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BenefitsLink Health & Welfare Plans Newsletter

September 24, 2013

Employee Benefits Jobs

Associate Pension Administrator
Alliance Pension Consultants, LLC
in IL

Sr. Pension Analyst
Hooker & Holcombe, Inc.
in CT

Retirement Plan Account Manager
Benefit Consultants Group
in NJ

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Webcasts and Conferences

Section 408(b)(2) and the Challenge of Balancing Cost and Value of Retirement Plan Services
November 6, 2013 WEBCAST
(American Society of Pension Professionals & Actuaries (ASPPA))

ERISA Workshop 2013 - Dallas
October 23, 2013 in TX
(SunGard Relius)

ERISA Workshop 2013 - Philadelphia
October 23, 2013 in PA
(SunGard Relius)

TDFs and the Impact on Participant Outcomes
October 8, 2013 WEBCAST
(Vanguard)

View All Webcasts and Conferences


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Hand-picked links to the web's best news articles,
official guidance, jobs, webcasts and more.

California Superior Court Finds Vested Right to Retiree Health Benefits But Raises Many Questions
"The case is confusing in its implications for future policy.... Was it the employer's decision to prefund benefits that made them vested, or could an employer's practice of providing retiree health benefits on a pay as you go basis create a similar vested right? ... The court held that retirees who worked full-time for the City for at least 25 years must receive 100% of the maximum subsidy, but did not specify what that maximum subsidy must be.... [W]hat if the maximum benefit under the plan had been frozen, and an entirely new plan had been set up to receive the 4% contributions and provide an additional benefit? Would that have satisfied the contractual requirements?" (Calhoun Law Group)


[Advert.]

Payroll Auditing: A Guide for Multiemployer Plans

Sponsored by International Foundation of Employee Benefit Plans (IFEBP)

Learn how to conduct payroll audits and manage audit programs that are both effective and cost efficient with the newly published Payroll Auditing. Find answers to commonly asked questions, helpful sample documents and practical advice. Order Now!



[Guidance Overview]

Carrot or Stick? When Does a Voluntary Wellness Program Become Involuntary?
"While cautious employers may decide to implement rewards/penalties that are below the levels endorsed by the Affordable Care Act, it is unclear whether the EEOC would consider a program involuntary even at those lower levels. Even more cautious approaches include offering non-financial incentives, offering participatory instead of health-contingent wellness programs, or offering programs that do not require medical exams or health or disability-related questions. However, these alternatives may not be as effective in incenting participation in wellness programs and in helping individuals attain the health goals that the programs are designed to promote." (Pepper Hamilton LLP)

Swapping COBRA for Obamacare Likely to Be Windfall for Big Business
"Forty-one percent of large businesses recently surveyed ... expect former employees eligible for COBRA to seek coverage next year on the exchanges instead. Analysts expect few ex-employees if any to choose COBRA once the online marketplaces, scheduled to open in October, become established in a few years." (Kaiser Health News)

The Demand Side: Consumer-Focused Strategies to Improve Health System Outcomes (PDF)
"[E]ngaging patients as 'consumers' in the health care marketplace is a new world for providers and consumers alike, with unlimited potential but also an unlimited amount of work yet to be done. The first order of business will be to continue monitoring and evaluating the many and various initiatives that are under way or planned. Success factors need to be identified, tools and program designs refined. Opportunities to use different strategies to reinforce each other should be explored... The potential of behavioral economics to sharpen and strengthen various types of incentive and decision-support strategies needs to be fully exploited." (AcademyHealth)

ML Strategies Health Care Reform Memo, September 23, 2013 (PDF)
Update on developments in federal and state health care reform legislation and regulations, including summaries of recent announcements and regulatory activity by HHS, CCIIO, IRS and CMS. (ML Strategies, LLC)


[Advert.]

Same-Gender Marriage Rulings: Impacts on Employee Benefit Plans Across the Nation - September 30 Webinar

Sponsored by Lorman and BenefitsLink

This live webinar will provide information needed to administer benefit plans in accordance with applicable laws and will discuss best practices for offering benefits to civil union partners and other same-sex partners. Registration discount for BenefitsLink readers.



2012 Health Care Cost and Utilization Report
"After three years of slowing growth, spending per person on prescription drugs and devices reversed course, growing 3.8 percent in 2012, due mainly to increased use and rising prices for generic drugs. Inpatient spending grew slower (2.4%) than any other medical service category in 2012, while spending on outpatient services grew at the fastest rate (6.5%). As in past years, price increases rather than use of services remained the primary cause of spending growth for outpatient and inpatient facility claims. Prices rose 5.4 percent for inpatient services, and 5.6 percent for outpatient services." (Health Care Cost Institute)

Enhancing Value in the Group Life Insurance Marketplace
"Focusing on cost alone has helped reduce this core and essential benefit to a low-value commodity in the eyes of employers. It has also pushed down employer costs so far that plans risk noncompliance with ERISA and imputed income regulations ... [Group life insurance] plans include many largely untapped features and services that can be unleashed with little to no cost to the plan sponsor and considerable benefit to employees and their families. And there are often opportunities to enhance value by improving the efficiency and effectiveness of an employer's plan administration through outsourcing and employee self-service." (Towers Watson)

Is This Time Different? The Slowdown in Healthcare Spending (PDF)
"[The authors] first study trends in a variety of measures of U.S. health care, including personal health expenditures, total health spending, health care prices and quantities, and factor inputs such as employment in the health care sector. While the measurement issues tell somewhat different stories about inflection points, nearly all of them point to a recent decline in health care spending, with the exception of one: the Current Employment Statistics shows no slowdown in health care employment growth." (The Brookings Institution)

Delaying the Individual Mandate Would Disrupt Overall Implementation of the ACA
"Delay would reduce insurance coverage, increase average premiums in the nongroup and possibly the small group insurance markets, and increase the government cost per newly insured person. Plus, the change would invalidate insurer premium rates already approved for 2014, creating disruption and uncertainty for insurers, consumers, and government." (Urban Institute)

What Consumers Really Want from an Obamacare Plan
"Price is a key consideration, but so are hospital networks, even more so than doctors. And most consumers will decide frighteningly fast.... [Some] national consulting firms have been running simulations for clients almost since the day the [ACA] became law in 2010. The distilled data have helped insurers better understand their new customers and, in turn, design their marketplace products." (Kaiser Health News)

Employers Use Exchanges to Shift Employees, Retirees Away from Traditional Benefit Plans
"For years, employers have been seeking to control the rising cost of employee health insurance. Now they have a new way to limit health care spending: the public and private health insurance exchanges.... The move to defined-contribution plans may make it difficult for health care journalists to track employers' health insurance spending strategies in the coming years because employers likely will be reluctant to report how much they allot to each worker and retiree." (Association of Health Care Journalists)

[Opinion]

Deloitte Health Care Current, September 24, 2013
"Much of the discussion about the life sciences industry and health care reform among the general population has been about prescription drugs because this is a more visible component of the cost in our industry.... The medtech sector is less talked about, even though it accounts for about 6 percent of health spending. There is increased attention in the market today to address these cost categories from buyers that are increasingly sophisticated and organized." (Deloitte Center for Health Solutions)

[Opinion]

How Buying Insurance Will Change Under Obamacare
"[E]ven when the early kinks are all smoothed out, the process will no doubt seem complicated and confusing to some.... [M]uch has been done to simplify the process under Obamacare: People will be able to apply for advance premium tax credits in exchanges in a variety of ways... Plan choices will be arrayed online based on where you live.... All insurers will be required to cover mostly the same benefits,... Coverage will be standardized into tiers ... But, probably the single biggest step to make buying insurance simpler than today is the prohibition of what's known as 'medical underwriting.'" (Kaiser Family Foundation)

[Opinion]

Value-Based Health Care Is Inevitable and That's Good
"[O]ne breakthrough that will change the face of medicine is being slowed by criticism, misunderstanding, and a reluctance to do things differently. That breakthrough is value-based care, the goal of which is to lower health care costs and improve quality and outcomes. It will eventually affect every patient across the United States. Not everyone, however, is onboard yet, because part of the value-based equation is that hospitals will be paid less to deliver better care. That's quite a challenge, but one that Cleveland Clinic is embracing as an opportunity to do better. Others must, too." (Harvard Business Review; free registration required)

[Opinion]

State Insurance Exchange Blind Spots: Unknown Risks and Unintended Consequences
"[A] predominantly unknown and potentially unhealthy population will flood the individual health insurance marketplace in a two weeks just as most states quickly phase out their high-risk pre-existing condition pools and shift them into the exchanges.... This period of uncertainty, along with the fall-out created by an inability to medically investigate new members prior to enrollment, impacts the very means by which carriers price their products, measure/control risk, and manage the care of its members." (The Health Care Blog)

[Opinion]

Out-of-Pocket Costs in the California Exchange
"Traditional insurance theory holds that patients should pay out of pocket for expenses that are small and over which they have a great deal of discretion. Insurance, on the other hand, should pay for expenses that are large and over which patients don't have a lot of discretion. The [Silver Plan described by Covered California] turns that theory on its head." (John Goodman's Health Policy Blog)

[Opinion]

The Summer of Wellness's Discontent
"We hope history will record the Penn State debacle as the industry's high-water mark for stupidity, and we are proposing a total re-boot to ensure nothing like this ever happens again. Start by acknowledging that science knows shockingly little about obesity's causes or solutions, blood values are crude predictors of adverse medical events, and screens are a major and expensive contributor to overdiagnosis. Put it all together and ... you are experimenting on your employees -- and neither the science nor the math presages a favorable outcome. So why not try a wholly new approach to wellness and instead of doing questionable or even harmful things to employees, do things for them and with them?" (The Health Care Blog)

Benefits in General; Executive Compensation

[Guidance Overview]

DOL Guidance Clarifies Action Steps for Puerto Rico Retirement Plan Sponsors on Definitions of 'Spouse' and 'Marriage' (PDF)
"Retirement plans intended to be qualified only under the provisions of the Puerto Rico Internal Revenue Code of 2011... are generally not subject to the provisions of the U.S. Internal Revenue Code ... or the jurisdiction of the IRS (PR-Only Plans). Consequently, the IRS interpretations in RR 2013-17 are not applicable to PR-Only Plans. Nevertheless, PR-Only Plans are subject to the provisions of Title I of ERISA and to the jurisdiction of the DOL. Consequently, TR 2013-04 is fully applicable to PR-Only plans for purposes of Title I of ERISA (e.g., spousal consent requirements, beneficiary designations). On the other hand, it would appear that the current definitions of 'spouse' and 'marriage' under Puerto Rico law (i.e., no same-sex marriages and no domestic partnerships or civil unions) continue to apply with respect to those provisions and requirements of the PR Code which are not subject to ERISA (e.g., hardship withdrawals)." (Groom Law Group)

[Guidance Overview]

New Pay Ratio Disclosure Rule: Will the Employee with the Median Level of Compensation Please Raise Your Hand?
"The proposed rule is the product of the SEC's review of nearly 23,000 comment letters -- many highlighting the burdens and complexities of implementation. While the proposed rule itself is approximately 6 pages, the SEC explained the proposed rule in over 83 pages of preamble heavily citing comment letters and another 55 pages of economic analysis. [This memo] summarize[s] some of the main points of the proposed rule." (Groom Law Group)

[Guidance Overview]

SEC Proposes Rule on Required CEO Pay Ratio Disclosure
"The SEC's proposed rule will require most listed companies to disclose the following: The median of the annual total compensation of all employees, excluding the CEO; The annual total compensation of the CEO; The ratio of these two amounts. The SEC contemplates that its proposed rule may be effective for the 2016 proxy season. We expect, however, that the SEC will receive many adverse comments on the proposed rule, despite the flexibility that the rule is intended to permit, because the calculation of the median compensation will be burdensome -- particularly for large multinational companies." (Morgan Lewis)

[Guidance Overview]

SEC Issues Proposed CEO Pay Ratio Rule (PDF)
"The SEC estimated that of 4,000 registrants that will be subject to the rule, approximately 50% have an organizational structure which would allow the registrant to use a simple random sampling method. Of these companies, the majority would still have a sample size of 500 or more. The remaining 50% have multiple business and/or geographical segments. For these companies, statistical sampling will be much more difficult." (Exequity)

[Guidance Overview]

At Long Last: SEC Proposes New Rules to Compel Disclosure of CEO Pay as Ratio to Median Employee Pay
"Among other things, the Proposed Rules articulate: which companies and which SEC filings must contain the Pay Ratio Disclosure; how to determine annual total compensation; how to identify the median; what disclosures must be provided on the underlying methodology, assumptions and estimates used in preparing the Pay Ratio Disclosure; and when the Pay Ratio Disclosure requirements would become applicable. [This article] provides a brief overview of the Proposed Rules in question and answer format." (SheppardMullin)

Struggling, San Jose Tests a Way to Cut Benefits
"San Jose now spends one-fifth of its $1.1 billion general fund on pensions and retiree health care, and the amount keeps rising.... [A] plan to reduce benefits ... [was] passed by 70 percent of voters in a referendum last year. The plan is being opposed in court by unions that represent city workers and say it is illegal under state law. It would introduce a second tier for new city employees involving much lower pension and health benefits. It would also alter pension benefits for existing workers, allowing them to choose either a similar, second-tier benefits plan or to pay significantly more out of their own pockets for the benefits they had come to expect." (The New York Times; subscription may be required)

Press Releases

NAPA Launches Research Institute with Warren Cormier National Association of Plan Advisors (NAPA)

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