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BenefitsLink Health & Welfare Plans Newsletter

January 21, 2013

Employee Benefits Jobs

Regional Sales Consultant
for Third Party Administration Firm in NC

Retirement Plan Consultant
for Stalker and Associates, Inc. in PA

Associate Vice President, Retirement Plan Consulting
for United Retirement Plan Consultants in CT

Project Manager, Benefits Administration
for Publix Super Markets, Inc. in FL

Installation or Compliance Specialist
for Sunwest Pensions in AZ

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Webcasts and Conferences

New Final Regulations on HIPAA Privacy and Security: HITECH, Breach Notification, Individual Rights, and More Nationwide on February 28, 2013 presented by Thomson Reuters / EBIA

Keeping Current: What's New with EPCRS and other Washington Updates Nationwide on January 24, 2013 presented by National Institute of Pension Administrators

SafeHarbor 401(k) Plans ? An Advanced Look Nationwide on February 19, 2013 presented by National Institute of Pension Administrators

Automatic Enrollment - Is There Strength in Numbers? Nationwide on March 14, 2013 presented by National Institute of Pension Administrators

Health Benefits Laws Compliance Assistance Seminar in Louisiana on March 13, 2013 presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

View All Webcasts and Conferences


[Guidance Overview]

One Week to Get Business Associate Agreements Executed Under HIPAA Omnibus Rule's Grandfather Clause
"While the new rule establishes a compliance date of Sept. 23, 2013, it includes up to a one-year extension for covered entities and business associates to revise their business associate agreements if such agreements were entered into and compliant with HIPAA as of Jan. 25, 2013, the expected date of formal publication of the new rule in the Federal Register." (Davis Wright Tremaine 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]

IRS Announces Procedures Relating to Retroactive Increase in 2012 Transit Benefit Income Exclusion
"The Notice provides a special administrative procedure for employers who have not yet filed Form 941 (Employer's Quarterly Federal Tax Return) for the fourth quarter of 2012; and have repaid or reimbursed employees for FICA taxes on excess transit benefits. These employers may use the fourth quarter Form 941 to account for the increased amount excludable from wages and the resultant decrease in FICA taxes for all quarters in 2012." (McGuire Woods LLP)

IRS Explains Tax Reporting for Retroactive Increase in Limit on 2012 Qualified Transportation Benefits
"[W]ith only two weeks until fourth quarter Form 941 is due, many may find it difficult to take full advantage of the special administrative procedure. Employers utilizing the guidance should be careful to observe its distinction between overcollected FICA and income taxes. IRS regulations do not allow for the adjustment of overpaid income tax after the end of the calendar year, so the procedure does not provide for corrections to the amount of federal income tax withheld." (Thomson Reuters / EBIA)

[Guidance Overview]

HHS Proposes Process for Exchanges to Verify Employer-Sponsored Health Coverage
"Employers will want to review these new verification procedures, which are included in lengthy proposed regulations addressing a number of other complex issues ... Employers may also be interested in the process for appealing Exchange determinations of an applicant's eligibility for advance payment of premium tax credits.... [E]mployers offering affordable, minimum value coverage may wish to use the appeals process to ensure, as much as possible, that their employees are not mistakenly receiving advance payment of premium tax credits." (Thomson Reuters / EBIA)

[Guidance Overview]

New HIPAA Omnibus Regs Include Revised Marketing Rules
"The Omnibus Rule now requires that prior to sending any marketing materials to an individual relating to a product or service paid for by a third party, the covered entity sending the communication must obtain individual authorization to receive such communications. OCR removed the distinctions between authorization requirements for communications relating to treatment versus those for health care operations included in its proposed rule." (Mintz Levin)

[Guidance Overview]

HIPAA/HITECH Omnibus Final Regs Include More Rules for Business Associates
"The Final Rule makes some of the obligations of the HIPAA Privacy and Security Rules directly applicable to business associates. It also includes 'subcontractors' in the definition for 'business associates,' requiring business associates to enter into written contracts with subcontractors that are substantially similar to business associate agreements. Significantly, business associates and subcontractors will be required to come into full compliance with the Security Rule by the September 23 compliance date." (Morgan, Lewis & Bockius LLP)

[Guidance Overview]

Long-Awaited HIPAA Final Regs Released: New Presumption of Breach Upon PHI Disclosure
"The final rule removed the 'harm standard' found in the interim rule that limited notification obligations to those breaches that posed significant financial, reputational, or other harm to individuals. Now ... any disclosure of protected health information is presumed a 'breach unless the covered entity or business associate, as applicable, demonstrates that there is a low probability that the protected health information has been compromised.'" (Spencer Fane)

[Guidance Overview]

New HIPAA Omnibus Regs Published by HHS
"[T]he new rule: Modifies the standard for reporting breaches to patients and HHS.... Confirms HIPAA requirements for business associates and their subcontractors.... Confirms providers are liable for their business associate's violations if the business associate is acting as the agent for the provider.... Makes it easier for family members to obtain information about decedents.... Expands patients' right to obtain electronic copies of their records." (Holland & Hart)

[Guidance Overview]

HHS Releases HIPAA Omnibus Final Regs; 'Harm Standard' Removed
"[B]reach notification is necessary in all situations except those in which the covered entity ... demonstrates that there is a low probability that PHI has been compromised or one of the other exceptions to the definition of 'breach' applies. HHS removes the harm standard. Instead of assessing the risk of harm to the individual, covered entities and business associates must assess the probability that PHI has been compromised based on a risk assessment." (Drinker Biddle)

HHS Issues Long-Awaited Final Omnibus HIPAA Regs; March 26 Effective Date
"According to HHS Office for Civil Rights Director Leon Rodriguez, 'This final omnibus rule marks the most sweeping changes to the HIPAA Privacy and Security Rules since they were first implemented.' ... The final omnibus rule will be effective on March 26, 2013. Covered entities and business associates will have until September 23, 2013 to comply." (Vorys, Sater, Seymour and Pease LLP)

[Guidance Overview]

Final HIPAA Regs on Breach Notification: A Breach is Now Something Different
"A key change to the notification requirements for breaches involving protected health information (PHI) could make a significant difference to healthcare providers, health plans and their vendors, increasing the risks of their failing to notify affected individuals.... Under the current interim rule, a breach is defined as an inappropriate use or disclosure of PHI involving significant risk of financial, reputational or other harm. The final rule changes this definition by stating that an impermissible use or disclosure of PHI is presumed to be a breach, unless the covered entity can demonstrate that there is a low probability that the PHI has been compromised." (Beazley Group)

Rise in Health Insurance Premiums Due to Competition?
"Competition and consolidation together are one of eight main factors driving up health care costs ... In most types of markets, competition lowers prices. But health care is different ... because 'consumers are often shielded from the direct cost of care.' In many ways, health care providers control the supply and the demand." (Wisconsin State Journal)

Doctors Gain Small Foothold in CO-OP Insurance Before Funding Stops
"As federal funding rapidly dries up for a new consumer-oriented health plan model that was supposed to be a health system reform alternative to for-profit insurance, observers are suggesting that the financial and administrative challenges to launching these plans may explain why so few that managed to get off the ground are being sponsored by physician organizations.... Numerous physician organizations showed interest in this process, but most couldn't get past the logistical hurdles[.] (American Medical Association)

IRS Releases 2013 Cost-of-Living Adjustments for Transportation Benefits, Adoption Assistance and More
"Employers with transportation or adoption assistance plans will need to determine whether their plans automatically apply the latest limits or must be amended to recognize these changes. Changes in limits should also be communicated to employees." (Thomson Reuters / EBIA)

Flu Season Fuels Debate Over Paid Sick Days
"An unusually early and vigorous flu season is drawing attention to a cause that has scored victories but also hit roadblocks in recent years: mandatory paid sick leave for a third of civilian workers -- more than 40 million people -- who don't have it.... Advocates have cast paid sick time as both a workforce issue akin to parental leave and "living wage" laws, and a public health priority. But to some business owners, paid sick leave is an impractical and unfair burden for small operations." (Fox News)

How Obamacare Encourages Marriage But Only for the Middle Class
"[A table] shows the ratio of the individual mandate penalty amount relative to the out-of-pocket bronze plan premium for selected households. Note that at incomes above 200% of [the Federal Poverty Level] it is rational to pay the penalty rather than to buy health insurance." (John Goodman's Health Policy Blog)

New ACA Regs Put Unexpected IT Burdens on Employers
"[HHS] draft regulations governing the health exchanges ... [put] employers on notice that ... the burden will fall on them to ensure the availability of data for determining employee eligibility for subsidies as well as whether the employer has offered affordable coverage.... [B]ecause the federal data hub will not be fully functional on October 1, 2013, employers will need to provide their employees and new hires with a 'one-page template' of information on their health care coverage offerings, or go through a burdensome appeals process if they do not want to pay improper ACA penalties in 2014." (HR Policy Association)

Health Insurer Fined $700,000 for Explanation-of-Benefit Statement Failures
"New York insurance regulators have fined the parent of BlueCross BlueShield of Western New York $700,000 for failing to provide complete 'explanation of benefits' statements in some cases that lay out consumer rights and benefits or tell members how to appeal claims denials." (Buffalo News)

Five Ways Older Workers Benefit a Business
"Lots of people think a mature employee will bring higher benefits costs. This is simply not true. In most cases, mature employees have few or no dependents to cover on their insurance. With Medicare eligibility beginning at age 65, these employees may even have their own insurance and choose not to participate in the company's benefits plan. Depending on your company's policies, an older worker may not even require benefits coverage; in my experience, many mature employees prefer to work on a project basis or part time instead of full time." (Inc.)

[Opinion]

Obamacare's Fiscal Cliff of Upcoming Taxes
"[F]ive of the tax increases Americans are facing this month are new taxes created under the Affordable Care Act (ObamaCare). Three of the five will hit people who are solidly middle class. Next year, things will get worse. The new tax on health insurance is about as regressive as a tax can be. It will total $100 billion over the next 10 years and very little of that amount will be paid by anyone who can be called 'rich.'" (John Goodman's Health Policy Blog)

[Opinion]

Massachusetts Legislature Must Act on Unfunded Retiree Health Benefits
"Unfunded municipal retiree health care liabilities total approximately $30 billion statewide, dwarfing the $13 billion in unfunded local pension liabilities. These unaffordable obligations are the direct result of Massachusetts cities and towns providing some of the most generous retiree health care benefits in the country without setting aside money to pay for them." (The Salem News)

[Opinion]

ACA Administrative Costs Escalating
"On just California's insurance exchange alone, taxpayers are having to foot additional costs of two-thirds of a billion dollars just for administration and marketing of the exchange plans. In the future, these additional administrative costs will be downloaded to us through new fees assessed on the health policies sold through the exchange." (Physicians for a National Health Program)

Benefits in General; Executive Compensation

Statements Due Very Soon to Participants Who Exercised Incentive Stock Options in 2012 or Transferred Shares Acquired under an Employee Stock Purchase Plan in 2012
"The January 31, 2013, deadline is approaching for an employer to provide statements to employees or former employees who exercised incentive stock options in 2012 or who first transferred legal title to shares acquired under an employee stock purchase plan with an option price between 85 percent and 100 percent of fair market value of the stock. In addition, the employer must file IRS Forms 3921 and 3922 with the IRS by February 28, 2013." (Haynes and Boone, LLP)

Press Releases

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