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December 19, 2016 logo logo
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Employee Benefits Jobs

Retirement Plan Administrator
Leading Retirement Solutions
in WA

Implementation Project Manager
Newport Group
in AZ, CA, CO, FL, GA, IL, IN, MA, NC, NJ, NY, OH, SC, SD, TN, TX, VA, WA, WI, Telecommute

Senior Plan Administrator
NestEggs, Inc.
in FL

Employee Benefits Associate
Day Pitney LLP
in NJ

Benefits Analyst
Universal Health Services, Inc.
in PA

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Webcasts and Conferences

How to Help Your Employees Keep Their New Year's Resolution

Will the ACA Get Trumped?

Get Ready for Form 1094/1095 Reporting
January 12, 2017 WEBCAST
Thomson Reuters / EBIA

Prep for Compliance Testing Season!
January 12, 2017 WEBCAST

Cafeteria Plan Election Changes: What You Need to Know Now
January 18, 2017 WEBCAST
Thomson Reuters / EBIA

9th Annual Health Plan Marketing Summit
March 6, 2017 in FL
World Congress

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[Official Guidance]

Text of CMS Final 2018 Actuarial Value Calculator Methodology (PDF)
27 pages, dated Dec. 16, 2016. "This document is revised from the 2017 version to incorporate updates in the final 2018 version. The first part of this document provides background that includes an overview of the regulation that allows HHS to make updates to the AV Calculator as well as the updates that are incorporated into the 2018 AV Calculator. The second part of the document provides a detailed description of the development of the standard population and the AV Calculator methodology." [Also available: Actuarial Value calculator for 2018 (XLS)]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


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[Official Guidance]

Text of CMS FAQ on Agent/ Broker Compensation and Discriminatory Marketing Practices (PDF)
"[A] commission arrangement or other agent/broker compensation that is structured to discourage agents and brokers from marketing to and enrolling consumers with significant health needs constitutes a discriminatory marketing practice ... [If] an issuer pays agents or brokers less through all forms of compensation for higher metal level plans (such as platinum and gold level plans) ... than the issuer pays for lower mental level plans (such as bronze and silver level plans), this act constitutes a failure on the part of the issuer to comply with the applicable Federal guaranteed availability provisions and QHP marketing standards."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of CMS Guidance Regarding Age Curves and State Reporting (PDF)
"This guidance provides important information concerning Federal rating factors that apply to each age band, unless the State establishes its own age curve, and also provides guidance about the process of State reporting of rating requirements for plan years starting in 2018." [Unnumbered document, dated Dec. 16, 2016.]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

CMS Finalizes New Marketplace Payment Rule, Effective Three Days Before Presidential Inauguration
"Because it will be in effect by the time President-elect Trump takes office on the 20th, the rule cannot be simply set aside by the Trump administration.... The topics addressed by the final rule ... include: [1] modifications of the ACA's general market reforms ... [2] changes in the risk adjustment program for 2017 and 2018; [3] the 2018 payment parameters ... [4] changes in plan benefits ... [5] eligibility, enrollment and other changes ... [6] strengthening marketplace oversight ... and [7] final changes to the rules governing special enrollment periods and the CO-OPs."
Timothy Jost, in Health Affairs

CMS Addresses Risk for Marketplace Insurers in Final Rule
"The new risk adjustment model accounts for a number of factors, including the number of individuals who had a marketplace plan for less than a year, and the risk of high-cost patients. It improves compensation for healthier members and uses prescription drug data as another way to account for sicker members[.]"
Healthcare Finance News


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The 21st Century Cures Act and What You Need to Know
"[This] infographic highlights the important points regarding the 21st Century Cures Act and standalone HRAs for insurance premium reimbursements. The Cures Act affects millions of small businesses and their employees."

Waste in the Health Care World (PDF)
19 pages. "Pharmacy, which was determined to generate 4% wasteful spending, suffered from problems such as over-prescription and non-adherence to drug regimes. Inpatient, generating 6% wasteful spending, was beset by problems such as medical errors, preventable admissions, and hospital acquired infections. Outpatient, which at 9% generated the highest waste score of the top categories, faced the problems of missed prevention opportunities and defensive medicine."
American Health Policy Institute

Catholic Health Initiatives Pulls Out of Insurance Business
"As more hospitals across the country consider launching their own health insurance plans, one big hospital operator is pulling out of the business. Catholic Health Initiatives (CHI), a large nonprofit health system based in Colorado, no longer plans to develop a 'wholly owned and nationally driven' insurance business ... The provider, which operates 103 hospitals in 18 states, lost nearly $110 million during the last fiscal year[.]"


ERIC Letter to Congress Urging Repeal of Cadillac Tax
"Increasing taxes on individuals, employers, and/or their health insurance will not reduce the cost of delivering health care. It will, however, constitute a tax increase and drive up out-of-pocket health care costs for employees and their families, risking disruption to the system, and threatening the benefits working families enjoy and want to keep. American voters want lower-cost and high quality health care; they do not want more taxes."
The ERISA Industry Committee [ERIC]

Executive Compensation and Nonqualified Plans

[Guidance Overview]

Maximum Tax Withholding and Liberal Share Counting: A Deadly Combination
"ISS issued its new FAQs regarding equity compensation plans [in a document dated Dec. 16, 2016]. FAQ #32 deals with the issue of withholding at the maximum tax rate coupled with liberal share counting which permits shares withheld to be added back to the plan's share authorization."

$253,088 Monthly in Retirement is Coming for Some CEOs
"One hundred U.S. CEOs have company retirement funds collectively worth $4.7 billion, a total equal to the retirement savings of the 41% of U.S. families with the smallest reserves for their golden years ... The nest eggs of those chief executives are large enough to generate an average $253,088 in monthly retirement payments for the rest of their lives ... The 100 CEOs studied have retirement funds equal to the entire retirement savings of 44% of white working class households, 59% of African-American families, 75% of Latino families and 44% of female-headed households[.]"

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David Rhett Baker, J.D., Editor and Publisher
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

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