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April 22, 2014          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Plan Administrator
BlueStar Retirement Services
in FL

Retirement Plan Conversion Specialist
Wilmington Trust, an affiliate of M&T Bank
in AZ

ERISA Attorney
Corporate Synergies Group, LLC
in NJ

Retirement Plan Administrators
MVP Plan Administrators, Inc.
in NC

Employee Benefits Attorney
Keating Muething & Klekamp, PLL
in OH

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Webcasts and Conferences

The Importance Of Internal Controls For Employee Benefit Plans -- Recorded
April 28, 2014 WEBCAST
(McGladrey LLP)

Legal Analysis and Considerations for 3(16) Administrators
April 29, 2014 WEBCAST
(Principal Financial Group)

Plan Document Maintenance: Why is it Important for Benefit Plans?
May 8, 2014 WEBCAST
(McGladrey LLP)

Best Practices for Conducting Effectual Plan Committee Meetings
May 15, 2014 WEBCAST
(Pension Consultants, Inc.)

PPA Pre-Approved Plans Workshop - Corbel and PPD Documents - Charlotte
May 20, 2014 in NC
(SunGard Relius)

2014 Webinar: Rollovers Between Retirement Plans and IRAs
May 20, 2014 WEBCAST
(Ascensus)

401(k) Plan Workshop 2014 - Charlotte
May 21, 2014 in NC
(SunGard Relius)

Tax Forms Workshop: 5500 and More - Charlotte
May 22, 2014 in NC
(SunGard Relius)

Public Exchange Enrollment-Mix and Claims Results: Implications for 2014 Performance and 2015 Planning
May 28, 2014 WEBCAST
(Atlantic Information Services, Inc)

View All Webcasts and Conferences


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

Statistics on Access to Employer-Sponsored Healthcare Benefits for Domestic Partners
"In March 2013, among all civilian workers, 72 percent had access to employer-sponsored healthcare benefits, and virtually all of those workers could extend those benefits to their spouses; this compares with 32 percent of workers who had access to healthcare benefits that could be extended to unmarried same-sex partners, and 26 percent who had access that could be extended to unmarried opposite-sex partners." (U.S. Bureau of Labor Statistics)  


[Advert.]

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Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Co-sponsored by the International Foundation of Employee Benefit Plans and the Wharton School of the University of Pennsylvania, the CEBS designation gives you the knowledge and confidence to succeed in today's business environment. Learn More!



Are Your Pharmacy Benefits Being Adjudicated Properly?
"While almost all pharmacy benefit manager (PBM) contracts include audit provisions, many plan sponsors underestimate the value of auditing their PBM, which can help recover funds lost through overpayments or system errors. Recovered losses mean that a typical pharmacy benefit audit claim more than pays for itself, but at the very least ensures plan sponsors that they are meeting fiduciary responsibilities in the area of managing it's PBM contract." (Milliman)  

The Latest Problem With Obamacare: COBRA and the ACA
"Laid off workers who opt for temporary coverage under [COBRA] while they evaluate options under the [ACA] can't switch to Obamacare until the next open enrollment period in November.... Most people ... wait a month or more to get the COBRA notice and then make the decision.... What happens if you have medical costs during the gap period? ... If [a family] elects and pays for COBRA, those expenses will be covered retroactively. But if the family chooses Obamacare, they aren't. What's more, it takes at least three or four days after you apply for Obamacare for it to cover you[.]" (Forbes)  

Exiting Retiree Medical: An Approach for Eliminating the Obligation While Protecting the Promise to Retirees
"For most large employers, sponsoring a retiree medical benefit program has proved a costly, long-term obligation with no strategic value. Yet until now, few employers were willing to risk the potentially adverse consequences of a plan termination, which included union contract issues, retiree lawsuits and concerns about the financial burden placed on retirees.... [A] new approach ... uses customized group annuities and an innovative transaction structure to overcome traditional barriers to an exit strategy without adverse tax and legal consequences." (Towers Watson)  

CMS to Private Insurers: Adopt Payment Reforms More Quickly
"Leaders from [CMS] think private insurers have been too slow to adopt payment reforms, but they would be best served by adopting value-based payment systems in tandem with CMS today.... [P]rivate insurers may be further along in the journey than CMS gives them credit for. Cigna is aiming to have 100 accountable care initiatives in place by the end of the year, many of them with physician groups, while more than 50 percent of WellPoint's physician contracts now use value-based reimbursement models." (Healthcare Payer News)  

Effects of Prescription Drug Insurance on Hospitalization and Mortality: Evidence from Medicare Part D
"[O]btaining prescription drug insurance through Medicare Part D was associated with an 8% decrease in the number of hospital admissions, a 7% decrease in Medicare expenditures, and a 12% decrease in total resource use. Gaining prescription drug insurance through Medicare Part D was not significantly associated with mortality." (National Bureau of Economic Research [NBER]; purchase required)  

A Take-Away from the Quality Stores Decision
"Quality Stores tried to argue that the payments should not be considered 'employee' wages that are subject to FICA tax because they were made after termination of employment. The Supreme Court flatly rejected that argument, essentially relying on a simple rationale that payments to former employees have the employment relationship as their genesis.... In various circumstances, employers have taken, and may currently be taking, positions that certain types of employee-related payments are not subject to FICA tax (e.g. contract terminations or signing bonuses). If so, employers should revisit those positions." (Squire Sanders)  

Private Exchanges and Employer Implementation
"Over half (54.5 percent) of employers report that they are somewhat to very familiar with private exchanges.... [L]ess than 7 percent of these employers are already using exchanges.... [An] Infographic provides an outlook of private exchange implementation among employers, as well as what employers report looking for in a private exchange." (Healthcare Trends Institute)  

Bankruptcy Judge Rules Mostly in Retirees' Favor in American Airlines Health Benefits Case
"U.S. Bankruptcy Judge Sean Lane on [April 18] denied part of American Airlines' request for summary judgment on the issue of retiree health benefits and approved part of the request.... The judge wrote that the question was whether promises made to provide the benefits had been promised in way that they were vested and couldn't be unilaterally changed.... American had argued that commitments to retirees provided in union contracts changed when the contracts changed. But Lane ruled that the collective bargaining agreement in place at the time of the employee's retirement governed that retiree's benefits, not any subsequent labor contracts approved after the person retired." [In Re: AMR Corporation et al. v. Committee of Retired Employees, No. 12-01744 (Bankr. S.D.N.Y. Apr. 18, 2014)] (Dallas Morning News)  

CMS: Engaging Multiple Payers in Payment Reform
"CMS is testing more than 20 models under this authority that create new incentives for clinicians and organizations that deliver medical care through CMS programs to deliver better care at lower cost. CMS is also supporting a variety of state efforts to create new incentives for these clinicians and organizations through the Medicaid and CHIP programs. All of these models share a common pathway for success: they hinge on getting clinicians and health care organizations to manage the health of populations and to act as good stewards of health care resources." (JAMA)  

Insurance Coverage Provisions of the ACA: CBO's April 2014 Baseline (PDF)
Report includes four tables: [1] Effects on the Deficit of the Insurance Coverage Provisions of the ACA; [2] Effects of the ACA on Health Insurance Coverage; [3] Enrollment in, and Budgetary Effects of, Health Insurance Exchanges; and [4] Comparison of CBO and JCT's Current and Previous Estimates of the Effects of the Insurance Coverage Provisions of the ACA. (Congressional Budget Office)  

Were Higher Healthcare Costs in the Second Half of 2013 Caused by the ACA?
"With expanded insurance coverage, it was expected that there would be a surge in short-term health spending, as previously unmet healthcare needs were addressed. The real question of interest, however, is whether that initial surge will be moderated or will continue and/or accelerate over time, as the new enrollees' health status is assessed and treated and the costs of that fully enter the healthcare system." (Sheppard Mullin)  

As Medical Providers Consolidate, Questions Arise About Effects on Costs, Quality of Care
"When Idaho's largest hospital system bought the state's largest doctor practice in 2012, the groups expressed hope that the deal would spark a revolution in delivering better-quality care.... Despite St. Luke's good intentions, the judge worried that the merged entity would be so dominant that it could raise prices at will. He suggested that hospitals could work with doctors to deliver more efficient care without buying them out. Similar arguments are being raised in other areas, including Boston, Pittsburgh and Northern California, where hospital systems have gained strength through acquisitions of doctors' practices and other hospitals at a time of rapid consolidation." (The Washington Post; subscription may be required)  

Healthcare Costs in U.S. Far Exceed Costs in Other Countries
"An average one-day hospital stay in the United States cost $4,293 last year, six times more than it did in Argentina and nearly 10 times the cost in Spain ... Medical procedures, tests, scans and prescription medicine cost far more in the United States than in eight other countries ... Heart bypass surgery cost an average of $75,345 in the United States, compared with $15,742 in the Netherlands and $16,492 in Argentina. The average cost of an MRI ranged from $138 in Switzerland to $1,145 in the United States." (Los Angeles Times)  

2013 Prices of Medical Procedures, Tests, Scans and Treatments in Nine Countries
"Designed to showcase the variation in healthcare prices around the world, the report examines the price of medical procedures, tests, scans and treatments in nine countries. This year the survey also shows pricing for five specialty prescription drugs. As in prior years, the survey data shows that the United States continues to have the highest fees of those countries surveyed for drugs and various medical procedures. Some of the larger disparities were in prescription and specialty drugs prices." (International Federation of Health Plans [IFHP])  

Attitudes Toward Mandated Coverage of Birth Control Medication and Other Health Benefits
"Most respondents ... supported a policy of mandated coverage of birth control medication in health plans. This proportion was significantly lower than the proportion that supported other benefits ... In multivariable regression analysis, support for mandated coverage of birth control medication was significantly higher among women, non-Hispanic blacks, Hispanics, parents with children younger than 18 years living in the home, and adults with private or public insurance vs comparison groups ... but was not associated with education or income." (JAMA)  

[Opinion]

Text of Comments by NHeLP to CMS on Exchange and Insurance Market Standards for 2015 and Beyond
22 pages. Excerpt: "We recommend that the notices be sent no later than October 31.... The option of allowing notices to be sent up until the first day of open enrollment could hinder some individuals from getting the assistance they need, particularly given that this open enrollment period will encompass both Thanksgiving and the winter holidays.... All insurers participating in the Exchange should be required to comply with similar procedures on terminations, cancellations and reinstatements so that there is a consistent process.... Consumers will benefit by having ready access to quality ratings, along with the ability to further research and consider the underlying bases for those ratings." (National Health Law Program [NHeLP])  

Benefits in General; Executive Compensation

District Court for New Jersey Rejects Equitable Tolling Argument, Imposes Contractual Limitations Period
"The Court noted that '[a]n administrator need only "substantially comply" with' ERISA's claims regulations procedures -- thus the denial letter 'was sufficient to discharge its obligations under the ERISA regulations.' The Court charged the provider with knowledge imputed to his patient. This issue merges to some extent with the duty on the plaintiff regarding diligence in asserting equitable tolling, but overall, the Court's position seems rather harsh." [Torpey v. Anthem Blue Cross Blue Shield, 2014 U.S. Dist. LEXIS 53342 (D.N.J. Apr. 16, 2014)] (Health Plan Law)  

Fifth Circuit Widens Split on Firestone, Reviews Fiduciary Breach Claim De Novo
"Despite finding no fiduciary breach in a plan trustee's decision to pay legal fees with plan assets, the court rejected the trustee's argument that his actions were entitled to deferential judicial review under [Firestone] ... In a footnote, the court explained that Firestone applied only to benefit denials and didn't govern suits for fiduciary breach. This issue -- the extent to which Firestone deference applies outside of the context of benefit denials -- has split the circuits and may be headed for the U.S. Supreme Court." [Futral v. Chastant, No. 13-30856 (5th Cir. Apr. 18, 2014)] (Bloomberg BNA)  

Sixth Circuit Provides Guidance for ERISA Penalty Claims
"The [Sixth Circuit] adopts the 'clear notice' standard: '[T]he key question under the clear notice standard is whether the plan administrator knew or should have known which documents were being requested.' Plaintiff's counsel's 'broadly phrased' request should have alerted the plan administrator that this request included the accidental death policy because that was the key document supporting its decision to deny the claim. The court did not abuse its discretion in awarding $55 per day penalty rather than the maximum $110 per day because there was a 'lack of prejudice' caused by the delay." [Cultrona v. Nationwide Life Insurance Company, Nos. 13-3558/3585 (6th Cir. Apr. 9, 2014)] (Lane Powell PC)  

Employee Financial Wellness Survey 2014 (PDF)
24 pages. Excerpt: "Healthcare continues to be a hot issue in the U.S. with most employees believing that healthcare costs will rise, and less than half of all Baby Boomers confident they'll be able to cover their medical expenses in retirement.... Nearly half say that they would be willing to sacrifice a portion of their future pay increases for guaranteed retirement income, with a majority of employees saying they prefer a retirement plan with guaranteed fixed monthly payments for life over a plan where they can take a lump sum at retirement and invest the funds themselves." (PricewaterhouseCoopers)  

Rise in Executive Comp Was Offset by Pension Value Changes in 2013
"Total compensation disclosed in company proxy statements for [CEOs] at the nation's largest corporations remained relatively unchanged in 2013, primarily the result of sharply lower pension values ... [T]otal pay for S&P 1500 CEOs increased less than 1% (0.5%) in 2013, down from the 5.7% median increase CEOs received in 2012.... [R]ealizable pay, which takes into consideration the current value of a CEO's outstanding stock-based awards, increased nearly 15% last year, reflecting strong stock market performance.... Nearly eight in 10 (78%) companies awarded performance-based long-term incentive awards in 2013, compared with 67% in 2011. Meanwhile, 58% of companies awarded stock options in 2013, down from 64% in 2011." (Towers Watson)  

Court Invalidates New York State's Restrictions on Executive Comp Paid by State-Funded Private Organizations
"On April 8, a trial court in Nassau County concluded that the rules capping executive compensation and another unrelated rule prohibiting certain conflicts of interest were both invalid ... because [the New York State Department of Health (DOH)] built a regulatory scheme based on its own conclusions about the appropriate balance of trade-offs between health and cost and was acting solely on its own ideas of sound public policy, thus operating outside of its proper sphere of authority[.]" (Towers Watson)  

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