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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 Plan Management Casework FAQs (PDF)
20 Q&As covering [1] Enrollment; [2] Advanced Premium Tax Credits (APTC) and Cost Sharing Reductions (CSR); [3] General Customer Service; and [4] Health Insurance Casework System (HICS) and Handling of Casework.
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)
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[Guidance Overview]
PCORI Fee Is Due July 31 (PDF)
"For calendar year plans, and plan years that started on November 1 or December 1, the PCORI fee payable by July 31, 2014 is $2 per covered life. This is the second year that the fee has been paid for those plans. For all other plan years starting on the first of a month, the fee payable by July 31, 2014 is $1 per covered life. This is the first year that the fee has been paid for those plans."
(Buck Consultants)
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[Guidance Overview]
Two Hidden ACA Clarifications in DOL's FAQ XIX
"On top of breast-cancer medications, Obamacare requires plans or health insurance issuers to cover tobacco-use counseling and interventions. And the FAQ listed a 'safe harbor' regarding these services -- which must be provided to employees at no-cost as preventive services -- that applies if a plan provides: a screening for tobacco use, and at least two tobacco cessation attempts per year for individuals who use tobacco products."
(HR Benefits Alert)
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[Guidance Overview]
Bay Area Commuter Benefit: Deadline to Establish Program Is September 30, 2014
"Employers who have more than 50 full-time employees (employees normally working at least 30 hours or more per week) within the Air District jurisdiction will need to make sure they meet the new requirements and register on the new website. If they were previously reporting to San Francisco, they no longer have to comply with the San Francisco Ordinance or report separately to the Dept. of Environment.... For those employers who have less than 50 full-time employees in the Bay area but have 1 to 49 employees in San Francisco and more than 20 nationwide, the new state law will not apply but the local ordinances may still apply and the reporting is different."
(TRI-AD)
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[Guidance Overview]
Parental Leave Act Strengthens Maryland Employee Leave Protections
"The [Parental Leave Act (PLA)] provides that eligible employees are entitled to six workweeks of unpaid parental leave during any 12-month period for the birth of the employee's child or the placement of a child with the employee for adoption or foster care. The law does not define the 12-month period, so it is unclear if an employer can select the 12-month period, as employers may under the FMLA. Unlike the FMLA, the PLA does not provide employees with leave rights for one's own or a family's members' serious health condition."
(Jackson Lewis LLP)
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[Guidance Overview]
Connecticut Amends Paid Sick Leave Law to Provide Some Employer-Friendly Changes
"On June 6, 2014, Governor Dannel P. Malloy signed into law an amendment to Connecticut's Paid Sick Leave Act that: [1] changes the method for determining if an employer is exempt from providing paid sick leave; [2] changes the time-frame for accruing paid sick leave and [3] adds radiologic technicians to the employees covered by the Act. The amendment ... will take effect on January 1, 2015."
(Littler)
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Plan Administrator Must Give Healthcare Providers ERISA Appeal Process
"This case marks a compelling victory for providers by affording them the same procedural safeguards that ERISA requires for plan participants. This decision considerably strengthens providers' ability to challenge overpayment determinations and impedes employer health plans' use of offsets.... Going forward, plan administrators will have to give in-network providers a 'full and fair review' of their decisions to reduce or withhold future payments, and much of that has to do with notification and transparency." [Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, No. 09 C 5619 (N.D. Ill. Mar. 28, 2014)]
(Thompson SmartHR Manager)
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Flex-Related Legislation, Updated June 12, 2014 (PDF)
Chart lists all pending federal legislation related to account-based benefit plans. Includes bill number, summary, date of introduction, co-sponsors, and current status.
(Employers Council on Flexible Compensation)
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Premium Affordability, Competition, and Choice in the Health Insurance Marketplace, 2014 (PDF)
"Individuals who selected plans in the [Federally-facilitated Marketplace (FFM)] with tax credits have a post-tax credit premium that is 76 percent less than the full premium, on average, as a result of the tax credit -- reducing their premium from $346 to $82 per month. 69 percent of individuals selecting plans with tax credits in the FFM have premiums of $100 or less after tax credits -- nearly half (46 percent) have premiums of $50 or less after tax credits. Individuals choosing silver plans in the FFM tended to select lower premium plans -- 65 percent chose the lowest or second-lowest cost silver plan.... Eighty-two percent of people eligible to purchase a qualified health plan live in rating areas with 3 to 11 issuers in the Marketplace; 96 percent live in rating areas with 2 to 11 issuers in the Marketplace."
(Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services)
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Insurer Begins Huge Palliative Care Program
"[Cambia Health Solutions, which includes Regence Blue Cross Blue Shield,] is going to start paying for things not typically reimbursed by other insurance companies including home health aides and advanced care planning counseling. One of the larger initiatives is training physicians and caregivers in how to have appropriate conversations about end-of-life care."
(Kaiser Health News)
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What Same-Gender Marriages Mean for Your Employee Benefit Plans
"Since these self-insured plans are governed by federal law, including the Title VII of the Civil Rights Act of 1964 which does not currently recognize sexual orientation as a protected class, employers offering self-insured plans have asserted the argument that there is no federal law preventing them from discriminating against their same-sex employees. Until the passage of the Employment Non-Discrimination Act (ENDA), which would likely establish federal protections for same-sex couples, or the courts' establishment of sexual orientation as a protected class, employers that offer self-insured plans who choose to discriminate will likely continue to assert this legal argument and continue to discriminate."
(Foley & Lardner LLP)
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Boeing, Health Care Providers Join Forces in Bid to Curb Costs in Northwest Washington State
"UW Medicine as well as Providence Health & Services and Swedish Health Services have each recruited a network of hospitals and clinics and formed their own ACOs. Boeing has separate contracts with each to provide care for Puget Sound-area employees beginning next year. These employer-driven ACO arrangements, with no insurance company involved, are believed to be among the first in the nation to use this approach and could serve as models elsewhere."
(Kaiser Health News)
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Hospital Networks: Updated National View of Configurations on the Exchanges
"Broad networks are available to close to 90 percent of the addressable population. In addition, narrowed networks are available to 92 percent of that population; they make up about half (48 percent) of all exchange networks across the U.S. and 60 percent of the networks in the largest city in each state.... Compared to plans with narrowed networks, products with broad networks have a median increase in premiums of 13 to 17 percent[.]"
(McKinsey & Company)
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Estimating -- or Not -- the Budgetary Effects of the ACA
"A retrospective analysis of the effects of a current law is very different from a cost estimate for proposed legislation, particularly because it requires formulation of a counterfactual benchmark representing what would have happened if the law had not been enacted -- a challenging undertaking that is beyond the scope of CBO's usual analyses. Therefore, CBO and JCT cannot readily provide a retrospective analysis of the ACA that is analogous to the cost estimate provided by the agencies in 2010."
(Congressional Budget Office [CBO])
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$495 Million Unfunded Liability Puts Finances at Risk in Pittsburgh
"Pittsburgh's fiscal recovery plan includes a strategy to deal with nearly $500 million in retiree benefits, a liability that exceeds revenue collections and is poised to get worse before it gets better.... By 2031, annual OPEB costs are expected to peak at about $29 million, before tapering off, according to a report filed with the state in 2012. [Dean Kaplan, a coordinator of the Act 47 financial oversight team,] said the liability is likely to end in three to four decades."
(Pittsburgh Tribune-Review)
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CalPERS Committee Recommends Health Premium Increases for 2015
"The [CalPERS] Pension and Health Benefits Committee (PHBC) today recommended the Pension Fund's Board of Administration adopt health care premium rates that reduce premiums for more than 570,000 members by about 3 percent from last year's rates. Additionally, approximately 175,000 members will experience increases of less than 3 percent if they stay with their current health plan. If the full Board approves the new premium rates, they will take effect on January 1, 2015."
(CalPERS)
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HSA Balances, Contributions, Distributions, and Other Vital Statistics (PDF)
32 pages. Excerpt: "Starting from scratch a decade ago, enrollment in HSA-eligible health plans is estimated to range from 15.5 million to 20.4 million policyholders and their dependents ... The average HSA balance at the end of 2013 was $1,766, up from $1,280 at the beginning of the year. Average account balances increased with the age of the owner of the account. Account balances averaged $697 for owners under age 25 and $4,460 for owners ages 65 and older.... On average, individuals who made contributions deposited $2,032 to their account. HSAs receiving employer contributions received $1,184, on average."
(Employee Benefit Research Institute [EBRI])
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Online ACA Marketplaces: The Value of Consumer Experience Assessments
"Unlike typical website performance studies that might track system downtimes, analyze where in the process people exit the system or seek help, or conduct post-enrollment interviews, these usability assessments involved watching consumers as they applied for coverage. By doing so, researchers were able to uncover reasons why consumers resorted to guessing, why they would quit at certain points, and why and where they encountered the most difficulty in applying online."
(Health Affairs Grantwatch Blog)
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Cancelled Non-Group Plans: What We Know Now That We Did Not Know In October
"Recent survey data indicates the number of persons affected by cancelled policies was about 1.9 million persons, less than the often cited 4.8 million estimate. When persons with group health insurance are included in the denominator, these cancellations affected less than one percent of persons holding comprehensive private insurance. The number of people with non-group policies who became uninsured following last October's cancellation of policies is similar to what occurs in the normal churn of the non-group market."
(Health Affairs Blog)
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[Opinion]
What a New Benefit from Starbucks Teaches Us About the Future of Employer-Provided Health Insurance
"While Howard Schulz the founder and current CEO of Starbucks has long said the firm offers health insurance because it is the 'right thing to do' for their employees, [the authors] have always suspected a more profit maximizing goal for this compensation decision.... [As] a profit-maximizing firm, what Starbucks giveth with tuition benefits it may soon taketh away from health insurance benefits. In the process, Starbucks may be heralding the demise of employer sponsored health insurance[.]"
(The Health Care Blog)
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Benefits in General; Executive Compensation
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IRS Announces Section 409A Compliance Initiative Project; A Self-Audit Would Be Prudent
"[E]mployers ... should have all their nonqualified deferred compensation plans reviewed for operational and documentary compliance with Section 409A. By doing so, employers will be able to identify Section 409A violations and be eligible to voluntarily correct the violations under the Section 409A Voluntary Correction Program. Once the plan, employer, or executive is under audit, however, the plan will not be eligible to voluntarily correct for any Section 409A operational or documentary violations, and the plan participants may be subject to immediate taxation of all vested deferred amounts and the Section 409A 20 percent penalty."
(Ford & Harrison LLP)
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Press Releases
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