Employee Benefits Jobs
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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]
Agency FAQs Offer Details on OOP Limits, Essential Health Benefits, Expatriate Plans and Fixed Indemnity Policies (PDF)
"Despite early indications that the [out-of-pocket (OOP)] rules might apply only to small insured plans, federal regulators have made it clear that all non-grandfathered group health plans are subject to the OOP requirements.... If an employer's [self-insured] plan includes no annual or lifetime dollar limit on any benefit, and accumulates OOP expenses for all in-network benefits against its OOP limit, there's no need for the plan to identify its EHBs. But for other self-insured plans, the need to identify EHBs remains."
(Lockton)
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Text of District Court Opinion: LTD Insurer Must Substantively Address Treating Physician's Opinion
"Although the opinions of a treating physician are not entitled to a presumption of deference, a plan may not arbitrarily disregard such opinions in making a benefits determination.... MetLife was not required to accept [the treating physician's] opinion, but it could not reject it without reason.... Furthermore, that MetLife failed to conduct an in-person examination, and relied solely on file reviews, weighs against a finding that the MetLife's review was full and fair." [Vochaska v. Metropolitan Life Insurance Company, No. 1:12-CV-1070 (W.D. Mich. Jan. 21, 2014)]
(U.S. District Court for the Western District of Michigan)
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Here's How Heimeshoff Could Affect COBRA Limitations Periods
"Perhaps a more interesting question from a COBRA perspective is which statute of limitations should apply for claims seeking to impose COBRA late notice penalties. The COBRA cases that have considered this question have applied state-law statutes of limitations of various sorts, including those for unfair insurance-related practices, breach-of-contract cases, state-law penalty statutes, etc. The open question after Heimeshoff is whether a plan could define its own 'statute of limitations' for bringing COBRA notice penalties."
(Thompson SmartHR Manager)
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Final Regs Issued for Mental Health Parity and Addiction Equity Act
"Plan sponsors that have already fully implemented plan changes necessary to comply with the MHPAEA will only need to review a few aspects of the plan design to determine whether the plan complies with the final MHPAEA rules. Key areas for these plans to address are how intermediate treatment facilities are reimbursed, and how network tiers are affected by MHPAEA."
(Sibson Consulting)
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Mental Health Parity Final Regs Issued
"The final regulations do not explicitly define which mental health conditions are subject to the [Mental Health Parity and Addiction Equity Act (MHPA)]. Instead, the regulations provide that plans may make this determination based on generally recognized independent standards of current medical practice, such as state guidelines and the most current version of the Diagnostic and Statistical Manual of Mental Disorders. As a result, it is still unclear whether some conditions, such as autism, are subject to the MHPA."
(Mazursky Constantine LLC)
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The Cost of Spousal Health Coverage (PDF)
"[S]pouses, on average, cost more to cover than otherwise comparable policyholders. This, in conjunction with the latitude offered by PPACA, makes spousal coverage a target for employers seeking ways to lower their health care expenditures. However, this analysis finds that working and non-working spouses are likely quite different in their use of health services."
(Employee Benefit Research Institute [EBRI])
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Next Wave of Insurance Cancellations Starts to Hit Employer Plans
"[V]irtually all fully-insured employers will be getting their current plans cancelled. Many will simply comply with the new requirements and pay more for coverage.... Large numbers of employers may decide they simply can't afford to pay the additional premiums, especially now that the exchanges are operational. Plus, the exchanges offer a selection of health plans and subsidies that often are more generous than the employer can provide. Employers no longer have to feel guilty about sending their workers out into the individual market and the companies can relieve themselves of the enormous burden of selecting and administering a health insurance program. The savings in the Human Resources departments alone will be substantial."
(John Goodman's Health Policy Blog)
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To Buy or Not to Buy: Uninsured Young Adults and the Perverse Economic Incentives of the ACA
"[A]fter accounting for subsidies and cost-sharing, 6 out of 7 uninsured, young adult households will find it financially advantageous to forego health coverage, and instead pay the mandate penalty and cover their own health care costs. As the penalty increases, that number will drop from 86 percent in 2014 to 71 percent in 2015 and 62 percent in 2016, before ticking back up to 66 percent in 2019."
(American Action Forum)
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Uninsured Rate Shows Modest Decline in 2014
"The U.S. uninsured rate is 16.1% so far in January, modestly down from 17.3% in December after the Affordable Care Act's requirement for Americans to have health insurance took effect on Jan. 1. The percentage of uninsured adults aged 18 and older for Jan. 2-19 is slightly lower than what Gallup has measured in any month since December 2012."
(Gallup)
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Trying to Count Obamacare's Medicaid Enrollment? Good Luck.
"Using Arkansas numbers, Sean Trende has estimated that about 45 percent of those signing up for Medicaid are newly eligible under the health-care law. Taken together, these numbers seem to suggest about one-third to half of the Medicaid sign-ups are among those newly-eligible under Obamacare. But again, we won't know the actual number until April at the earliest."
(Sarah Kliff in The Washington Post; subscription may be required)
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Texas Imposes Additional Rules on Health Insurance Navigators
"The rules require the consumer guides to receive 20 hours of state-specific training, in addition to the 20 online hours required by federal rules, to undergo background checks and to provide proof of identity. The rules also prohibit navigators from charging consumers, selling or negotiating health insurance coverage, recommending a specific health plan, or engaging in electioneering activities or otherwise supporting a candidate running for a political office."
(Kaiser Health News)
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[Opinion]
Understanding Target's Decision to Cut Health Benefits
"Target's move is upsetting for those who are directly affected, but it's not evidence of any failure of ObamaCare. Benefits plans for part-timers usually do not provide generous coverage, payroll deductions are too costly for workers living paycheck to paycheck, out-of-pocket expenses deter patients from seeking care, and many employees lose their insurance when they get sick because they stop being able to go to work. As a result, not many people enroll in the plans even when they have access, and those with coverage can't always make use of the benefits."
(Healthcare Payer News)
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Benefits in General; Executive Compensation
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Employee Benefits in the Biopharmaceutical Industry
"[T]he value of retirement benefits -- which often include defined benefit, defined contribution and retiree medical programs -- is generally 2% to 3% higher in biopharma than in other sectors.... On a per-employee per-year basis, biopharma employers' spending on health care benefits is the highest among all industries."
(Towers Watson)
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Fiduciaries Can Sometimes Rely on Legal Advice (or: Why ERISA Counsel Is a Good Thing to Have)
"[W]hile it appears the [Court of Appeals for the District of Columbia Circuit] agrees that the plan made the right call, the court seemed more inclined to focus on why reliance on legal advice is OK and under what circumstances it would be justified. It was not just using a legal expert, but using one that was qualified and knew the subject well.... Due diligence means more than just taking legal advice. It means considering whether the advice is sound and from a knowledgeable source." [Clark v. Feder Semo and Bard, P.C., No. 12-7092 (D.C. Cir. Jan. 7, 2014)]
(Fox Rothschild LLP)
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The Importance of Procedural Timing Issues in ERISA Litigation
"As [two recent Supreme Court] cases make clear, one can waive clear rights to recovery under ERISA by failing to prosecute them exactly as required and on the exact time schedule required by applicable plan terms and governing statutes. While some might view the particular timing requirements addressed in Ray Haluch Gravel and Heimeshoff as picayune, the Court's strict enforcement of them make clear that parties seeking relief under ERISA had best not treat them that way."
(Stephen Rosenberg of The McCormack Firm, LLC)
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Deadlines Approaching for Employer Return Requirements for ISOs and Employee Stock Purchase Plans
"A corporation (including private and public corporations) may be subject to penalties if it fails to furnish the applicable form in a timely manner, fails to include all the required information, or includes incorrect information in the form. The corporation has an obligation to file the applicable form with the IRS and distribute the applicable form to the relevant employee and will be liable for penalties with respect to each failure to file or provide the form."
(Proskauer Rose LLP)
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Press Releases
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