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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 Technical Assistance on State-Specific Data for the Actuarial Value Calculator (PDF)
"The purpose of this document is to provide technical guidance to states that are interested in submitting data to be considered for approval for use in a state-specific Actuarial Value (AV) Calculator.... [T]he federal AV Calculator uses a standard population to calculate plans' AVs, and since last year, states have had the option to submit data to be used as the standard population in the template of the federal AV Calculator to create a state-specific AV Calculator beginning in 2015.... All states have the option of continuing to use the federal AV Calculator, and any state that chooses to continue using the federal AV Calculator will not need to take any of the actions described in this
document." [The document is dated August 15, 2014; no identifying number.]
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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[Advert.]
Executive Forum on Creating a Culture of Health & Wellness
Wellness and HR executives with diverse viewpoints and experiences will come together to discuss, debate and exchange ideas on the impact of strong culture of health in the workplace on employee productivity and costs. $200 discount with code BLINK2.
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Verbal COBRA Notice OK, Says Court in Ruling for Employer
"In a decision that overlooked key COBRA guidance, a federal district court ruled that an employer/plan administrator fulfilled its notice obligation by verbally providing a notice of COBRA rights and accepting premium payments -- which apparently the qualified beneficiary had to pay a few days after her employment termination.... [The court's] reasoning did not consider federal regulations that describe the form and structure of COBRA notices. It also did not consider that an employer is required to give a qualified beneficiary at least a 60-day election period and at least 45 days from the election date to pay the initial COBRA premium." [Madonia v. S 37 Management, Inc., No. 14-C-678 (N.D. Ill. Aug. 14,
2014)]
(Thompson SmartHR Manager)
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Text of District Court Opinion Granting Award of Attorney's Fees Because of Extended Delays in Approval of Disability Benefits (PDF)
"LINA could have exercised greater care in reviewing the record and applying the literal terms of its Policy to its review of Nozal's claim.... LINA offered to pay Nozal's attorney's fees and costs, but offered her nothing in return for the significant delay and apparent violation of the ERISA plan's administrative review process. Nozal's attorney will not be faulted for rejecting such an offer.... LINA sought an extension to answer the Complaint and ostensibly to continue settlement negotiations, which Nozal granted. However, instead of continuing to negotiate, LINA filed a Rule 12(b)(6) motion to dismiss the entire Complaint and largely ignored the delay in the appeals process." [Nozal v. Allina Health Systems Long-Term Disability Benefit Plan; and Life Insurance Company of North America [LINA], No. 13-2270 (D. Minn. Aug. 15, 2014)]
(U.S. District Court for the District of Minnesota)
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Sixth Circuit Confirms Michigan's Tax on Health Claim Payments Is Enforceable Against Self-Insured Plans
"[T]he Sixth Circuit took pains to distinguish a recent Second Circuit decision barring application of Vermont's health data-reporting law to self-insured ERISA plans ... While there are some differences in the laws, one wonders whether these decisions might set the stage for the Supreme Court to take another look at ERISA preemption in this context.... If not preempted, the additional compliance costs of state tax and reporting obligations ultimately will be borne by plan sponsors -- either directly or through their TPA contracts -- and should be taken into account in estimating total plan costs." [Self-Insurance Inst. of America v. Snyder, No. 12-2264 (6th Cir. Aug. 4, 2014)]
(Thomson Reuters / EBIA)
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District Court Allows Fiduciary Claim to Proceed Against CEO Who Had Checkwriting Authority Over Company Account Containing Participant Contributions
"This lawsuit filed by the DOL alleged that a company and three of its officers breached their fiduciary duties under the company health and welfare plan by failing to segregate [employee payroll deductions and COBRA premiums] from general corporate accounts and using the contributions for company operations instead of benefits.... For purposes of [a motion to dismiss filed by one of the officers], the court held that under the plain language of ERISA, a person can be a fiduciary through the exercise of any authority or control over plan assets, even without discretion.... [The court found] that the officer's checkwriting authority over general corporate accounts containing participant contributions gave him sufficient authority and control over plan assets to make him a fiduciary." [Perez v. Geopharma, Inc.,No. 8:14-cv-66-T-33TGW. (M.D. Fla. July 25, 2014)]
(Thomson Reuters / EBIA)
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Individual Medical Policy Arrangements May Result in Significant Excise Tax Liability (PDF)
31 pages. "[ECFC agrees] that the payment of [individual market (IM)] policy premiums is a permissible cafeteria plan qualified benefit and that the provision of such coverage through the cafeteria plan continues to be exempt from income and employment tax under the Internal Revenue Code. We also agree that a cafeteria plan, in and of itself, is not a group health plan subject to the ACA. However, the Agency Guidance clearly states that any arrangement, which pays or reimburses an employee's IM policy premiums on a pre-tax basis would be an 'employer payment plan', which the Agency Guidance clearly indicates is a 'group health plan' subject to the ACA. The Agency Guidance is also clear that an employer payment plan violates the ACA and employers who sponsor such arrangements would be subject to a potential excise tax of $100 per employee per day."
(Employers Council on Flexible Compensation [ECFC])
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Detroit to Sell Millions in New Debt to Settle Bankruptcy
"Detroit plans to sell about $975 million in bonds for retirement costs and some creditor settlements as part of its bankruptcy restructuring plan awaiting approval by a federal judge.... $632 million in bonds would finance $450 million for retiree health care through a voluntary employee beneficiary association, agreed to by retirees."
(Bloomberg)
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Missouri Lags Behind in Insurance Pricing Transparency
"The Show-Me State is one of the only states that does not have the ability to review health insurance rates. Wyoming is close behind; it has only the ability to review rates for health maintenance organizations, or HMOs.... Only two carriers, Coventry and Anthem Blue Cross Blue Shield, offered plans on the Missouri exchange during the inaugural year. And while both are expected to offer plans again this year, details about their insurance products -- as well as those offered by other insurance companies -- are unlikely to be known before the Nov. 15 start of open enrollment on the exchange."
(St. Louis Post-Dispatch)
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Patient Advocacy Groups Claim Insurance Discrimination in New Forms
"Ending insurance discrimination against the sick was a central goal of the nation's health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers. The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there's reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors."
(ABC News)
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California's Enrollment Success Is Its Greatest Challenge: 30% of Population Now on Medicaid
"Altogether, there are now about 11 million Medi-Cal beneficiaries, constituting nearly 30 percent of the state's population. That has pushed the public insurance program into the spotlight, after nearly 50 years as a quiet mainstay of the state's health care system, and it has raised concerns about California's ability to meet the increased demand for health care. Even as sign-ups continue, state health officials are struggling to figure out how to serve a staggering number of Medi-Cal beneficiaries while also improving their health and keeping costs down."
(Kitsap Sun)
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Are Pharmacy Discount Cards Still Relevant?
"Providers of prescription drug discount cards are increasing their efforts to reach out to employers, even as the [ACA] is expected to decrease the ranks of those most likely to use the cards -- those without health insurance.... But not everyone agrees that these types of prescription drug discount cards still offer value in the post-ACA world."
(Employee Benefit News)
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Be Careful with Plan Rules: The Trouble with Exceptions
"[If] the ultimate purpose of a benefit plan is to provide benefits to participants, plan administrators and sponsors should look at possible exceptions as a means of tweaking and improving their plan to really provide benefits. A proposed exception might suggest a logical amendment to a plan that makes the exception the new rule. It is also possible that a requested exception can actually be justified because of ambiguities or silence in the actual plan itself."
(Fox Rothschild LLP)
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[Opinion]
How We Can Transcend Obamacare
"If we were to spend all our capital 'repealing and replacing' Obamacare, we might not have enough left to tackle the real drivers of unsustainable single-payer health care in America: Medicare and Medicaid.... Exchange-based plans would give those below the poverty line access to high-quality, private insurance and phase out single-payer public-option health insurance. Over the long run, only private insurers will have the competence and the incentive to come up with innovative, cost-efficient ways to improve health outcomes for the poor.... [M]igrating future retirees and low-income Americans onto exchanges could yield substantial benefits to the quality and cost of subsidized health coverage. But there's no reason we should accept the Obamacare exchanges as they are."
(Avik Roy, in National Review)
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