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November 6, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Senior Benefits Manager
Wood Group
in TX

Actuary or DB Plan Reviewer
MGKS, Inc.
in AZ

Analyst 3 - Benefits (Retirement Plans)
E. & J. Gallo Winery
in CA

Employee Benefits Analyst
Ice Miller LLP
in IN

Senior Defined Contribution Analyst
A Full Service Qualified Plan Administration Firm
in OH

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Webcasts and Conferences

Affordable Care Act 101
November 7, 2013 WEBCAST
(U.S. Small Business Administration (SBA))

Defined Benefit and Cash Balance Plans
November 12, 2013 WEBCAST
(United Retirement Plan Consultants, Inc.)

Teleconference: IRS Issues Long-Awaited Rollover Guidance for FSAs
November 13, 2013 WEBCAST
(Employers Council on Flexible Compensation (ECFC))

Affordable Care Act 101
November 14, 2013 WEBCAST
(U.S. Small Business Administration (SBA))

ERISA Litigation Update
November 19, 2013 in CA
(Western Pension & Benefits Council - San Diego Chapter)

Practical Considerations for Issuing Equity as Compensation - Recorded
November 20, 2013 WEBCAST
(DLA Piper LLP)

View All Webcasts and Conferences

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

HHS Discourages Third-Party Subsidies on Exchanges (PDF)
"Contrary to indirect indications made last week, HHS [has now] issued explicit guidance ... discouraging providers from subsidizing patient premiums on health exchanges and encouraging issuers to reject such payments.... The HHS directive will likely moderate the interest level of hospitals to pursue direct subsidies ... Although it would certainly help, the significant benefits [the equity research authors] project from coverage expansion for hospitals are not tied to the ability to subsidize patient premiums, with free or low-cost coverage available to millions from government subsidies alone." (JPMorgan)  


How Does The DOMA Decision Impact Your Benefit Plan?

Sponsored by International Foundation of Employee Benefit Plans (IFEBP)

The Supreme Court decision in Windsor v. U.S. found the Defense of Marriage Act (DOMA) to be unconstitutional. Are you prepared for how this will impact your plan? Enroll in one of the International Foundation's new e-learning courses to learn more.

[Guidance Overview]

Qualified Health Plans Are Not Federal Health Care Programs -- Does This Mean Providers Can Subsidize Premiums?
"The Sebelius letter [of October 30, 2013 to Rep. Jim McDermott] eliminates a major concern for providers who are considering subsidizing premiums for QHP enrollees. However ... providers should analyze applicable state law restrictions and evaluate non-profit tax laws ... Premium assistance provided to patients may also result in tax liabilities for the patients, and providers may be required to report each patient's premium assistance amounts on a Form 1099-MISC." (Davis Wright Tremaine LLP)  

[Guidance Overview]

HHS Clarifies that ACA Qualified Health Plans are Not Subject to Federal Anti-Kickback Statute; Expresses Concern about Providers Paying Premiums for Enrollees
"[T]he HHS letter reminds issuers that under the ACA, the False Claims Act applies to 'payments made by, through, or in connection with an Exchange if the payments include Federal funds.' ... [A]lthough the federal anti-kickback law will not apply, arrangements involving QHPs will have to be evaluated to determine if they raise a risk of being characterized as causing a false claim or statement." (McDermott Will & Emery)  

[Guidance Overview]

IRS Modifies Health FSA Rules to Permit Carryover of Up to $500
"The use of a carryover option does not, however, limit an employer's ability to allow for a claims run-out period.... Thus, for a plan allowing both the new carryover option and a claims run-out period, a participant's unused health FSA funds from the prior plan year may be used to reimburse expenses incurred both (a) during the prior plan year and submitted during the plan's run-out period, and (b) during the current plan year." (Verrill Dana LLP)  

Taft-Hartley Plans May Get Exemption from Reinsurance Fee
"Buried in [recently-issued HHS rules] is the disclosure that the administration will propose exempting 'certain self-insured, self-administered plans' from the law's temporary reinsurance fee in 2015 and 2016 [at page 65051 in the October 30, 2013 Federal Register]. That's a description that applies to many Taft-Hartley union plans acting as their own insurance company and claims processor ... Eliminating the reinsurance fee was one of several resolutions adopted at the AFL-CIO's September convention, along with giving union plans access to ACA tax credits for lower-income members." (Kaiser Health News)  


23rd Annual National Health Benefits Conference & Expo

Sponsored by HBCE- Health Benefits Conference & Expo

The Biggest Challenge Remains: Addressing the Most Intractable Cost Problem Facing Employers, Employees & Governments at All Levels - January 28-29, 2014 - Clearwater Beach, FL. High quality, moderate cost - Register now for best rates!

Preparing for the Coming Storm: What Current Lawsuits Teach Us About ACA Compliance
"[L]awsuits [are now being] filed by insured against insurance companies seeking to enjoin the cancellation of their policies, charging fraud and misrepresentation.... [E]mployers should anticipate in that the same thing will happen to them in October and November of 2014 when they roll out their compliance programs. Whatever changes, limitations or revisions are made to health benefits next year, if employers do it incorrectly, employees will sue.... Insurance companies spent the last three years preparing for this day and still got sued. Employers should spend the next 12 month working with their lawyers, accountants and benefits professionals developing a fully compliant program." (Fox Rothschild LLP)  

What Should Disability Plan Administrators Know About Allegations of Fraud and Abuse in the Social Security Disability Trust Fund?
"ERISA plan participants seeking long-term disability benefits often cite a favorable Social Security award as support for their claims. These new allegations suggest possible additional bases to distinguish these awards[.]" (Seyfarth Shaw LLP)  

Eight Steps to a Successful Voluntary Benefits Program
"Offer voluntary benefits based on what you know about your employees.... Offer voluntary benefits based on what you know about your competitors.... Management buy-in and commitment is critical.... Pre-rollout planning is essential.... Facilitate ease of enrollment with channel of choice options.... Before you attempt to enroll employees, educate them.... Repeat yourself.... Conduct a post-enrollment follow-up." (Corporate Synergies Group, Inc.)  

Health Insurers Urged to Extend Policies Beyond Year-End
"Federal lawmakers and state officials are stepping up pressure on insurers to allow consumers whose coverage has been canceled in response to the health overhaul to keep their policies beyond the end of the year. On Tuesday, one of the largest regional health plans in the nation, Blue Shield of California, said it would relax its stance on terminated policies for about 115,000 people after state regulators demanded it do so. Customers now will have until March to decide which plan to choose for 2014, a three-month extension." (The Wall Street Journal; subscription may be required)  

Humana Says It's Expecting Extension of Enrollment Deadline
"'Our assumption is that there will be an extension to the open enrollment period,' Chief Operating Officer Jim Murray said during a call with investors to discuss quarterly results. The company also said it was waiting to hear whether there would be a delay in when the part of the law requiring Americans to have health insurance kicks in." (Reuters)  

CMS Wants More Brokers on Exchanges
"[CMS] wants 'to bring 60,000 more' agents and brokers on for consumer assistance with the [ACA]'s federally run exchanges ... 'war room notes' from CMS meetings that included a line item dated Oct. 11: 'Next week we will [be] attempting to stoke the furnace of agent brokers and get more of them in.' The note also included that this strategy is 'contingent' on broker identity and password software functioning." (Employee Benefit Adviser)  

Senate Finance Committee Hearing on Health Insurance Exchanges: An Update from the Administration
Video of hearing held on Wednesday, November 6. Includes statements from Sens. Max Baucus and Orrin Hatch, and testimony of HHS Secretary Kathleen Sebelius. (U.S. Senate Committee on Finance)  

Notes Reveal Chaotic White House Talks on Health Care Site
"The notes indicate that by Oct. 8, one week after the exchange opened, administration officials had begun to realize that its problems were widespread and could not be easily fixed. No sooner was one problem solved than others popped up. The documents show that officials were focused on addressing individual bugs, rather than the larger issue: The website was not working properly from Day 1." (The New York Times; subscription may be required)  

Oversight Committee Releases October Healthcare.gov Administration 'War Room' Notes
"New information included in the War Room meeting notes: ... 'The first case of Navigator fraud (not a Navigator, just fraud) came today out of OH,' the notes state on October 1st... CMS has both official and unofficial numbers from states.... Limited information, learning from the news ... Flawed applications due to 'event skip' ... Wrong codes causing issues ... The 'War Room' notes released today run from October 1, 2013 to October 29, 2013. You can read all the 'War Room' notes here." (Committee on Oversight and Government Reform, U.S. House of Representatives)  

Obamacare Site Can Handle 17,000 People an Hour, CMS Says
"The U.S. health-insurance exchange is seeing improvement and can now register 17,000 customers per hour 'with almost no errors' ... Fixes included speeding up the site so insurance plans are displayed 'in just seconds,' Marilyn Tavenner, head of [CMS], said in remarks to the Senate Health, Education, Labor and Pensions Committee [on Nov. 5]. The agency also doubled the number of servers and replaced a virtual database with a physical one as it tries to reach a goal of 800,000 sign-ups in the first month." (Bloomberg)  

Obama Administration Hoping 800,000 Enroll by End of November
"[T]hat estimate includes people signing up for Medicaid as well as private insurance.... [CMS Administrator Marilyn] Tavenner told the Senate Health Education Labor & Pensions committee that she did not think the debacle surrounding the healthcare.gov web site would affect enrollment because most people would wait until December or later to sign up." (Kaiser Health News)  

New Census Estimates Show 3 Million More Americans Had Health Insurance Coverage in 2012
"[T]he number of Americans with insurance coverage increased from 260.2 million in 2011 to 263.2 million in 2012. The corresponding percentage of people in all age groups without health insurance decreased from 15.7% in 2011 to 15.4% in 2012, a statistically significant change.... [F]rom 2000-2010, the number of uninsured Americans went up each year. Since 2010, as the economy improved and the early features of the Affordable Care Act took effect, the number of uninsured has gone down. The decline in rates of employer-sponsored coverage, which dropped sharply in the previous decade, have leveled off, and public coverage under Medicare, Medicaid, and CHIP has increased." (Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services)  

Text of Letter from Rep. Camp to IRS Requesting Data on Number and Location of Persons Eligible for Premium Tax Credits (PDF)
"To assist the Committee in our oversight of the implementation of the Affordable Care Act, please provide the Committee with: [2] The number of Exchange applicants, by State of residence, the IRS has reviewed and determined, based on their income, are eligible to receive premium tax credits towards the purchase of a health plan. [2] The number of Exchange applicants, by State of residence, the IRS has reviewed and determined that their income is below the threshold that would make them eligible for premium tax credits. [3] The number of Exchange applicants, by State of residence, the IRS has reviewed and determined that their income is above the threshold that would make them eligible for premium tax credits. [4] The average age, by State of residence, of the Exchange applicants for which the IRS has been asked to make an eligibility determination. Please provide this information to the Committee by Tuesday, November 12, 2013." (Committee on Ways and Means, U.S. House of Representatives)  

CBO Estimate of Budgetary Effect of Requiring Congressional Staff to Purchase Health Insurance Coverage Through ACA Exchanges (PDF)
"CBO estimates that implementing section 142 of H.J. Res. 59 would yield discretionary savings, assuming appropriation actions consistent with the provision, of $833 million over the 2014-2018 period and about $2 billion over the 2014-2023 period... Enacting the legislation also would increase direct spending and reduce revenues. Together, changes in those two components of the budget would increase the deficit by $474 million over the 2014-2018 period and by $978 million over the 2014-2023 period, CBO and JCT estimate." (Congressional Budget Office)  

Public Insurance Is Increasingly Crucial to American Families Even as Employer-Sponsored Health Insurance Coverage Ends Its Steady Decline
"In 2012, the share of non-elderly Americans with employer-sponsored health insurance [ESI] did not decline for the first time in 12 years. After falling every year since 2000, for a total decline of 10.9 percentage points to 2011, coverage was essentially flat between 2011 and 2012, increasing slightly to 58.4 percent.... As many as 29 million more people under age 65 would have had ESI in 2012 if the ESI coverage rate had remained at its 2000 level.... On-the-job coverage for strongly attached workers (those who worked at least 20 hours per week for at least half the year) continued its march downward, from 55.4 percent in 2007 to 51.6 percent in 2012." (Economic Policy Institute)  

Camp Subpoenas CMS for Enrollment Data
"Ways and Means Committee Chairman Dave Camp (R-MI) issued a subpoena to [CMS] to provide all data the agency has on enrollment in the Exchanges. The subpoena ... comes after CMS refused to provide enrollment data for the ObamaCare Exchanges. The data was first requested by Camp during a hearing with CMS Administrator Tavenner and again in a letter Friday, November 1.... Chairman Camp demanded CMS provide the documents by close of business Friday, November 8." (Committee on Ways and Means, U.S. House of Representatives)  


Hyperdiagnosis: The Wellness Industry Doubles Down on Overdiagnosis
"Many insignificant conditions get overdiagnosed and subsequently overtreated, at considerable cost to the health plans and risk to the patient.... We call this new plateau of clinical unreality 'hyperdiagnosis,' and it is the wellness industry's bread-and-butter. It differs from overdiagnosis four ways: It is pre-emptive. It is either negligently inaccurate or purposefully deceptive. It is powered by pay-or-play forfeitures. The final hallmark of hyperdiagnosis is braggadocio -- wellness companies love to announce how many sick people they find in their screens." (The Health Care Blog)  


A Woman May Die Because of Obamacare
"For the past 20 years I have been trying to convince my colleagues in the health policy community that managed competition contains perverse economic incentives.... [T]he theoretical predictions we were making were always much more extreme than anything we observed in real world examples of managed competition ... But remember, most insurance companies have traditionally operated more like Blue Cross look-a-likes rather than dog-eat-dog competitors. Until now." (John Goodman's Health Policy Blog)  


Obamacare's Insurance Cancellations: A Feature, Not a Bug
"What's mostly been lost in the well-documented outrage over the cancellations is that they're a feature, not a bug, of the Affordable Care Act. Some policies are being canceled because the law is doing precisely what it was meant to do: create an insurance market where Americans share the cost of getting sick more broadly." (John Tozzi in Bloomberg BusinessWeek)  


Exchange Plans Hide Your True Financial Exposure
"These boring minutiae on benefits of two actuarially equivalent plans offered through the Massachusetts health insurance exchange seem like they would have little relevance compared to the major features of the [ACA]. Quite the opposite. These numbers demonstrate that the concept of transparency in shopping for plans in the ACA exchanges is a cruel fiction. It is impossible to know what your out-of-pocket expenses will be for any given plan that you select." (Physicians for a National Health Program [PNHP])  


The Latest Mystery: What Is Happening to All Those Paper Applications?
"One thing is crystal clear from the health plans' meager enrollment to date: the insurance companies are not getting these 'thousands' of paper applications.... Health plans are separately enrolling more people on their own sites and through their call centers in great part because of all of the cancellation letters they have recently sent out.... [An] overwhelming number of existing customers are opting to keep their current plan versus taking an Obamacare-compliant plan from the carrier -- an interesting outcome given that so many of these plans are said to be 'substandard.'" (Robert Lazewski in The Health Care Blog)  

Benefits in General; Executive Compensation

[Guidance Overview]

Proposed CEO Pay Ratio Rules Provide Companies with Flexibility to Satisfy Dodd-Frank Mandate (PDF)
"By proposing only a brief discussion of pay ratio methodology, assumptions and estimates, the SEC appears to be somewhat sensitive to the additional costs associated with mandating a more extensive narrative of the pay ratio components or the inclusion of supplemental information regarding compensation structures and polices, neither of which is required by the text of Section 953(b). It is likely, however, that the length (and therefore cost) of such disclosure will vary significantly between companies depending on the methodology used and the number of estimates involved." (Bass, Berry & Sims via Bloomberg BNA)  

Alternative Pay-for-Performance Measures: The Importance of Understanding the Nuances
"As more companies embrace alternative pay definitions, such as realizable and earned pay, in their proxy disclosures and pay-for-performance analyses, it's important to keep in mind that these definitions can produce sharply differing results based on business and market performance.... How rewards from various incentive plans are counted differs significantly under the common definitions of earned pay (sometimes called realized pay) and realizable pay[.]" (Towers Watson)  


Text of Comments by Steven Hall & Partners to ISS on 2014 Draft Policies
"By continuing to use TSR as the sole quantitative benchmark for corporate performance and relegating an analysis of operational and financial performance metrics to the qualitative assessment, we believe that this policy puts many compensation committees in the position of having to choose between doing the right thing for the long-term value of the company and doing the right thing to secure favorable Say on Pay vote recommendations from ISS." (Steven Hall & Partners)  

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