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November 7, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Internal Wholesaler
PAi
in ANY STATE

Pensions Field Services Representative
Nationwide Financial
in CT, NJ

Associate General Counsel - Retirement Benefits
General Board of Pension and Health Benefits
in IL

Retirement Plan Wholesaler
Ohio National Financial Services
in GA

Relationship Manager / Administrator
Qualified Plans, LLC
in ANY STATE

Consulting Support Specialist
Northwestern Benefit Corporation of Georgia
in GA

Sr. Nurse Manager
Unite Here Health
in IL

Senior Business Leader - Retirement Specialist
Envisage Information Systems
in NY

Client Service Manager - Defined Contribution
Tegrit Group
in OH

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Webcasts and Conferences

Legislative and Regulatory Update Defined Benefit Plan Issues
November 13, 2013 WEBCAST
(American Society of Pension Professionals & Actuaries (ASPPA))

Affordable Care Act 101
November 21, 2013 WEBCAST
(U.S. Small Business Administration (SBA))

It Takes A Village: How TPAs and Advisors Can Work Together
November 21, 2013 WEBCAST
(American Society of Pension Professionals & Actuaries (ASPPA))

Conquering the FMLA Medical Certification Process: Best Practices for Employers
December 5, 2013 WEBCAST
(Franczek Radelet PC)

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 Submission to OMB of Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey Data Collection
"Section 1311(c)(4) of the ACA requires the [HHS] to develop an enrollee satisfaction survey system that assesses consumer experience with qualified health plans (QHPs) offered through an Exchange. It also requires public display of enrollee satisfaction information by the Exchange to allow individuals to easily compare enrollee satisfaction levels between comparable plans. CMS is developing, testing and implementing two surveys, a survey for adult enrollees in QHPs and a survey for health insurance Marketplace consumers. CMS is requesting approval for information collection associated with these surveys." [Also see Supporting Statements for detailed description of methodology.] (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


[Advert.]

Why and How to Wrap ERISA Welfare Plans Free Webinar

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Interested in learning more about Wrap Plans? Join us 12/5 for the basics of Wrap plans and SPDs. Our expert will cover using a wrap to coordinate the numerous health care plan disclosures and discuss whether wraps are newly relevant with HCR changes.



[Guidance Overview]

Sponsors of Non-Grandfathered Group Health Plans Must Soon Review Their Definition of 'Provider'
"Plans that prohibit payment to one type of provider, but pay another for a similar service may need to amend plan documents.... State laws governing licensing of the health care provider may mean that claims may be payable in one state but not another. Plans that restrict payment to certain types of providers based on their license (e.g., chiropractors, acupuncturists, optometrists, naturopaths, midwives or other similar providers) may need to revise plan documents to permit payment if these providers hold a license to provide the treatment in the state where services were rendered." (Segal)  

[Guidance Overview]

Dealing with the ACA in Labor Negotiations: The Looming Excise Tax on 'Cadillac' Plans
"[U]nionized employers need to address the potential excise tax in their upcoming rounds of bargaining in order to ensure that the contractual changes necessary to avoid the excise tax are in place before 2018.... [E]mployers with open or soon-to-open contracts need to consider trimming their plans, as necessary, now.... Even if employers are able to achieve health plan cost containment measures during contract negotiations, employers should also seek to include a provision in their labor contracts that would trigger cost reductions necessary to avoid the excise tax." (Jones Day)  

[Guidance Overview]

New Health FSA Carryover Rule Poses Tough Choices for Plan Sponsors
"[A] plan with a grace period must eliminate it in order to adopt the carryover.... On the one hand, the grace period allows more than $500 to be carried over, but only for a limited time. On the other hand, the carryover is capped at $500 but can be used up over an entire year.... [A] plan with a grace period that wants to change to the carryover for 2013 account balances will have to act by the end of this year -- and explain the change to participants who had been expecting the grace period at the end of 2013. Action in 2014 seems more likely as employers ponder their choices." (Davis Wright Tremaine LLP)  

[Guidance Overview]

Not So Fast: HHS Cautions Against Third-Party Payment of Premiums for Qualified Health Plans
"While the CMS Q&A does not say specifically what laws or regulations would potentially be violated by third-party premium subsidies to [qualified health plan (QHP)] enrollees, it is clear that [HHS] does not approve of the practice. As a result, hospitals or other health care providers who provide premium subsidies, as well as QHP issuers who accept third-party subsidies, risk investigation or sanction by the federal government." (Quarles & Brady LLP)  

Supreme Court Asked to Hear Obamacare Contraceptive Mandate Case
"'Clearly, the lower courts are at odds with one another as to who has standing to challenge the Mandate, whose religious exercise is substantially burdened by the Mandate, and whether a secular or for-profit corporation has any religious exercise rights at all,' the ACLJ argues. 'Given these conflicting decisions, and the fact that the Mandate impacts the exercise of a fundamental liberty protected by the First Amendment, there cannot be a more compelling case or controversy warranting this Court's intervention.'" [Text of petition for certiorari in Gilardi v. U.S. Department of Health and Human Services] (American Center for Law and Justice)  

Sebelius Testifies That Employer Based Plans Will Face Same Grandfathering Caveats as Lost Individual Plans
"[T]he 'grandfathering' process comes with caveats, meaning if plans didn't meet new Obamacare standards, they would be cancelled.... 'Employer based grandfathered plans will have the same caveats,' Sebelius said under questioning from Republican Senator John Thune.... So what kind of numbers are we looking at here when it comes to losing health insurance? 93 million people will lose their plans either in the individual market or through their employer. That's quite the caveat." (TownHall.com)  

A Small Business Starts to Navigate the Affordable Care Act
"[In] my renewal package I found two crucial pieces of information that I never would have had without the [ACA]. I can see at a glance how my plan ranks in the universe of choices ... I now have a breakdown of the cost of covering every individual in my group ... In the old system, every person in my group fell into one of three tiers -- single, couple, family with children -- and everyone in the same tier paid the same rate.... In the new system, everyone is paying per individual, and those rates vary by age and tobacco use. Now it's cheaper for the young and (presumably) healthy, and smaller families don't subsidize the larger." (The New York Times; free registration required)  

Sebelius Rejects Delays to Get Time to Repair Problems at Healthcare.gov
"Kathleen Sebelius [told the Senate Finance Committee] that the government needed to fix hundreds of problems with the website for the federal health insurance marketplace, but she categorically rejected bipartisan calls to delay parts of the new health care law. She made her comments ... hours after the Obama administration disclosed that the chief information officer at [CMS] would retire. His office supervised the creation of the troubled website.... Even as Ms. Sebelius testified about progress in repairing the website, HealthCare.gov, agency officials were reporting new problems ... [A spokeswoman] said it was hard to pinpoint the cause because different consumers had experienced different problems." (Robert Pear in The New York Times; subscription may be required)  

Inside the Obamacare War Room, Healthcare.gov's Launch Was Chaos
"Each day brought different issues, some of which the administration learned about from reading outside news reports.... If you're building one insurance marketplace, the thinking would go, its easy enough to plop that model down in any state where the feds are running the show.... [B]ehind the scenes, the war room notes paint a completely different narrative, where each state's idiosyncratic issues didn't lend themselves to scale. Alaska and Wyoming ... had totally different problems -- ones that couldn't be addressed with a singular fix. On Oct. 4 alone, three separate states reported three completely different issues." (Sarah Kliff in The Washington Post; subscription may be required)  

How Many People Are Losing Their Plans Under Obamacare, Really?
"For most Americans, the answer is simple: Yes, you can keep your plan. The Medicare program hasn't changed its eligibility threshold; Medicaid has expanded its income limits. And while some firms have moved about 1 million workers to private exchanges, the vast majority of Americans who get coverage through employer-sponsored insurance plans will see no changes in 2014.... At least half of the 14 million people who shop in the individual insurance market can expect to receive a cancellation letter ahead of next year.... The cancellation letters are piling up at a much faster rate than Americans are able to sign up for new coverage." (California Healthline)  

What You'll Pay for Obamacare
Interactive chart shows how much a mid-range plan on the Obamacare exchange will cost, before tax subsidies, in the largest city in each state. (CNNMoney.com)  

The Health Exchange Marriage Penalty
"The structure of the exchange subsidies creates perverse disincentives to family formation that add to the existing marriage penalty in the tax law. As a result of these penalties, many moderate-income couples could decide marriage is a luxury they cannot afford." (National Center for Policy Analysis)  

Disregarding Health Status When Setting Premiums: Resulting Costs Mean Sticker Shock for Some Consumers
"Regulatory filings and comments from insurers show they expect that accepting the sick as well as the healthy could raise their claims costs 5 percent to 50 percent or more next year. That 'would be the largest single factor' at Blue Shield of California, accounting for about a 20 percent increase in expected claims costs, said Mike Beuoy, director, actuarial services." (Kaiser Health News)  

People Love the Idea of Health and Wellness Mobile Apps But We're Not Actually Using Them Yet
"[Of] the 40,000+ health care apps now available for download on the U.S. Apple App Store, over 50% of them get downloaded fewer than 500 times... So what's the problem? ... [1] There are just too many apps!... [2] [J]ust 54% have a legitimate health-related function, and therefore have the potential to help us stay healthy or manage existing conditions.... [3] We have no way to tell the good apps from the bad apps.... [4] The vast majority of these apps are completely disconnected from the rest of our health care providers and systems." (ExtendHealth)  

Retiree Health Care, Not Pension Shortfall, a Core Reason for Detroit Bankruptcy
"Despite a bitter dispute over whether Detroit emergency manager Kevyn Orr can reduce pensions, [former Michigan treasurer Andy] Dillon testified during Detroit's bankruptcy trial that the city's nearly $6 billion unfunded retiree health care liability was more concerning.... The city agreed to delay cuts to retiree health care insurance for those not covered by Medicare until the end of January, a month later than they were to take effect ... because of the problems with the [ACA] website and confusion about the insurance changes." (Detroit Free Press)  

BLS Report of Leave Benefits, March 2013
"Paid holidays were provided to 76 percent of civilian workers and paid vacation days were available to 74 percent. Among major occupational groups, natural resources, construction, and maintenance workers were the most likely to have access to paid holidays, while service workers were the least likely (85 percent vs. 57 percent, respectively). Management, professional, and related workers were the most likely to have access to paid sick leave (85 percent); service workers were the least likely (47 percent). Paid jury duty leave, paid sick leave, and paid funeral leave benefits were available to about two-thirds of civilian workers: 66 percent, 65 percent, and 64 percent, respectively." (U.S. Bureau of Labor Statistics)  

Explaining Shanghai's Health Care Reforms, Successes and Challenges
"With a per capita income almost twice as high as that in the rest of China, Shanghai ... offers its 23.8 million residents a health care system that is the most advanced in China.... Through global budgeting and other reform measures, the system has made great strides in improving its cost-effectiveness. Fundamental to that effort has been a powerful health information technology system that provides both vertical and horizontal integration of patients' medical records." (Health Affairs)  

[Opinion]

Seven Reasons Obamacare Isn't Facing a 'Death Spiral'
"Obamacare is protected from an actual death spiral by interlocking failsafes. Some kick in if not enough healthy people sign up. Others give healthy people reasons to sign up. Others make sure insurers don't raise premiums too fast. But together, they offer substantial protection against an actual death spiral." (Ezra Klein and Evan Soltas in The Washington Post; subscription may be required)  

[Opinion]

An Escape Hatch from Obamacare: The Switch to Self-Funding
"Today, more than 60 percent of workers in large corporations and 80 percent of unions, along with 15 percent of workers in small businesses, are covered by self-insured plans. In fact, most of the 100 million workers now covered by self-insured plans don't even know it. The differences to them are that minimal. The exemption from many ObamaCare rules will encourage more businesses to shift to self-insurance -- but there's a nationwide drive to stop them." (Former New York Gov. George E. Pataki, in The New York Post)  

[Opinion]

Text of Letter from American Academy of Actuaries to Congress on Implications of Delaying the ACA Individual Mandate (PDF)
"Without the individual mandate or limited open enrollment period, premiums would likely be higher than they would be otherwise.... Regulators already have approved the premium rates for 2014, and these premiums are based on the assumption that the individual mandate and limited open enrollment period will be in effect as specified by the ACA.... Costs to the federal government could increase as higher-than-expected average medical claims are more likely to trigger risk corridor payments.... Delaying the individual mandate or extending the limited open enrollment period could increase premiums for 2015." (American Academy of Actuaries)  

[Opinion]

ACA 'Moon Shot' Spurs New Spirit of Health Insurance Innovation
"The ACA forced issuers working with public marketplaces to start development based on little more than their own expectations of the interaction. These are organizations that thrive on actuarial charts; they do not typically undertake projects without knowing each and every requirement and milestone ahead of time. But in the world of the ACA, new information continues to come out every day, even now." (Healthcare Payer News)  

[Opinion]

Shop and Compare: An Essential (and Absent) Element of a Customer-Friendly Exchange
"Although several of the Exchange websites now include calculators to give people a sense of what the cost will be for various plans, most do not include much about the plan options, including basic information about deductibles, co-pays, and out-of-pocket maximums. Understanding what they will be required to pay out of pocket for care will be essential for consumers to make smart, informed decisions about the plan that will best meet their needs." (James Knickman via Health Affairs Blog)  

[Opinion]

There's a Better Way for Medicare to Pay Doctors
"The proposal before Congress ... would repeal the 1997 formula, permanently removing the threat of payment reductions. In their place, the measure would help Medicare catch up with a shift that private health insurers have already started: changing the way doctors are paid, by emphasizing the quality and cost of care over quantity of services.... By the end of last year, more than half the primary-care providers in WellPoint Inc.'s network worked under some sort of value-based purchasing program; for Humana Inc., that figure was 84 percent." (Bloomberg)  

[Opinion]

Text of Letter from American Academy of Actuaries to Actuarial Standards Board on Coordinating ASOPs Involving Retirement Benefits (PDF)
"To effectively coordinate the two standards, we recommend the [Actuarial Standards Board (ASB)] look at the retirement benefit standards holistically, with detailed attention from both pension and [retiree group benefit (RGB)] specialists in drafting the concepts and language. The differences between the pension practice and the RGB practice (primarily retiree health benefits) need to be examined, with an understanding that below-standard work in any practice is a disservice to the public and our profession. Given the differences in pension and RGB practice, the ASB should review the process that placed the ASB Pension Committee in the position of editing an RGB ASOP." (Pension Committee, Joint Committee on Retiree Health, and Pension Finance Task Force of American Academy of Actuaries)  

[Opinion]

Text of Letter from Health Choices Coalition to Senators in Support of Legislation to Allow Payment for OTC Medications from FSAs
"We believe this restriction on the use of tax-preferred accounts for the purchase of OTC medicines has resulted in unintended consequences to both physicians and patients. We thank you for your efforts to restore the ability to pay for OTC medicines with tax -- preferred account funds without the need for a prescription." (Health Choices Coalition)  

Benefits in General; Executive Compensation

ERISA at 40: The Past Puts Pension Law in Perspective
"[1] The fallout from Watergate placed pressure on those hoping to pass the bill to get everything done before President Nixon's impeachment. They succeeded in getting ERISA passed by Congress, but it was signed into law by President Ford. [2] The agreement between the Departments of Labor and the Treasury as to what role each agency would play in administering ERISA was decided over Chinese food and written down on a paper napkin. [3] ERISA didn't have support from powerful interests but it passed anyway because of media attention spurred by congressional hearings and the resulting overwhelming support it received from regular Americans." (Pension Rights Center)  

[Opinion]

Text of Comments by Council of Institutional Investors to SEC on Proposed Pay Ratio Rules (PDF)
"The members generally agreed that the Commission has done an admirable job in proposing to implement Section 953(b) in a flexible manner that attempts to strike an appropriate balance between providing potentially useful information to investors and limiting company compliance costs.... Two of the three members were 'not comfortable' with the proposed exemption from the pay ratio disclosure requirements for emerging growth companies, smaller reporting companies, foreign private issuers, and MJDS filers .... The three members generally agreed with the SEC that, consistent with the language of Section 953(b), all employees, including non-U.S. employees, should be considered in the calculation of the median[.]" (Council of Institutional Investors)  

Press Releases

56th Annual Survey Report
Plan Sponsor Council of America (PSCA)

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