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Employee Benefits Jobs
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Webcasts and Conferences
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Hand-picked links to the web's best news articles,
official guidance, jobs, webcasts and more.
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[Guidance Overview]
New FAQs Address ACA and Mental Health Parity Requirements
"The FAQ clarifies that there are certain situations in which fixed indemnity coverage that pays on a basis other than a per-service basis may still be considered as excepted benefits.... If these proposed revisions are implemented, fixed indemnity insurance in the individual market could qualify as an excepted benefit even if it does not pay benefits solely on a per-period basis. Until these proposed amendments are finalized, HHS will treat fixed indemnity coverage in the individual market meeting the conditions above as excepted benefits for enforcement purposes."
(McDermott Will & Emery)
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[Guidance Overview]
CCIIO Notice Allows Issuers to Defer Portion of Premiums in 2013 MLR and Rebate Calculations
"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."
(Wolters Kluwer Law & Business)
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[Guidance Overview]
CMS Overview of Marketplace Payment Process, January 13, 2014 (PDF)
46 presentation slides. Excerpt: "In February, CMS will make payments for the February payment month which will include: Payments for the February enrollment month (enrollments effective in February and submitted prior to the February cutoff date of January 15th, 2014); and Payments for adjustments to the January enrollment data, including effectuated enrollments submitted after the original January cutoff date (Dec. 15th, 2013) and any retroactive enrollment data. In this presentation we will outline how enrollment and payment data will be submitted for the February payment month and how to update payments for prior enrollment months (e.g. January) under the interim payment process."
(Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)
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Proposed Excepted Benefits Regs Have Good News for EAPs and Self-Insured Vision and Dental Plans
"The proposed regulations also clarify the requirements for employee assistance plans (EAPs) to qualify as excepted benefits beginning in 2015. An EAP will constitute an excepted benefit as long as [1] the EAP does not provide 'significant' benefits that consist of medical care, [2] the EAP benefits are not coordinated with benefits under another group health plan ... [3] employees do not have to pay a premium to participate in the EAP, and [4] the EAP does not require cost sharing. The regulators requested comments on how to define 'significant' for this purpose."
(Benefits Bryan Cave)
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Self-Insurance Industry Fights Restrictions
"By the end of 2013, four states had passed laws restricting stop-loss in one way or another.... Self-insured plans are exempt from several provisions of the [ACA]. Some health policy watchers have suggested that small employers with the lowest claims might try to cut their premiums by switching to self-insured plans.... [Proposed federal] legislation seeks to clarify existing law to ensure that federal regulators cannot re-define stop-loss insurance as traditional health insurance. Such a designation, they say, could force many self-insured entities that retain stop-loss insurance to discontinue their health plans."
(Treasury & Risk)
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[Advert.]
Premium Educational Event for Taft-Hartley Trustees
Attend FRA's Taft-Hartley Benefits Summit to effectively manage your fund's investments and ensure your members' health & welfare benefits remain top-notch. Feb. 10-11, 2014 - Lake Buena Vista, FL. Mention FMP164 during registration for 10% discount.
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Text of D.C. District Court Ruling: ACA Allows Premium Subsidies in States with Federally Run Health Insurance Marketplaces
"Why would Congress have inserted the phrase 'established by the State under [42 U.S.C. 18031]' if it intended to refer to Exchanges created by a state or by HHS? But defendants provide a plausible and persuasive answer: Because the ACA takes a state-established Exchange as a given and directs the Secretary of HHS to establish such Exchange and bring it into operation if the state does not do so. In other words, even where a state does not actually establish an Exchange, the federal government can create 'an Exchange established by the State under [42 U.S.C. 18031]' on behalf of that state." [Halbig v. Sebelius, No. 13-062 (D.D.C. Jan. 15, 2014)]
(U.S. District Court for the District of Columbia)
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District Court for D.C. Rules That Tax Credits Are Available Through Federal Exchange
"Judge Paul Friedman of the District Court for the District of Columbia held that the ACA unambiguously supports an IRS regulation allowing the agency to issue premium tax credits to individuals enrolled through federal, as well as state, exchanges.... The plaintiffs have already reportedly appealed Judge Friedman's decision, but his reasoning is persuasive, and [the author expects] that not only will his decision be upheld but that the judges in the other cases will follow his reasoning." [Halbig v. Sebelius, No. 13-062 (D.D.C. Jan. 15, 2014)]
(Timothy Jost in Health Affairs Blog)
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Supreme Court Justices Consider Taxability of Certain Severance Pay During Quality Stores Oral Arguments
"Justice Ginsburg questioned the government about the impact of its position on state unemployment compensation payments. Justice Alito pressed the government on whether its argument would be different if the severance payments were not connected to employees' length of service and salary -- to which the government responded that the payments would still be considered wages as 'keyed to the critical aspects of the employment relationship.' ... If the Supreme Court upholds the Sixth Circuit's ruling ... the [IRS] could owe more than $1 billion in FICA tax refund claims to individuals and employers that have filed protective refund claims pending the outcome of the Quality Stores case."
(Ogletree Deakins)
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Insurers Concerned About Obamacare's Catch-22 for MLR Calculations
"Insurers don't think it's fair to penalize them for expenses they incurred solely because of the government's broken website or the administration's last-minute policy changes.... The Affordable Care Act says individual policies can spend only 20 percent of their premiums on overhead and profit. If they spend more, they have to rebate the difference to their customers. Some plans worry they'll go over the limit this year because of the extra administrative costs the administration has dumped on them since October."
(NationalJournal)
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Health Insurers Think Obamacare Is Going to Be Fine
"Health insurers arguably have the biggest financial stake in the exchanges' success. They are the ones who are selling products on the new marketplaces, and who would have to bear the costs of covering a sicker-than-expected exchange population. But even after a troubled launch, and with early enrollment shaping up to be lower and older than expected, plan executives generally cite two reasons they're not panicking -- and not pulling out of the exchanges after year one.... [M]any approached 2014 as a test year for the Affordable Care Act and participated in only a handful of exchanges to test the waters.... And even as the health exchanges grow, they will likely still remain a smaller part of a health plan's business."
(Sarah Kliff in The Washington Post; subscription may be required)
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How Much to Deliver a Baby? Charges Vary Widely by Hospital
"Comparing nearly 110,000 uncomplicated births and Caesarean sections, researchers found the lowest charge for a vaginal birth involving an average woman was $3,296, while the highest was $37,227. For an uncomplicated Caesarean delivery, the lowest charge was about $8,312, while the highest was $70,908.... The researchers found that hospitals charged more if they were located in areas with a higher cost of living, treated sicker populations or were for-profit institutions. But the differences in hospital characteristics only explained about a third of the difference in the charges[.]"
(Kaiser Health News)
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Medicare Physician Payment Reform: Will 2014 See the Fix for SGR?
"Physicians can receive bonuses of up to 5% per year from 2017 to 2022 for transitioning to 'alternative payment models' in which payments are increasingly related to value defined as measured quality and total cost of care.... How much physician payment reform occurs in 2014 may come down to how much physicians are willing to advocate for alternatives to the predictable but consuming short-term patches -- alternatives that may not be permanent or clear but that would give physicians much more opportunity to lead in reforming health care."
(JAMA)
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Lack of Context Likely in Release of Doctor Pay Data
"Releasing data showing how much money individual doctors have received for treating Medicare patients could cause public misunderstanding while failing to achieve significant change ... It has long been hoped that learning which doctors are more costly to Medicare would result in consumers and healthcare purchasers steering their business to lower-cost providers. That would mean saving money and reducing overall healthcare spending. However, the carefully couched wording of Medicare's announcement Tuesday provided few details on what information will be released and to whom."
(MedPage Today)
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[Opinion]
Is the U.S. Too Corrupt for Single-Payer Health Care?
"The key to a single-payer system is that the government sets prices. Usually, it empowers boards of independent experts who set those prices low. [Uwe] Reinhardt's argument is that in the United States, health industry interests have so much sway over Congress that the prices would end up being set by health-care interests.... Reinhardt's argument is a reminder that the simple fact that a policy worked in another country does not mean it will work in this country. His point about the importance of independence is particularly crucial."
(Ezra Klein in The Washington Post; subscription may be required)
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[Opinion]
Resounding Victory for Obama Administration in ACA Premium Subsidy Litigation
"Friedman closes by referring to the purpose of the ACA to provide for near-universal coverage. The challengers' interpretation, he says, 'runs counter to this central purpose.' Accepting it 'would violate the basic rule of statutory construction that a court must interpret a statute in light of its history and purpose.' At any rate, even if the statute were ambiguous -- and Friedman is crystal clear that he doesn't think it is -- the administration's interpretation, he says, would be upheld as a 'permissible construction of the statute.'" [Halbig v. Sebelius, No. 13-062 (D.D.C. Jan. 15, 2014)]
(The Incidental Economist)
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Benefits in General; Executive Compensation
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NASDAQ Amends Compensation Committee Independence Rules
"As a result of this amendment, NASDAQ-listed companies should reexamine the composition of their compensation committees to ensure compliance with amended listing rules prior to the implementation deadline. NASDAQ-listed companies should also review their committee charters, directors' and officers' (D&O) questionnaires, and corporate governance guidelines or policies to determine whether any changes are required. For example, companies may need to update their D&O questionnaires for the 2014 proxy season to include additional questions soliciting information on the sources of compensation of directors and, if applicable, remove the exemption of fixed amounts of compensation under a retirement plan from existing questions relating to fees received by directors."
(Morgan Lewis)
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Executive Pay: Corporate Directors, Institutional Investors See Things Very Differently
"Only one in five (20%) directors say the executive pay model in the U.S. has led to excessive CEO pay levels, a sharp drop in the past five years, while nearly three in four (72%) investors say the pay model has led to excessive pay levels. Seven in 10 (70%) directors say the executive pay model at most companies is closely linked to company strategy, compared with just one in three (34%) investors. Less than one-fourth (23%) of directors say executive pay is overly influenced by management, versus two-thirds (66%) of investors."
(Towers Watson)
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Non-Qualified Plan Litigation Reversal: Snatching Victory from the Jaws of Defeat
"Many of the putative class members actually vested in and received more shares under the Retirement Award vesting schedule than they would have if they had been paid under ERISA's minimum vesting schedules. Plan participants who have already been paid benefits equal to or in excess of what they would have received under ERISA vesting have no viable cause of action in this case." [Bond v. Marriott Int'l, Inc. (D. Md. Aug. 9, 2013)]
(Winston & Strawn LLP)
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Reinhart Employee Benefits Update, January 2014 (PDF)
Topics include: U.S. Supreme Court upholds plan provision shortening limitations period; Bipartisan Budget Act affects single employer pension plans; Determination letters update; IRS releases post-Windsor guidance regarding same-sex spouses and cafeteria plan; Departments issue proposed regulations expanding the definition of excepted benefits; Sixth Circuit expands scope of relief available upon unlawful denial of benefits; and DOL issues expanded form 5500 for use in reporting for 2013 plan year."
(Reinhart Boerner Van Deuren s.c.)
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Press Releases
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