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December 12, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Regional Vice President, Sales
Transamerica Retirement Solutions
in IL

Benefits Manager
Growing Firm
in CA

Pension Administrator
Alliance Pension Consultants, LLC
in IL

DB DC Assistant
The Pension Studio

Benefits/ERISA Associate
Littler Mendelson P.C.
in CA

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Webcasts and Conferences

SHOP Overview for Agents and Brokers
December 17, 2013 WEBCAST
(Centers for Medicare & Medicaid Services (CMS))

Conquering the FMLA Medical Certification Process: Best Practices for Employers - Recorded
December 27, 2013 WEBCAST
(Franczek Radelet PC)

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

HIPAA Compliance Risks for Group Health Plans and Plan Sponsors: Employers Often Overlook Compliance Obligations
"[T]he Privacy Regulations place obligations on the Plan and restrict the flow of information from a Plan to the Plan Sponsor. This ultimately places compliance burdens on the Plan Sponsor, which will vary depending on (i) whether the Plan is self-funded or provides fully insured health benefits through a health insurance issuer or HMO, and (ii) the extent of PHI the Plan sponsor receives from the Plan or the Insurer." (Wolff & Samson)  


Get your 2014 Health & Benefits Leadership Conference Brochure

Sponsored by HRE's Health & Benefits Leadership Conference

One glance through it, you'll quickly see the program focus isn't your typical run-of-the mill benefits event. Instead, you'll find sessions that spotlight real solutions to create meaningful results in your workplace. Register now for best rate!

[Guidance Overview]

HHS and IRS Release Updates on the SHOP Marketplace, Fees, Taxes, and Payment Parameters
"HHS proposes to modify its definition of 'contributing entity' for 2015 and 2016 to exclude a self-funded plan that does not use a third-party administrator for claims processing. In defining when a third-party administrator is used, HHS suggests that it will look to certain core administrative functions ... HHS is also interested in how to address circumstances where a self-insured group health plan uses a third-party administrator only for certain benefits such as benefits for pharmaceutical or behavioral health expenses. As defined in the proposed rule, the exception for self-administered plans is likely to affect few self-funded employer-sponsored plans[.]" (Ballard Spahr)  

[Guidance Overview]

Changes Proposed to Transitional Reinsurance Program (PDF)
"[E]xcluded self-administered plans are those that do not use a third party administrator for core administrative processing functions, such as adjudicating, adjusting, and settling claims, and processing and communicating enrollment information to plan participants and beneficiaries.... This exemption ... will likely be of limited benefit to employer-sponsored health plans ... Union and multiemployer plans are more likely to benefit from this exemption ... HHS proposes an objective definition of major medical coverage that ... [would] exclude plans designed to satisfy the first prong of the employer mandate (the $2,000 per full-time employee penalty) but that do not provide minimum value (and thus may result in a penalty under the second prong of the mandate ) -- so-called 'skinny plans'[.]" (Buck Consultants)  

The Sixth Circuit Dramatically Expands the Scope of Relief Available for Denial-of-Benefits Claims Under ERISA
"If the decision stands and is followed by other courts, it will place plan sponsors in a difficult position when making decisions to deny benefits.... As the dissent noted, the majority decision turns every wrongful denial-of-benefit decision into an automatic breach of fiduciary duty. And the majority's decision is hard to square with existing precedent, which holds that 502(a)(3) relief is generally unavailable for denial-of-benefit decisions." [Rochow v. Life Insurance Co. of North America, No. 12-2074 (6th Cir. Dec. 6, 2013)] (Sidley Austin LLP)  

'New' GM Doesn't Owe $450 Million Payment for Delphi Retiree Health Benefits
"Judge Avern Cohn of the U.S. District Court in Detroit said Tuesday that a 2009 settlement pact between the UAW and GM on retiree benefits superseded all prior agreements. 'New GM assumed only what was in that agreement; the $450 million payment was not among those obligations,' Judge Cohn wrote in a 34-page opinion." (The Wall Street Journal; subscription may be required)  


Premium Educational Event for Taft-Hartley Trustees

Sponsored by Financial Research Associates, LLC

Attend FRA's Taft-Hartley Benefits Summit to effectively manage your fund's investments and ensure your members' health & welfare benefits remain top-notch. Feb. 10-11, 2014 - Lake Buena Vista, FL. Mention FMP164 during registration for 10% discount.

For Some Obamacare Shoppers, a Brief Grace Period on Premiums
"[S]ome insurers and state-run online marketplaces are giving shoppers an extra week to pay their first premiums. The shift to early January from the end of December provides a short grace period for insurers and shoppers to work through any errors in the new policies caused by technology problems dogging enrollment since it opened on October 1." (Reuters)  

The Mysterious Surge of Higher-Income Obamacare Enrollees
"Buried in a Kaiser Health News report about the latest Obamacare enrollment numbers is a curious fact that helps explain why we've heard so many complaints about the high costs of insurance plans on the new insurance exchanges. It seems an unexpectedly large number of people with higher incomes are exploring enrollment, which means they're not getting the federal subsidies President Obama has touted.... [It] would make a lot of sense if what we're seeing in the early batch of enrollment attempts is not a flood of uninsured people, but rather solidly middle-class people whose private-market plans have been cancelled moving to the new exchanges." (The Atlantic)  

Senate Finance Committee Asked to Consider Amendment Impacting Health FSAs
"This amendment [submitted by Sen. Mike Enzi (R-WY)] would amend the Internal Revenue Code to allow amounts in a flexible spending arrangement (FSA) that are not spent for medical care to be distributed to the FSA participant as taxable income after the close of a plan year (currently, such unspent amounts are forfeited). The amendment also includes such FSAs in the definition of tax-exempt cafeteria plans." (Employers Council on Flexible Compensation)  

Average Deductible and Other Out-Of-Pocket Costs for Obamacare Plans
"The entry-level bronze plan had a deductible 42% higher ($5,081) than the $3,589 deductible average for the 2013 pre-reform market. In contrast, the top-tier platinum plan had an average deductible ($347) that was 90% less than the deductible average for the 2013 pre-reform market. When charting the average deductibles from metal tiers, the decrease in deductible amount did not follow the increase in covered medical expenses[.]" (HealthPocket)  

Among 38 Nations, U.S. Is the Outlier When It Comes to Paid Parental Leave
"Of the 38 countries represented, the U.S. is the only one that does not mandate any paid leave for new mothers. In comparison, Estonia offers about two years of paid leave, and Hungary and Lithuania offer one-and-a-half years or more of fully-paid leave. The median amount of fully-paid time off available to a mom for the birth of a child is about five-to-six months." (Pew Research Center)  

Lawmakers Propose 'Self Plus One' Option for Federal Health Program
"The bipartisan budget proposal ... would pave the way for a 'self plus one' coverage option under the federal employee health insurance program.... FEHBP currently offers self-only and family coverage; enrollees with spouses and no dependents must choose the family plan to receive coverage for their spouse. The Federal Employees Dental and Vision Insurance Program, or FEDVIP, has had a self plus one option since 2004." (Government Executive)  

Will the Affordable Care Act Make Health Care More Affordable?
"RAND researchers ... examined two kinds of consumer spending -- out-of-pocket spending ... and total spending, which includes out-of-pocket spending plus the net cost of premiums (total premiums minus subsidies).... For most lower-income individuals, total spending will fall as a result of the coverage they obtain under the ACA. However, for some higher-income people who become newly insured through the individual market (especially those not eligible for federal subsidies), total spending will increase because they now must pay health insurance premiums for the first time." (RAND Corporation)  


Opening Statement by Chairman Dave Camp on H.R. 2810 'Medicare Patient Access and Quality Improvement Act of 2013'
"For more than a decade, Congress has had to step in and prevent Medicare from cutting physician payments.... This legislation today provides stability for physicians so they will no longer face massive cuts, but also begins the process of improving how we pay for medical care to focus on positive outcomes and new innovative treatment options. Importantly, the bill also gives relief from the current multiple physician incentive programs and begins to eliminate duplicative requirements." (Committee on Ways and Means, U.S. House of Representatives)  


The Buck Stops Here: Taking Responsibility for Healthcare Costs
"A few years ago, I was obese, inactive and feeling entitled to keep my bad habits at any cost. The price I paid was type 2 diabetes ... The estimated cost of diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity. My thinking changed after I went to work in the group employee benefits industry.... I began a medically supervised diet, joined a gym and lost 60 pounds. My health and welfare costs decreased along with my blood glucose levels. I felt my jaw drop when my annual prescription costs plummeted by a third." (Corporate Synergies Group, Inc.)  

Benefits in General; Executive Compensation

Company's Stock Bonus Plan May be Subject to ERISA with No Statute of Limitations
"[The federal district] Court refused to dismiss the plaintiffs' nearly 20 year-old claims due to the statute of limitations because the plaintiff 'did not understand ERISA, how it applied to the Marriott pension scheme, what the top-hat exemption consisted of, or how his Retirement Award benefits might have been affected by the application of ERISA's substantive requirements.' (Under this rationale, the statute of limitations would bar only about 100 people in the world from bringing 20-year old ERISA claims.) ... Lacking any other basis for this unusual result, the Court argued that 'Marriott did not adopt an administrative claims procedure until after the Plaintiffs filed this lawsuit, and so it was impossible for the Plaintiffs to participate in any internal benefit claims determination, receive a formal denial therefrom, and accrue a cause of action.'" [Bond v. Marriott Int'l, Inc., No. 10-cv-1256-RWT (D. Md. Aug. 9, 2013)] (Winston & Strawn LLP)  

Text of IRS Information Reporting Program Advisory Committee (IRPAC) Annual Report for 2013
"The Information Reporting Program Advisory Committee (IRPAC) today released its annual report for 2013, including numerous recommendations to the Commissioner of Internal Revenue on new and existing issues in tax administration." [Editor's note: the Employee Benefits & Payroll Subgroup report is included.] (Internal Revenue Service)  

Press Releases

CalSTRS Names New Defined Contribution Plan Chief
California State Teachers' Retirement System (CalSTRS)

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