than a Decade
"After plan design changes and vendor negotiations, the average health care premium rate increase for large employers in 2013 was 3.3 percent, down from 4.9 percent in 2012 and 8.5 percent in 2011. In 2014, however, average health care premium increases are projected to move back to the 6 percent to 7 percent range.... [T]he average health care cost per employee was $10,471 in 2013, up from $10,131 in 2012.... [A]verage employee out-of-pocket costs, such as copayments, coinsurance and deductibles, increased 12.8 percent ($2,239) in 2013, compared to just 6.2 percent in 2012 ($1,984)." (Aon Hewitt)  

Small Employer Perspectives on the ACA's Premiums, Shop Exchanges, and Self-Insurance
"Sixty percent of the small firms offered employee health benefits in 2012, and 41 percent of employees were enrolled in their employer's plan. Among firms not offering coverage, 75 percent pointed to cost as the most important reason why they do not. When asked what monthly premium for single-employee coverage they could afford, firms reported prices considerably below the current market average of $502.... Eighty percent of firms offering coverage use brokers to help with tasks such as selecting health plans and enrolling employees -- functions the SHOP marketplaces can provide." (The Commonwealth Fund)  

Hospitals Requiring Patients to Pay Up Front as Deductibles Rise
"Many of the plans offered through the [ACA]'s insurance exchanges have low initial premiums to attract customers, while carrying significant deductibles and other out-of-pocket cost sharing.... Hospitals say they need to charge patients prior to treatment because Americans are increasingly on the hook for more of their own medical costs. And once care is provided, it's often difficult for hospitals to collect." (Bloomberg)  

Measuring the Success of the Affordable Care Act: Keeping Our Eyes on the Ball
"How will we really know if the [ACA] is working as intended, and if and when its provisions need to be modified? ... To measure success on the coverage side, there are several questions to consider. [1] Are the marketplaces fully operational by December 15, 2013 (in time to have coverage begin on January 1, 2014)? [2] Are people enrolling in health plans? [3] Is the number of people who are uninsured falling? [4] Is the number of people who are underinsured falling?" (The Commonwealth Fund)  

Search Tools Wanting on Many Exchanges
"Most of the 15 exchanges run by states and the District of Columbia do not have provider directories or search tools on their Web sites -- at least not yet -- so customers cannot easily check which doctors and hospitals are included in a particular plan's network. Most allow customers to search for providers by linking to the insurers' Web sites, but the information is not always accurate or easy to navigate ... [E]ven many doctors are uncertain about whether they are contracted with exchange plans from state to state because the plans -- and even some of the insurers -- are so new." (The New York Times; subscription may be required)  

As Obamacare Tech Woes Mounted, Contractor Payments Soared
"As U.S. officials warned that the technology behind Obamacare might not be ready to launch on October 1, the administration was pouring tens of millions of dollars more than it had planned into the federal website meant to enroll Americans in the biggest new social program since the 1960s. A Reuters review of government documents shows that the contract to build the federal Healthcare.gov online insurance website ... tripled in potential total value to nearly $292 million as new money was assigned to the work beginning in April this year." (Reuters)  

Obama Health Target: 500,000 Signups by Oct. 31
"For the first month alone, the Obama administration projected that nearly a half million people would sign up for the new health insurance markets, according to an internal memo... But that was before the markets opened to a cascade of computer problems. If the glitches persist and frustrated consumers give up trying, that initial goal, described as modest in the memo, could slip out of reach." (ABC News)  

In Week Two, Washington State Exchange Enrollment Nearly Triples
"About 25,000 Washington state residents have enrolled in health plans through the state's online insurance exchange marketplace during its first two weeks. That figure is nearly triple the 9,500 residents who completed their enrollment during the first week that the exchange ... was open for enrollment. An additional 37,000 people have completed applications to enroll in coverage but have not yet submitted their first payment, which is not due until December." (Kaiser Health News)  

State Medicaid Agencies Reporting Problems in New Exchange-Linked Enrollment System
"The primary challenge for state Medicaid programs in converting to the exchange-linked enrollment system was moving from what, in most cases, was a paper-based system to an online system, [Matt Salo, head of the National Association of Medicaid Directors] said. 'It's important to stress just how massive an undertaking this was from an IT perspective,' he said. 'It's unprecedented. The startup for Medicare Part D, which was relatively simple, had a lot of bumps. This is 100 times more complicated.'" (Bloomberg BNA)  

Blue Cross Ends Medicare Contract Offering Senior Drug Plans in Louisiana
"Blue Cross Blue Shield of Louisiana announced in a letter to its members that it will discontinue its Medicare Part D coverage in 2014.... About 13,000 seniors were covered through the company's BlueRx prescription plans, which have been offered since 2006. That's out of 333,0000 Louisianians who currently receive Part D prescription coverage, according to the state Department of Insurance." (The Times-Picayune)  


The State of the Exchanges, Income Verification, and More
"It is frustrating that HHS has failed to provide information as to what precisely is wrong with the exchange. Some of the problem is clearly due to the high volume of website visits during the first few days of the exchanges operation ... but visits have dropped dramatically and problems persist. Moreover, it is becoming increasingly clear that problems persist throughout the enrollment process, and particularly at the back end where applicants are actually supposed to be enrolled with insurers ... [I]n the end, it is the responsibility of HHS, or perhaps the White House, to explain to the American public what exactly is wrong and when we can expect it to be fixed. This has not yet been done." (Timothy Jost in Health Affairs Blog)  


Should Obamacare Be Delayed -- And More to the Point, Can It?
"When considering a delay to Obamacare, it's important to understand the difference between statutory and discretionary deadlines. For example, the ACA's language directly calls for many mandatory deadlines -- like rolling out the individual mandate or implementing a slew of insurance market reforms on Jan. 1, 2014. But the agencies also have had considerable leeway on how they've chosen to apply the law -- like choosing an Oct. 1 launch date for the exchanges, a deadline that retrospectively seems ambitious." (Kaiser Health News)  


The GOP's Income Verification 'Concession' Is Meaningless
"[T]he deal basically requires two submitted reports in the course of the next year. [HHS] Secretary Kathleen Sebelius is due to submit the first report by Jan. 1, which must detail 'the procedures employed by American Health Benefit Exchanges to verify eligibility for credits and cost-sharing reductions' ... Six months later, the HHS inspector general is required to submit a report 'regarding the effectiveness of the procedures and safeguards provided under the [ACA] for preventing the submission of inaccurate or fraudulent information by applicants.'" (The Washington Post; subscription may be required)  


Four Things I Learned About Obamacare from Shopping on Healthcare.gov
"After two weeks of trying, I was able to successfully apply for coverage on HealthCare.gov. After spending the morning tooling around the site ... [1] The site is moving faster but not at full speed.... [2] Applying for coverage without subsidies is way easier than seeking financial help.... [3] In Virginia, premiums really vary.... [4] Shopping is pretty easy! Logging into HealthCare.gov, as many Americans have learned since Oct. 1, is hard." (Sarah Kliff in The Washington Post; subscription may be required)  


Don't Eliminate Fee-for-Service
"Serious payment reform in this country ... needs to retain some form of fee-for-service, the leading culprit of the ongoing health spending spree ... Fee-for-service provides some accounting system to help payers divide the risk-adjusted capitation payments the payment system is inching toward, according to Len Nichols, PhD, director of the Center for Health Policy Research and Ethics at George Mason University in Fairfax, Va. 'If you abolished all fee-for-service tomorrow, you abolished all those codes, you'd have no clue what's going on out there,' Nichols said[.]" (MedPage Today)  

Benefits in General; Executive Compensation

Argument Analysis: Nobody Seems Worried About ERISA Limitations Periods
"In Tuesday's argument in Heimeshoff v. Hartford Life & Accident Insurance Co., the Justices seemed convinced that no matter how they decide this case, it probably won't be a big deal.... [T]here is a dearth of data explaining how often the statute of limitations actually prevents the beneficiary of an ERISA-regulated plan from filing suit. Sometimes, such information gaps invite speculation, wild theories, and entertaining hypotheticals. On Tuesday, however, the Justices responded by wondering out loud whether the issues in the case even matter." (SCOTUSblog)  

High Court Hears Arguments on Accrual of Limitations Periods in ERISA Plans
"Justice Stephen G. Breyer asked [Heimeshoff's attorney Matthew W.H.] Wessler whether Heimeshoff's problem could be solved by allowing her to file a 'protective complaint' prior to the conclusion of the administrative review process. Wessler argued that this solution would distort the administrative review process, saying that this 'gets lawyers and courts involved in a process that should be private.'" (Bloomberg BNA)  

California Governor Signs New Law Reducing State Tax Penalty for Section 409A Violations
"California law previously provided for ... a 20% state income tax penalty in addition to the 20% federal income tax penalty on amounts previously deferred and includible in income as a result of a Section 409A violation. The new law ... substitutes the phrase 'five percent' in lieu of the phrase '20 percent' as the additional income tax penalty for violations of Section 409A. The reduced income tax penalty is applicable for taxable years beginning on or after January 1, 2013." (Proskauer's ERISA Practice Center)  

California Public Pension Ballot Initiative Would Eliminate Vested Right to Future Benefit Accruals
"The proposal if passed would amend the California constitution to provide that employees have no vested rights in future pension and retiree health benefit accruals, but only to benefits accrued based on past employment. As such, it would cause the vesting of public retirement plans in California to be more comparable to the vesting of private retirement plans under [ERISA]. The proposal, if adopted, would be particularly significant inasmuch as California has historically been a leader in the recognition of the right of public employees to vesting in future benefit accruals." (Calhoun Law Group)  

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