401(k) Plan Relationship Manager
MVP Plan Administrators, Inc.
in NC

Technical Director, Advanced Consulting Group
Nationwide
in OH

Retirement Plan Administrator (Part-time and/or Full-time)
WLR & Associates, Inc.
in NC

Sr. Benefits Analyst - Health & Welfare Plans
PVH Corp.
in NJ

Benefits Administrator - Health & Welfare Plans
PVH Corp.
in NJ

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Regulatory Update and Current Hot Topics
September 16, 2014 in TX
(ASPPA Benefits Council [ABC] of Central Texas)

FAs, TPAs, CPAs Working Together
September 16, 2014 in FL
(ASPPA Benefits Council [ABC] of North Florida)

Creative and Complicated World of DC ADP/ACP Nondiscrimination Testing
September 18, 2014 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

CIGNA v. Amara, Three-Years Later: Remedy Game Changer or Business as Usual
September 18, 2014 WEBCAST
(Momentum Events Group)

Lost Participants: Welcome to the 21st Century
September 22, 2014 WEBCAST
(SunGard Relius)

ESOPs: A Tax-Advantaged Strategy for Growth, Liquidity and Succession Planning
September 23, 2014 in OH
(Porter Wright)

Importance of Party-in-interest Transaction Controls for Benefit Plans
September 23, 2014 WEBCAST
(McGladrey LLP)

Ethics in the Digital Age
September 24, 2014 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

Controlling the Cost of Compounded Medications: Health Plan/Employer Strategies
September 25, 2014 WEBCAST
(Atlantic Information Services, Inc)

Compliance with the ACA for Benefit Plans
October 1, 2014 WEBCAST
(McGladrey LLP)

View All Webcasts and Conferences

[Guidance Overview]

Final Regs and Related Guidance Address Health Insurance Exchange Eligibility Redeterminations and Enrollment
"Employers offering coverage in the small group market can expect some form of renewal or discontinuation notice as the 2015 enrollment approaches, even though final small group market forms were not part of this release. Calendar-year coverage that is being discontinued would require a notice be sent by October 3 (90 days before discontinuation) but -- recognizing that many insurers may not have finalized their 2015 plan offerings by then -- CMS indicates it will not take action against insurers who send the notice consistent with the timing requirements for renewal notices (60 days advance notice in the small group market)." (Thomson Reuters / EBIA)  

[Advert.]

Join us at IHC FORUM West November 10-12, 2014 in Las Vegas!

Come to the ONLY national event 100% dedicated to health care consumerism progress, collaboration and educational content. We'll provide a real-time look in at this year's open enrollment results and much more. Sign up today for the lowest rates!

[Guidance Overview]

IRS Releases Draft Instructions to Forms for Reporting Health Coverage Information
"The instructions confirm that filers of 250 or more of these forms (the threshold is applied separately to each form) must file them with the IRS electronically, and state that a guide (Publication 5165) for software developers and transmitters is currently under development. The detailed Q&As also confirm that TPAs or other third-party service providers may furnish and file the statements and returns, but warn that entering into a reporting arrangement does not transfer an employer's liability." (Thomson Reuters / EBIA)  

[Guidance Overview]

Compliance Checklist for Health & Group Benefit Plans
"[For] September 23, 2014 through January 1, 2015. This checklist is intended to help plan sponsors manage reporting and compliance deadlines in the ever-changing health benefits landscape. This list is not necessarily all-encompassing as each organization may have its own unique circumstances." (Findley Davies)  

Controlling Health Care Costs Through Limited Network Insurance Plans: Evidence from Massachusetts State Employees
"[E]nrollees are very price sensitive in their decision to enroll in limited network plans, with the state's three month 'premium holiday' for limited network plans leading 10% of eligible employees to switch to such plans. We find that those who switched spent considerably less on medical care; spending fell by almost 40% for the marginal complier. This reflects both reductions in quantity of services used and prices paid per service. But spending on primary care actually rose for switchers; the reduction in spending came entirely from spending on specialists and on hospital care, including emergency rooms." (National Bureau of Economic Research [NBER])  

Waiting Period Limits for California Small Group Early Renewals
"California law governing insurers and HMOs restricted the waiting period to 60 days under legislation that very recently has been repealed effective January 1, 2015. The repeal left open the issue of whether carriers would hold employers renewing late in 2014 to the 60-day waiting period limit. At least with regard to small group coverage (2 to 50 employees), the answer to that question appears to be 'yes' for two major carriers in the state whose approach may be a bellwether for other carriers. They will not permit a 90-day eligibility waiting period on small group policies or HMO contracts that are renewed or first issued during the remainder of 2014." (E is for ERISA)  

Hospital Administrative Costs in Eight Nations: U.S. Costs Exceed All Others by Far
"[A]dministrative costs accounted for 25.3 percent of total US hospital expenditures -- a percentage that is increasing. Next highest were the Netherlands (19.8 percent) and England (15.5 percent), both of which are transitioning to market-oriented payment systems. Scotland and Canada, whose single-payer systems pay hospitals global operating budgets, with separate grants for capital, had the lowest administrative costs.... Reducing US per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011." (Health Affairs)  

ACA Premiums in Some Cities Will Drop Slightly in 2015
"Overall, the average premium price for silver plans in the 16 cities will decline to $208 per month in 2015, down from $209 in 2014.... However, ... premiums for bronze plans will increase by 3.3% on average in 2015. Premium changes for bronze plans ranged from a 15.7% decrease in Hartford, Conn., to a 13.3% increase in Baltimore." (California Healthline)  

Does Privatized Health Insurance Benefit Patients or Producers? Evidence from Medicare Advantage
"[F]or each dollar in increased capitation payments, [Medicare Advantage (MA)] insurers reduced premiums to individuals by 45 cents and increased the actuarial value of benefits by 8 cents.... [A]dvantageous selection into MA cannot explain this incomplete pass-through.... [E]vidence suggests that insurer market power is an important determinant of the division of surplus, with premium pass-through rates of 13% in the least competitive markets and 74% in the markets with the most competition." (National Bureau of Economic Research [NBER])  

[Opinion]

Zeke Emanuel, Center for American Progress Give Up on Obamacare
"The examples given in [a recent paper by the Center for American Progress] are too government-heavy: All-payer databases, price fixing, and mandatory 'transparency.' Another weakness is that only governments will be able to share in the savings. How about a model where patients share in the savings, through a credit to a Health Savings Account (or Medicare MSA), for example?" (National Center for Policy Analysis Health Policy Blog)  

Signature Authority Can Trigger ERISA Fiduciary Responsibility
"[T]he court held that [the chief executive officer's] signature authority [over the corporate bank account into which participant contributions were placed] made him a plan fiduciary [with respect to the health & welfare plan] because, among other things, ERISA provides that a person can become a plan fiduciary by exercising any authority or control over the management or disposition of plan assets, even without discretion. The Court declined to decide whether discretion was an ERISA fiduciary requirement at this stage, but noted that at least one Circuit (the Eleventh) has suggested that discretion is a necessary prerequisite for ERISA fiduciary status." [Perez v. Geopharma, No. 8:14-cv-66-T-33T (M.D. Fla. July 25, 2014)] (Benefits Bryan Cave)  

Text of District Court Opinion: ERISA Does Not Preempt Claim for Value of Benefits Denied Because of Employee/Independent Contractor Misclassification (PDF)
"Plaintiffs could not have asserted a claim ... until they litigated their employment status, which they did here ... Plaintiffs seek the value of employee benefits denied them based on their misclassification as independent contractors; any damages would come from FedEx, not from the plan itself.... For these reasons, the Court concludes that Plaintiffs ' damages claims are not pre-empted by ERISA." [Gray v. FedEx, No. 4:06-CV-00422 (E.D. Mo. Sept. 5, 2014)] (U.S. District Court for the Eastern District of Missouri)  

It's Time to Review Your Plan's Benefit Denial Letters
"On August 7, the U.S. Court of Appeals for the Sixth Circuit decided in Moyer that the contractual time limits governing the period during which a participant must initiate judicial review of a benefits denial must be included in the denial letter issued by the plan administrator in order to comply substantially with the requirements of Section 503 of [ERISA]. This holding differs from earlier decisions in the Fourth and Fifth Circuits, which held that even if a denial of benefits letter failed to include the time limit for submitting a claim for judicial review, the time limit would be honored if the plan administrator's communications substantially complied in the aggregate with the requirements of Section 503 of ERISA." [Moyer v. Metropolitan Life Ins. Co., No. 13-1396 (6th Cir. Aug. 7, 2014)] (Sutherland Asbill & Brennan LLP)