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August 14, 2014          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Investment Analyst
eRIA Services
in WI

Defined Contribution Plan Administrator
FACTS, inc.
in IN

Retirement Plan Administrator
Pension Firm in New York City
in NY

Senior Financial Analyst
Nolan Financial
in MD

Defined Contribution Department Manager
Keating & Associates, Inc.
in KS

Employee Benefits/ERISA Associate
Sherman & Howard
in CO

Part-time Retirement Planning Consultant
Transamerica Retirement Solutions
in CA

Regional Vice President/Retirement Plan Wholesaler
Ohio National Financial Services
in CA, GA, KS, MO

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Webcasts and Conferences

FSA Rollover Revisited: Mid-Year Results, Strategies for Open Enrollment
August 21, 2014 WEBCAST
(Alegeus Technologies, LLC)

Valuation Actuary Symposium
August 25, 2014 in NY
(Society of Actuaries)

Who’s an Employee and Why Does it Matter?
August 28, 2014 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

Understanding Qualified Longevity Annuity Contracts (QLACs)
September 4, 2014 WEBCAST
(ABA Joint Committee on Employee Benefits)

Employment Law Essentials and Best Practices
December 3, 2014 in PA
(ALI-ABA [American Law Institute-American Bar Association])

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 Bulletin 11: Guidance for QHP Issuers Regarding Individuals Who Are Determined Not to Be Qualified Individuals Due to Data Matching Issues (PDF)
4 pages. "When the FFM cannot resolve a data matching issue, resulting in an enrollee no longer being a qualified individual, the FFM will send the QHP issuer an 834 termination transaction notifying the issuer of the FFM's termination of the enrollee's Marketplace enrollment and termination of eligibility for advance payments of the premium tax credit and/or cost-sharing reductions, if applicable. This termination will be effective on the last day of the month during which the FFM determines that the individual is not a qualified individual." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

What Will You Do With Your Medical Loss Ratio Rebates?
"The rebates may be used in a variety of ways as long as the method is consistent with ERISA fiduciary requirements. For example, rebates may be distributed in cash, used to reduce future premiums (commonly referred to as a premium holiday) or to enhance benefits. However, if participants pay their required contributions on a pre-tax basis under a Section 125 plan, MLR rebates distributed as cash or a reduction in employee premium are taxable in the year of distribution." (Miller Johnson)  

[Guidance Overview]

Colorado Requires Supplement to Summary of Benefits and Coverage (SBC)
"The state of Colorado mandates the inclusion of a two- to three-page supplement to the SBC for each plan that is provided to state residents. These supplements must be distributed along with the SBCs and contain additional information about deductibles, covered cancer screenings, pre-existing condition rules, balanced billing and binding arbitration clauses." (HighRoads)  

[Guidance Overview]

CMS Presentation: Registering to Participate in the Federally-Facilitated Marketplace for the 2015 Plan Year (PDF)
44 slides from an August 12, 2014 presentation. "Objectives: [1] Describe the registration requirements for Agents and Brokers who wish to participate in the FFM for the 2015 plan year; [2] Distinguish between registration requirements for new and renewing Agents and Brokers; [3] Describe 'What's New' with FFM Agent and Broker registration for the 2015 plan year; [4] Provide tips on registering as an Agent or Broker in the FFM; [5] Provide an overview of Agent/Broker assisted enrollment in the FFM; [6] Identify relevant CMS resources and guidance." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

CMS Presentation: The Transitional Reinsurance Program -- Submission of Supporting Documentation Through Pay.gov (PDF)
56 slides from a presentation made August 11, 13, and 15, 2014. "Purpose and Objectives: [1] Provide detailed information on the Supporting Documentation requirements; [2] Explain various scenarios for submitting the 'ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form' and the Supporting Documentation Review key points about registering on Pay.gov and the payment submission process; [3] Provide clarifications on common questions." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


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ACA Grandfathering Driving Premiums Up for Non-Grandfathered Policies, Blues Say
"For Blue Cross Blue Shield of North Carolina, the Obama administration's decision is 'definitely' driving up 2015 exchange plan rates ... That's because of the 234,000 members with the option to keep their original plan, a 'very large share' did so.... And in Florida, the largest insurer -- Florida Blue -- said most of its 300,000 members with stayed enrolled in their transitional policies. Florida Blue is now raising premiums by an average of 17.6 percent for its plans sold on health insurance exchanges." (FierceHealthPayer)  

Hospitals Seek to Help Consumers Pay Obamacare Premiums
"Some hospitals in New York, Florida and Wisconsin are exploring ways to help individuals and families pay their share of the costs of government-subsidized policies purchased though the health law's marketplaces -- at least partly to guarantee the hospitals get paid when the consumers seek care. But the hospitals' efforts have set up a conflict with insurers, who worry that premium assistance programs will skew their enrollee pools by expanding the number of sicker people who need more services." (Kaiser Health News)  

Mailing of FMLA Notices Not Sufficient to Overcome Denial of Receipt by Employee
"The takeaway for employers in the Third Circuit is that simply mailing a letter and placing a copy in a file will not be sufficient evidence of receipt if an employee denies actual receipt. Employers should take care to document receipt of FMLA notice letters in some manner, either by confirmation of hand delivery, by email or by sending the letter via registered mail, return receipt requested, or via overnight mail, signature required. An employer should make certain that its records include this documentation of receipt[.]" [Lupyan v. Corinthian Colleges Inc., No. 13-1843 (3rd Cir. Aug. 5, 2014)] (Pepper Hamilton LLP)  

Requiring Pregnant Employee to Work, Then Firing Her for Underperforming, Raised FMLA Interference Claim
"A federal district court ... [had rejected] Evans' claim because she was paid her full salary while she worked from home, and, therefore, 'has not established that she suffered any legal damages.' ... Evans requested several forms of equitable relief, which the 11th Circuit said were not considered, and further noted that the magistrate judge and the district court appeared to have ignored FMLA's remedy provisions entirely." [Evans v. Books-A-Million, No. 13-10054 (11th Cir. Aug. 8, 2014)] (Thompson SmartHR Manager)  


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Analysis of Health Claims Data Drives Appropriate Plan Design and Targeted Wellness (PDF)
"Data drives the ability for employers and insurers to address trends in claims data via plan design, plan election steerage, incentives and disincentives for use and participation, and targeted wellness programs. Self-funding (aka self-insurance, partial self-funding, etc.) has traditionally provided the greatest ability for employers to have access to and analyze their employee, dependent, and spouse claims data.... [T]he self-funding trend is beginning to move to smaller employers ... and that creates a significant opportunity for employers of all sizes to review their claims data." (Kushner & Company)  

Is 30 the New 40? The ACA's 30-Hour Coverage Threshold May Lead to More Off-The-Clock Claims
"In addition to an increased potential for allegations of off-the-clock work, the [ACA] also invites the potential for additional damages. Employees who argue that they were improperly forced to work off the clock, and whose reduced hours averaged fewer than 30 hours per week, will now add remedies under benefits law to their back-wage claims." (Constangy, Brooks & Smith, LLP)  

Applied Behavior Analysis Therapy Coverage as Autism Treatment: Implications for the ACA
"[T]he United States District Court for Oregon ruled that Providence Health Plans are required to cover Applied Behavior Analysis therapy for a class of plaintiffs who are covered by Providence's insured ERISA employer group plans and diagnosed with an autism spectrum disorder.... Providence Health Plan had excluded coverage for 'services related to developmental disabilities, developmental delays, or learning disabilities.' The court held that the exclusion violated Oregon's Mental Health Parity Act and Mandatory Coverage for Minors with Pervasive Developmental Disabilities Act ... [as well as] ERISA because it violated the federal Mental Health Parity Act." [A.F. v. Providence Health Plan, No. 3:13-cv-00776-SI (D. Ore. Aug. 8, 2014)] (Timothy Jost for Health Affairs)  

Impact of the Affordable Care Act: 2014 Survey
"About 83 percent of respondents believe that the ACA will continue to put upward pressure on medical plan costs.... One out of four respondents are hiring more part-time workers, with another 14.5 percent considering similar action.... Almost 25 percent of respondents indicated they are considering the elimination of employer-sponsored plans.... 25.7 percent of respondents indicated they have already reduced expenditures or are considering such action on dental, vision and life coverage's as a result of the ACA's impact on medical plan costs.... 73 percent of respondents indicated that the ACA will negatively impact profits." (Cherry Bekaert Benefits Consulting, LLC)  

The Evolution of a Two-Tier Health Insurance Exchange System
"Arguably, small and mid-sized employers could benefit even more than large employers from exchanges, because large employers already enjoy a competitive insurance market, have the resources to manage health care costs, and experience economies of scale ... [P]rivate exchanges could provide greater choice of health insurance plans; increase competition among insurers; offer lower cost, cheaper products for employees; and enable employees to pick a health plan that fits their needs. Thus, insurance agents, brokers, and some small business associations -- who see public exchanges as a potential threat to their business -- are leaping into the breach to fill the need that SHOP exchanges are failing to fill." (Health Affairs Blog)  

Administration Warns Some Could Lose Health Care Coverage on Federal Exchange
"The warnings, in letters being mailed this week to 310,000 people in the three dozen states that rely on the exchange, give the recipients until Sept. 5 to send copies of green cards, citizenship documents or other information showing that they qualify for the coverage. If they miss the deadline, their coverage will end on Sept. 30." (The Washington Post; subscription may be required)  

Simplifying Retiree Health Benefits: Where Less Is More
"Rather than requiring retirees to select from a vast and often confusing array of individual Medicare products, the single-carrier national Medicare Advantage strategy streamlines and simplifies the transition process. Unlike local Medicare Advantage plans that have been around for many years, this new breed of national Medicare Advantage plan provides retirees with national coverage and larger networks of doctors and hospitals, as well as the ability to tailor benefits to each employer's needs." (Employee Benefit News)  

Benefits in General; Executive Compensation

Benefit Denial Letters: Include the Time Limit for Judicial Review or Lose Contractual Limitations Defense
"If your denial letter fails to expressly state the contractual limitations timeframe, it might not preserve that defense.... [A federal district court dismissed the complaint] because the plan contained a three-year limitations period for filing suit. The Plan provided constructive notice of the time limit.... [On appeal, the 6th Circuit held that the] 'failure to include the judicial review time limits in the adverse benefit determination letter renders the letter not in substantial compliance with [ERISA] Section 1133.'" [Moyer v. Metropolitan Life Ins. Co., No. 13-1396 (6th Cir. Aug. 7, 2014)] (Lane Powell PC)  

Performance-Based SERPs: Changing the Executive Comp Landscape (PDF)
"[T]here is no empirical data linking the use of broad-based, equity-based grants below the top tier of executives to a company's performance.... In the bright light of the new compensation disclosure rules, the traditional reasons for implementing a SERP -- whether based on a defined contribution or defined benefit concept -- lack appeal for compensation committees because of the absence of a relationship between the performance of the company and benefit design to the financial performance of the business unit or company." (Fulcrum Partners LLC)  

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