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Northwestern Benefit Corporation of Georgia
in GA

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Employee Benefits Post-DOMA: How U.S. v. Windsor Affects Your Plans
January 15, 2014 WEBCAST
(King & Spalding LLP)

DOL Confidential: Understanding Retirement Plan Investigations and Your Fiduciary Duty
January 21, 2014 in CA
(Western Pension & Benefits Council - Orange County Chapter)

Let’s Talk Data: Discriminating Benchmarks in Population Health
January 31, 2014 WEBCAST
(Dynamic Health Strategies)

Health Care Reform for Employers: Now What?
February 13, 2014 in LA
(Lorman Education Services)

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[Official Guidance]

Text of IRS Final Regs on Computation of, and Rules Relating to, Medical Loss Ratio
"In light of the comments received, the Treasury Department and the IRS have concluded that transition rules to phase in the three-year period provided in these final regulations are appropriate. Accordingly, the final regulations provide that for the first taxable year beginning after December 31, 2013, an organization's MLR will be computed on a one-year basis.... The Treasury Department and the IRS continue to consider whether, and, if so, how to permit organizations to address de minimis failures to satisfy the MLR under section 833(c)(5).... [T]he Treasury Department and the IRS have concluded that a change in an organization's eligibility for treatment under section 833 solely by reason of section 833(c)(5) will not be treated as a material change in the operations of such organization or in its structure for purposes of section 833(c)(2)(C)." (Internal Revenue Service)  

[Advert.]

Your 2014 Health Care Reform To Do List—Prepare or Pay!

Join the International Foundation on January 16 for a webcast that focuses on the requirements for employers in 2014. The webcast will cover the employer mandate, plan design issues, fees required and what has and has not been delayed. Register Now!

[Official Guidance]

Text of CMS FAQs on Options Available for Consumers with Cancelled Policies (PDF)
"[Question:] What do I have to do to enroll in catastrophic coverage using this exemption? [Answer:] In order to receive a hardship exemption and be able to purchase catastrophic coverage, you must submit the hardship exemption form and should submit supporting documentation showing your health insurance policy was cancelled to an issuer offering catastrophic coverage in your area." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Official Guidance]

Text of OPM Interim Final Regs on Eligibility of Pathways Programs Participants for FEHBP
"The Pathways Programs ... are designed to enable the Federal Government to compete effectively for students and recent graduates by improving its recruitment efforts through internships and similar programs with Federal agencies. This interim final rule furthers these recruitment and retention efforts by providing health insurance, as well as dental and vision benefits, to eligible program participants and their families." (Office of Personnel Management)  

[Guidance Overview]

New Guidance Permits HRAs to Offer Dental and Vision Coverage as Excepted Benefits; New Wraparound Excepted Benefit Option Announced
"Plans that offer only excepted benefits are not subject to most health care reform rules (including the prohibition on annual limits, prohibition on waiting periods over 90 days, minimum cost-sharing requirements, the requirement to distribute an SBC, etc.). Three changes were proposed: [1] The requirements to provide limited-scope dental and limited-scope vision benefits were modified so that a premium is no longer required for the benefits to be excepted.... [2] A new type of excepted benefit is permitted, called 'wraparound coverage', meant to wrap around non-grandfathered individual health coverage.... [3] Employee assistance programs were also specifically added as a type of excepted benefit." (Wolters Kluwer Law & Business / ftwilliam.com)  

[Guidance Overview]

Departments Release Guidance on Dental and Vision Plans, EAPs, and 'Wraparound' Coverage
"The Proposed Regulations attempt to level the playing field between insured and self-insured dental and vision coverage by eliminating the requirement that participants pay an additional contribution for a self-insured dental or vision benefits to be considered excepted. They also provide much-needed guidance for employers that were struggling with how to administer their EAPs in light of the ACA's new market reforms." (Proskauer Rose LLP)  

[Advert.]

Weight Loss at the Workplace: Legal Issues in Reducing Health Care Costs and Promoting Wellness

January 17 webinar - learn the issues to address when formulating and implementing a corporate wellness program that is aimed at weight loss. Potentially applicable federal and state laws require careful consideration. Special BenefitsLink discount.

[Guidance Overview]

Agencies Propose Important Changes to Excepted Benefits Under HIPAA and Health Care Reform
"The preamble implies that the exception is designed for employers subject to Section 4980H(b)'s $3,000 annual penalty (because the employer's health plan is 'unaffordable' to some employees) ... [As] a practical matter, it is unclear whether it will make economic sense to provide additional benefits to employees already triggering a $3,000 penalty. The exception might be more palatable for employers whose lower-paid employees are part-timers (since employees averaging fewer than 30 hours per week do not trigger employer penalties). Similarly, the exception might appeal to some smaller employers not subject to Section 4980H at all." (Thomson Reuters / EBIA)  

[Guidance Overview]

Proposed Regs Detail Process for Health Plans to Certify Compliance with HIPAA's Electronic Transaction Standards and Operating Rules, Starting in 2015
"The proposed regulations provide the first official indication that health plans did not have to comply with the December 31, 2013 statutory deadline for certifying compliance with the First Certification Transactions. While the delay until December 31, 2015 is welcome, the preamble emphasizes that all HIPAA-covered entities, including health plans, were required to be compliant with the operating rules for the eligibility for a health plan and health care claim status transactions by January 1, 2013 and for the EFT/ERA transaction by January 1, 2014. This delay relates only to the requirement to certify compliance." (Thomson Reuters / EBIA)  

[Guidance Overview]

IRS Releases 2013 Form 8839 (Qualified Adoption Expenses) and Instructions
"Employer-provided adoption benefits may be excluded from an employee's gross income if they are furnished pursuant to an adoption assistance program that meets the Code's requirements. Benefits under a qualified adoption assistance program may be funded by the employer directly, by employees through salary reductions under a cafeteria plan, or by a combination of both. Employees may also claim a tax credit for qualified adoption expenses, although both the credit and exclusion cannot be claimed for the same expense." (Thomson Reuters / EBIA)  

[Guidance Overview]

CMS Explains Reinsurance Contributions for Retiree-Only HRAs and Employees Covered by Medicare
"The guidance in the HRAs FAQ provides welcome confirmation of an exception for retiree-only HRAs that was presaged in the December 2013 proposed reinsurance program regulations ... The Medicare FAQ seems to reiterate a position that was made clear in the final reinsurance program regulations published in March 2013 ... The preamble to those regulations explains how a plan may reduce its number of covered lives to take into account participants for whom Medicare provides primary coverage. However, employers should keep in mind that the Medicare Secondary Payer rules make Medicare secondary to the employer's plan in most situations." (Thomson Reuters / EBIA)  

This Is Not Your Parents' Health Insurance
"Oscar is not your typical health insurance company. The New York City startup -- the first new health insurer in years -- is run by veterans of many of Silicon Valley's biggest names. And the way the company's founders see it, your insurance should play a bigger role in your life -- not just handling claims, but using technology to keep medical life organized." (National Public Radio)  

Administration Asks Supreme Court to Reject Nuns' Challenge to Health Law
"[T]he Obama administration said Friday that it could not compel Christian Brothers Services to provide contraceptive coverage to employees of the Little Sisters nursing homes.... Moreover, the Obama administration said that the [ACA] did not really impose an 'employer mandate.' The birth control requirements 'apply only if an employer offers a group health plan,' the administration said in its brief. 'Employers, however, are not required to offer group health plans in the first place,' the brief continued. 'Large employers (those with more than 50 full-time-equivalent employees) face a potential tax if they do not provide coverage, but that gives them a choice between two legal options: provide a group health plan or risk payment of the tax.'" (The New York Times; subscription may be required)  

The Little Sisters Case and EBSA Form 700
"It seems like a bureaucratic thing to do, but gaining an understanding of what it means to sign government form EBSA 700 is the key to a historic religious controversy now before the Supreme Court ... Signing that form, the federal government argues, is a simple way for a religious organization like the Little Sisters to avoid what they regard as a sin: providing contraceptives and other pregnancy-related services to their female employees. But signing, the Little Sisters counter, would be the very act of violating their faith by clearing the way for such services for those employees. In the government's view, that is a legal issue, easily resolved by a court. To the Little Sisters, it is a religious question, and only they can decide what their faith tells them about it. The Supreme Court may have to decide which it is, and soon." (SCOTUSblog)  

Millions of Lower-Income People Expected to Shift Between Exchanges and Medicaid During 2014
"In 2014, millions of people are expected to shift between the health exchanges and Medicaid, as their income fluctuates over the year. That could be costly for states and insurance companies, and patients could wind up having gaps in coverage or having to switch health plans or doctors.... Until now, people who churn out of Medicaid because of an income bump often wound up uninsured because they can't afford private insurance. Starting this month ... many will become eligible for insurance and subsidies through the exchanges." (Kaiser Health News)  

[Opinion]

Ten Health and Wellness Resolutions Not to Make in 2014
"2014 will be the year the get-well-quick mentality driving corporate and individual health choices implodes -- and people start taking genuine steps to be healthy. The way to ensure that 2014 is your year for good health? Start with a double negative: (a) wellness industry advice is almost always wrong; and (b) most people don't keep their New Year's resolutions." (The Health Care Blog)  

[Opinion]

Text of Comments by American Academy of Actuaries to CCIIO on Unified Rate Review Template and List of Technical Corrections (PDF)
10 pages. Excerpt: "[We offer] technical comments on the updated versions of the Unified Rate Review Template (URRT) and the actuarial memorandum instructions. This letter also includes comments on the proposed list of changes to URRT (version 2.0) for quarterly 2014 and annual 2015 filings ... If there are technical issues in the URRT that can not be addressed for whatever reason, we would encourage CCIIO to provide specific instructions on how to work around those technical issues." (Rate Review Practice Note Work Group, American Academy of Actuaries)  

[Opinion]

Why Hospitals Are Still Gouging the Uninsured
"[ACA statutory language] purports to limit hospitals' charge to uninsured patients in the ER to 'not more than the lowest amounts charged to individuals who have insurance covering such care'. Hospitals which fail to adhere to this policy risk losing their non-profit status.... Hospitals take threats to their non-profit status very seriously. So, since the law was passed in 2010, you might expect that the overcharging of uninsured patients has long since stopped. You would be wrong. Like everything else in ObamaCare, this has malfunctioned." (John Goodman's Health Policy Blog)  

[Opinion]

The Myth of Health Care's Free Market
"How many of us have 'reasonable knowledge' of medical procedures, costs, or even the difference between a neurologist and a nephrologist? Is an accident victim writhing in pain, life's blood flowing out of his body, free of compulsion? And how many of us know the assortment of facts needed to price an MRI, an angiogram or just a dozen stitches? Or, for that matter, whether any of those procedures is the best alternative, or even necessary? We don't have a free market for health-care services." (David Cay Johnston in Newsweek)  

Chris Blair Joins Mercer’s San Francisco Office as Principal in its Defined Contribution Advisors Practice
Mercer

2014 AACE Awards — Call for Submissions
ESOP Association

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