EmployeeBenefitsJobs.com logo BenefitsLink.com logo

BenefitsLink Health & Welfare Plans Newsletter

November 20, 2013          Get Retirement News  |  Advertise
         Past Issues  |  Search

Employee Benefits Jobs

Senior Defined Benefit Calculation Analyst
Transamerica Retirement Solutions
in MA

Manager of Retirement Plan Administration
Heartland Financial, USA
in IA

401(k) / Defined Contribution Administrator
Third Party Administration Firm
in PA

Analyst: Retirement Plan Administrator
Investment Consulting Firm
in CO

Sr. 401K/DC Plan Administrator
CUNA Mutual Group
in WI

Post Your Job

View All Jobs

RSS feed for jobs RSS Feed: All Jobs

Webcasts and Conferences

Ethics: Principles and Case Studies - Encore
December 12, 2013 WEBCAST
(SunGard Relius)

Managing Diabetes Care: Health Plan/PBM Strategies to Improve Medication Compliance
December 17, 2013 WEBCAST
(Atlantic Information Services, Inc)

Just for ERPAs Workshop
February 4, 2014 in FL

DC Defaults Forum
February 24, 2014 in MA
(Financial Research Associates)

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]

CMS Submission to OMB of Proposed Notice and Certification of Contraceptive Coverage Accommodation
"Each organization seeking accommodation under the proposed rules must self-certify that it meets the definition of eligible organization and provide a copy to a group health insurance coverage issuer." Submission includes: Text of proposed notice and certification, a Summary of changes in response to comments, and Supporting statement. (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


Why and How to Wrap ERISA Welfare Plans Free Webinar

Sponsored by ftwilliam.com

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]

United States v. Windsor: Where Is My Money? Obtaining Tax Refunds for Same-Sex Spouse Benefits
"While the employer can file a single Form 941-X for each open year (as opposed to a separate Form 941-X for each quarter), the usual procedures for corrections apply (i.e., repaying/reimbursing the employees, obtaining required statements, providing the IRS and employees with a Form W-2c, etc.). The employer should write "WINDSOR" in dark, bold letters across the top margin of page 1 of each Form 941-X. As with "Alternative 2", this special administrative procedure for prior years can only be used to seek a refund of FICA taxes attributable to the same-sex benefits." (Porter Wright Morris & Arthur LLP)  

[Guidance Overview]

Mental Health Parity Update: Final Regs Incorporate Prior FAQs and Make Other Changes
"Perhaps the most notable change in the final regulations is the elimination of the exception contained in the interim final regulations for differences in nonquantitative treatment limitations (NQTLs) between medical/surgical benefits and mental health or substance use disorder benefits based on 'clinically appropriate standards of care'. The DOL FAQ notes that the reason for not including this exception in the final regulations was that they believed it was 'confusing, unnecessary, and subject to potential abuse.'" (Benefits Bryan Cave)  

[Guidance Overview]

Paying Insurance Premiums for Patients
"The ability of a provider to pay for insurance premiums for individuals otherwise unable to maintain coverage is dependent on the source of health care coverage, the type of entity seeking to provide such payments, and the applicable state laws and insurance contract terms. There is significant risk for a provider in paying for insurance premiums for a federal health care program beneficiary. As for payments for premiums in the insurance marketplaces, based on HHS's current position, it does not appear that payment of premiums by providers would result in [Anti-Kickback Statute] or [Civil Monetary Penalties] Law violations, but HHS has decried this practice." (Holland & Hart LLP)  

New York's Highest Court Indicates an Indefinite Leave of Absence May Be a Reasonable FMLA Accommodation
"[T]he court held that NYC law shifted the burden of proof from [the employee] to the employer to show that the accommodation requested by [the employee] would impose an undue hardship on the [employer]. In other words, at least in New York City, there is no accommodation -- indefinite leave or otherwise -- that is categorically excluded as a reasonable accommodation under the NYC law. In refusing to dismiss the case, the court erased a bright-line rule that an indefinite leave of absence is not required and replaced it with a more obscure standard that indefinite leave will be required unless the employer can show either: 1) that the employee could not, with reasonable accommodation, satisfy the essential functions of the job; or 2) that the accommodation would result in an undue hardship on the company." [Romanello v. Intesa Sanpaolo, No. 152 (N.Y. Ct. App. Oct. 10, 2013)] (FMLA Insights)  

Accountable Care Organizations: An Employer Primer (PDF)
"As the primary partners in delivering ACOs, payers and providers have begun to collaborate on the opportunities presented by the legislation. For employers, however, this new approach to managed health care delivery models will present challenges in adoption different from its predecessors: preferred provider organizations, health maintenance organizations and consumer driven models.... For employers, the method to capturing the value of these emerging delivery models is to have a broad understanding of the evolving payer and provider marketplace, how to access or develop ACOs, and how smart decisions today can improve the future landscape of health care." (International Society of Certified Employee Benefit Specialists [ISCEBS])  

Does the Insurer Have the Right to Cancel a Grandfathered Plan?
"An insurer generally can't single out one individual and cancel that person's policy, but it can terminate coverage for everyone in a 'block of business' that it sold a particular policy to.... (This is different from the highly publicized problems that individuals sometimes used to confront when they became ill. In the past, some insurers dropped people after they got sick, claiming they lied on their applications. These rescissions are prohibited under the health law unless someone commits fraud.)" (Kaiser Health News)  

Republican Senators Introduce Bill to Exclude Stop-Loss Insurance from ERISA and ACA Definition of Health Insurance Plan
"'For millions of employees in small and mid-sized businesses, keeping the health insurance they're happy with means keeping their self-insurance health plans. Unfortunately, the President could end up breaking his promise to these employees by ending these self-insurance plans and forcing these employees to find new ones,' said [Sen. Marco Rubio (R-Fla.)]. 'Small and mid-sized employers should have the freedom to continue offering their employees the self-insurance health plans they are happy with. That's all this bill does.'" (Senators Lamar Alexander (R-Tenn.), Jim Risch (R-Idaho), Marco Rubio (R-Fla.), and Senate Republican Leader Mitch McConnell (R-Ky.))  

Testimony of Phyllis C. Borzi Before the Senate Committee on Small Business and Enterpreneurship on EBSA ACA Efforts
"EBSA works to provide understandable and easily accessible communications about the law's requirements. Our approach to date has been to work together with plans, issuers, consumers, providers, States, and other stakeholders to help members of the regulated community come into compliance with the law and to help individuals and small businesses understand and benefit from the law, as intended." [Testimony further includes a review of EBSA's regulatory and outreach programs.] (U.S. Department of Labor)  

U.S. Health Benefit Cost Growth Slowed Again in 2013
"[G]rowth in the average total health benefit cost per employee slowed from 4.1% in 2012 to just 2.1% in 2013. Cost averaged $10,779 per employee in 2013; this includes employer and employee contributions for medical, dental and other health coverage. But employers expect that the rate of growth in the per-employee cost of coverage will rebound next year, to 5.2%. This increase reflects changes they will make to reduce cost; if they made no changes to the current plans, they estimate that cost would rise by an average of 8.0%." (Mercer)  

Oregon Healthcare Exchange Website Never Worked, Has Zero Subscribers
"Unlike most other states, Oregon set an ambitious course to make its insurance exchange ... an 'all-in-one' website for every individual seeking health coverage, including those who are eligible for Medicaid.... Oregon's online exchange has remained inaccessible to the public, requiring the state to sign up applicants the old-fashioned way, using paper forms. This has made comparison shopping more difficult for consumers and severely slowed the enrollment process." (Reuters)  

How Data Mining Can Help Build a Health and Wellness Program
"Data mining can verify suspicions or uncover issues about benefits utilization.... At a minimum, employers should examine certain metrics like utilization statistics and average cost per variable such as gender, claimant, and dependent status within certain key benefits like: Office visits; Emergency room use; Out-patient surgery; Hospitalization occurrences; [and] Prescription drugs." (Corporate Synergies Group, Inc.)  

Private Exchanges Rise as Health Care Options
"A relatively small but growing number of midsize and larger companies that already offer insurance to employees are now shifting to private exchanges -- perhaps the most significant change employees have seen in a while.... [One] consulting firm estimates that one million people will enroll in private exchanges this year, but that number could grow to 40 million by 2018.... So far, the exchanges seem to appeal to companies that have a range of employees at varying pay levels -- like retail and restaurant companies, which have hourly workers as well as salaried employees -- because employers can offer more options in plan design[.]" (The New York Times; subscription may be required)  

The Administration's 'Fix' for Insurance Cancellations: Five Things Worth Taking Into Account
"The threshold question is whether state insurance regulators will be willing, or able, to let insurers take advantage of the relief.... Even if the states are willing to 'play ball,' insurers are under no obligation to continue these policies. Insurers will have to take into account significant business and logistical considerations in deciding how to proceed.... Not every policy that is non-compliant with the ACA market reforms can be 'saved' by this relief. Notably, it appears 'mini-med' policies cannot take advantage of the relief and therefore are no longer viable." (Crowell Moring)  

New York's Anti-Subrogation Law Fights Back, Knocks Out ERISA Preemption
"The new law eliminates federal preemption of New York's General Obligations Law ... that prevents health insurers from seeking reimbursement from the victims for settlements reached in tort cases.... Presumably, New York's new law will be viewed as a law regulating the insurance industry, which under ERISA's savings clause ... is exempted from preemption.... [It] will not likely prevent self-funded ERISA plans from asserting their liens and/or subrogation rights[.]" (Goldberg Segalla)  

Perks Ease Way in Health Plans for Lawmakers
"On the website run by the Obama administration for 36 states, it is notoriously difficult to see the prices, deductibles and other details of health plans offered by different insurers. It is much easier for members of Congress and their aides to see and compare their options on websites run by the Senate, the House and the local exchange." (The New York Times; subscription may be required)  

The McKinsey Report: Why Healthcare.gov Wouldn't Work at Launch
"In March, outside consultants from McKinsey & Co. were brought in to do a 'red team,' or outside progress report, on the system we know as HealthCare.gov.... [One] slide sums up most of the key problems we eventually saw with the rollout of HealthCare.gov last month: limited testing time, evolving requirements, over-reliance on contractors and 'stacking' of all the phases of development." [Also see the full McKinsey presentation.] (National Public Radio)  

CMS Indicates Insurers Will Be Able to Bypass Healthcare.gov
"Spokeswoman Julie Bataille kicked off the call by announcing that her agency has 'completed fixes for two-thirds of the high priority bugs responsible with issues with 834 transactions.' ... [We] don't know, right now, how many of those are buggy.... Insurers should be able to directly enroll shoppers through their own Web sites at this point, including (and this is the important point here) people who are shopping with insurance subsidies." (Sarah Kliff in The Washington Post; subscription may be required)  

New Tech Worries Loom for Health Law
"A top government technology official told Congress on Tuesday that about 30% of the federal health-insurance marketplace 'is still being developed' ... Henry Chao, deputy chief information officer at the federal agency building the marketplace, said work on 'back office' functions such as transferring federal subsidies to insurers is continuing even as contractors try to patch up remaining problems with the site, which is used by consumers in 36 states." (The Wall Street Journal; subscription may be required)  

Doctors Complain They Will Be Paid Less By Exchange Plans
"Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors. But many primary care doctors say they barely have time to take care of the patients they have now." (Kaiser Health News)  


What the 'Brosurance' and 'Creepy Uncle Sam' Ads Don't Get About Millennials
"The problem with these campaigns -- with all the Invincible-targeted ads in the Obamacare muddle, actually -- is twofold. First, they don't inform all that much. There's a lot of hot air and fearmongering and noise. Second, there's very little respect for the intended audience.... In seeking to sway Invincibles, political groups are using distraction tactics that are far more suited to pushing Miller Lite and Xboxes.... It's too early to say whether Invincibles will sign up to support Obamacare. The success or failure of the system is in their hands[.]" (The Atlantic)  


Landrieu-Manchin Bill Would Raise Premiums and Threaten Viability of Insurance Marketplaces; Administration Policy Poses Much Less Risk
"While the Upton and Landrieu-Manchin bills differ, both would substantially enlarge the risk of adverse selection and higher premiums compared to the Administration's policy. They would therefore be much more likely to threaten the long-term viability of the marketplaces and the ACA's major insurance-market reforms that start in 2014. While not without risks of its own, the Administration's new policy would be significantly less dangerous." (Center on Budget and Policy Priorities)  


A California-Style Fix for Obamacare's Runaway Premiums
"The [ACA] places no limits on the price insurance companies can charge for the coverage we are required to buy.... Thus it's no surprise that the insurers are now jacking up premiums and copays while limiting prescription drug benefits and dumping doctors and hospitals from their networks. California lawmakers made a similar egregious error in 1984 when they passed a law requiring residents to buy automobile insurance but failed to regulate prices. So, of course, the insurance companies took advantage, imposing double- or triple-digit premium increases. A voter revolt ensued." (Consumer Watchdog)  


Obamacare Rollout Week Seven: Better and Nowhere Near Good Enough
"The enrollment ... for a health plan that might have to sign-up 100,000 people in order to get their share of the 7 million Obama administration's national enrollment objective, has grown from perhaps 10-15 enrollments a day a few weeks ago to 40-50 a day now. If this new higher trend continues, such a plan would sign up only another 12,000 people toward the 100,000 objective by March 31. Backroom error rates being committed by Healthcare.gov, when enrollment data are transmitted to the health plans, are still far too high to transition to high volume processing without serious customer service issues." (Bob Laszewski's Health Care Policy and Marketplace Review)  

Press Releases

CalPERS to Recover $261 Million in JPMorgan Federal Investigation Settlement
CalPERS (California Public Employees' Retirement System)

Connect   LinkedIn   Twitter   Facebook
BenefitsLink.com, Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
Phone (407) 644-4146
Fax (407) 644-2151

Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

Copyright © 2013 BenefitsLink.com, Inc. -- but feel free to forward this newsletter without further permission from us, if you do not modify the newsletter in any way (including this lower portion).

All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

Links to Web sites other than those owned by BenefitsLink.com, Inc. are offered as a service to readers. The editorial staff of BenefitsLink.com, Inc. was not involved in their production and is not responsible for their content.

Useful links: