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December 23, 2013          Get Retirement News  |  Advertise
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SchwabRT Specialist
Carroll Consultants, Ltd.
in PA

Account Manager
Lincoln Financial Group

Employee Education Consultant
in PA

Retirement Education Specialist
The Newport Group
in NC

Part Time On Call Retirement Planning Consultant
Transamerica Retirement Solutions
in AR, CA, HI, MO, NJ, NY, TN, UT

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official guidance, jobs, webcasts and more.
[Official Guidance]

Text of OPM Proposed Regs on Federal Employee Dental and Vision Insurance Program; Qualifying Life Event Amendments
"OPM is proposing to expand enrollment opportunities so [Federal Employee Dental and Vision Insurance Program] enrollees can make enrollment changes under the same qualifying life events as enrollees under the [Federal Employees Health Benefits (FEHB)] Program." (U.S. Office of Personnel Management)  


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[Official Guidance]

Text of OPM Proposed Regs on Federal Employees' Group Life Insurance Program: Options B and C
"[OPM] is proposing to amend the Federal Employees' Group Life Insurance (FEGLI) regulations to provide an election opportunity for employees enrolled in FEGLI Option B and Option C. This new procedure replaces the procedure by which FEGLI enrollees elect the allowable multiples of coverage they wish to continue during retirement or while receiving compensation." (U.S. Office of Personnel Management)  

[Guidance Overview]

CMS Overview of the New Application and Enrollment Process for the Federally-Facilitated SHOP Marketplace (PDF)
19 presentation slides. Excerpt: "When can small employers enroll in SHOP coverage? Apply by December 23, for coverage that takes effect as early as January 1, 2014; Apply anytime year-round for coverage that takes effect later. How can businesses enroll in SHOP coverage? In states using the Federally Facilitated SHOP -- For 2014: 'Direct Enrollment' using agent, broker or insurer; For 2015: enroll through agent, broker, insurer or SHOP online. States running their own SHOP have their own enrollment processes." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Guidance Overview]

ACA Round-Up, Including Proposed Regs on Excepted Benefits
"Under current rules, self-insured group plans cannot offer dental or vision coverage unless employees pay a separate, at least nominal, premium for the coverage. The proposed rule would eliminate this requirement so that self-insured plans can offer oral and vision coverage without an additional payment.... The proposed rule would permit an employee who cannot afford employer coverage to get subsidized coverage through the exchange but also receive 'wraparound' coverage from the employer as excepted benefits to supplement the exchange coverage. To qualify as excepted benefits, however, the wraparound coverage must meet certain conditions intended to keep employers from using wraparound coverage to replace group medical coverage and to require employers to offer their lower-income employees comparable coverage to higher-income employees." (Timothy Jost in Health Affairs Blog)  

[Guidance Overview]

CMS Restricts Application of Minimum Participation Requirements in SHOPs
"Although media reports have largely focused on problems with the individual market Exchanges, implementation challenges have plagued state-based SHOPs and the FF-SHOP as well. These two FAQs provide some welcome clarifications. The first protects small employers that did not have an opportunity to enroll in a state-based SHOP during the 2013 annual enrollment period. And the second reconciles -- but only for the FF-SHOP -- a seeming inconsistency in the application of the guaranteed-availability and guaranteed-renewability rules by effectively eliminating a mismatch that had created uncertainty." (Thomson Reuters / EBIA)  


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.

[Guidance Overview]

HHS Regulations Address Enrollment and Other Issues for Exchange Coverage That Begins January 1, 2014
"HHS notes that these regulations are specifically designed to address 'unforeseen barriers to enrollment' in Exchange coverage -- implicitly acknowledging the access issues with the HealthCare.gov website and giving small employers a bit more time to enroll through the FF-SHOP and through any state-based SHOPs that choose to extend their enrollment deadlines." (Thomson Reuters / EBIA)  

[Guidance Overview]

Post-Windsor Guidance from the IRS: Cafeteria Plans, Flexible Spending Accounts and Health Savings Accounts
"Notice 2014-1 confirms that a same-sex married couple (married as of the last day of the taxable year) is subject to the joint deduction limit for contributions made to an HSA where either spouse elects family coverage under a high deductible health plan.... If the contributions already exceed $6,450, the excess may be distributed from the HSAs of one or both spouses no later than the tax return filing deadline for the spouses. Any excess that remains undistributed as of such date will be subject to excise taxes under the Code." (Proskauer's ERISA Practice Center)  

[Guidance Overview]

Latest Post-Windsor Guidance from IRS Addresses Issues for Cafeteria Plans, Flexible Spending Accounts
"Since ... a participant may be deemed to have notified a plan of his or her marital status by filing a revised W-4, even where a new election form has not been filed, employers may need to review the latest W-4 filed by any participant whose same-sex domestic partner (for purposes of the plan) is covered under the employer's health plan.... Employees will still be able to correct over-withholding or under-withholding with their own filings, but if employers wish to help employees by doing an employer filing, they will have to act before December 31, 2013, which, as a practical matter, could not be accomplished by many employers." (Epstein Becker Green)  

[Guidance Overview]

Health Insurance Casework System for Issuers, December 19, 2013 (PDF)
34 presentation slides. Topics include: Health Insurance Casework System (HICS) Policy; HICS Technical Guidance; Submission of Inquiries; and Resources. (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

Seventh Circuit Reinstates Fiduciary Breach Claim for Failure to Disclose Providers' Out-of-Network Status
"Two judges, writing separately, thought the case should have been analyzed under common-law contract rather than fiduciary principles. Two dissenting judges thought the case should be dismissed, since the participant and her spouse did not specifically inquire about their providers' network affiliation. For fiduciaries trying to navigate this thicket, this case highlights the importance of clearly written communications (including collateral materials, like ID cards) and, if oral information is critical to fully understanding benefits, training representatives to listen actively and anticipate participants' information needs." [Killian v. Concert Health Plan, 2013 WL 5942703 (7th Cir. 2013) (en banc)] (Thomson Reuters / EBIA)  

District Court Grants Injunction to Self-Insured Catholic University in Challenge to Contraceptive Mandate
"Religious organizations like Catholic University -- that offer health insurance to their employees through an insured group plan -- may avail themselves of the accommodation simply by memorializing their objection to the mandate in writing. The insurer is obligated under the rules to exclude the coverage from the University's plan and to provide and pay for the coverage itself, and therefore ... Catholic University has no grounds for a RFRA claim.... Thomas Aquinas College is covered by the set of regulations directed towards religious organizations that are self-insured, and ... does not offer its employees coverage through a plan offered by the church, which cannot be compelled to comply with the mandate. In the case of a self-insured entity like Thomas Aquinas, the newly enacted regulations fall short of the mark. Since the accommodation imposes a duty upon the religious organization to contract with a willing third-party administrator that will arrange for the payments for contraceptives, they compel the organization to take affirmative steps -- to do something -- that is in conflict with the tenets of its faith. And therefore, defendants are enjoined from enforcing the mandate against Thomas Aquinas College." [Roman Catholic Archbishop of Washington et al v. Sebelius, No. 2013-1441 (D.D.C., Dec. 20, 2013)] (U.S. District Court for the District of Columbia)  

Obama Administration Quietly Extends ACA Enrollment Deadline by a Day
"At midnight Monday, the official deadline arrives for Americans to sign up through the new federal health insurance exchange for health plans that begin Jan. 1. But, without any public announcement, Obama administration officials have changed the rules so that people will have an extra day to enroll, according to two individuals with knowledge of the switch. Over the weekend, government officials and outside IT contractors working on the online marketplace's computer system made a software change that automatically gives people a Jan. 1 start date for their new coverage as long as they enroll by 11:59 p.m. on Christmas Eve." (The Washington Post; subscription may be required)  

'Catastrophic' Policies Prove Hard Sell So Far
"In California, only 1 percent of those who had picked a plan in the first two months since the marketplace opened had chosen a catastrophic plan. In Kentucky and Connecticut, just 2 percent have chosen a catastrophic plan from their state's online exchange. In Washington state, just 0.4 percent of consumers have chosen [a] catastrophic plan." (Kaiser Health News)  

Fewer California Residents Are Receiving Health Insurance from Their Employers
"Data compiled by the California Healthcare Foundation showed that 54 percent of residents received coverage through their jobs last year. That's down from 63 percent in 1988.... 3.1 million people in California will remain uninsured despite the federal law.... One in 4 adults who work are uninsured. About 40 percent of those working for small businesses with fewer than 10 employees are likely to have no insurance. More than 30 percent of the uninsured have annual household incomes of $50,000 or more, and 62 percent of uninsured children have parents who worked full time in 2012." (Merced Sun-Star)  

Employer Contribution and Premium Growth in Health Insurance
"Using 1991-2011 data before and after a 1999 premium subsidy policy change in the Federal Employees Health Benefits Program (FEHBP), we find that the employer premium contribution scheme has a differential impact on health plan pricing based on two market incentives: 1) consumers are less price sensitive when they only need to pay part of the premium increase, and 2) each health plan has an incentive to increase the employer's premium contribution to that plan. Both incentives are found to contribute to premium growth. Counterfactual simulation shows that average premium would have been 10% less than observed and the federal government would have saved 15% per year on its premium contribution had the subsidy policy change not occurred in the FEHBP." (National Bureau of Economic Research [NBER]; purchase required)  

Proposed Legislation Would Require Paid Family/Medical Leave Nationwide
"The Family and Medical Insurance Leave Act of 2013, or the FAMILY Act, would cover workers in all companies, no matter their size and be funded by employee and employer payroll contributions of two-tenths of one percent each, or about $1.50 per week for a typical worker. Workers would be eligible to collect benefits equal to 66 percent of their typical monthly wages, with a capped monthly maximum amount of $1,000 per week. Unlike the [FMLA], which is only available based on the size of the employer, FAMILY Act benefits would be available to every individual who is: (1) insured for Social Security Disability Insurance when the SSDI application is filed; (2) has earned any income from employment or self-employment in the 12 months before applying for benefits; and (3) is/was engaged in qualified caregiving." (Thompson SmartHR Manager)  

Senators Renew Push for Mass Transit Benefit Change
"Lawmakers in the Senate introduced a bill [on December 19] to maintain the current levels of monthly tax subsidies provided to those who ride public transportation to work. Currently, that subsidy -- which maxes out at $245 per month -- is set to decrease by almost half on Jan. 1, to $130. The parking benefit will actually increase in 2014 by $5 to $250 per month." (Government Executive)  


Latest ACA 'Clarification' Creates More Obstacles for Small Businesses
"This latest change makes more murky the options available to the self-employed because insurers are left scrambling to produce suitable insurance products. There is currently no pricing available for 'catastrophic' coverage for those 30 and older, which creates an unstable insurance market for all levels of consumers.... The majority of America's smallest businesses -- the self-employed and micro-businesses -- will fall into the Individual exchange market for health care coverage." (National Association for the Self-Employed)  


Text of Comments by ERIC to HHS on Proposed Notice of Benefit and Payment Parameters for 2015 (PDF)
"ERIC's recommendations include: [1] Any change to HHS's long-standing position on application of the reinsurance fee should apply fairly and impartially to all self-insured group health plans. [2] Detailed information about the impact of any re-calculation of the reinsurance fee should be provided to the regulated community. [3] Amounts to be collected from plans for the reinsurance fee should be offset by any excess contributions from prior years. [4] The open enrollment period for the Exchanges should begin no later than November 1st in 2014." (The ERISA Industry Committee [ERIC])  


Text of Comments by American Academy of Actuaries to HHS on Proposed Notice of Benefit and Payment Parameters for 2015 (PDF)
"We recommend HHS clarify the proposal for composite rating.... Preliminary analyses of plans using the proposed 2015 AV calculator reveal that many plans that previously met the AV target now fall outside of the de minimis range. Moreover, many plans falling outside of the range will require increases in plan generosity -- which in turn may result in premium increases -- in order to meet the target.... [We] request additional disclosure of ... underlying elements of the AV calculator, including how claims were distributed across the various service categories ... and [t]he frequency units for each of the service categories (e.g., per visit, per service)." (American Academy of Actuaries)  

Benefits in General; Executive Compensation

Supreme Court Upholds Plan's Statute of Limitations for Filing Claims in Court
"Although the Court did not state how long a limitations period must be to be considered reasonable, the Court found the three-year statute of limitations to be reasonable because it provided ample time for a participant to file suit after a typical one-year internal review process. Plan administrators may also want to re-evaluate the benefit of providing additional internal appeals beyond what is required by ERISA regulation, because any such additional levels of appeal will toll the plan's statute of limitations period, thereby lengthening the time a claimant has to file suit." (Sutherland)  

New Tax Increases Make Deferral of Compensation a (More) Valuable Benefit for Many Employees
"The combination of the new additional Medicare taxes on wages, additional taxes on certain investment income of higher income taxpayers, and the new higher marginal income tax rates on both ordinary income and capital gains make income deferral opportunities a potentially valuable benefit for many employees. Because many taxpayers are likely to be subject to these additional taxes or higher tax rates during some or all of their remaining working lives, yet not subject to some or all of these increased taxes in other years or following their retirement, managing the date of recognition of taxable income by use of available deferral techniques can produce actual tax savings." (Pillsbury Winthrop Shaw Pittman LLP)  

Institutional Shareholder Services Releases Updated FAQs Regarding 2014 U.S. Compensation Policy
"[T]he FAQs include: [1]The impact of an adverse say-on-pay recommendation on equity plan proposals. [2] The changes ISS made to its pay for performance quantitative screen, [and] [3] The calculation method for 'granted pay' that is compared to a CEO's 'realizable pay'." (Practical Law Company)  

Hodgson Russ Employee Benefits Developments, December 2013
Topics include: Modification of "Use-or-Lose" rule for health FSAs; Women's preventive services and for-profit employers; A lesson on maintaining historical plan documents; First spouse awarded survivor pension benefits; and Claim for post-bankruptcy pension benefits rejected following "free and clear" purchase of assets. (Hodgson Russ LLP)  

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