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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[Official Guidance]
Text of CMS FAQ on Qualified Health Plans and Guaranteed Availability Standards: Issuer Responsibilities (PDF)
Dated June 3, 2014. Excerpt: "As we explained in our FAQ of May 16, 2014, all non-grandfathered individual market health insurance products must be guaranteed available to all individuals, unless an exception applies. Issuers may direct consumers who wish to enroll in a QHP to the Marketplace for enrollment, and are not required to market any QHP for sale outside of the Marketplace. Issuers who intend a QHP to be primarily for sale in the Marketplace are not required to create a designated pathway for off-Marketplace enrollment, and will satisfy the guaranteed availability standard if they enroll consumers who wish to enroll outside of the Marketplace using a process employed entirely on an ad hoc basis."
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)
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[Official Guidance]
Text of IRS Rev. Proc. 2014-35: Application of the General Welfare Exclusion to Indian Tribal Government Programs That Provide Benefits to Tribal Members (PDF)
"This revenue procedure describes principles of the general welfare exclusion and provides safe harbors under which the [IRS] will conclusively presume that the individual need requirement of the general welfare exclusion is met for benefits provided under Indian tribal governmental programs described in sections 5.02 or 5.03 of this revenue procedure, and will not assert that benefits provided under programs described in section 5.03 of this revenue procedure represent compensation for services." [The safe harbors apply to benefits provided under certain housing, educational, elder and disabled, cultural and religious, and other qualifying assistance programs.]
(Internal Revenue Service [IRS])
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[Guidance Overview]
CMS Maximizes Reinsurance Protections
"CMS is essentially maximizing reinsurance protections in the long run by changing the payment threshold level. While these programs are likely to provide stabilization for the industry, the budget neutrality and sequester cuts that necessitate prospective payment deferment to outlying years could threaten the cash position of certain payers, particularly those who priced aggressively in the first year."
(HighRoads)
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Are Pre-Existing Condition Bans for Health Insurance Still with Us?
"Under the law, the only plans that may continue to exclude coverage for pre-existing conditions ... are individual plans that are 'grandfathered,' or haven't changed substantially since the law was passed in 2010. It turns out that the Jan. 1 date wasn't quite as set in stone as many have thought. 'It's more of a rolling plan year effective date,' said a spokesman for the Department of Labor, meaning as plans renew in 2014, pre-existing condition exclusions will get dropped."
(National Public Radio)
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'No Harm, No Foul' and the FMLA Still Means 'Be Diligent'
"[The First Circuit] determined that an employer's failure to provide timely FMLA notices is not in and of itself a violation of the FMLA and its implementing regulations. Rather, failure to provide timely notices only violates the FMLA when an employee can demonstrate that but for the tardy notice, he or she would have scheduled his FMLA leave differently. In other words, ... the absence of a formal notice or designation does not violate the FMLA as long as an eligible employee is provided with the required twelve weeks of leave." [Bellone v. Southwick-Tolland Regional School District, No. 13-1341 (1st Cir. May 2, 2014)]
(Foley & Lardner LLP)
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HHS-Developed Risk Adjustment Model Algorithm Software (PDF)
"This document provides instructions for the HHS risk adjustment models for the 2014 benefit year, with revisions from the software instructions posted on the CCIIO website on May 7, 2013." Also available: Technical Details (xls file) and SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (zip file).
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)
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Aetna Joins Other Health Insurance CEOs in Declining to Refuse a Taxpayer Bailout Under Obamacare
"After quizzing from the National Center for Public Policy Research's Justin Danhof, Aetna CEO Mark T. Bertolini on Friday joined other health insurance CEOs questioned by the National Center in refusing to pledge to reject a taxpayer bailout of his company should ObamaCare continue to fail to perform as advertised.... Danhof and [National Center's David Hogberg, Ph.D] both have attended health insurer shareholder meetings this year, including Wellpoint, Humana, and now Aetna to ask about bailouts. So far, every health insurance company CEO has said his company will take bailouts."
(The National Center for Public Policy Research)
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[Opinion]
Small Business Groups Send Joint Letter to D.C. City Council Opposing New Health Care Tax
"[The] groups call the new tax short-sighted and will result in hurting those individuals who stand to benefit most from the consumer protections already provided for in the [ACA]. The letter states: It is not unreasonable to assume this 1% tax on health-insurance carriers will be immediately tacked on to the premium costs paid by the policyholder."
(National Association for the Self-Employed)
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Benefits in General; Executive Compensation
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U.S. Workers Shy Away from Savings
"With personal incomes flat and GDP growth feeble, U.S. 401(k) participants expect to make lower retirement contributions in the coming year. Those aged 50 years and older anticipate significantly lower contributions than their 2012 forecast.... Saving for health care expenses in retirement has escalated as a major savings objective ... Of those 50 to 64 years old, 45% are now focused on saving for retirement health expenses, a 13-point increase over the prior year's survey."
(Mercer)
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Health Savings Accounts Can Double as Shadow IRAs
"The accounts work as supplements to your retirement package only if you have relatively few medical expenses that you need to pay out-of-pocket -- or if you can pay whatever medical expenses you do have from other sources, so that the HSA dollars stay in place and compound."
(The Wall Street Journal; subscription may be required)
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Preparing for IRS Section 409A Audits (PDF)
"[At] a minimum, companies should review the deferral elections of, and payments to, their top 10 highest compensated employees. Under the IRS correction program, certain types of operational failures, if corrected promptly, can be relatively easy to correct with few consequences. In addition, companies that last reviewed their plan documents in 2008 may consider taking a fresh look, particularly to ensure documentary compliance prior to an IRS audit. Importantly, once a company or an executive is under an IRS audit on these issues, the correction programs are no longer available."
(Groom Law Group)
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Press Releases
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