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December 16, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Benetech, Inc.
in GA

Senior Year End Services Specialist
in NJ

401K Account Manager
in PA

401K Client Service Representative
in PA

Year End Services Consultant
in PA

Business Development Specialist
DailyAccess Corporation
in AL, KS, TX

401k/S125 Client Onboarding Manager
in NY

Senior Operations Leader
in PA

Research Project Director
National Center for Employee Ownership (NCEO)
in CA

Benefits Manager
Western Southern Financial Group
in OH

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Webcasts and Conferences

ERISA Class Certification: Strategies to Defeat or Certify the Class After Dukes and Comcast
January 28, 2014 WEBCAST

Compliance Outreach Program
January 30, 2014 in DC
(Securities and Exchange Commission)

Compliance and Legal Society Annual Seminar
March 30, 2014 in FL
(Securities Industry and Financial Markets Association (SIFMA))

View All Webcasts and Conferences

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

Final Regs Issued under Mental Health Parity and Addiction Equity Act of 2008
"The 2010 interim final rules included an exception for differences in non-quantitative treatment limitations between medical/surgical benefits and mental health or substance use disorder benefits based on 'clinically appropriate standards of care.' The final regulations omit this exception. In a set of frequently-asked-questions that accompanied the final regulations, the Departments explained that the exception 'has been determined to be confusing, unnecessary, and subject to potential abuse.' The same FAQ goes on to assert that: 'The underlying requirements regarding non-quantitative treatment limitations (even without this exception) are sufficiently flexible to allow plans and issuers to take into account clinical and other appropriate standards when applying non-quantitative treatment limitations such as medical management techniques to medical/surgical benefits and mental health or substance use disorder benefits.'" (Mintz Levin)  


Special Web Event – ACA Pay or Play & Defining Who is Full Time

Sponsored by Benefit Comply, LLC

When: Jan 22, 2014. Large employers must offer health coverage to full time employees, but there are various ways to define full time! Learn the best approach for your organization. On Feb 5, don't miss 'Contribution Strategies to Avoid Employer Penalties.'

2013 Year-End Review of Health Plan Issues (PDF)
Topics include: Health Plan Changes; Tax Changes and New Fees; Employer Administrative Requirements; Final HIPAA Privacy and Security Rules; DOMA Changes Employers Need to Understand; and Optional Limited Medical FSA Rollovers. (McGraw Wentworth)  

Court Multiplies Award After Insurer Profited from Denial
"[T]he court saw no complete bar to simultaneous awards under Sections 502(a)(1)(B) and 502(a)(3) ... Bifurcated awards can be allowed if the extra relief: [1] is not a repackaged claim for benefits, as when an ongoing business-wide practice must cease in order to prevent further losses to participants; and [2] responds to plan misconduct that (for example a misrepresentation) damages the victim in ways that are not remedied by restoration of benefits alone." [Rochow v. LINA, No. 12-2074 (6th Cir. Dec. 6, 2013)] (Thompson SmartHR Manager)  

Disgorgement of $3,800,000 Ordered for Failure to Pay $900,000 in Disability Benefits
"The Sixth Circuit labeled this case a 'logical extension of the Hill exception to Varity ... because Section 502(a)(1)(B) cannot provide all the relief Rochow seeks.' Of course, the issue under Varity is not what relief the plaintiff seeks, but what relief is adequate. It is hard to imagine how an award of benefits plus interest is not adequate. The court was untroubled by the fact that the additional relief Rochow sought was more money in his pocket for the denial of his claim (rather than a plan-wide injunction against a claim processing technique).... Rochow plainly had a single injury: the improper denial of his disability claim." (Begos Brown & Green LLP)  

HHS Announces Obamacare Website Fix One Week Before Deadline
"[HHS] says HealthCare.gov is now successfully generating 834 forms -- the critical documents that get sent to an insurance company to finalize enrollment -- for nearly everyone who signs up. Missing 834 forms as a percentage of total enrollments is now reportedly 0.38% -- a significant improvement from mid-October, when as many as 15% were never generated or sent to insurers, leaving consumers in limbo." (ABC News Radio)  


ACOs Summit 2014 - The viability & future business outlook of ACOs - January 27-28, Austin, TX

Sponsored by Opal Events

You want to know the viability & future business outlook of ACOs going into 2014, right? Is the idea of accountability in healthcare sustainable given today's approach? This January, we'll convene a robust group of experts to tackle these issues and more.

JPMorgan, Other Employers Move to Cover Costly Autism Therapies
"Many employers with self-funded plans are moving forward even without mandates. Several of the country's major technology companies, including Microsoft Corp and Intel Corp, led the way more than a decade ago, possibly because autism -- according to California Department of Developmental Services records -- is especially prevalent in Silicon Valley. The past two years have seen other employers catching up." (Reuters)  

Health Law Seen as Eroding Coverage
"The poll found a striking level of unease about the law among people who have health insurance and aren't looking for government help.... [N]early half of those with job-based or other private coverage say their policies will be changing next year -- mostly for the worse. Nearly 4 in 5 (77 percent) blame the changes on the [ACA] ... Sixty-nine percent say their premiums will be going up, while 59 percent say annual deductibles or copayments are increasing." (Associated Press)  

Enrollment Errors Cut, Officials Say
"The government's overriding message to insurers is: Do whatever you have to do to maximize enrollment and to provide coverage by Jan. 1 to anyone who wants it. Federal health officials have told insurers that they can sort out the details and work out financial arrangements with the government later." (Robert Pear in The New York Times; subscription may be required)  

Thousands of Healthcare.gov Sign-Ups Didn't Make It to Insurers
"The preliminary estimate that fewer than 15,000 enrollments failed to reach carriers comes from a recently completed federal analysis ... [which] does not generate a list of specific shoppers whose enrollment files were never sent, but rather provides a ballpark estimate of the discrepancy between enrollments finished and reports generated. The federal government does not have a list of people whose sign-up forms were never sent to their insurer." (Sarah Kliff in The Washington Post; subscription may be required)  

Smoothing the Transitions to New Health Insurance Policies
"Has the deadline just changed for choosing a health plan if I want to have insurance starting Jan. 1? ... Aren't there some people who definitely get more time?... But what about more time for the rest of us?... Is there something new about how long I have before I need to pay?... Could I have even more time to pay that bill?... How about if I'm one of the people whose old insurance is being canceled?" (The Washington Post; subscription may be required)  

Errors Continue to Plague HealthCare.gov
"Thousands of insurance applicants from HealthCare.gov -- at least one in five at the height of the problems by one estimate -- have received inaccurate assignments to Medicaid or to the marketplace for private plans, or have received incorrect denials ... In some cases ... legal immigrants who aren't yet eligible for Medicaid in Illinois -- it takes five years of residence to join the state-run programs for low-income people -- were nevertheless told they would be enrolled." (The Wall Street Journal; subscription may be required)  

Narrow Hospital Networks Key to Lower Exchange Premiums
"Paul Mango, a director at the consulting firm McKinsey & Co.... said the majority of the lowest-priced insurance plans sold through the new online marketplaces use very small networks of hospitals. The study did not evaluate doctor participation in those networks.... Enrollment so far in three states -- California, Maryland and Washington -- 'skews toward the aged and mimics the background of the [current] individual market [policyholders], not the uninsured,' Mango said." (Healthcare Payer News)  


Insurers Will Spend More Than $500 Million to Get People to Sign Up for Obamacare
"Insurers look at these next few years as a gold rush. Tens of millions of people will be buying private insurance of the exchanges. It's a swarm of customers like nothing they've ever seen. And they plan to capture them -- even if they need to spend hundreds of millions of dollars to do so." (Ezra Klein and Evan Soltas in The Washington Post; subscription may be required)  

Oversight Report on Obamacare Navigator Program Reveals Mismanagement and Lax Oversight
"Key Findings: [1] Navigators Were Unprepared for Website Crash and Lacked a Contingency Plan; [2] A Navigator grantee organization in North Carolina has been collecting and mailing paper applications on behalf of applicants, in violation of Navigator rules and procedures; ... [3] Lax Oversight at HHS Fails to Ensure Organizations Report Navigator Misconduct. HHS officials responsible for the navigator program did not learn of [listed] incidents from internal oversight procedures, but rather from news reports[.]" (Committee on Oversight and Government Reform, U.S. House of Representatives)  


Why Do Employers Do What They Do?
"[E]mployers don't require employees to enroll in their health insurance plans. So why don't they experience death spirals? ... Think of employers as health insurers and think of your premium as the work you have to do for the employer in order to get the insurance. All the employers are required to guarantee issue and community rate (at least modified). So like the health plans in the (ObamaCare) exchanges, employers have strong incentives to attract the healthy and avoid the sick. After enrollment, they have strong incentives to over-provide to the healthy and under-provide to the sick." (John Goodman's Health Policy Blog)  


White House Forces Obamacare Insurers to Cover Unpaid Patients at a Loss
"The White House ... knows that millions of Americans will enter the new year without health coverage. So instead of actually fixing the problem, the administration is retroactively attempting to force insurers to hand out free health care -- at a loss -- to those whom the White House has rendered uninsured.... The chaos and recriminations have made insurers like UnitedHealth, who have largely stayed out of the exchanges, look smart." (Avik Roy in Forbes)  


Pressing the Panic Button?
"The administration is trying to present this as a set of perfectly ordinary kind of transition measures that insurers normally make available to new customers ... But that's not what this looks like to [this author], and a few conversations today suggest it's not what it looks like to the insurers. To 'strongly encourage' insurers to take these kinds of steps (to use the Orwellian phrase of the HHS announcement), and to do it just a couple of weeks before the new system is supposed to start, suggests that the administration's health experts mapped out how January is shaping up and had a collective heart attack." (Yuval Levin in National Review)  

Benefits in General; Executive Compensation

[Guidance Overview]

2014 Reporting and Disclosure Calendar for Multiemployer Pension and Welfare Benefit Plans
"The latest version of this annual publication summarizes the 2014 reporting and disclosure requirements of the [ACA, HHS, DOL, IRS and PBGC] of interest to sponsors of multiemployer plans.... [It] lists and describes the forms, schedules and notices that must be filed with each organization for which plan types and by what deadlines. It also indicates who must file and whether copies must be provided to participants." (Segal)  

[Guidance Overview]

2014 Reporting and Disclosure Calendar for Single-Employer Pension and Welfare Benefit Plans
"Sibson Consulting's 2014 Reporting & Disclosure Calendar for Benefit Plans summarizes compliance requirements for qualified, single-employer benefit plans." (Sibson Consulting)  

Text of Supreme Court Opinion Upholding Statute of Limitations Stated in Plan Document (PDF)
"A plan participant's cause of action under ERISA 502(a)(1)(B) ... does not accrue until the plan issues a final denial. But it does not follow that a plan and its participants cannot agree to commence the limitations period before that time.... It is also unlikely that enforcing limitations periods that begin to run before the internal review process is exhausted will endanger judicial review. To the extent that administrators attempt to prevent judicial review by delaying the resolution of claims in bad faith, the penalty for failure to meet the regulatory deadlines is immediate access to judicial review for the participant." [Heimeshoff V. Hartford Life and Accident Ins. Co., No. 12-729 (S.Ct. Dec. 16, 2013)] (Supreme Court of the United States)  

Unanimous Supreme Court in Heimeshoff Permits Contractually-Based Statues of Limitations in ERISA Denial of Benefit Cases
"[T]he one part of the decision that seemed fanciful [to this author] was this idea that plan participants and beneficiaries 'agree' with their plans to these [statutes of limitations]. The Court said this with regard to this critical aspect of the case: 'the parties have agreed by contract to commence the limitations period at a particular time.' ... [B]enefit plans are classic contracts of adhesion with usually no bargaining between the parties taking place. It is legal fiction to say that most participants consented to this provision." (Paul Secunda in Workplace Prof Blog)  

Before the Ball Drops for the New Year, Don't Forget to Address These 2013 Employee Benefit Items!
Includes checklists for issues pertaining to Qualified Plans; The Defense of Marriage Act ("DOMA") -- Repeal of Section 3; Executive Compensation; and Group Health Plan Amendments Due to Health Care Reform. (Benefits Bryan Cave)  

DOL Releases Form 5500 for 2013 Plan Year
"The most noteworthy item here is that all welfare plans must attach a statement regarding Form M-1 Compliance -- even those not required to file Form M-1. While the Troubleshooter's Guide is not new, referencing it in the Instructions seems to be part of a larger effort to reduce filing errors. And remember that this is an informational copy of Form 5500 -- the form is filed electronically using EFAST2." (Thomson Reuters / EBIA)  

Volume, Depth of Pay Ratio Comments Highlight Issues the SEC Must Resolve in Final Rule
"[T]he more than 116,000 submissions show that proponents are largely satisfied with the rule while opponents have grave concerns.... The typical submission from proponents, which include labor unions, pension funds and smaller investors, is brief ... praising the pay ratio as another 'additional metric to evaluate say-on-pay votes and other executive compensation issues.' ... Comments from opponents make several consistent suggestions regarding the need for greater flexibility under the rule and question the SEC's estimated costs of implementation in the proposed rule." (HR Policy Association)  

Press Releases

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