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December 31, 2013          Get Retirement News  |  Advertise
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Installation Coordinator
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Compliance Analyst/Client Relations Manager
Alliance Benefit Group of Houston, Inc.
in TX

Installation Coordinator
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Group Insurance Account Manager
Benefit Sources & Solutions Chadler
in NJ

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Webcasts and Conferences

Latest Developments in ERISA Litigation
January 22, 2014 in IL
(Worldwide Employee Benefits Network (WEB))

Developing and Implementing a Successful Financial Wellness Program
January 23, 2014 WEBCAST
(International Foundation of Employee Benefit Plans)

2014 San Francisco Mid-Sized Retirement & Healthcare Plan Management Conference
March 16, 2014 in CA
(University Conference Services)

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

Text of HHS Proposed Regs for Administrative Simplification: Certification of Compliance for Health Plans
"Although HIPAA standards and operating rules can reduce administrative burden, the health care industry has experienced difficulty transitioning to them by the regulatory compliance dates. Many in the industry attribute at least some implementation difficulties to the lack of a consistent testing process or framework before implementation of new standards and operating rules. This proposed rule is intended to serve as an initial step toward the development of a consistent testing process that will enable entities to better achieve and demonstrate compliance with HIPAA standards and operating rules. This rule proposes that controlling health plans (CHPs) must submit certain information and documentation that demonstrates compliance with the adopted standards and operating rules for three electronic transactions: eligibility for a health plan, health care claim status, and health care electronic funds transfers (EFT) and remittance advice. Such documentation would be an indication that a CHP has completed some internal and external testing." (U.S. Department of Health and Human Services)  


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[Official Guidance]

Text of CMS FAQ on the State-Based Marketplace Annual Reporting Tool (SMART) (PDF)
"What is the purpose of the State-based Marketplace Annual Reporting Tool (SMART)? ... Where is the SMART stored? ... What authority does the CMS have to require [a state-based marketplace (SBM)] to complete the SMART? ... What requirements must be addressed in the SMART? ... Why do some questions require the SBM to upload a document or report while other questions only require an attestation? ... The SBM has already submitted the reports listed and believes this work is duplicative. Why does the SBM have to verify and/or resubmit the information again? ... When must SBMs submit the SMART to CMS? ... What will the SBM need to report in 2014? ... Who will be required to sign the SMART? ... What guidance and resources are available to assist SBMs with completing and submitting the SMART?" (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Official Guidance]

Text of CCIIO Technical Guidance 2013-0004: Q&A on the Medical Loss Ratio Reporting and Rebate Requirements. (PDF)
"For the 2013 MLR reporting year, issuers may defer including in their MLR and rebate calculations the portion of 2013 premiums collected for 2014 ACA assessments or fees on non-calendar year policies. If issuers elect to defer this portion of premium in the 2013 MLR and rebate calculations, they must disclose the deferred amount for each respective state and market. In addition, issuers must disclose and reduce the MLR tax adjustment to premium by the amount of federal and state taxes and fees associated with the deferred portion of premium." (Center for Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Guidance Overview]

HHS Announces Transitional Reinsurance Fee for 2015 and Payment Schedule
"Based on HHS's estimate of the number of enrollees in contributing plans, the annual per capita contribution rate for 2015 is $44 -- $3.67 per month per covered life. This is a reduction from the annual per capita contribution rate of $63 in 2014, or $5.25 per month per covered life.... The proposed rules change the reference from 'benefit year' to 'plan year' in the Form 5500 counting method to clarify that self-insured group health plans may use the enrollment count reported in Form 5500, even if the plan is based on a plan year other than the benefit year. The benefit year is defined as a calendar year for which a health plan provides coverage for health benefits." (Towers Watson)  

[Guidance Overview]

IRS Releases Final Regs on ACA Health Insurance Providers Fee (PDF)
"The preamble to the final regulations notes that an educational organization providing health coverage to students may qualify for an exclusion as a governmental entity if it is wholly state-owned. It may also avoid the fee if its net premiums written for US health risks for a calendar year do not exceed $25 million.... The regulations state that the only type of VEBA that would be considered a covered entity subject to the health insurer fee is a VEBA that is also a non-fully insured MEWA." (Buck Consultants)  

An Obamacare Remedy for Some (But Not All) Small Businesses Without Exchange Access
"Treasury Department officials recently announced that tax credits available to firms that buy coverage through the government's new health care exchanges will also be made available to employers who buy insurance through the private market, but only in certain counties of Wisconsin and Washington state, where not a single insurance company elected to sell small-business plans through Healthcare.gov. Meanwhile, in states like Maryland, where the new small-business exchanges have attracted insurance providers but the Web sites themselves have not yet opened for business, small firms cannot yet receive subsidies to help them pay for coverage." (The Washington Post; subscription may be required)  

2013 Cost and Benefits of Individual and Family Health Insurance (PDF)
31 pages. Excerpt: "The average premium paid nationwide for individual policies was $197 per month (a 3.7% increase vs. 2012), while the average premium paid for family policies was $426 per month (an increase of 3.4%). The average deductible for individual policies nationwide was $3,319 per year (a 7.8% increase vs. 2012), and the average deductible for family policies was $4,230 per year (a 3.7% increase). The average premium paid for policies offering richer 'comprehensive coverage' was $247 per month for individual plans or $544 per month for family plans. Half of all individual policy holders paid $163 (median) or less per month in premiums, and half of all family policyholders paid $362 (median) or less for monthly premiums." (eHealthInsurance)  

The Amazing, Indisputable Slowdown in Health Spending
"The great deceleration in health costs continues, with nominal Medicare spending actually lower in the first two months of fiscal year 2014 than in 2013. Focusing on Medicare is particularly interesting, since there is no reason to suspect that Medicare spending has been affected by the recession." (The Washington Post; subscription may be required)  

What's Behind Health Insurance Rate Increases? An Examination of What Insurers Reported to the Federal Government in 2012-2013 (PDF)
"The [ACA] requires health insurers to justify rate increases of 10 percent or more for nongrandfathered plans in the individual and small-group markets.... [F]or rates taking effect from mid-2012 through mid-2013, insurers attributed the great bulk -- three-quarters or more -- of these larger rate increases to routine factors such as trends in medical costs.... The ACA-related factor mentioned most often, but only in a third of the rate filings in this study, was the requirement to cover women's preventive and contraceptive services without patient cost-sharing." (The Commonwealth Fund)  

Fort Wayne-South Bend Catholic Diocese Gets Relief from Contraception Mandate
"While houses of worship are exempt from the mandate, the Fort Wayne-South Bend Diocese argued for more: Protection on behalf of a host of Catholic guided not-for-profit institutions deemed essential to carrying out the mission of the church. The list includes the Franciscan Alliance of hospitals that runs St. Anthony in Michigan City and the Saint Anne home and retirement community in Fort Wayne Furthermore, there's 'Our Sunday Visitor,' a publishing house in Huntington and Catholic Charities which offers a food pantry and refugee settlement.... [T]he entities account for some 20,000 employees ... Less than two weeks ago, Chief Judge Philip P. Simon sitting in Hammond issued the ruling that denied injunctive relief for the University of Notre Dame." (WNDU.com)  

How Are State Insurance Marketplaces Shaping Health Plan Design? (PDF)
"This analysis focuses on how state-based and state partnership marketplaces are using their flexibility in setting certification standards to shape plan design in the individual market. It focuses on three aspects of certification: provider networks; inclusion of essential community providers; and benefit substitution, which allows plans to offer benefits that differ from a state's benchmark plan.... 13 states go beyond the minimum federal requirements with respect to provider network standards, four states specify additional standards for including essential community providers, and five states and Washington, D.C., bar benefit substitution." (The Commonwealth Fund)  

What States Are Doing to Simplify Health Plan Choice in the Insurance Marketplaces (PDF)
"This issue brief examines the policies set by some state-based marketplaces to simplify plan choices: adopting a meaningful difference standard, limiting the number of plans or benefit designs insurers may offer, or requiring standardized benefit designs. Eleven states and the District of Columbia took one or more of these actions for 2014, though their policies vary in terms of their prescriptiveness." (The Commonwealth Fund)  

Health Insurers Race to Complete Enrollments
"As of Monday [Dec. 30], only about half of enrollees billed for plans offered by more than 100 insurers in 17 states had paid their first month's premium ... [M]ost insurers in turn extended their deadlines for payment ... Some ... pushed the deadline as far back as Jan. 28. Humana Inc. said Monday that it would accept payments as late as Jan. 31.... Insurers expect people who haven't paid to try to use health-law coverage anyway. 'We anticipate that people will be using screen printouts' from online marketplaces in an attempt to demonstrate coverage, even if they haven't completed enrollment, said [one insurer]." (The Wall Street Journal; subscription may be required)  

Another Top Official in Charge of Troubled Healthcare.gov Rollout Retires
"The departure of Michelle Snyder, chief operating officer of the CMS, is the second instance of an administration official leaving the agency since the Web site launched with a multitude of glitches in October, preventing many users from enrolling in health plans through the government's online insurance exchange." (The Washington Post; subscription may be required)  

Medicaid on the Eve of Expansion: A Survey of State Medicaid Officials About the ACA
"By focusing specifically on those experiences of officials in states expanding Medicaid for 2014, [the authors] were able to explore in depth the specific policies states are pursuing in the areas of outreach and enrollment, cost control, and improving access to care for newly eligible adults.... Overall, the responses indicated a combination of optimism in some areas -- particularly enrollment efforts and benefits to beneficiaries of getting coverage -- but also concerns about the impact of the expansion on state budgets, and specific barriers to care that remain in the program." (Timothy Jost in Health Affairs Blog)  


AHIP Statement on Status of Health Care Reform Implementation
"Over the past three and a half years, health plans have worked to implement all of the changes required by the ACA in the most affordable and least disruptive manner possible.... Health plans will continue to work with state and federal agencies to help consumers through the enrollment process get the high-quality, affordable health care coverage they need.... Moving forward, more work will need to be done to ensure coverage is affordable for consumers and employers. Congress should start by repealing the ACA's new $100 billion health insurance tax that begins in 2014. Taxing health insurance makes it more expensive and that undermines the goals of health care reform." (America's Health Insurance Plans [AHIP])  


Health Insurers Are Being Battered by Obamacare, and They Deserve It
"Health insurers were always going to be the bad guys in the battle over Obamacare. While the law affects virtually every sector of the health care system, it was primarily about health insurance, because of the Democrats' widely held conviction that the private health insurance industry unethically profits off patients needing medical care. The primary purpose for the Affordable Care Act was to stop what liberals perceived as health insurer abuses and profiteering." (Forbes)  

Benefits in General; Executive Compensation

[Guidance Overview]

IRS Provides Guidance on Deduction of Bonuses Under All-Events Test
"Although unfavorable to the taxpayer at issue, this FAA provides additional guidance to accrual-method taxpayers in determining when their bonus liabilities will meet the all-events test of section 461 ... The FAA should serve as a reminder to taxpayers that to the extent a bonus plan provides the taxpayer with the ability to rescind or modify its bonus liability prior to payment, it is possible the bonus liability will not be treated as fixed or determinable prior to payment." [IRS Field Attorney Advice Memorandum 20134301F] (McGladrey)  

Press Releases

NCEO Publishes "Acquisition Strategies for ESOP Companies"
National Center for Employee Ownership

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