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December 13, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Retirement Planning Consultant
Transamerica Retirement Solutions
in WI

Actuary/Defined Benefit Administrator
Pension Benefits Unlimited, Inc. (PBU)
in CA

Defined Contribution Retirement Consultant
Capital Group
in TX

Regulatory Services Analyst
OneAmerica Financial Partners
in IN

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Webcasts and Conferences

Voluntary Insurance Products in the Workplace: Compliance Issues and Changing Legal Requirements
December 12, 2013 WEBCAST
(Thomson Reuters / EBIA)

Optimizing Your HSA Program After Open Enrollment
December 17, 2013 WEBCAST
(Tango Health)

Health Care Reform 101
January 16, 2014 WEBCAST
(Society of Actuaries)

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 Interim Final Rule: Maximizing January 1, 2014 Coverage Opportunities
"[F]or coverage offered outside an Exchange or SHOP, for plan selections received on or before December 15, 2013, coverage must take effect on January 1, 2014 and that for plan selections received between December 16th and December 31st, 2013, coverage generally must become effective February 1, 2014. These amendments maintain for individual and small group market coverage outside of an Exchange or SHOP the plan selection and coverage effective dates originally finalized in the Exchange Establishment Rule. However, we also permit issuers to align their plan selection and corresponding coverage effective dates with those in the applicable Exchange.... [T]his rule amends the regulation text to specify that an Exchange must ensure a January 1, 2014 coverage effective date for plan selections received on or before December 23, 2013, in contrast to the previous regulatory date of December 15, 2013. This policy applies to the various types of plans sold through the Exchanges, including SHOP QHPs, multi-State plans, and stand-alone dental plans. While we do not expect to do so, we will consider moving this deadline to a later date should exceptional circumstances pose barriers to consumers enrolling on or before December 23, 2013.... [T]his rule states that the Exchange may allow issuers to provide for a coverage effective date of January 1, 2014 for plan selections received after December 23, 2013 but on or before January 31, 2014, if a QHP issuer is willing to accept such enrollments." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


23rd Annual National Health Benefits Conference & Expo - Jan. 28-29, FL

Sponsored by HBCE- Health Benefits Conference & Expo

Hear Here: Sprint, L.L. Bean, We Energies, City of Houston, Eastman Chemical, Univ. of IA, AL & S.FL, Palm Beach Co Schools, Crowley Maritime Corp, Anoka Co, S. Shore Hospital, more. Jan 28-29 - Hi quality, moderate cost. Complete Program brochure online now!

[Guidance Overview]

Administration Extends Enrollment and Premium Deadlines; Provider and Drug Transitions Eased
"The emergency rule will surely not be welcome to insurers, already under a great deal of stress because of the widely publicized back-end problems with the exchange and lower-than expected enrollments. They promise massive headaches for insurers, providers, and consumers as consumers attempt to access care in January and providers try to figure out whether patients are covered or not, and by whom.... HHS has concluded that the urgent, immediate, need for coverage facing many Americans was worth further inconveniencing the insurers that participate in the exchange." (Timothy Jost in Health Affairs Blog)  

[Guidance Overview]

HHS Announces Steps to Ensure Americans Signing Up Through the Marketplace Have Coverage on January 1
"The steps taken today include: [1] Requiring insurers to accept payment through December 31 for coverage that will begin January 1, and urging issuers to give consumers additional time to pay their first month's premium and still have coverage beginning Jan. 1, 2014. [2] Giving people enrolled in the federal Pre-existing Condition Insurance Plan (PCIP) the chance to extend their coverage through Jan. 31, 2014 if they have not already selected a new plan.... [3] Formalizing the previously announced decision giving individuals until December 23, instead of December 15, to sign up for health insurance coverage in the Marketplaces that would begin January 1. [4] Strongly encouraging insurers to treat out-of-network providers as in-network to ensure continuity of care for acute episodes or if the provider was listed in their plan's provider directory as of the date of an enrollee's enrollment. [5] Strongly encouraging insurers to refill prescriptions covered under previous plans during January." (U.S. Department of Health and Human Services)  

Federal Government Wants Health Insurers to Ease Coverage Rules
"While consumers face a Dec. 23 deadline to sign up for coverage that will start Jan. 1, the administration said it was encouraging insurers to begin coverage in the new year even if applicants miss the deadline by a few days. Also, it said enrollees who pay their first month's premium by Dec. 31 have to be given coverage starting the next day. Insurers previously were allowed to set earlier payment deadlines. Officials even encouraged insurers to do something that normally would be anathema: offer coverage to consumers who sign up and pay a few days into the new year, but backdate the policies to Jan. 1. It wasn't clear how many carriers would take up the idea." (The Wall Street Journal; subscription may be required)  

Enrollment Extended for Health Plans
"The administration encouraged insurers ... to accept late payments and partial payments. That would allow people who sign up and pay on Jan. 5 to obtain coverage with an effective date of Jan. 1. In addition, they could obtain federal subsidies to help them pay premiums for January.... While these steps are voluntary, federal officials said they could consider an insurer's response in deciding whether to allow the company to participate in the federal exchange in 2015." (The New York Times; subscription may be required)  


COBRA: A Little of Everything - December 16 webinar

Sponsored by Lorman and BenefitsLink

COBRA -- impact of the subsidy and of ACA dependent coverage, and what to do about Health FSAs and payroll deduction. Registration discount for BenefitsLink readers.

Upshot of Two Ohio Cases: When It Comes to the FMLA, Employers Need to Set Their Radars to Detect Potential Interference Claims
"While the plaintiffs are certainly sympathetic, these cases highlight that retaliation claims are not the only FMLA lawsuit employers face. Interference claims can arise if an employer refuses to authorize FMLA leave, discourages an employee from using FMLA leave or manipulates an employee's position, hours or job location in an effort to avoid employee eligibility. This means that an employee may interpret an employer's subtle actions as discouraging and pursue a claim." (Porter Wright Morris & Arthur LLP)  

Fifth Circuit Rules Disabled Employee Can Assert Retaliation Claim Concerning Termination of Health Benefits (PDF)
"[W]hen a current employee suffers a disability that (1) makes him unable to perform his job duties for a period of time; and (2) entitles him to benefits under a plan that qualifies as an ERISA plan, it would be unconscionable to require that employee -- who, but for his new disability was qualified for his position -- to demonstrate that he was qualified for his position at the time of his termination in order to prove a retaliation claim. If such a requirement were part of the employee's prima facie case, a disabled employee that was unable to perform his job for a period of time would never be able to establish a prima facie case of ERISA retaliation, even if it was otherwise undisputed that the employer terminated him solely to avoid paying ERISA benefits." [Jimmy Parker v. Cooper Tire & Rubber Company, 12-60503 (5th Cir. Dec. 12, 2013)] (U.S. Court of Appeals for the Fifth Circuit)  

Aetna Will Not Reinstate Individual Insurance Plans
"Aetna is the largest insurer yet to announce a decision on how it would proceed across the United States after President Barack Obama said last month that insurers could extend these health plans under a temporary transitional policy.... Aetna, the third-largest U.S. insurer, declined to say how many individuals have plans that are being canceled or how many were offered early renewals on their expiring 2013 plans to enable them to continue coverage into 2014. The company would have had to seek approvals for rate increases across the United States[.]" (Reuters)  

U.S. Appeals Court Refuses to Block Lower Court Order Preventing UnitedHealthcare from Dropping Doctors from Its Medicare Advantage Plans
"A federal appeals court on Thursday refused to issue an interim stay in the UnitedHealthcare case and has referred the matter to a three-judge panel. The case focuses on a plan by the nation's largest health insurer to cut thousands of Connecticut doctors from its Medicare Advantage network on Feb. 1. On Dec. 5, a U.S. District judge in Bridgeport issued a preliminary injunction that halted the cuts for members of two doctor associations that took UnitedHealthcare to court. The insurer appealed to the 2nd U.S. Circuit Court of Appeals in New York and asked for an 'emergency' stay of the lower-court order -- and an 'interim' stay until that request is decided. The appeals court Thursday referred the request for the emergency stay to the three-judge panel and denied the interim stay." (Hartford Courant)  

New Report Shows Disappointing Lag in Americans' Use of ACA Health Insurance Exchanges Despite Administration Spin
"Among other things, the Report reveals that between October 1 and November 30, 2013 ... 39.1 million visitors visited the state and federal Exchange sites; and HHS estimates that approximately 5.2 million calls were received by the state and federal call centers; but [o]nly 364,682 Americans selected plans from the state and federal Marketplaces." (Solutions Law Press)  

Health Benefits for Members of Congress and Certain Congressional Staff (PDF)
"Under the final rule [issued by OPM], beginning January 1, 2014, Members and designated congressional staff will no longer be able to purchase FEHBP plans as active employees; however, if they enroll in a health plan offered through a small business health options program (SHOP) exchange, they will remain eligible for an employer contribution toward coverage.... This report summarizes the provisions of the final rule and describes how it affects current and retired Members and congressional staff." [Editor's note: the report is dated November 4, 2013; it was first released online on December 13, 2013, along with a second report which describes the FEHBP.] (Congressional Research Service)  

Three-Month Medicare 'SGR Fix' Passes House
"The House of Representatives passed a 3-month patch late Thursday to stabilize physicians' Medicare payments -- delaying dramatic cuts scheduled for 2014 -- while Congress works on a permanent repeal of Medicare's sustainable growth rate (SGR) payment formula. The Senate is expected to take up the temporary patch next week. Meanwhile, bills to permanently repeal the SGR worked their way through committees in the House and Senate, with further action and possibly votes from the full chambers expected early next year." (MedPage Today)  

Thousands In Obamacare's High-Risk Pools Get One-Month Reprieve
"About 85,000 people with a history of serious illnesses, who are enrolled in high-risk insurance pools created under the health care law, will get a month's reprieve before they lose that coverage. The Pre-Existing Condition Insurance Plan (PCIP) -- scheduled to close at the end of the year -- is being extended until the end of January 2014 to give people more time to enroll in health plans through state and federal insurance enrollment websites[.]" (Kaiser Health News)  

Obamacare Week 10: A Dearth of Enrollment In the States and Continuing Backroom Problems
"In states where the exchange has been running at least adequately for many weeks now, the enrollment numbers are far from what [the author] would have expected.... Health plans ... are also worried about the people who have enrolled so far paying for their coverage.... So far, [some] health plans ... have seen only about 20% of their enrollees pay their premium.... There have been reports of HealthCare.gov enrolling exchange eligible people in Medicaid instead of the private plan they want ... No one seems to know how big a problem this is." (Bob Laszewski's Health Care Policy and Marketplace Review)  

California Obamacare Enrollees Make Up Nearly a Third of Nation's Total
"Through November, a total of 109,296 Californians enrolled in a plan, according to Covered California officials -- almost one third of the nation's 364,682 total enrollees reported by the federal government the day before. During that same two-month period, 179,000 individuals qualified for the expanded version of Medi-Cal, the state's health plan for the very poor. Of the 109,296 enrollees who have signed up for a plan under the exchange, the majority -- 93,813 -- qualified for subsidies; the balance of 15,483 were unsubsidized." (San Jose Mercury News)  

Trends in Healthcare Decision Support
"For any tool to work and help consumers arrive at their desired results -- coverage that meets their benefit and budget needs or an effective resolution to a health concern, for example -- it must be well-designed, easily accessible to users, and actionable at the right stage of the decision-making process. At their core, all decision support tools enable people to take an active role in the management of their healthcare." (Healthcare Trends Institute)  

Mobile Apps Can Save Billions in Health Costs
"Mobile solutions ... can help save the U.S. more than $23 billion a year by controlling chronic diseases such as diabetes and heart disease ... That's a savings of between $2,000 and $3,000 per year per member with the condition. An estimated 500 million smartphone users worldwide will use some form of healthcare application by 2015 ... By 2018, half of the 3.4 billion smartphones and tablet users will have some type of downloaded mobile health applications." (MedPage Today)  


Obamacare's Never-Ending Fix-a-Thon
"[One reporter] asked whether it was now possible that the net coverage numbers would be lower in January 2014 than they were this year. HHS hemmed and hawed. [The reporter] pressed them, asking whether they were confident that coverage was going to increase. [CMS spokeswoman] Julie Bataille finally answered that they were confident millions more people were going to have access to affordable coverage -- not have it, mind you, just have access to it, in the same way that I have access to a sousaphone and a week on the beach in Maui.... Day by day, the administration is putting more of the onus on insurers to make this market work -- voluntarily, out of the goodness of their hearts or at least out of mutual self-interest." (Megan McArdle for Bloomberg)  


This is Big
"Unless the insurers oblige, it appears that several million people will have a gap in their coverage come January. The administration is obviously very worried about the bad publicity that will result. So it is asking insurers in the exchanges to pay medical bills they don't really owe to prevent the patients from bearing the full cost of the gap in coverage." (John Goodman's Health Policy Blog)  


Urban Institute Testimony on ACA's Impact on Premiums and Provider Networks
"In this testimony before the US House Oversight and Government Reform Committee on the [ACA's] impact on premiums and provider networks, [Urban Institute Fellow Judy] Feder concludes that by filling the gaps in the current financing structure and slowing the growth in health care costs, the ACA has enormous potential to address the flaws in the country's health care system. The biggest barrier Feder sees to realizing the law's potential is the political resistance to the law's implementation." (Urban Institute)  

Benefits in General; Executive Compensation

Top Hat Plan Testing Review
"Courts will uphold the vesting schedule and forfeiture provisions of an employer's non-qualified deferred compensation plan, but only as long as that plan is exempt from ERISA as a 'top-hat' plan. To be exempt as a top-hat plan, the non-qualified deferred compensation plan must limit eligibility to 'a select group of management or highly compensated employees.' [This post includes an] informal list of key factors for determining whether the plan limits coverage to a select group, ... collected over the years, based on existing case law, DOL views, and experience with clients[.]" (Winston & Strawn LLP)  

HR Spends More Time Educating About Benefits
"Despite competing priorities, one-third of HR professionals in the U.S. (32 percent) have increased the time they spend educating employees about workplace benefits ... Over the past two years, HR practitioners have spent significantly more time on activities related to their health care plans (61 percent of respondents), their company's 401(k) plan (38 percent), recruitment and layoffs (32 percent), and other compensation and employee-benefit-related issues (22 percent). The larger the company, the more likely it was that the HR professional put more time into these areas." (Society for Human Resource Management)  

Three Tips for Assessing Employee Stock and Options
"[1] Get a firm grip on exactly what you have been given.... [T]he most important implications to understand ... are the tax implications.... [2] Understand the factors that affect the company's growth so you can adjust your expectations and potential action accordingly.... [3] Most importantly, don't overestimate the blind spots you have precisely because you are an employee." (U.S.News & World Report)  

Press Releases

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