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February 4, 2014          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Actuary
The Retirement Plan Company, LLC
in ANY STATE

Senior Associate, Research, States' Public Sector Retirement Systems
The Pew Charitable Trusts
in DC

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Webcasts and Conferences

Basics of Qualified Retirement Plans, Session 3
February 6, 2014 WEBCAST
(ASC Institute)

2014 Qualified Health Plan (QHP) Series II
February 6, 2014 WEBCAST
(Centers for Medicare & Medicaid Services (CMS))

How to Participate in Towers Watson Data Services 2014 Executive Compensation Survey
February 11, 2014 WEBCAST
(Towers Watson)

HR Smartcast: Employee Benefits Legislative Update — The Devil is in the Details
February 18, 2014 in WI
(Davidson Marketing Group -- FutureOffice Network)

SEC Exam Priorities for 2014
February 27, 2014 WEBCAST
(Regulatory Compliance, LLC )

Annual HR Forum
May 14, 2014 in NY
(Corporate Synergies)

View All Webcasts and Conferences


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

DOL, HHS and Treasury Issue Proposed Regs on 'Excepted Benefits'
"A handful of recent guidance items ... make some important changes related to the regulation of 'excepted benefits.' ... Included are helpful new rules governing Employee Assistance Plans (EAPs), some welcome clarifications dealing with stand-alone vision and dental plans, and a new 'wrap-around' employee benefit that can supplement public exchange coverage. For the most part, these changes should be welcomed by both employers and employees as they endeavor to comply with the ACA." (Mintz Levin)  


[Advert.]

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Sponsored by International Foundation of Employee Benefit Plans (IFEBP)

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[Guidance Overview]

Mental Health Parity and Addiction Equity Act of 2008: Final Regulations and Federal Guidance
19 pages. Excerpt: "The definitions of mental health benefits, substance use disorder benefits, financial requirements and treatment limitations are particularly important in understanding how parity is analyzed.... These meanings seem to offer plans a great deal of flexibility to define 'mental health conditions' and 'substance use disorders.' Additionally, they raise questions about where to draw the line for treatment of certain conditions, such as smoking cessation or autism, for which the benefits may fall into more than one category. What is critical is the requirement that the definitions of conditions or disorders must be consistent with independent standards recognized in the medical community." (National Health Law Program [NHeLP])  

Vague Appeal Letters Help Overturn Denial for Dental Work
"The claims administrator of an employer-sponsored health plan abused its discretion when it rejected a health benefits claim because it: [1] denied it without an explanation or plausible support; [2] had a structural conflict of interest because it was also the insurer; and [3] violated ERISA regulations by merely reciting its policy without refuting the opinion of the participant's care provider[.]" [Yox v. Providence Health Plan, 3:12-CV-01348-HZ (D. Ore. Dec. 31, 2013)] (Thompson SmartHR Manager)  

CBO Says ACA Will Cost 2 Million Full-time Jobs; Botched Rollout Will Reduce Signups by 1 Million People
"The CBO said that the program would catch up over time, with a total of 13 million Americans signing up in 2015 and 24 million by 2017. The [ACA] will also reduce the number of full-time workers by more than 2 million in coming years, congressional budget analysts said in the most detailed analysis of the law's impact on jobs. The CBO said the law's impact on jobs would be mostly felt starting after 2016." (The Washington Post; subscription may be required)  

Insurance Coverage Provisions of the ACA: CBO's February 2014 Baseline (PDF)
Tables include: [1] Effects on the Deficit of the Insurance Coverage Provisions of the Affordable Care Act; [2] Effects of the Affordable Care Act on Health Insurance Coverage; [3] Enrollment in, and Budgetary Effects of, Health Insurance Exchanges; and [4] Comparison of CBO's Current and Previous Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act. [The full text of the 175-page CBO report, entitled The Budget and Economic Outlook 2014-2024, is here; a discussion of the ACA's effect on the number of full-time employees begins at page 117.] (Congressional Budget Office)  


[Advert.]

6th Annual Leadership Summit on Consumerism Through Health Plan Innovation

Sponsored by World Congress

Insights and experiences from leaders at Medicare Advantage plans, commercial under-65 plans, providers of voluntary and specialty benefits, and plan sponsors/employers. Practical solutions, actionable tools. March 11-12, Orlando. BLINK3 for discount.



Funding Not Clearly Provided by ACA for Risk Corridor Payments (PDF)
"While the language of ACA 1342(b)(1) establishes a directive to the Secretary to make such payments, it does not specify a source from which those payments are to be made. Therefore, Section 1342 would not appear to constitute an appropriation of funds for the purposes of risk corridor payments under that section.... [T]he amounts received by HHS from plans that have overestimated premiums for a given year are not explicitly designated to be deposited in a revolving account or otherwise made available for outgoing payments under Section 1342(b)(1). Therefore, there does not appear to be sufficient statutory language creating a revolving fund that would make amounts received under Section 1342(b)(2) available to pay amounts due to eligible plans under Section 1342(b)(1)." (Congressional Research Service)  

California Court Says State Sick Leave Law Not Always Preempted by ERISA
"Federal law regulating employee benefits does not always preempt state law requiring an employer who grants paid sick leave to allow employees to use that leave to care for ill family members, the [California] First District Court of Appeal ruled [on Jan. 31, 2014]. The court, in an opinion by Justice Timothy A. Reardon, said that United Airlines' employee sick leave plan and trust did not come within the scope of [ERISA]. San Francisco Superior Court Judge Charlotte Woolard said United Airlines trust assets were reachable by creditors and therefore were not part of a 'bona fide separate trust,' thereby failing to comply with the Department of Labor's criteria for ERISA trusts." (Metropolitan Enterprise)  

IRS Customer Service Strategy Sufficiently Addresses ACA Tax Provisions; Changes in Implementation Will Create Challenges (PDF)
"In an attempt to mitigate the effect that implementation changes may have on the IRS's ability to provide adequate customer service, the IRS has developed oversight and monitoring processes and procedures. These are in place to alert the IRS at the earliest possible time period of actions that may affect its operations." (Treasury Inspector General for Tax Administration [TIGTA])  

Employers, Non-Discrimination Rules and the 'Cadillac Tax'
"[T]he existing Section 105(h) regulations are unclear at best, to say the least. It's difficult to imagine how the IRS will interpret these existing 'rules' to regulate insured arrangements.... [T]he excise tax will present employers who wish to sponsor plans with two alternatives: (a) incorporating the tax into their pricing -- by increasing employer and/or employee contribution -- or (b) by cutting benefits to avoid the tax -- by increasing co-payments or co-insurance paid by the employees." (Pepper Hamilton LLP)  

CMS Says Healthcare.gov Enrollment Appeal Hearings to Begin Soon
"'CMS is working to fully implement an automated appeals system. Until we have that functionality, we are putting in place a manual review process wherever possible and expect hearings to begin soon,' said the agency. 'In the meantime, CMS is reaching out to these consumers to provide assistance so they can successfully complete their application without the need to complete the appeals process.'" (Reuters)  

HealthCare.gov Can't Handle Appeals of Enrollment Errors
"Roughly 22,000 Americans have filed appeals with the government to try to get mistakes corrected ... They contend that the computer system for the new federal online marketplace charged them too much for health insurance, steered them into the wrong insurance program or denied them coverage entirely.... For now, the appeals are sitting, untouched, inside a government computer. And an unknown number of consumers who are trying to get help ... by calling the health-care marketplace directly -- are told that HealthCare.gov's computer system is not yet allowing federal workers to go into enrollment records and change them[.]" (The Washington Post; subscription may be required)  

Proposed Mississippi Legislation Would Force Health Insurers to Use Any Qualified Provider
"Insurers would have to accept any medical provider who meets contract terms into their network under a bill moving forward in the Mississippi House.... The measure comes after a dispute between Community Health Services, which owns 12 hospitals in the state, and Blue Cross & Blue Shield of Mississippi, the state's largest private health insurer. Blue Cross kicked 10 CHS hospitals formerly owned by Health Management Associates out of its network in 2013, taking the hospitals back Jan. 1." (Sacramento Bee)  

ACA Premium Stabilization Programs: How Reinsurance, Risk Corridors, and Risk Adjustment Protect Consumers (PDF)
"Because of the increased uncertainty with the www.healthcare.gov website and the change in treatment of 2013 policies, [reinsurance, risk corridors, and risk adjustments (the '3Rs')] will play a more critical role in creating a stable market for consumers. Consumers' decisions to continue their 2013 policy, purchase an ACA-compliant policy, or forego coverage in 2014 may necessitate adjustments to the 3Rs. Without additional support, consumers may face higher premiums and fewer choices in future years." (America's Health Insurance Plans [AHIP])  

[Opinion]

It's Too Soon for Moody's to Go Negative on Health Reform's Marketplaces
"Moody's based its industry outlook in part on the mix of the insurance risk pool: whether enough people with lower health costs will join, balancing out the higher costs of those with greater health needs. But the data that will answer this question is still being generated ... and it's far more individualized per company than the rating agency's sweeping, industry-wide generalization. And although Moody's cited a concern that enrollment of younger people is lagging, the health status of enrollees is far more important to the risk pool's balance than their age." (Center on Budget and Policy Priorities)  

[Opinion]

Comments by American Academy of Actuaries on ASOP No. 35, Selection of Demographic and Other Noneconomic Assumptions for Measuring Pension Obligations (PDF)
"In the more substantive sections in the exposure draft ... there is no mention of [retiree group benefits (RGB)] plans; every reference is to pension plans.... The lack of specific reference to RGB may make it difficult for an actuary who needs guidance on work such as a retiree life measurement or a retiree health redesign to know what information from ASOP No. 35 applies. Similarly, anyone evaluating whether such actuarial work meets professional standards may find it difficult if there are no references to the RGB work in question." (Joint Committee on Retiree Health of the American Academy of Actuaries)  

Benefits in General; Executive Compensation

Readability Still a Major Challenge for Compliance Documents
"Compliance document readability continues to be a struggle for government agencies, payers and employers alike, emphasizing the demand for and importance of clear benefits communication.... Here are some helpful tips for writing clear, easy-to-understand compliance documentation: Be a Communicator, First and Foremost.... Here are some helpful tips for writing clear, easy-to-understand compliance documentation: Be a Communicator, First and Foremost.... Write SPDs at a Sixth-Grade Level.... Don't Assume Level of Knowledge.... Avoid Jargon." (HighRoads)  

ERISA Lessons in the Supreme Court's Heimeshoff Decision
"Serious consideration should be given to adopting a reasonable limitations period for each ERISA plan.... Plan claims procedures should comply with DOL regulations and expeditiously adjudicate benefit claims in accordance with those regulations.... Plan sponsors should regularly review and update each plan document to be sure the document is current and compliant....The Supreme Court has continued its skepticism in recent years regarding ERISA arguments advanced by the DOL." [Heimeshoff v. Hartford Life & Accident Ins. Co., No. 12-729 (S. Ct. Dec. 16, 2013)] (McGuire Woods LLP)  

Equity Compensation Update for February 3, 2014
Topics include: [1] Challenge to stock option award in excess of maximum allowed in plan can proceed; [2] Marriott employees do not qualify as a class in stock award suit; [3] New study on trends in M&A, private equity activity; and [4] New surveys on employee attitudes toward stock plans. (National Center for Employee Ownership [NCEO])  

Final IRS Guidance Issued on Additional Medicare Tax on High Earners
"The final rules ... are nearly identical to the proposed regulations and FAQs IRS issued back in June ... Notably, commentators requested various relief provisions which were denied -- such as [1] more flexible correction of overpayments and underpayment for inadvertent errors, [2] waiver of penalties for de minimis errors, [3] allowing corrections within a certain period without penalty, and [4] applying certain wage repayment rules." (Groom Law Group)  

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