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BenefitsLink Health & Welfare Plans Newsletter

January 16, 2013

Employee Benefits Jobs

Manager of Retirement Plan Processing
for Aspire Financial Services in FL

Omni Software Application Project Manager - IRC20789
for NRECA in DC

Manager, Benefits & Retirement Services
for Sports-Oriented Organization in NJ

Sr. 401K/DC Plan Administration Specialist
for CUNA Mutual Group in WI

Marketing and Sales
for National Retirement Services, Inc. in CA

Analyst Retirement Services - Pension / Contribution
for Catholic Health Partners in OH

Plan Administration Support Specialist / New Client Account Coordinator
for ePlan Services, Inc., a Paychex Company in CO

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Webcasts and Conferences

Rehires, including HEART and USERRA Nationwide on January 23, 2013 presented by McKay Hochman Co., Inc.

Long Term Care Insurance: What Now? WEB Chapter Meeting in Illinois on January 23, 2013 presented by WEB (Worldwide Employee Benefits Network) Chicago Downtown Chapter

New Pay or Play Regulations (December 28, 2012) ? Are You Up-to-Date? Nationwide on January 23, 2013 presented by International Foundation of Employee Benefit Plans

Evolving Role of Defined Contribution Plans in the Public Sector Webcast Nationwide on February 28, 2013 presented by National Association of Government Defined Contribution Administrators

View All Webcasts and Conferences


[Official Guidance]

Text of IRS Notice 2013-8: Application of Retroactive Increase in Excludable Transit Benefits (PDF)
"This notice provides guidance with respect to issues related to the enactment of section 203 of [ATRA], which increased the monthly transit benefit exclusion ... from $125 per participating employee to $240 per participating employee for the period of January 1, 2012 through December 31, 2012. To address employers' questions regarding the retroactive application of the increased exclusion for 2012 and to reduce filing and reporting burdens, the [IRS] is clarifying how the increase applies for 2012 and providing a special administrative procedure for employers to use in filing Form 941, Employer's QUARTERLY Federal Tax Return, for the fourth quarter of 2012 to reflect changes in the excludable amount for transit benefits provided in all quarters of 2012, and in filing Forms W-2, Wage and Tax Statement." (Internal Revenue Service)


[Advert.]

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[Official Guidance]

Text of DOL Guidance on Definition of 'Adult Child' Under FMLA
"A parent will be entitled to take FMLA leave to care for a son or daughter 18 years of age or older, if the adult son or daughter: (1) has a disability as defined by the ADA; (2) is incapable of self-care due to that disability; (3) has a serious health condition; and (4) is in need of care due to the serious health condition It is only when all four requirements are met that an eligible employee is entitled to FMLA-protected leave to care for his or her adult son or daughter." [Wage and Hour Division, Administrator's Interpretation No. 2013-1, Jan. 14, 2013] (U.S. Department of Labor, Wage and Hour Division)

[Official Guidance]

Text of HHS Instructions for the Proposed HHS Risk Adjustment Model (PDF)
"To protect against potential effects of adverse selection, the risk adjustment program transfers funds from plans with relatively lower-risk enrollees to plans with relatively higher-risk enrollees. It generally applies to non-grandfathered individual and small group plans inside and outside Exchanges.... The methodology that HHS proposes to use when operating a risk adjustment program on behalf of a State would calculate a plan average risk score for each covered plan based upon the relative risk of the plan's enrollees, and apply a payment transfer formula in order to determine risk adjustment payments and charges between plans within a risk pool within a market within a State." (U.S. Department of Health and Human Services)

[Guidance Overview]

DOL Issues Guidance on 'Caring for an Adult Child' Under the FMLA
"[The Administrator's Interpretation] does not declare anything new or otherwise signal a change in direction by the DOL in how it approaches the adult child provisions of the FMLA. In fact, one DOL official told [the author] that the AI is meant to clarify and confirm the DOL's long-held position on caring for an adult child and provide guidance in this area to DOL field staff. Despite the relative straightforward nature of the AI, there are a few nuggets in the AI of which employers should take note:" (FMLA Insights)

[Guidance Overview]

New California Disability Regs Expand Protections for Employees Affected or Disabled by Pregnancy (PDF)
"[Effective December 30, 2012,] regulations added 'perceived pregnancy' as a new basis of unlawful discrimination. It is now unlawful for an employer to engage in acts of discrimination based upon the perception that an applicant or employee is pregnant. The regulations define 'perceived pregnancy' as 'being regarded or treated by an employer or other covered entity as being pregnant or having a related medical condition'." (Winston & Strawn LLP)


[Advert.]

Nat'l Health Benefits Conf & Expo (HBCE) Jan.29-30, 2013 -- Clearwater Beach, FL

Sponsored by Health Benefits Conference & Expo (HBCE)

Speakers wrote the books on wellness, onsite clinics, disease management, obesity and health reform. Hear from public employers, universities, BAE Systems, FirstEnergy, JetBlue, Mayo Clinic, many more. Low cost, high quality! HBCE.com Ph: 941-484-1430 info@HBCE.com


[Guidance Overview]

Complicated Proposed Regs Address Premium Tax Credit Eligibility and Appeals
"[The proposed regulation includes] provisions governing eligibility determinations, notices, and appeals for eligibility for premium tax credits and cost-sharing reduction payments, as well as rules for appeals from determinations regarding exemptions from the individual responsibility requirement and employer and employee SHOP eligibility determinations. It describes how exchanges will verify the availability of employer coverage, which would normally bar premium tax credit eligibility, and how appeals from those determinations will be handled.... This [regulation] is exceptionally difficult to parse. Many of the proposals amend current rules, thus the printed text consists of snippets of additions or modifications which can only be understood by locating the existing rule and putting the changes in context. At a number of places the preamble references existing guidance that must be located and read to fully understand the proposed changes. And many of the proposals are very technical." (Timothy Jost, in Health Affairs Blog)

[Guidance Overview]

Fiscal Year Health Plan Transition Relief Under the ACA (PDF)
"The relief applies to all employees (whenever hired) who would be eligible for coverage (whether or not they take the coverage) before the first day of the 2014 fiscal plan year if the following conditions have been satisfied: [1] The health plan must have been a fiscal year plan, as of December 27, 2012, and the plan meets Minimum Value and is Affordable by the 1st day of the 2014 fiscal plan year. [2] (a) the fiscal year plan (including any other fiscal year plans that have the same plan year) was offered to at least 1/3 of the employer's employees (full-time and part-time) at the most recent open season or (b) the fiscal year plan covered at least 25% of the employer's employees[.]" (Chao & Company, Ltd.)

IRS Warns Employers: Do Not Try to Avoid Obamacare Insurance Mandate
"The IRS said it would issue a so-called 'anti-abuse rule' in an attempt to prevent employers from using temp agencies to circumvent the mandate, essentially writing into law that even though an employer hires temporary workers and therefore is not technically under the mandate's jurisdiction, the IRS would fine them anyway for not providing health insurance." (CNS News)

348 Days Until Obamacare is Fully Enacted
"Small groups (2-99 employees) can expect to see price increases between 20% and 50% upon the full enactment of reform. When factoring in medical trend, taxes and fees, carrier and product changes and the introduction of community rating, your premiums will jump significantly.... The objective of a health insurance plan should not be to carry you over to the next year with as little pain as possible, but to address your company's healthcare expenses for the long term. You need a road map that will allow you to offer affordable coverage to employees while keeping costs in line." (Forbes)

HIPAA v. the iPhone
"HHS recently included on its website some helpful information regarding security of mobile devices in video format. While primarily directed at health care providers, the videos are still useful for health plan sponsors/administrators (and their business associates).... Interestingly, the videos are emblazoned with disclaimers that following the videos does not guarantee compliance with HIPAA or any other law." (Benefits Bryan Cave)

Managing Employee Absenteeism and 'Presenteeism' During Flu Season
"In addition to the FMLA and comparable state laws, some states and municipalities require covered employers to provide paid sick leave to employees.... Regardless of the law in your state, to minimize lost productivity during flu season, employers should consider implementing absence policies that encourage sick employees to stay home, including paid time off (PTO) for short-term illnesses. Employers should make sure employees understand what human resources policies, workplace and leave flexibilities, and pay and benefits will be available to them." (Jackson Lewis LLP)

Play or Pay? Seven Reasons Why 'Pay' Is Not the Easy Answer
"While the 'pay' option might be worth considering, there are strong reasons why employers should look carefully at all of their options and do their best to calculate the actual outcomes of each.... 1. Lost Tax Advantages ... 2. Reporting Burdens Remain ... 3. Recruitment and Retention Challenges ... 4. Counting Employees Can Be Complex ... 5. The Cost of Coverage Can Be Adjusted ... 6. Other Financial Implications ... 7. Carriers Will Address Plan Designs[.]" (Employee Benefit Adviser)

An Economist's View of Tax Exclusions for Health Insurance
"A typical approach to estimating the size of the health subsidy implicit in the tax exclusions is to estimate the amount of federal personal income tax revenue that is lost because of the income that escapes tax.... However, the income-tax approach underestimates the amount of the exclusion, because health services are often excluded from many other taxes.... [E]mployer-provided health-insurance premiums are exempt from payroll and state personal income taxes, too, regardless of whether the employer or employee pays them." (The New York Times; free registration required)

In 'Fiscal Cliff' Deal, a Blow to Obamacare
"The decision to end funding for the Consumer Operated and Oriented Plans has left as many as 40 start-ups vying for federal dollars in limbo. Some are considering legal action against the Obama administration, after many spent upwards of $100,000 preparing their applications.... The Consumer Operated and Oriented Plan, or CO-OP, program was aimed at spending as much as $6 billion to help launch nonprofit health insurance carriers." (The Washington Post; free registration required)

California Faces Looming Liability for Unfunded Retiree Health Benefits for State Employees
"Sacramento leaders have failed to set aside money to cover $62 billion in projected costs for retiree health care. Some veteran state workers have been promised the full state-funded contribution toward their health plans for the rest of their lives. That typically covers most, if not all, of their premiums. Many newer employees must pay a share of their costs." (San Diego Union-Tribune)

Fourth Circuit Rules That Short-Lived Affiliated Service Group Did Not Trigger COBRA Liability
"A former employee argued that her former employer, which employed fewer than 20 employees (and thus was exempt from COBRA) for eight months of the year, formed an affiliated service group with another employer and thus employed more than 20 employees for four months of that year ... In an unpublished opinion, the 4th U.S. Circuit Court of Appeals rejected the employee's arguments and held that the employees of the combined employer group cannot be counted together for purposes of COBRA's small-employer exception until after the business transaction actually combines the two employers." [Feamster v. Mountain State Blue Cross & Blue Shield, Inc., 2012 WL 6720915 (4th Cir., Dec. 28, 2012)] (Thompson SmartHR Manager)

Letter Carriers Win Raise But Will Pay More for Health Benefits
"USPS' Federal Employees Health Benefits Program [FEHB] contribution will drop from the current level of 80 percent to 78 percent in 2014. For new employees, the rate will be 77 percent and drop to 76 percent in 2016. The contract establishes a labor-management group to study the possibility of removing postal employees from FEHB altogether. The [GAO] is also assessing the viability of the Postal Service creating its own benefits system." (GovExec.com)

Examining Life Disruptions for Midlife and Older Adults with High Out-of-Pocket Health Expenditures
"Participants described explicit and rank-ordered strategies for coping with new medical expenses. Participants understood their health benefits with exceptional detail but described considerable anxiety about changes to those benefits that could easily disrupt carefully managed household budgets. Benefit designs that resulted in large a variations in financial liability from month to month (e.g., large deductibles or coverage gaps) imposed considerable financial challenges." (Annals of Family Medicine)

[Opinion]

The Uneasy Case Against Free Market Health Care
"Basically, it all has to do with 'asymmetry of information.' The doctor knows more than the patient. Therefore the patient has no choice but to trust the doctor and rely or her advice. There are quite a few problems that flow from this fact, but here is a big one: since the doctor has a financial interest in persuading the patient to over consume health care, this 'market imperfection' will lead to too much spending on medical care (to say nothing of the wrong kind of spending) and too little spending on everything else." (John Goodman's Health Policy Blog)

[Opinion]

Deloitte Health Care Reform Memo, January 14, 2013
"[The recent CMS] Office of the Actuary report for 2011 national health spending [states that] overall spending increased only 3.9 percent.... Lest there be any confusion: the 3.9 percent increase is not a sign health costs are under control nor a basis for what most Americans can expect to pay next year. And clearly, the burden of health costs is shifted most to individual consumers who must grapple with its costs and make deliberate tradeoffs in their purchases of other necessities." (Deloitte Center for Health Solutions)

[Opinion]

Stronger Regulation Needed to Control Double-Digit Premium Increases for Health Insurance
"National health care spending has been rising at an unusually low rate for three consecutive years. Yet health insurance companies in some states with lax regulations are requesting and winning double-digit premium increases for some customers. That jarring discrepancy suggests that both the federal government and the states need more power to reject premium increases that can't be justified.... Most states can reject increases found to be unjustifiable. But some states cannot; they simply rely on public disclosure to deter insurers from getting too greedy. " (The New York Times; free registration required)

Benefits in General; Executive Compensation

Top Executive Compensation Issues for 2013, Part II
"[The authors of a recent article] claim to have examined SEC filings since 2004 and found that 'of the 20,237 executives who traded their own company's stock during the week before their companies made news, 1,418 executives recorded average stock gains of 10% (or avoided 10% losses) within a week after their trades'.... The issue is already on the SEC's radar screen.... [This author predicts] that this is the year that the SEC tightens the rules for 10b5-1 plans and requires some form of public disclosure of them." (Winston & Strawn LLP)

Press Releases

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