EmployeeBenefitsJobs.com logo BenefitsLink.com logo

BenefitsLink Health & Welfare Plans Newsletter

December 18, 2013          Get Retirement News  |  Advertise
         Past Issues  |  Search

Employee Benefits Jobs

Litigation Associate
Mid-Sized National Employee Benefits Law Firm
in DC

Sr. Analyst, Compliance
NADA (National Automobile Dealers Association)
in VA

Pension / Retirement Plan Administrator
Polycomp Administrative Services, Inc.
in CA

Employee Benefits Compliance Attorney
Gallagher Benefit Services, Inc.
in TX

Internal 401(k) Relationship Manager
Rapidly Growing Privately Owned Firm
in NC

Post Your Job

View All Jobs

RSS feed for jobs RSS Feed: All Jobs

Webcasts and Conferences

No Returns? What’s Your Exchange Policy?
December 19, 2013 WEBCAST
(National Association of Professional Employer Organizations (NAPEO))

The IRS and DOL Have Spoken: Same-Gender Partner Benefits in a Post-Windsor World -- Recorded
January 3, 2014 WEBCAST
(Thompson Interactive)

Two New Half-day Specialty Topic Seminars – Denver and 16 Other Cities - January
January 9, 2014 in CO
(SunGard Relius)

Two New Half-day Specialty Topic Seminars – San Francisco and 16 Other Cities - January
January 10, 2014 in CA
(SunGard Relius)

How to Survive a Visit from the IRS
January 16, 2014 in NY
(WEB (Worldwide Employee Benefits Network) New York Chapter)

Weight Loss at the Workplace: Legal Issues in Reducing Health Care Costs and Promoting Wellness
January 17, 2014 WEBCAST
(Lorman Education Services)

3(16) Administration: Is it Just for Chumps?
January 21, 2014 WEBCAST
(American Society of Pension Professionals & Actuaries (ASPPA))

Wall Street’s 2014 Outlook for Health Plans: Forecast for the Industry and Individual Plans
January 23, 2014 WEBCAST
(Atlantic Information Services, Inc)

Mental Health Parity Final Rules: Design and Administration for Employer Health Plans
January 23, 2014 WEBCAST
(Thomson Reuters / EBIA)

Healthcare Benefits Trends to Watch in 2014
February 4, 2014 WEBCAST

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 Q&A on Minimum Participation Requirements for Renewal of Coverage in FF-SHOP
"Will employers need to meet the minimum participation requirement upon renewal for renewals occurring from November 15-December 15? Answer: No.... Because under guaranteed availability requirements at section 147.104(b)(1) an employer must be allowed to purchase coverage from Nov. 15-Dec. 15, even if the employer cannot meet minimum participation requirements, we believe it would impose undue burden on issuers, employers, their employees, and the FF-SHOP to non-renew coverage under the exception to guaranteed renewability for failure to meet minimum participation rates and then re-enroll employers under guaranteed availability during this period." [The Q&A is labeled as "FAQ ID 574" on the "Registration for Technical Assistance Portal" operated by CMS.] (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


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!

[Official Guidance]

Text of CMS Q&A on Open Enrollment Delays in State-Based SHOPs
"Are state-based SHOPs delaying open enrollment until January 2014 or later able to deny enrollment during 2014 to small employers that fail to meet minimum participation requirements? Answer: No. The exception to guaranteed availability allowing issuers to restrict enrollment for small employers that fail to meet minimum participation requirements requires that enrollment be available to such employers from Nov. 15-Dec. 15 of the preceding year." [The Q&A is labeled as "FAQ ID 575" on the "Registration for Technical Assistance Portal" operated by CMS.] (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Official Guidance]

Text of IRS Notice 2014-6: Transition Relief with Respect to the Tax Credit under Section 45R for Employee Health Insurance Expenses of Small Employers in Certain Counties of Washington and Wisconsin (PDF)
"This notice provides guidance on section 45R of the Internal Revenue Code for certain small employers that cannot offer a qualified health plan (QHP) through a Small Business Health Options Program (SHOP) Exchange because the employer's principal business address is in a county in which a QHP through a SHOP Exchange will not be available for the 2014 calendar year.... With respect to those employers, this notice provides guidance on how to satisfy the requirement s for the section 45R credit for the 2014 taxable year." (Internal Revenue Service)  

[Guidance Overview]

Employer Reporting Requirements Under Healthcare Reform (PDF)
12 pages. Excerpt: "This reporting will be a significant new requirement for plan sponsors. While the proposed regulations also address the reporting requirements for insurers that offer qualified health plans in the marketplaces and reporting requirements for various government health programs, this FYI primarily focuses on the obligations of sponsors of group health plans, and includes a table that summarizes key reporting requirements for those sponsors." (Buck Consultants)  

[Guidance Overview]

Preparing for New HIPAA Wellness Program Rules for 2014
"The new rules implement changes mandated by the Patient Protection and Affordable Care Act (PPACA), as well as other, rather sweeping, changes to wellness programs. The new rules apply to plan years that begin on or after January 1, 2014." (Groom Law Group via PLANSPONSOR Magazine)  


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]

IRS Answers Some Outstanding Questions for Same-Sex Spouses
"[T]he Notice confirm[s] that certain limitations apply in the case of same sex married couples the same way as they apply to opposite sex married couples. For example, the limitation on dependent care contributions is $5,000 on a joint return, and would prohibit the couple from contributing more than a combined total of $5,000, even to separate dependent care FSAs. Similarly, the contribution limit for HSAs -- $6,450 in 2013 -- applies to the total contributions made by the couple to one or more such accounts." (Ford & Harrison LLP)  

Court's Award of $3.8 Million Raises Questions About Scope of ERISA Remedies
"The dissent argued that the award of benefits, pre-judgment interest for the denied benefits, and the participant's attorney's fees, was an adequate remedy under ERISA 502(a)(1)(B) to make Rochow whole. The dissent also characterized the award of disgorged profits as resulting 'in an improper repackaging of the benefit claims' that constituted an unauthorized departure from Varity Corp. and a contravention of ERISA's basic purposes." [Rochow v. LINA, No. 12-2074 (6th Cir. Dec. 6, 2013)] (Williams Mullen)  

The ACA Hour Counting Rules: Measurement Methods, and Effect of State & Local Paid Leave Laws
"There has been a growing trend of cities enacting laws that require employers to provide mandatory paid leave to their workforce. The proposed employer shared responsibility regulations make it clear that hours of service include each hour an employee is paid or entitled to be paid.... An employer electing not to use the look-back measurement method will have to track each employee's hours of service on a monthly basis beginning in 2015.... [T]here is uncertainty as to whether employers limiting an entire segment of their workforce's hours of service to less than 30 hours per week can use the look-back measurement method." (Moulder Law)  

Study Finds Americans Need Help When Using Health Exchanges
"LIMRA found that 59 percent of Americans anticipate they will require help finding a cost-effective plan. More than half think they will need help understanding the health insurance options and what their eligibility is, determining which plan will meet their needs, and how it will work[.]" (LIMRA)  

Senators Introduce Bill to Reverse Administration's Decision to Delay Next Year's Obamacare Insurance Enrollment Until After 2014 Election
"The two-page bill sets the open enrollment dates of the exchanges from Oct. 15 to Dec. 7 in statute, rather than after the November 2014 mid-term elections as the Obama administration currently has planned. It also requires the administration to provide American families with notice of any premium increases and cost-sharing requirements 30 days before open enrollment. Alexander noted that the 30-day notice -- which HHS says is not possible -- is the same that seniors receive for Medicare Advantage, a program that provides private insurance options under Medicare." (Committee on Health, Education, Labor and Pensions, U.S. Senate)  

Health Care Reform: Views from the Hospital Executive Suite
"Unlike politicians, pundits, and the public, the leaders of America's leading hospitals and health systems are optimistic about reform. Fully 65 percent indicated that by 2020, they believe the healthcare system as a whole will be somewhat or significantly better than it is today. And when they were asked about their own institutions, the optimism was even more dramatic. Fully 93 percent predicted that the quality of care provided by their own health system would improve." (Andrew Steinmetz, Ralph Muller, Steven Altschuler, and Ezekiel Emanuel in HealthAffairs)  

New York City's Earned Sick Time Act to Go Into Effect on April 1, 2014 (PDF)
"Employers that employ twenty or more employees must comply with the Act by April 1, 2014, and employers employing fifteen to nineteen employers must comply by October 1, 2015.... Employers subject to the Act must provide a minimum of one hour of paid sick time for every thirty hours worked by an employee. The Act provides that an employer need not provide more than forty hours of paid sick leave per year." (Patterson Belknap Webb & Tyler LLP)  

Aetna Devised Quick Fixes for Early Exchange Mess
"Mired deep in early problems it didn't expect with the exchanges, Aetna turned to tools from its previous large enrollment experiences to get operations on track.... The hard fought experiences brought a silver lining of significant collaboration among major payers in an alpha group, along with the CMS team for Healthcare.gov and state-based marketplaces, and others [who were] brought in ... for 'unraveling complex issues and noodling creative solutions'[.]" (Healthcare Payer News)  

Self-Employed or Employed Part Time? Here Are Things You Should Know About Health Insurance
"[An] estimated 42 million Americans are self-employed. And, of the approximately 155 million employed Americans, about 27 million work part time.... [T]hings to consider when exploring coverage alternatives in the age of the ACA. [1] There are more existing options than you might think.... [2] You have three new options under the ACA.... [3] You might qualify for a federal subsidy." (ExtendHealth)  

Why Your Health Insurance May Soon Resemble Your 401(k)
"What we're talking about here is a shift in workplace health insurance akin to the dramatic shift in recent decades from traditional pensions to 401(k)s. Health insurance will move in the same direction in the next five years ... Employers like defined-contribution systems because they reduce their exposure to risk and volatility. In the case of 401(k)s, risk and volatility are shifted to the employee -- and defined-[contribution] health insurance won't be much different." (Reuters)  

Why Obamacare Won't Spiral Into Fiery, Actuarial Doom
"If young adults (those under 35) were 25 percent less likely than the rest of the population to sign up for Obamacare, they would represent 33 percent of exchange enrollees -- rather than 40 percent. This means there would be fewer young people to subsidize older insurance subscribers. To make up that difference ... insurers would need to increase premiums by a terrifying ... 1 percent. Yes, exactly 1 percent." (Sarah Kliff in The Washington Post; subscription may be required)  

It's All Healthy People -- Not Just Young Adults -- Who Are Critical to ACA Success
"Even if insurance pools contain only 25 percent young adults rather than the hoped-for 40 percent, medical claims and other costs would exceed premium revenue by only about 2.4 percent ... That's far below the kind of loss that would lead to an unsustainable spiral of huge premium increases and fewer and fewer subscribers[.]" (Kaiser Health News)  

Text of Amicus Brief Filed by ERIC Asking Supreme Court to Confirm That FICA Taxes Do Not Apply to Supplemental Unemployment Benefits (PDF)
"Both the statutory text and the legislative history support the conclusion that SUB payments ... are not 'wages'. The government's arguments to the contrary are internally inconsistent and at odds with this Court's precedents.... [T]he government's approach produces a cumbersome system in which the classification of SUB payments for FICA purposes turns on a recipient's eligibility for state unemployment benefits." [U.S. v. Quality Stores, No. 12-1408 (on petition for certiorari to 6th Cir.; brief as amicus curiae in support of respondent Quality Stores, Inc.)] (The ERISA Industry Committee [ERIC])  


Why John Goodman Doesn't Like Health Insurance Deductibles
"Most people who defend deductibles and co-payments argue that these devices give patients incentives to make better decisions. But, if that is the goal the means to achieve it are too crude and too weak. In the case of the deductible, the incentive to economize vanishes once the deductible is exceeded. In the case of coinsurance, the incentives are incredibly weak. If I have a 10% copayment, my incentive is to consume care until it's worth 10 cents on the dollar to me. At 20%, my incentive is to consume care until it is worth 20 cents on the dollar. Can't we do better than that?" (John Goodman's Health Policy Blog)  

Benefits in General; Executive Compensation

Supreme Court Holds that ERISA Plan Can Enforce Contractual Limitations Provision to Bar Benefit Claim Lawsuit
"The Court left unanswered the question of when the statute of limitations will begin to run when benefits are terminated years after an initial 'proof of loss' is required. While many employee benefits call for a one-time claim decision, others, like the disability benefits at issue in this case, require ongoing administration and may be terminated after years of payments if the participant is no longer eligible. Courts may find that a limitations period based upon 'proof of loss' is inapplicable by its own terms if the language does not apply to the circumstances under which benefits were denied." [Heimeshoff v. Hartford Life and Accident Ins. Co., No. 12-729 (S.Ct. Dec. 16, 2013)] (Littler)  

Supreme Court Upholds ERISA Plan Document's Three-Year Statute of Limitations for Benefit Claims
"[The DOL] as amicus curiae got it backwards with their argument that ERISA, not the plan, controls, and that the plan terms violated ERISA's structure.... [T]he U.S. Supreme Court decided on Friday to review Dudenhoeffer v. Fifth Third Bancorp. In that case, the United States has made virtually the same argument, regarding plan provisions requiring investment primarily in employer securities that purportedly violate ERISA structure." [Heimeshoff v. Hartford Life and Accident Ins. Co., No. 12-729 (S.Ct. Dec. 16, 2013)] (Porter Wright Morris & Arthur LLP)  

Supreme Court Upholds ERISA Plan's Three-Year Deadline to File a Lawsuit
"By including a limitations period in an ERISA benefit plan, a plan sponsor can provide uniformity to claim accrual across various states.... [C]ourts generally apply the most applicable state statute of limitations for benefit claims, which is typically the state breach of contract statutory period. State limitations periods vary broadly, with some states applying as short as a two-year limitations period while others utilize as long as a fifteen-year period. In addition, a limitations period written into the ERISA plan typically will drastically shorten the applicable limitations period, as courts have upheld as reasonable contractual limitations provisions as short as 90 days." [Heimeshoff v. Hartford Life and Accident Ins. Co., No. 12-729 (S.Ct. Dec. 16, 2013)] (McDermott Will & Emery)  

Federal District Court (In Its Capacity As An Employer) Must Reimburse Employee for the Cost of Health Benefits for Her Same-Sex Domestic Partner
"[The Ninth Circuit] Judicial Council held that the denial of benefits violated Oregon's nondiscrimination law because the clerk and her partner were being treated differently from opposite sex partners who could marry and receive spousal health benefits from the federal government. The Council found that, while 'Oregon's statutory scheme purports to confer upon same-sex domestic partners the same rights and legal status as those conferred on married partners,' in actuality it does not, since those partners are denied benefits provided to married couples.... [This] decision has far-reaching consequences inasmuch as it appears to require federal government employers to provide health benefits to unmarried same-sex domestic partners who reside in states that provide them with rights equivalent to marriage, even though Windsor only conferred rights on married partners (and has been interpreted as not applying to couples in domestic partnerships and civil unions)." (Proskauer's ERISA Practice Center)  

IRS Guidance on the Deductibility of Annual Bonus Payments
"The IRS Chief Counsel concluded that neither the fact of liability prong nor the amount of liability prong was met with respect to bonuses so long as (i) the taxpayer retains the unilateral right to modify or eliminate the bonuses at any time prior to payment, (ii) the bonuses are subject to board or committee approval, or (iii) subjective calculation need to be made to calculate the amount of the bonuses. These conclusions are generally consistent with previous IRS interpretations of the all events test." [IRS Field Attorney Advice Memorandum 20134301F] (Winston & Strawn LLP)  

Strong Market Gains Put Pressure on Companies to Hit Heightened Performance Expectations
"By most accounts, the third year of say on pay in 2013 was a non-event for most companies, and 2014 is expected to follow suit. With 30% [Total shareholder return (TSR)] gains year to date, it's reasonable to assume that the fourth year of say-on-pay votes in the U.S. will be even less challenging." (Towers Watson)  

Press Releases

IRS Announces New ETAAC Members, Chairperson
Internal Revenue Service (IRS)

Six-month Free NCEO Membership Offer
National Center for Employee Ownership

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: