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Hand-picked links to the web's best news articles, official guidance, jobs, webcasts and more.
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[Guidance Overview]
Final Regs on Orientation Periods Released
"[E]mployers should review the terms of their group health plans ... to ensure that any orientation period is reasonable, bona fide and employment-based, and not merely a subterfuge for the passage of time. In addition, employers should consider application of the pay-or-play mandate when structuring eligibility and waiting periods to ensure that coverage is offered to new full-time employees no later than the first day of the fourth full calendar month of employment."
(Proskauer's ERISA Practice Center)
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[Guidance Overview]
One-Month Orientation Period Will Provide Relief from the 90-Day Rule
"[T]he final regulations do not address whether, in order to be 'bona-fide,' an orientation period must apply to all benefits, tie to a formal probationary period, or appear in the employer's handbook. Conservative employers may want to develop an across the board orientation-period policy to eliminate the perception that its sole purpose is to delay health plan enrollment."
(Don Mackanos, Alliance Benefit Group)
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Advanced Premium Tax Credit Reconciliation Questions and Answers
"For many individuals, their projected annual income will differ from their actual income at year-end, resulting in a refundable credit or the need to pay back excess premium tax credits. The purpose of this brief is to address questions raised by states about the federal requirements that apply to premium tax credit eligibility when actual income at year-end differs from projected annual income."
(State Health Reform Assistance Network, a program of the Robert Wood Johnson Foundation)
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Are Plan Eligibility Restrictions for Adult Dependent Children Still Allowed?
"Prior to 2014, grandfathered plans were allowed to deny or terminate a dependent's health insurance coverage prior to age 26 if the dependent gained eligibility under their own employer's group health plan. However, even grandfathered plans must now eliminate these restrictions when the plan renews in 2014."
(Hill, Chesson & Woody)
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Understanding the Potential Role Web Brokers Can Play in State-Based Marketplaces
"[W]hile there has been some state interest, no State-Based Marketplace (SBM) has fully embraced the federal model for contracting with web brokers. This may be changing now that the first open enrollment period has closed and states are looking ahead to crafting sustainable models for reaching as many consumers as possible. The purpose of this executive summary and its associated comprehensive issue brief is to help SBMs think about how they might work with web brokers."
(State Health Reform Assistance Network, for Robert Wood Johnson Foundation)
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PwC's 2014 Health and Well-Being Touchstone Survey Results
"Over 60% of employers have either implemented or are considering implementing high deductible health plans as the only option, and over 85% have or are considering implementing worksite wellness programs. Additionally, about one third of employers are considering implementing private exchanges for their active populations, and leveraging high performance (tiered) network solutions, while over 40% are interested in value-based designs."
(PricewaterhouseCoopers; free registration required for download)
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Double-Digit Rate Hikes Get OK from Moody's
"Health insurers in 10 states that reported rate filings have the support of Moody's Investors Services to go forward with double-digit rate hikes in 2015. Moody's analysts said the rate increases reflect an increasing medical cost trend, the Affordable Care Act industry fee and regulatory changes that allow people to keep noncompliant plans for another year[.]"
(FierceHealthPayer)
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Older Women Bear the Brunt of Higher Insurance Costs Under Obamacare
"The government's report shows that federal tax credits make health insurance premiums more affordable for everyone. The academics' report, however, shows that women age 55 to 64 will face a huge spike in cost when they go out to buy individual insurance on the federal exchange. These women bear the brunt of the increased premiums and out of pocket expenses after the [ACA].... The government report ... doesn't take into account out of pocket costs and doesn't say anything about how premiums might have changed because of the health care reform."
(The Washington Post; subscription may be required)
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Benefits in General; Executive Compensation
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Text of D.C. Circuit Court Opinion: ERISA Statutory Claim Is Not Subject to Exhaustion of Administrative Remedies (PDF)
"Pension plan beneficiaries need not exhaust internal remedial procedures before proceeding to federal court when they assert violations of ERISA's substantive guarantees.... Because Appellants assert a right granted them by ERISA's regulations -- the right to receive a lump sum payment without unreasonable delay -- they assert a statutory claim not subject to the exhaustion requirement. In other words, Appellants assert a statutory claim because the district court on remand will have to evaluate the plan's administration under a reasonableness standard created and defined by federal law." [Stephens and Mahoney v. PBGC, No. 13-5129 (D.C. Cir. June 24, 2014)]
(U.S. Court of Appeals for the District of Columbia Circuit)
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Press Releases
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