Equity Investment Analyst
Retirement and Investment Consulting Firm
in IL

Fixed Income Investment Analyst
Retirement and Investment Consulting Firm
in IL

Peer Reviewer and Technical Resource
The Angell Pension Group, Inc.
in ANY STATE

Retirement Plan Consulting Actuary
Shore Tompkins Actuarial Resources, LLC
in IL

Retirement Plans Recordkeeper
First American Bank
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Retirement for the Ages
January 17, 2014 in DC
(American Academy of Actuaries)

Affordable Care Act 101 Webinar
January 23, 2014 WEBCAST
(U.S. Small Business Administration (SBA))

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[Official Guidance]

Text of IRS Chief Counsel Memo 20140201F on Treatment of Premium Stabilization Reserves (PDF)
"Issue: May positive balances in the Company's Experience Premium Stabilization Reserve (PSR) accounts be deducted from gross income under Section 832? Conclusion: The positive balances in the PSR are not return premiums and cannot be deducted from gross income under Section 832 until they are refundable to customers or creditable to customers' accounts. Because the Company's contracts at issue provide that positive PSR balances are not returned to a customer upon termination of the contract, the Company's liability for the amounts at issue is not fixed." [Memo is dated December 3, 2013; published on IRS website January 14, 2014.] (Internal Revenue Service)  

[Official Guidance]

Text of CMS Announcement Extending the Sale of Individual Market Policies to Medicare Beneficiaries Under 65 Losing Coverage Due to High Risk Pool Closures (PDF)
"This bulletin sets forth circumstances under which the Secretary has determined that issuers may sell individual market health insurance policies to certain Medicare beneficiaries under age 65 who lose state high risk pool coverage.... [F]or sales to these individuals, HHS will not enforce the anti-duplication provisions of section 1882(d)(3)(A) of the Social Security Act from January 10, 2014 to December 31, 2015.... At least three states have announced their intent to close their high risk pools between February 1, 2014, and April 1, 2014, and several other states have indicated that they may do so in the next two years." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Official Guidance]

Text of CMS Notice on Change in Policy for Disclosure of Amounts Paid to Individual Physicians under the Medicare Program
"The Secretary has considered the court's decision [to vacate its injunction prohibiting disclosure] and the wide spectrum of public comments received by CMS.... [HHS] has decided to replace the prior policy, as set forth in the November 28, 1980 Federal Register ... with a new policy in which CMS will make case-by-case determinations as to whether exemption 6 of the Freedom of Information Act applies to a given request for information pertaining to the amounts that were paid to individual physicians under Medicare." (U.S. Department of Health and Human Services)  

[Guidance Overview]

New FAQ Grab-Bag Guidance Sheds Light on Numerous ACA Issues (PDF)
"When a new preventive item or service is added to the [United States Preventive Services Task Force (USPSTF), Health Resources and Services Administration (HRSA) or Advisory Committee on Immunization Practices (ACIP)] list of required coverage, the plan must cover the new item or service without cost-sharing (in-network) for plan years that begin on or after the date that is one year after the date the recommendation or guideline is issued. Accordingly, non-grandfathered plans must add the new USPSTF recommendation regarding risk-reducing medications for women at high risk for breast cancer in the first plan year beginning on or after September 24, 2014 (as of January 1, 2015 for a calendar-year plan)." (Trucker Huss)  

[Guidance Overview]

Agencies Issue Final Mental Health Parity Regs (PDF)
"[P]rior to the issuance of the final regulations, many plans considered intermediate care to be outside the six classifications and, therefore, not subject to the parity obligation.... The Departments rejected the idea of incorporating a mathematical parity analysis for [nonquantitative treatment limitations (NQTLs)] similar to that used for financial requirements and quantitative treatment limitations. The subjective nature of the NQTL parity analysis will create a challenge for plans trying to demonstrate compliance in the event of litigation." (Buck Consultants)  

[Advert.]

23rd Annual National Health Benefits Conference & Expo - Jan. 28-29, FL

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!

Text of District Court Opinion: 'Procedural Irregularities' Are Insufficient to Overcome Abuse of Discretion Standard of Review (PDF)
"It is undisputed that Prudential failed to notify Plaintiff of its decision to uphold its denial of benefits within 45 days of receipt of Plaintiff 's request for review.... Nevertheless, the Court finds that Prudential substantially complied with the procedural requirements of ERISA as a whole... That Prudential failed to send this to Plaintiff within 45 days is no doubt troubling, but it does not undermine the Court's view that the parties enjoyed a significant exchange overall... Accordingly, the Court finds no reason to abandon the abuse of discretion standard. This does not mean, however, that the Court will disregard Prudential's transgression. The Court will consider this 'procedural irregularity' in its overall analysis of whether Prudential abused its discretion." [Steward v. Prudential, NO. 3:12-CV-3844-B (N.D.Tx. Jan. 10, 2014)] (U.S. District Court for the Northern District of Texas)  

Six Obamacare Realities for Businesses in 2014
"[1] Many small businesses will not get to keep their plans.... [2] The employer mandate delay has not slowed the negative hiring trend.... [3] The exchange for small businesses is MIA.... [4] Larger businesses are also feeling the pain...[5] New taxes will increase costs in 2014.... [6] Additional taxes aren't the only new things for 2014." (U.S. Chamber of Commerce)  

Coworkers Reporting 'Strange' Behavior, Employee Seeking Time Off for 'Stress' May Show Employer Knew of Need for FMLA Leave
"Evidence that coworkers reported that an employee was engaging in 'strange behavior,' that his supervisor knew he had previously been diagnosed as bipolar and was on anti-depressants, that he reported feeling stressed and needing counseling a few weeks before he was fired for two unauthorized absences, and that he said he needed those days off due to 'stress,' raised an issue of fact on whether the employer had notice of his intent to take FMLA-qualifying leave, determined a federal district court in South Carolina, rejecting a magistrate judge's recommendation otherwise and denying summary judgment on the employee's FMLA interference claim." (Wolters Kluwer Law & Business)  

Employee Healthcare Cost Containment -- A Strategy that Works
"Despite countless incremental solutions such as wellness programs, consumer driven healthcare and provider payment reform there has been very little impact on both the quality and the price of healthcare for employers.... So how do employers move towards a value based healthcare delivery system within their organization? The strategy involves four interdependent and fundamental components.... [1] Population Health Management; [2] Directing Care to Maximize Value; [3] Bundled Case Rates; and [4] Measure Outcomes and Costs." (Healthcare Reform Magazine)  

CMS Modifies Policy on Disclosure of Physician Payment Information
"Going forward, CMS will evaluate requests for individual physician payment information (or requests for information that combined with other publicly available information could be used to determine total Medicare payments to a physician) on a case-by-case basis.... In addition, CMS will generate and make available aggregate data sets regarding Medicare physician services for public consumption." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

HHS Extends Coverage for Patients in Federal High-Risk Pools
"Enrollees in the high-risk pools must select a new plan by March 15 to avoid a gap in coverage, according to HHS. Open enrollment for the health law ends March 31. The current enrollment in both state and federal PCIP programs is less than 30,000, down from 85,000 in October, according to an HHS official.... The high-risk pool, or PCIP, program, was supposed to end Dec. 31." (Kaiser Health News)  

Bill Challenging Obamacare Filed In Missouri Legislature
"The bill would suspend insurance companies' state licenses if they accepted subsidies offered by the federal government to help pay health insurance premiums for low- and middle-income Missourians. [State Senator John] Lamping contends the subsidies are illegal and eventually will be thrown out by a federal court. By rejecting them, he said, Missouri could remove the trigger in the federal law that, beginning in 2015, will assess penalties against large employers that don't provide health insurance." (Kaiser Health News)  

How Exchanges Can Help Consumers Choose a Health Insurance Plan That Meets Their Needs
"To encourage consumers to choose the right plan, health insurance exchanges should: [1] Provide a 'cost-at-time-of-care' calculator to give consumers an estimate of a plan's total cost, based on covered benefits, cost-sharing, expected use of medical services, premium, and any tax credit. [2] Use automatic filters and sorting mechanisms to ensure that the initial display of information shows the plans that best match the consumer's preferences. [3] Offer a shortcut that allows consumers to quickly view a plan comparison; the user has the option to seek the details or to select a plan. [4] Help consumers find health plans that include their providers or allow them to choose their providers." (Robert Wood Johnson Foundation)  

Does Obamacare Cause Psychological Distress Among U.S. Adults?
"Adults with private or no health insurance coverage had lower levels of psychological distress than those with public or other forms of coverage. Adults who recently experienced a change in health insurance status had higher levels of distress than those who had not recently experienced a change. However, for adults who had not experienced a change in status in the past year, the average absolute level of distress is higher among those with no coverage versus private coverage." (Stress & Health)  

Principles for Designing Consumer-Friendly Wellness Programs in Medicaid (PDF)
"This brief introduces the concept of wellness incentive programs, and it lays out the key elements that a Medicaid wellness incentive program should have to protect enrollees' access to care and help them make healthy behavior changes. It also discusses options consumer advocates can suggest if their state proposes a penalty-based wellness program that could harm enrollees' access to care." (Families USA)  

70% of Retirees Reevaluated Their Private Medicare Plans for 2014
"Even though more than two-thirds of plan holders reevaluated their coverage, just 29% reported that after doing so, they either replaced or dropped one or more of their plans. The remaining 71% took no action and allowed their existing plans to automatically renew. The percentage of retirees reevaluating their plans each year has increased since the last time we asked the question, while the percentage who replace or drop their plans has remained statistically the same." (ExtendHealth)  

Health Sign-Ups Skew Older, Raising Fears Over Costs
"One-third of health plan enrollees in new insurance marketplaces are 55 or older ... a figure that insurers said makes the pool older than they would need to sustain their coverage at current premiums.... [C]ushions built into the law mean it won't necessarily face trouble right away even if the 2014 pool of enrollees skews older." (The Wall Street Journal; subscription may be required)  

[Opinion]

Single-Payer Health Plan Is Not Dead
"The prospects for single-payer health care -- adored by many liberals, despised by private health insurers and looking better all the time to others -- did not die in the Affordable Care Act. It was thrown a lifeline through a little-known provision tucked in the famously long legislation. Single-payer groups in several states are now lining up to make use of Section 1332. Vermont is way ahead of the pack, but Hawaii, Oregon, New York, Washington, California, Colorado and Maryland have strong single-payer movements." (The Leaf Chronicle)  

[Opinion]

Timothy Jost Reviews What Four Years of the ACA Have Brought Us
"Although Jost suggests that the determination of the success or failure will be based on how successful the enrollment of the 50 million mostly lower-income uninsured Americans will be, it is more likely that those with incomes above 400 percent of the federal poverty level who will be bearing the full costs of their insurance, directly or through wage concessions, will consider the shift in employer-sponsored plans toward narrow networks and high cost sharing to be a failure of policy." (Physicians for a National Health Program [PNHP])  

Supplemental Unemployment Benefit Payments Are Likely 'Wages' Under FICA
"Oral argument Tuesday afternoon in United States v. Quality Stores, Inc.... ended after a scant 38 minutes, and the government appeared likely to prevail. Indeed, as the courtroom emptied, the real question seemed to be the precise rationale the Court would adopt in reversing the Sixth Circuit." (SCOTUSblog)  

P4P is Growing Up! NACD Provides New Guidance for Executive Compensation
"As pay for performance grows up, we are seeing more structure and commonality. As we experience this, there is more focus on the lack of commonality of comment terms like 'performance' and 'success'.... [A recent paper from the National Association of Corporate Directors (NACD)] attempts to provide some consistency in terminology and approach, with the goal of creating better credibility when reporting executive compensation." (Compensation Cafe)  

California Company Restores Nearly $2M in Pension Benefits to 515 Employees Following US Labor Department Investigation
Employee Benefits Security Administration (EBSA), U.S. Department of Labor

CalPERS Board Re-Elects Feckner as President; Elects Priya Mathur as Vice President
CalPERS (California Public Employees' Retirement System)

EdisonHealth Announces Its First Medical Destinations of Excellence
EdisonHealth Network LLC

Plan Sponsor Advisors Launches New QDRO Administration Service
Plan Sponsor Advisors

Trustees of Hico Flex Brass Co. Restore More than $79,000 to Machesney Park, Ill., Employee Retirement Plan
Employee Benefits Security Administration (EBSA), U.S. Department of Labor

New Strategy Helps Financial Professionals and Clients Solve a 403(b) Dilemma
Principal Financial Group

Mercer’s 2014 Guide to Social Security and 2014 Medicare Booklet Provide the Answers Needed to Begin Planning a Dream Retirement
Mercer

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