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November 15, 2013          Get Retirement News  |  Advertise
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Defined Contribution Plan Administrator
San Diego Pension Consultants
in CA

Office Administrator
The Savitz Organization, Inc.
in PA

Retirement Plan Services - Client Services Manager
Charles Schwab
in OH

Retirement Plan Administrator
Katz, Sapper & Miller
in IN

Manager of Technologies, Systems and Innovation
EPIC Advisors, Inc
in NY

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

Fact Sheet: New Administration Proposal to Help Consumers Facing Health Insurance Cancellations
"Many consumers receiving these cancellation letters will be able to find a better deal with financial assistance or better coverage through the Health Insurance Marketplace, but we know a small slice of these consumers may not be eligible for a plan at a more affordable price.... HHS is using its administrative authority to: [1] Allow insurers to renew their current policies for current enrollees without adopting the 2014 market rule changes.... [2] Require insurers offering such renewals to ensure consumers are informed about their options.... To protect against the potential impacts this change will have on premiums, HHS will adjust the temporary risk corridor program which is designed to stabilize premiums as changes are implemented.... Whether an individual can keep their current plan will also depend on their insurance company and State insurance commissioner -- but [this] action means that it will no longer be implementation of the law that is forcing them to buy a new plan." (The White House Blog)  

[Official Guidance]

Text of Statement by President Obama Extending ACA Grandfathering to Cancelled Individual Policies
"Already, people who have plans that predate the [ACA] can keep those plans if they haven't changed. That was already in the law. That's what's called a grandfather clause. It was included in the law. Today, we're going to extend that principle both to people whose plans have changed since the law took effect, and to people who bought plans since the law took effect. So state insurance commissioners still have the power to decide what plans can and can't be sold in their states. But the bottom line is, insurers can extend current plans that would otherwise be canceled into 2014, and Americans whose plans have been canceled can choose to re-enroll in the same kind of plan.... [E]ven if we get the hardware and software working exactly the way it's supposed to with relatively minor glitches, what we're also discovering is that insurance is complicated to buy." (The White House Blog)  

[Official Guidance]

Text of CMS Notice with Comment Request on Exchanges and Qualified Health Plans,Quality Rating System, Framework Measures and Methodology
"This notice with [comment request] describes the overall Quality Rating System (QRS) framework for rating Qualified Health Plans (QHPs) offered through an Exchange. The purpose of this notice is to solicit comments on the list of proposed QRS quality measures that QHP issuers would be required to collect and report, the hierarchical structure of the measure sets and the elements of the QRS rating methodology. In addition, this notice solicits comments on ways to ensure the integrity of QRS ratings, and on priority areas for future QRS measure enhancement and development.... In future rulemaking, we intend to propose requirements for QHPs and Exchanges regarding the collection and submission of specific quality-related information. In addition, we intend to provide future technical guidance for QHP issuers and Exchanges related to the QRS measure specifications, detailed rating methodology guidelines, and data reporting and procedures." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Guidance Overview]

An 'Administrative Fix' for Policy Cancellations
"The administration's administrative fix raises several questions. The first is whether it is legal.... A second question is how state insurance commissioners will react to having this hot potato being tossed into their hands.... At least a dozen states have adopted the federal market reform requirements as state law or regulation and more states have changed their rating requirements. Insurance Departments in these states may well lack the authority to simply ignore these legal requirements.... Yet another question is whether insurers will in fact take advantage of the enforcement delay.... A fourth question involves the comprehensiveness of the reforms waived by the enforcement delay." (Timothy Jost in Health Affairs Blog)  

[Guidance Overview]

Expanded Final Mental Health Parity and Addiction Equity Act Regulations Require Plan Sponsor Consideration Early in 2014 for 2015 Plan Year
"One of the big changes came in what the regulations refer to as the non-quantitative or qualitative restrictions (the 'Nonnumeric Limitations'), which cover medical necessity or medical appropriateness determinations and coverage of different treatment settings. These are the changes that plan sponsors should consider as they review their contracts with vendors administering claims or selecting the provider network for their health plan for the first plan year under the MHPAEA Regs. These changes may require coverage of treatments at facilities the plan's terms had historically excluded from coverage or an elimination of coverage of the comparable facilities on the Med/Surg side.... The evaluation of these types of treatment limitations is a new evaluation that will require plan sponsors to make new inquiries into the operations of the plan's vendors and into the terms of their plans to ensure compliance." (Winstead PC)  


10th Annual American Health Care Congress - Dec. 2-3 - Anaheim, CA

Sponsored by World Congress

Senior health care executives from hospitals, health systems, health plans, and medical groups gather to address meaningful change in our system - policy, business strategy, and care delivery transformation.

[Guidance Overview]

Mental Health Parity and Addiction Equity Act Parity Analysis is Fine-Tuned
"Some of the notable changes that were made from the 2010 regulations include: Clarification of Non-Quantitative Treatment Limitations (NQTLs).... Variations in NQTLs for Recognized Clinically Appropriate Standards of Care.... Disclosure of Processes and Standards.... Sub-Classification Permitted for In-Network Tiers.... Sub-Classification Permitted for Outpatient Benefits.... Interaction with Preventive Health Services.... Small Employer Exemption.... Increased Cost Exemption." (Vorys)  

[Guidance Overview]

$500 Carryover Opportunity for Cafeteria Plan Health FSAs: Worth the Effort? (PDF)
34 presentation slides. Topics include: Introduction and Overview; Notice 2013-71; Examples; and Open Issues. Excerpt: "The long-standing 'use-it-or-lose-it' rule for cafeteria plan health FSAs now has a second exception." (Morgan Lewis)  

[Guidance Overview]

FSA Use It or Lose It Rule Modified
"Employers should consider whether this carry-over feature will be more beneficial for plan participants than the grace period. If the salary reduction contributions are low, the carry-over provision may be more beneficial as it will allow participants to incur expenses over the following plan year to use up the $500." (Clifton Budd & DeMaria, LLP)  

Actuaries Say Proposals to Address Insurance Cancellations Could Threaten Viability of New ACA Insurance Markets (PDF)
"Allowing consumers to retain cancelled plans could affect the composition of health insurance risk pools. In particular, if lower-cost individuals retain their prior coverage, and higher-cost people move to new coverage, the medical spending for those purchasing new coverage could be higher than expected. Other consequences could include: [1] Premiums approved for 2014 may not adequately cover the cost of providing benefits for an enrollee population with higher claims than anticipated in the premium calculations. [2] Costs to the federal government could increase as higher-than-expected average medical claims are more likely to trigger risk-corridor payments. [3] Relaxing the plan cancellation requirements could increase premiums for 2015." (American Academy of Actuaries)  

Health Insurers' Decisions on Insurance Exchange Participation
"[In] the vast majority of states the Obamacare exchanges will offer less, not more, insurer competition than the state's current individual market. Obamacare's complicated, income-based design of premium and cost-sharing subsidies will result in the exchange market essentially offering something akin to Medicaid managed care for the middle class. The resulting picture is one that millions of Americans are likely to find unappealing." (The Heritage Foundation)  

Five Reasons Restoring Canceled Plans Would Be Tough
"[E]fforts to extend existing policies ... face another set of challenges -- practical obstacles that ... are more difficult than most people realize.... [1] [If] a carrier cancelled the plan, it's because they didn't think it was worth the effort.... [2] Setting up an insurance plan takes work. And that's true even if the plan exists already.... [3] Dealing with state regulators would be its own, separate ordeal.... [T]his process can take a long time." (New Republic Magazine)  

You Can Keep Your Plan -- Maybe
"The move is likely to add additional confusion and uncertainty to an already chaotic marketplace shaken by the widely publicized problems at HealthCare.gov. It is unclear, for example, how the customers of specific health plans who have already had their coverage cancelled will be impacted. The decision of whether or not to reinstate individual plans is being left up to individual insurers. Exactly why they'd want to reinstate the cancelled plans isn't obvious." (The Health Care Blog)  

Higher Obamacare Deductibles Make Cheap Rates a Risk
"Private employers have been raising deductibles and co-pays for years to help control costs on health coverage for their workers. Now insurers are using the tactic to lower premiums on the government-run exchanges. While that has allowed President Barack Obama to tout the affordability of plans, it poses a choice: Do consumers gamble they won't face a major medical bill, or boost monthly premiums just in case?" (Bloomberg BusinessWeek)  

On the State Exchanges: Developments in October 2013
"All 34 states with exchanges run by the federal government faced challenges as the website, Healthcare.gov, was plagued by technical issues relating to higher traffic than anticipated. States running their own exchanges, on the whole, had more success in enrolling people in plans. Enrollment numbers continue to creep upwards as technical issues are resolved and more Americans enroll online, over the phone or in person." [Includes a detailed state-by-state review of status, enrollment and issues for both state-operated and federally-facilitated exchanges.] (ExtendHealth)  

Obamacare and the End of Employer-Based Health Insurance
"Our economy is becoming increasingly winner-take-all, with fewer people working for medium or high wages. As more employees work for lower wages, they also end up working for companies unable or unwilling to offer them health insurance coverage. What does this mean for employer-based insurance coverage, now that the ACA is slowly kicking into gear? ... Health insurance benefits ... will still make sense for most large employers.... For low-wage workers, the ACA may accelerate earlier trends." (Forbes)  

UnitedHealthcare Expands ACO Provider Program
"As a result of reducing practice variation, decreasing duplications in care and promoting the proper setting for care, WESTMED received nearly a $1 million bonus under its ACO agreement with UnitedHealthcare. The 260-physician group practice launched its ACO in collaboration with UnitedHealthcare and Optum in mid-2012, with more than 13,000 individuals participating.... Today, more than $25 billion of UnitedHealthcare's annual physician and hospital reimbursements is tied to ACOs, centers of excellence and performance-based programs." (Healthcare Payer News)  


Is the Administration Offering Insurers an Obamacare Bailout?
"If some Americans can keep their pre-Obamacare health plans next year, they will not enroll in the Obamacare exchanges. That means the enrollees in the exchanges are likely to be sicker than insurers previously expected.... The CMS guidance ... raises the possibility of using Obamacare's risk corridor program to compensate insurers for these losses.... [The] risk corridor program 'doesn't need to be budget neutral; if the math demands it, the government can pay out more than it collects through the program.' CMS's comments ... imply that it's contemplating exactly that -- undoing the concept of budget neutrality for the risk corridor program, and using it to compensate insurers for their losses." (The Heritage Foundation)  


ERIC Urges IRS to Further Simplify ACA Employer Information-Reporting Requirements
"ERIC suggests that the most appropriate and cost-efficient method for determining liability for both the individual and employer penalties would be a system in which employers affirm in an annual certification that they have met their shared responsibility requirements to provide minimum essential coverage to 95% of their full-time employees and places responsibility on individuals for establishing that they fulfilled their coverage obligation for themselves and their dependents." (The ERISA Industry Committee [ERIC])  


The Upton Bill Is No Small Matter
"There has been a lot of commentary recently that the Upton proposal won't really do much because insurers do not have the capacity to reopen plans in time to get people coverage by January 1. And it is certainly true that reversing the cancellations will entail significant expense and trouble for the insurance industry. But that does not mean it is impossible. It's worth noting the California insurance commissioner is forcing two insurers to reverse cancellations for hundreds of thousands of individual market plan enrollees, and the insurers are reluctantly complying to keep people in their plans beyond January 1. In that case, operational issues were not impossible to overcome." (The Weekly Standard)  


The Backlash to the Obamacare Fix Has Already Started
"It took about three hours exactly for states to start pushing back against President Obama's request that regulators allow insurance plans to offer current products in 2014. Washington state insurance commissioner Mike Kreidler has announced that he will not allow insurance companies to do so.... It does feel a bit weird to have one of the most liberal regulators be the first out of the gate to oppose Obama. At the same time, it also makes sense: What Kreidler is doing is a full-throated defense of the Affordable Care Act." (Sarah Kliff in The Washington Post; subscription may be required)  

Benefits in General; Executive Compensation

[Guidance Overview]

2013 End of Year Compliance Checklist for Group Health Plans and Retirement Plans (PDF)
"This [9-page] checklist provides an overview of new compliance items that should be addressed before 2014. The checklist also includes important ongoing year end requirements." (Reinhart Boerner Van Deuren s.c.)  

Retired Police, Fire Sue Providence, R.I. Over Pension Changes
"66 retired Providence firefighters and police officers have filed complaints in Rhode Island Superior Court ... over the recent pension reform agreement between the City and police, firefighters, and retirees.... The retirees named are individuals -- or their spouses -- who are contesting the recent changes made to health care benefits, including the Medicare enrollment statute, and Health Benefits Ordinance, which now require all police and firefighter and their spouses to enroll in Medicare, as well as the COLA adjustments made." (GoLocalProv.com)  

Detroit Agreement with EMTs, Paramedics Union Would Freeze Pension Plan, Restructure Health Benefits
"Under the new contract, EMTs and paramedics in the Police Officers Association of Michigan union accept a 10% wage cut, which is imposed on all city employees. The union also accepts a pension freeze and transfer of employee pensions to a defined contribution plan. Employees under the deal also agree to enter the city's restructured health plan. Under that plan, annual deductibles for Detroit's active city workers will rise to $750 annually from $200 and family plans will see annual out-of-pocket costs rise 50% to $4,500 from $3,000." (Pensions & Investments)  

Bad Faith Termination Can Be Good ERISA Interference Claim
"[T]he executive was placed on 'garden leave,' in other words, relieved of all responsibilities and told to stay home.... The court found that the executive had sufficiently alleged that the employer had manipulated the date of termination with the specific intent of depriving the employee of the severance benefits to which he would otherwise have been entitled.... The court said that there could be benign reasons why the company would pay the employee for 30 days after stripping the employee of all responsibilities but that there was also the possibility that the employer had improper motives for the timing of the employment termination given the fact that the garden leave saved the employer over $700,000 in severance pay." [Kirby v. Frontier Medex, No. ELH-13-00012 (D.C. Md. Oct. 30, 2013)] (Leonard, Street and Deinard)  

Global Equity Plans: Issues to Consider (PDF)
"This Note addresses the major legal and other issues that U.S. multinational companies should consider before granting equity awards outside of the U.S. including taxation, social insurance, withholding and reporting, securities law compliance, exchange control requirements, data privacy laws, restrictions on payroll deductions and employee communications. This Note also provides practical tips to aid in implementing a global equity plan." (Jones Day via Thomson Reuters Practical Law)  

Press Releases

AHIP Statement on Consumers Keeping Their Current Coverage
America’s Health Insurance Plans (AHIP)

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