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November 22, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

401(k) Retirement Plan Administrator
Wellington Financial Group, Inc.
in VA

Counsel, Benefits Law
in MA

Defined Contribution Assistant I
The Standard
in OH

Experienced Pension Consultant
Retirement Plan Administrators, LLC
in GA

Executive Director
Northwestern Ohio Administrators, Inc.
in OH

Manager of Operations
United Retirement Plan Consultants
in AZ

Internal Sales Support Specialist
United Retirement Plan Consultants
in MD

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Webcasts and Conferences

Beyond the Basics: Determining Eligibility for Premium Tax Credits - Recorded
December 5, 2013 WEBCAST
(Centers for Medicare & Medicaid Services (CMS))

The Overturning of DOMA and its Impact on Retirement Plans
December 10, 2013 in KY
(ASPPA Benefits Council of Greater Cincinnati)

Benchmarking & Demonstrating Value in the Age of Reasonableness
December 11, 2013 WEBCAST

Hanging on to Loose Ends
December 18, 2013 in PA
(ASPPA Benefits Council of Western PA)

Obama’s One-Year Delay: Actuarial Implications and Impact on Health Plans
December 18, 2013 WEBCAST
(Atlantic Information Services, Inc)

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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]

Text of CCIIO Guidance on Standard Notices for Transition to ACA Compliant Policies (PDF)
"Q1: Can health insurance issuers modify or customize the notices that were in the November 21, 2013 guidance? A1: No. The notices in the November 21, 2013 guidance cannot be modified in any way and are required to be used by health insurance issuers in informing policyholders of their right to continue their existing health insurance coverage in 2014 in order for the plan to meet the criteria of the transitional policy.... Q2: Can States develop their own notices and require health insurance issuers in their State to substitute their notices for the notices in the November 21, 2013 guidance? A2: Yes, with CMS approval.... Q3: Can the required notices be combined or inserted in other plan materials or correspondence that is being sent to policyholders? A3: No." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


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[Official Guidance]

Text of CCIIO Standard Notices for Transition to ACA Compliant Policies (to be Used by Insurers Offering Continuation of Non-ACA Plans) (PDF)
"Included with this guidance are standard notices that are required to be used in order to satisfy the requirement outlined above. Attachment 1 is the notice that must be sent to policyholders that have already been sent a cancellation notice for the existing coverage. Attachment 2 is the notice that must be sent to policyholders that have not previously been sent a cancellation notice for the existing coverage. The appropriate notice must be delivered to the policyholder separately from any other plan materials or correspondence. Also included as Attachment 3 is standard language that satisfies the requirement when health insurance issuers proceed with the cancellation of the coverage in either the small group or individual health insurance markets. The use of this language will be considered to satisfy the requirement to notify policyholders of the discontinuation of their policies if it is prominently displayed in all cancellation notices sent between the issuance of this guidance and December 31, 2014." (Center for Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Guidance Overview]

Improving Consumer Information: New Letters Make Health Insurance Choices Clear
"This new required notice will provide clear information letting enrollees know that they can purchase coverage through the Marketplace, where they can potentially qualify for premium tax credits. These notices tell consumers they have new options and rights to get quality, affordable health insurance. And they tell consumers what protections they would give up to keep the plan they have. In short, they give consumers the information they need to make the best choice, which may be keeping their old plans." (The White House Blog)  

[Guidance Overview]

President Obama's Transitional Policy for Canceled Plans
"Among all of the uncertainties, there are a few answers. A close reading of the letter sent by the federal government to state regulators implementing the president's fix provides some important insights: Which policies are eligible to be restored? ... How long will the exempted policies be available? ... Can issuers pick and choose which policies or plans to restore? ... Will these exempted policies be exempt from the entirety of the [ACA]? ... Are these exempted policies grandfathered?" (Milliman)  

[Guidance Overview]

Qualified Health Plans on the Marketplace Are Not Subject to the Anti-Kickback Statute, But There's More to the Story
"[The HHS] letter clarifies ... providers can legally pay premiums for patients with QHP coverage without violating the federal [anti-kickback statute (AKS)]. However, since most states also have their own 'mini-AKSs,' providers should also consider whether the states in which they operate would view this issue the same way.... The secretary's letter was viewed by some as helping providers who were concerned that they would not get paid due to the three month premium grace period afforded to QHP enrollees, which shifts the risk of non-payment to providers.... If hospitals start to take advantage of the option to pay QHP premiums in 2014, they could strategically ensure insurance payments for their most expensive patients, thereby avoiding the potential pitfalls associated with the QHP grace period." (Vorys, Sater, Seymour and Pease LLP)  

[Guidance Overview]

Implementing the Health FSA Carryover: Tips and Traps
"For your cafeteria plan to run smoothly you need to adopt 'ordering rules' for reimbursing medical expenses. It may be helpful to think of unused health FSA deferrals from the prior year as one 'bucket' from which medical expenses may be reimbursed, and the new/current plan deferral amount as another 'bucket.' Important Note: if your plan includes a claim run-out period, you will not know how much is in your 'carryover' bucket until the claim run-out period has expired. The carryover bucket can never hold more than $500." (E is for ERISA)  

[Guidance Overview]

Use It or Lose It: New IRS Guidance Permits Carryover for Health FSAs
"[It] is not clear how qualified beneficiaries should benefit under COBRA from a carryover, or for how long. IRS guidance on this issue is needed.... If a health FSA does not qualify as an excepted benefit ... the health FSA is subject to HIPAA's special enrollment and other portability rules. A health FSA that does not qualify as an excepted benefit is also subject to many of PPACA's mandates." (Drinker Biddle)  

[Guidance Overview]

Application of the Market Reforms to HRAs, FSAs, EAPs, EPPs and 125 Plans (PDF)
40 presentation slides. Topics include: Pre-ACA rules permit broad use of tax-advantaged employer funding vehicles for health; ACA makes important changes to the manner in which employers may use tax-advantaged dollars to pay for employee's health coverage; What worked in the past may not work today (or tomorrow); Certain open issues; Potential downstream implications for participants and beneficiaries. (Crowell Moring for American Benefits Council)  

[Guidance Overview]

Navigator Resource Guide on Private Health Insurance Coverage and the Health Insurance Marketplace
"This guide ... is intended to supplement the Navigator training available from [HHS].... Section 1 covers enrollment issues for individuals, beginning with those who do not have coverage or an offer of group coverage, i.e., from an employer. Section 2 covers enrollment issues for individuals who have coverage or an offer of coverage -- whether through an employer-sponsored plan, individual plan, high-risk pool, retiree plan, or student health plan -- and want to understand their options, including eligibility for premium tax credits through the health insurance marketplace. Section 3 covers enrollment issues for small employers who want to understand and compare their coverage options for their employees." (Robert Wood Johnson Foundation)  

For Small Businesses, a Hidden Tax in Health Care?
"The fee is expected to bring in a total of $8 billion next year and as much as $14.3 billion by 2018 ... and will be spread out among insurers based on the percent of the market they cover. But the [CBO] and industry experts say the expense will largely be passed on to small businesses and consumers who buy their own policies in the form of higher premiums.... [Patrick Norris, co-owner of a manufacturing company in New Iberia, La.] says his insurance broker projects they will increase by as much as 20%. 'I could hire another 25 employees right now but I'm holding off,' Mr. Norris says." (The Wall Street Journal; subscription may be required)  

Administration Unveils Letters Insurers Must Send About Health Plans
"The letters are blunt, declaring that the insurance that is about to be renewed 'will NOT provide all of the rights and protections of the health care law.' Renewal letters sent by insurance companies will have to list all the deficiencies in the policy.... The letters must also make it clear that consumers can still voluntarily switch to a plan offered by the new federal or state insurance marketplaces." (The New York Times; subscription may be required)  

Fourth Circuit: No Deferential Review Despite Plan's 'Satisfactory to Us' Language
"Language in a Prudential Insurance Co. of America disability policy requiring claimants to submit proof of disability that is 'satisfactory to Prudential' didn't constitute an unambiguous grant of discretionary authority that would entitle Prudential to deferential judicial review of an adverse benefit determination ... Citing a 'gradual but unmistakable change in the precedential landscape,' the court said that it joined 'five of our sister circuits' in holding that such language 'does not unambiguously confer such discretionary authority.'" (Bloomberg BNA)  

Representatives of Applicable Large Employers Meet IRS Resistance at Hearing on Information Reporting Regs
"Several suggestions, which were intended to reduce the reporting burden on employers by limiting the number of forms to be filled out and the number of employees for whom reporting would be necessary, received support from all three speakers representing large employers that provided health benefits to their millions of employees. However, IRS officials ... expressed concern that these suggestions would only increase the burden on software programmers, violate employees' privacy rights with respect to disclosure of the amount of their total household income, or leave certain employees uncertain as to their eligibility for the premium tax credit under Code Sec. 36B." (Wolters Kluwer Law & Business)  

Insurers to Get Extra Month to Set 2015 Obamacare Rates
"The Obama administration plans to push back by a month the second-year start of enrollment in its health program to give insurers more time to adjust to growing pains in the U.S. law, a move that may stave off higher premiums before the 2014 congressional elections. The enrollment period, previously scheduled to begin Oct. 15, 2014, will now start Nov. 15, said an [HHS] official ... who asked not to be identified because the decision isn't public. The change is important to insurers that need more time to evaluate the first year of the government-run marketplaces." (Bloomberg)  

Covered California: Older Jump In First, But Officials Buoyed by Number of Young Enrollees
"About 56 percent of Californians who signed up for coverage in October are over 45 and nearly 23 percent of the enrollees are between 18 and 34 years old ... The older enrollees make up a higher percentage than in the state's total population, while the proportion of younger consumers more or less match their makeup statewide." (Kitsap Sun)  

Private Health Insurance Exchanges: Misconceptions, Nuances and Little-Understood Attributes (PDF)
"Exchange providers appear to be designing a subsidy level in which 80 to 90 percent of employees/retirees 'win.' That is, they can get some combination of richer benefits and lower out-of-pocket premium costs that makes them winners if they pick the 'right' plan in the Exchange. Employers may want to analyze the following: Take note of the losers and the magnitude of the 'loss' in year one.... The losers will change over time ... Rates can vary significantly by location due to the pricing structure in private Exchanges... Employers may want to consider the overall value of Exchange coverage -- not just premium rates." (Sibson Consulting)  

Better Care at Lower Cost: Is It Possible?
"To get to a health care system that's affordable yet provides high quality, we need to tackle the issues that have made things so expensive in the first place.... [One] solution might be found in the dozens of innovative and promising experiments already under way in both the public and private sectors to transform how patient care is delivered and how we pay for it. Here are some of the more promising ideas, along with real-world examples of how they work.... Bundled payments.... Global payments.... Accountable care organizations." (The Commonwealth Fund)  

Older Capitol Hill Aides Shocked by Obamacare Prices
"Veteran House Democratic aides are sick over the insurance prices they'll pay under Obamacare, and they're scrambling to find a cure. 'In a shock to the system, the older staff in my office (folks over 59) have now found out their personal health insurance costs (even with the government contribution) have gone up 3-4 times what they were paying before,' Minh Ta, chief of staff to Rep. Gwen Moore (D-Wis.), wrote to fellow Democratic chiefs of staff ... 'Simply unacceptable.'" (Politico)  

Long History of Pregnancy Bias Favors Employees on FMLA Interference and Retaliation Claims
"Allegations that an employer kept data projecting when women might become pregnant and that the employees were demoted and, in one instance, fired after announcing they were pregnant overcame a motion to dismiss the employees' FMLA interference claim, ruled a federal district court in New York. Although one employee claimed that she was constructively discharged, there was a nexus between that claim and her interference claim that sustained the cause of action." [Stoler, Hess and Marcus v. Institute for Integrative Nutrition, 13 Civ. 1275 (S.D.N.Y. Nov. 18, 2013)] (Wolters Kluwer Law & Business)  

'If You Like Your Doctor You Will Be Able to Keep Your Doctor. Period'
"Now, all health plans have to fit into four strict boxes: Bronze, Silver, Gold, and Platinum. And, these boxes can only differ by out-of-pocket costs -- not benefits. So, if a health plan can no longer vary its benefit choices, how can it distinguish itself on price? ... [A recent study] pointed out that, 'Typically, the highest-priced hospital is paid 60% more for inpatient services than the lowest- priced hospital,' within the same market. With this kind of hospital price variation and no other ability to vary the product there should be no surprise that insurers are now using narrow networks as a means to compete on the basis of price." (Bob Laszewski's Health Care Policy and Marketplace Review)  


Low Payment Rates by Exchange Plans Threaten Adequacy of Provider Networks
"Insurers will be paying physicians less through their exchange plans than they do through their existing commercial plans. If the rates turn out to be typically 30 or 40 percent less ... they will have problems maintaining adequate provider networks. An insurance card is of little value if you cannot find physicians who will accept it.... [T]hose designing health care reform were making a terrible mistake when they decided to make health insurance premiums affordable while largely ignoring health care costs." (Physicians for a National Health Program [PNHP])  


Another Law Raising the Cost of Health Care: HIPAA
"Quietly, September 23 came and went as the compliance effective date for a new rule, expanding the reach of HIPAA, and likely driving many smaller players out of the health care industry.... Over the past decade, equipped with the noble aim of protecting our privacy, HIPAA has successfully demonstrated the power of the law of unintended consequences. Improved protection of PHI has been marginal. However, HIPAA has impeded communication among physicians, reduced physician time devoted to patient care, and deterred medical research. And all at an enormous cost of compliance." (The Health Care Blog)  

Benefits in General; Executive Compensation

Does California Court Ruling Signal the End of Compensation-Related Shareholder Suits?
"[T]he court provided a useful discussion of the claims made by the Clorox plaintiffs that offers advice for companies on the potential need to beef up their compensation disclosures.... Because it dismissed all of the plaintiff's claims, the Clorox ruling may bolster companies' efforts to streamline their disclosures by alleviating companies' fear of leaving out something material.... The Clorox court addressed six separate disclosure issues raised by the plaintiff: [1] Peer group analysis ... [2] TSR information ... [3] ISS CEO pay-for-performance analysis ... [4] Share usage and dilution analysis ... [5] Fair Value Transfer (FVT) and Shareholder Value Transfer (SVT) analysis ... [6] Burn rate analysis." [Mancuso v. Clorox, No. RG12-65165 (Cal. Sup. Ct. Alameda County, Aug. 2013)] (Towers Watson)  

Institutional Shareholder Services Releases 2014 Proxy Voting Policies
"Currently, when determining the Relative Degree of Alignment, ISS calculates the difference between a company's total stockholder return (TSR) rank and its CEO's total pay rank within a peer group over three-year and one-year periods... ISS is eliminating the use of the one-year period.... Under the new model, each year of TSR will be weighted equally and calculated to produce the annualized TSR for the measurement period, providing a smoother performance measure that does not over-emphasize any particular year during the measurement period." (Practical Law Company)  

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