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February 10, 2014          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Pension Plan Loan / Distribution Clerk
Retirement, LLC - Series Two
in IL, OK, SD

Retirement Plan Consultant
Stalker and Associates
in PA

Retirement Plan Admin Dept Supervisor
MidAmerica Administrative & Retirement Solutions, Inc.
in FL

Relation Manager
John Hancock Financial Services
in CA

Retirement Plan Administrator
United Retirement Plan Consultants
in NJ, PA

401(k) Pension Administrator
Nicholas Pension Consultants
in CA

Pension Administrators
Progressive Washington, DC Firm
in DC

Manager, Benefits Consulting
Northwestern Benefit Corporation of Georgia
in GA

Temporary Audit/ 401k Associate
Equity Trust Company
in OH

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Webcasts and Conferences

Wellness Programs After Health Care Reform: Compliance Checkup for Employers and Advisors
February 26, 2014 WEBCAST
(Thomson Reuters / EBIA)

Affordable Care Act 101 Webinar
February 27, 2014 WEBCAST
(U.S. Small Business Administration (SBA))

Cafeteria Plans
April 8, 2014 in GA
(Thomson Reuters / EBIA)

Health Care Reform for Employers: Now What?
April 30, 2014 in OH
(Lorman Education Services)

View All Webcasts and Conferences


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

Text of CMS FAQ on Third Party Payments of Premiums for Qualified Health Plans in the Marketplaces (PDF)
"Q1: Does the November 4, 2013 FAQ apply to QHP premium and cost sharing payments on behalf of QHP enrollees from Indian tribes, tribal organizations, urban Indian organizations, and state and federal government programs or grantees (such as the Ryan White HIV/AIDS Program)? A1: No.... QHP issuers and Marketplaces are encouraged to accept such payments.... Q2: Does the November 4, 2013 FAQ apply to QHP premium and cost sharing payments on behalf of QHP enrollees from private, not-for-profit foundations? A2: No. The concerns addressed in the November 4, 2013 FAQ would not apply to payments from private, not-for-profit foundations if: (a) they are described in [Q&A 1, above], or (b) if they are made on behalf of QHP enrollees who satisfy defined criteria that are based on financial status and do not consider enrollees' health status. In situation (b), CMS would expect that premium and any cost sharing payments cover the entire policy year." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


[Advert.]

11th Annual World Health Care Congress - April 7-9 - National Harbor, MD

Sponsored by World Congress

World-class faculty share innovative ideas, strategic initiatives, and best practices for shaping the future of health care delivery, affordability, and quality. BLINK3 for discount.



[Guidance Overview]

ACA Requires More Reports in 2015, So Change Your Payroll Systems Now
"The key requirements are the reporting of Minimum Essential Coverage and Employer-Sponsored Coverage. Although reporting begins for the 2015 calendar year, the reports won't be due until early 2016. Payroll systems should be modified in 2014 to capture the information required in 2015. For the other reporting requirements ... we are still waiting for initial guidance as to what and when to report." (Warner Norcross & Judd LLP)  

[Guidance Overview]

Don't Get Too Excited About Possible Change to ACA's 'Full Time' Employee Definition
"The definition of 'full time' under ERISA has never been officially formalized in any set hour figure. So plans have defined full-time as being anywhere from 30 to 40 hours per week for years. PPACA simply added the possibility of a penalty to employers who don't offer coverage to employees working 30 or more hours per week. Ostensibly these bills would eliminate the penalty (the 'employer mandate') if employers don't offer coverage to employees working less than 40 hours per week. However, as with the passage of PPACA, the drafters of these bills are again overlooking that various state laws regulating insurance coverage already dictate what full-time means for state-law insurance purposes." (Fox Rothschild LLP)  

[Guidance Overview]

CMS Proposes Changes to Reinsurance Program and Marketplace Operations (PDF)
"The proposed regulations modify the payment timing, but the timing for the notification of covered lives remains the same. The government proposes to split the payment and allow it to be paid in two installments. For 2014, the $63 charge per covered life would be split into two installments. The first installment of $52.50 would be due in January 2015. The second installment of $10.50 would be due during the fourth quarter of 2015. The government is seeking comments on this split payment approach." (McGraw Wentworth)  

[Guidance Overview]

CMS Presentation: Enrollment Reconciliation -- SHOP, January 28, 2014 (PDF)
18 presentation slides. Excerpt: "To provide Issuers with definitions of the content for the reconciliation files for SHOP." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


[Advert.]

4th Annual Leadership Summit on Ancillary Products and Voluntary Benefits

Sponsored by World Congress

This unique Summit convenes health plans, non-medical insurance carriers and brokers to discuss leveraging ancillary and voluntary products to increase their competitive edge and to meet the needs of a consumer driven market. March 11-12, Orlando. BLINK3 for discount.



[Guidance Overview]

CMS Presentation Slides: Enrollment, Terminations, and Special Enrollment Period Guidance, 2/6/2014 (PDF)
"CMS has finalized a series of processes and policies regarding enrollment and termination for issuers participating in Marketplaces using the CMS system, including Federally-facilitated Marketplaces (FFM) and State Partnership Marketplaces. The set of guidance covers a variety of topics related to consumers or issuers being able to make changes to information or plan selections based on changes in life circumstances or as the result of being granted a special enrollment period. New functionality in the FFM will allow consumers to make certain changes to their application. Interim processes are outlined for situations where functionality is not yet available, such as special enrollment periods[.]" (Center for Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Guidance Overview]

Agencies Issue Proposed Regs on HIPAA Excepted Benefits (PDF)
"[T]he Preamble clarifies that new exceptions for wraparound coverage and EAPs should be considered part of the second category of Excepted Benefits. This means that, while these new Excepted Benefits will be exempt from most of the HIPAA portability and ACA insurance market reforms and other mandates, they still will be subject to the HIPAA privacy and security rules." (Groom Law Group)  

Administration Will Allow Tweaks to Health Plan Choices Made on Healthcare.gov
"In a memo distributed ... to insurers, federal health officials said that people may pick a different health plan before the end of March if they are dissatisfied with the one they chose, but only if they stay with the same insurer and generally the same level of coverage. The 14-page memo ... also says people will be given more freedom and a longer opportunity to get a new health plan if they can prove that HealthCare.gov, the Web site for the new marketplace, displayed inaccurate information about the benefits that a health plan offers." (The Washington Post; subscription may be required)  

EBRI Study Says Cutting Spousal Coverage Could Have Unexpected Consequences
"The EBRI study suggests that the working spouses being sorted by primary insurance coverage likely have lower spending than non-working spouses, and that employers with net reductions in covered spouses may therefore witness a worsening in average risk, resulting in higher spending than expected." (Wolters Kluwer Law & Business)  

Denial of Benefits Under Health Plan's Work-Related Exclusion Was Arbitrary and Capricious
"This decision drives home the importance of process and documentation in claims and appeals determinations. Other medical evidence in the record indicated that the condition was work-related, and the standard of review favored the plan. The plan may have prevailed if the denial letters had reflected consideration of the court-ordered medical evaluation, along with reasons for distinguishing or rejecting it. The plan tried to do this at trial, but the court rightly ruled that it was limited to the administrative record." [ManorCare of Oklahoma City (Southwest), LLC v. Oklahoma Lumbermen's Ass'n Health Plan Plus, 2014 WL 288830 (W.D. Okla. 2014)] (Thomson Reuters / EBIA)  

11th Circuit Faults ERISA Disability Plan Administrator for Ignoring Claims Evidence That Was Never Submitted
"This case is a cause for concern for ERISA disability plan administrators that take into account SSDI benefit determinations in deciding benefit claims but do not affirmatively seek out those determinations or SSA medical records where the claimant fails to provide them.... [H]aving involved itself in Melech's SSDI process by requiring her to file under the SSA's program, LINA created an affirmative obligation on itself to specifically ask Melech to supply her SSDI paperwork (or even, as the court suggested, go directly to the SSA to request her file)." [Melech v. Life Insurance Co. of North America, No. 12-14999 (11th Cir. Jan. 6, 2014)] (Winston & Strawn LLP)  

Massachusetts Insurers See Medical Costs Trending Up 5 to 8 Percent This Year Despite Affordability Push
"That is substantially higher than the state's target of capping increases in total medical spending at 3.6 percent, a benchmark established last year to bring costs in line with the projected rate of annual economic growth in Massachusetts. But the insurance executives stressed that their forecast -- based on a formula combining the price of health care visits, tests, and procedures with the amount of care used by patients -- does not mean the state will fall short of its goal." (The Boston Globe)  

Obamacare Part of 'Unprecedented' Bounty for Insurers, So Far
"Though some health insurers say they may lose money in the first year offering benefits under the [ACA], the biggest health plans remain committed to the program with at least one saying ... it will be part of an 'unprecedented' amount of business to the industry.... [E]xecutives have been telling Wall Street analysts and investors they expect to begin recouping the investments they have to make in administrative costs, regulatory and other expenses to prepare for the [ACA] by next year if not sooner." (Forbes)  

Florida Set to Launch Its Own Limited Health Insurance Marketplace
"Six years in the making, Florida Health Choices will open for business with an inventory of products that cannot legally be marketed using the words insurance, coverage, benefits or premiums, according to Chief Executive Officer Rose Naff.... The Florida products do not meet the comprehensive requirements of Obamacare, and Naff said there is no timetable for Florida Health Choices to offer broader insurance plans that meet the new federal benefit standards." (Reuters)  

Will You Buy Your Health Insurance at Walmart?
"Since World War II, when employer-sponsored health insurance became the principal way Americans access insurance, health care has been business-to-business. Employers choose health insurers, and increasingly insurers choose providers, who choose specialist providers. And that's accepted because the employer pays the bill, or used to. Consumers did not know, or need to know, much about purchasing health care. The system told them what to do. This is now changing fast[.]" (Forbes)  

Early Indications of Changes to the 2015 Medicare Advantage Payment Methodology and the Potential Effect on Medicare Advantage Organizations and Beneficiaries (PDF)
13 pages. Excerpt: "[T]he potential reductions that could be included in the 2015 Advance Notice, in combination with the continued phase-in of the ACA cuts and other legislative and regulatory cuts which come on top of significant cuts that occurred in 2014 ... could result in a significant amount of upheaval in the [Medicare Advantage (MA)] market. This includes the potential for plan exits, reductions in service areas, reduced benefits, provider network changes, and reduced MA enrollment as beneficiaries see a significant decline in plan value from 2014 to 2015." (Oliver Wyman, for America's Health Insurance Plans [AHIP])  

[Opinion]

Congress Finally Produces Plan to Overhaul Doctor Payments
"What Congress wants to do differently this time around is, by 2021, put as much as nine percent of doctors' reimbursements at stake if providers can't hit certain quality standards. It would also include a bonus pool of $500 million for the doctors who do provide really great care. The idea is to use metrics, such as whether they're adopting electronic medical records and hitting certain medical quality targets, to adjust upward or downward what doctors' earn. That's quite different from the current, largely fee-for-service system, where doctors get a flat fee regardless of whether their patients get any better." (Sarah Kliff in The Washington Post; subscription may be required)  

[Opinion]

First Steps on a Long Road: Three Key Findings from ACA's Early Enrollment Numbers
"[1] Getting to universal coverage will be a long process.... [2] Tax credit eligibility is strongly correlated with enrollment.... [3] In states that have not expanded Medicaid, people are falling into the coverage doughnut hole." (Chapin White and Christine Eibner in Health Affairs Blog)  

[Opinion]

Is Obamacare Unraveling? More Rumors of Further Extension for Noncompliant Health Policies
"Rumors have been circulating ... that the administration was thinking of extending the individual health insurance policies that Obamacare was supposed to have cancelled for as much as three more years.... The health insurance plans hate the idea of another three-year reprieve.... With enrollment of the previously uninsured running so badly thus far, getting this relatively healthier block in the new risk pool is all the more important. The administration's now doing this wouldn't just be changing the rules; it would be changing the whole game." (Bob Laszewski's Health Care Policy and Marketplace Review)  

Benefits in General; Executive Compensation

Court Discusses How Attorney-Client Privilege Applies to 401(k) Committee Minutes
"Citing extensive ERISA case law, the Massachusetts district court articulated two guiding principles for exceptions to the general rule that favors disclosure, to participants, of the minutes of plan committee meetings. First, the attorney-client privilege is available for settlor matters, such as 'adopting, amending, or terminating an ERISA plan' because those decisions do not involve ERISA fiduciary functions of managing or administering the plan .... Second, the attorney-client privilege is available to a plan fiduciary who seeks the advice of counsel in response to a threat of litigation by plan beneficiaries (or the government) against the fiduciary." [Kenney v. State Street Corp., No. 09-10750-DJC (D. Mass. Dec. 30, 2013)] (Paul Hastings LLP)  

New 3.8% Investment Tax Raises Flags
"Congress enacted the 3.8% surtax on dividends, interest and other income back in 2010, but didn't make it effective until tax year 2013. Even though advisers have been studying the tax's rules, many still have some questions as they help clients report the tax for the first time.... Tax experts want more direction from the Internal Revenue Service on how to report retirement income and calculate write-offs for state and local taxes and certain expenses that are also subject to the tax." (The Wall Street Journal; subscription may be required)  

SEC Revises Staff Manual on Share-based Compensation Disclosure in IPO Prospectuses
"The revisions [to section 9520 of the SEC's Financial Reporting Manual] streamline the recommended disclosure on pre-IPO share-based compensation by, among other things, deleting earlier guidance that suggested that issuers include: [1] A table disclosing, for the twelve-month period preceding the most recent balance sheet date: the number of instruments granted; exercise price; fair value of the underlying stock; and fair value of the instruments granted; [and] [2] Narrative disclosure describing the factors that contributed to significant changes in the fair market value of the underlying stock during that twelve-month period, including a discussion of any changes in underlying assumptions." (Practical Law Company)  

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