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2014 Webinar: Advanced HSA
February 6, 2014 WEBCAST
(Ascensus)

2014 Webinar: IRA Frontline Fundamentals ? Part 1
February 11, 2014 WEBCAST
(Ascensus)

Opposing Perspectives on Recent ERISA Cases
February 12, 2014 WEBCAST
(John Marshall Law School)

Using Tactical Asset Allocation to Manage Participant Risk
February 13, 2014 WEBCAST
(National Association of Plan Advisors (NAPA) )

Employee Benefits Legislative Update ? The Devil is in the Details with Craig J. Davidson, CEBS
February 18, 2014 WEBCAST
(FutureOffice Network)

Small Business Health Options Program (SHOP) Webinar Series I
February 25, 2014 WEBCAST
(Centers for Medicare & Medicaid Services (CMS))

Health Plan and PBM Strategies to Curb Prescription Drug Abuse
March 5, 2014 WEBCAST
(Atlantic Information Services, Inc)

In the Wake of AMARA: Post-AMARA Pleadings and Remedies
March 11, 2014 WEBCAST
(ABA Joint Committee on Employee Benefits)

Cafeteria Plans
March 25, 2014 in WA
(Thomson Reuters / EBIA)

HSAs, HRAs, and Consumer-Driven Health Care
March 26, 2014 in WA
(Thomson Reuters / EBIA)

Annual HR Forum
June 3, 2014 in PA
(Corporate Synergies)

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Text of IRS Proposed Regs on Calculation of UBTI for Certain Tax-Exempt Organizations
18 pages. Excerpt: "This document contains a new proposed regulation providing guidance on how certain organizations that provide employee benefits must calculate unrelated business taxable income (UBTI) [namely, voluntary employees' beneficiary associations described in section 501(c)(9), supplemental unemployment benefit trusts described in section 501(c)(17), and group legal services organizations described in section 501(c)(20)].... This new proposed regulation retains the formula set forth in the 1986 Proposed Regulation and [the still-effective temporary regulation] 1.512(a)-5T but modifies and clarifies the description and adds examples. This new proposed regulation specifically states that any investment income a Covered Entity earns during the taxable year is subject to unrelated business income tax (UBIT) to the extent the Covered Entity's year-end assets exceed the account limit, and clarifies that this rule applies regardless of how that income is used." (Internal Revenue Service)

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Text of CMS 2015 Draft Letter to Issuers in the Federally-Facilitated Marketplace (PDF)
51 pages. Excerpt: "For the 2015 benefit year, CMS will consider issuers' data and actuarial justifications provided in the Unified Rate Review Template (URRT), other information submitted as part of a filing under an Effective Rate Review program and any recommendations provided to CMS by the applicable state regulator about patterns or practices of excessive or unjustified rate increases and whether or not particular issuers should be excluded from participation in the Marketplace.... For the 2015 benefit year, QHP issuers will not be allowed to change their service area after their initial data submission except via petition to CMS.... For the 2015 benefit year, issuers will be required to submit a provider list that includes all in-network providers and facilities for all plans for which a QHP certification application is submitted.... CMS will review the collected provider list to evaluate provider networks using a 'reasonable access' review standard, and will identify networks that fail to provide access without unreasonable delay ... CMS will focus most closely on those areas which have historically raised network adequacy concerns." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)

Text of OPM 2015 Annual Call for Applications and Recertification Submissions from Prospective and Current Multi-State Plan Issuers (PDF)
"For 2015, our goal is to expand MSP coverage to at least five additional States, and to add one or more new MSP issuers or groups of issuers.... Beginning in 2015, we expect MSP issuers to offer both family coverage and self-only coverage at the silver and gold metal levels.... [CMS] intends to propose through rulemaking that Marketplaces may require that issuers temporarily cover non-formulary drugs ... as if they were on the issuer's formulary during the first 30 days of coverage, for coverage beginning on January 1 of each year, starting with the 2015 plan year... We encourage MSP issuers to accommodate the needs of new enrollees by covering a transitional fill of these drugs for new enrollees.... We encourage MSP issuers to cover three primary care office visits prior to meeting any deductible.... We expect MSP issuers to have sufficient numbers and types of providers in their networks to meet the needs of a diverse population, to monitor their networks continuously for quality and access, and to make prompt adjustments to networks as needed." (U.S. Office of Personnel Management)

Text of CMS FAQs on the Sale of Individual Market Policies to Medicare Beneficiaries Under 65 Losing Coverage Due to High Risk Pool Closure (PDF)
The unnumbered document is dated January 31, 2014. Excerpt: "May an issuer request documentation from an applicant or enrollee to establish that the individual falls within the scope of this bulletin? ... When can Medicare beneficiaries enroll in individual market plans pursuant to the bulletin? ... When can Medicare beneficiaries enroll in Medicare Advantage or Prescription Drug plans? ... Can these Medicare beneficiaries who enroll in individual market plans pursuant to the bulletin receive a tax credit under Code section 36B? ... How will coordination of benefits occur between Medicare and the individual market plan issuer in these circumstances? ... Are issuers required to sell individual market coverage to Medicare beneficiaries in this specific circumstance?" (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)

Key Provisions of CMS 2015 Draft Letter to Issuers and OPM Multi-State Plan Program Call Letter
"CMS publishes a Letter to Issuers each year to set out the guidelines for qualified health plans participating in the [federal] exchange for the following year.... The biggest changes in the Letter from 2014 concern network adequacy and access to essential community providers.... CMS intends for 2015 to collect plan provider lists and review them to determine whether providers are available without unreasonable delay.... CMS intends to use its review to develop time and distance or other standards for future network review.... QHPs must include 30 percent of [essential community providers (ECPs)] in their provider network and offer contracts in good faith to all available Indian health providers in their service area and at least one ECP in each ECP category... CMS is also tightening its standards for reviewing QHPs for discriminatory benefit design.... The Letter requires greater transparency in drug formularies, including direct access to plan-specific formularies without enrollees having to log on or enter a policy number.... Like CMS, OPM intends to enforce network adequacy standards.... [Multi-State Plan (MSP)] issuers must have in place a process to provide timely exceptions to ensure that consumers who need care from out-of-network providers (because of rare or complex medical conditions or lack of in-network providers in a geographic area) can receive it with reasonable cost-sharing, applying enrollee costs to the in-network out-of-pocket maximum, and protection from balance billing." (Timothy Jost in Health Affairs Blog)

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New HIPAA Certification Requirement and Other New Health Plan 'To Do' Tasks Under HIPAA Standard Transaction Rules (PDF)
"Some of these new rules ... place responsibilities directly on the health plan, even if it normally looks to a third party to conduct its standard transactions. For example, the health plan must register for its own Health Plan Identifier number to be used in standard transactions. And ... the health plan must obtain a certification that its standard transactions are being conducted under the required Transaction Rules -- even for transactions conducted by its business associates.... Under the proposed rules, by December 31, 2015, health plans will be required to obtain the certification from an outside organization and then file an attestation with HHS that it has obtained the necessary certification. Plans may be penalized $1 per covered life per day (up to a maximum cap) for failure to file the required certification." (Groom Law Group via American Benefits Council)

Obamacare Insurers May Be Forced to Add Medical Providers
"Health plans offered through government-run insurance exchanges may be required to cover 30 percent of 'essential community providers' in each county in 2015, an increase from 20 percent this year, according to ... a letter to insurers [from HHS] .... More than two-thirds of health plans on exchanges have assembled provider networks considered 'narrow' or 'ultra-narrow,' in which as many as 70 percent of hospitals and other local health providers aren't included ... Exchange plans with broad networks of hospitals carry premiums 26 percent higher, on average, than similar plans from the same carriers with narrow networks[.]" (Bloomberg)

OPM Information for Issuers: Multi-State Plan Program and the Health Insurance Marketplace
"OPM is charged with implementing the Multi-State Plan (MSP) Program by contracting with private health insurance issuers to offer at least two MSP options in each State.... For the 2015 contract year, OPM seeks applicants with the capacity to provide affordable health insurance benefits in all States within the 4-year phase-in period. If you are interested in becoming an MSP issuer in 2015, you must first submit a Notice of Intent to Apply. The 2015 application will be available by early 2014; the 2014 application is included here for your reference." (U.S. Office of Personnel Management)

MEWA Reminder: Annual Form M-1 Filings Due March 1
"In 2013, the DOL made significant changes to the Form M-1 and converted the filing process to electronic only. Because of these changes, the deadline for filing the 2012 Form M-1 was delayed until May 1, 2013. However, no delayed filing deadline applies for the 2013 Form M-1, which is due March 1, 2014." (McKenna Long & Aldridge LLP)

Text of Second Circuit Opinion That ERISA Preempts Vermont State Reporting Requirements for Health Plans (PDF)
"We hold that the reporting requirements of the Vermont statute and regulation have a 'connection with' ERISA plans (though no 'reference to' them) and are therefore preempted as applied. Our holding is supported by the principle ... that 'reporting' is a core ERISA function shielded from potentially inconsistent and burdensome state regulation.... Not every state law imposing a reporting requirement is preempted.... But the reporting mandated by the Vermont statute and regulation is burdensome, time-consuming, and risky. Even considered alone, the Vermont scheme triggers preemption; considered as one of several or a score of uncoordinated state reporting regimes, it is obviously intolerable." [Liberty Mut. Ins. Co. v. Donegan, No.12-4881-cv (2nd Cir. Feb. 4, 2014); includes a vigorous dissent by Judge Straub.] (U.S. Court of Appeals for the Second Circuit)

Eleventh Circuit Says Social Security Determinations Issued After Initial Claim Denial Must Be Considered
"You already know that a Social Security disability (SSDI) decision should be considered in the context of deciding whether the claimant is disabled under the terms of the disability policy. But what happens when the SSDI decision occurs after you denied the claim, but during the ERISA-governed administrative appeal? Better yet: What happens when the claimant refuses to send you the SSDI determination during the appeal process?" [ Melech v Life Insurance Company of North America , 739 F.3d 663 (11th Cir. 2014)] (Lane Powell PC)

CBO Director's Testimony: Obamacare 'Creates a Disincentive for People to Work'
"'What the [ACA] does, is to provide subsidies focused on lower- and lower-middle-income people to buy health insurance. And in order to encourage a sufficient number of people to buy an expensive product like health insurance, the subsidies are fairly large in dollar terms. Those subsidies are then withdrawn over time -- withdrawn from people as their income rises. And by providing heavily subsidized health insurance to people with very low income, and then withdrawing those subsidies as income rises, the [ACA] creates a disincentive for people to work, relative to what would have been the case in the absence of that Act,' [Congressional Budget Office Director Douglas] Elmendorf told the House Budget Committee." (CNS News)

CBO Says Obamacare Is a Tax on Work, May Cut Full-Time Workforce by 2.5 Million
"CBO focuses mostly on those transitioning to full time work (with benefits). But the same disincentives apply to workers on Obamacare who are already employed full time, and looking to grow their income. The congressional actuaries go on to state that forgoing Obamacare subsidies and returning to full time work with health benefits (for lower wage and middle class workers) amounts to an average, implicit tax of about 15% paid by each worker." (Forbes)

White House Statement Disputing CBO Report's Conclusion That ACA Will Cause Job Loss
"Claims that the [ACA] hurts jobs are simply belied by the facts in the CBO report.... What the CBO report does find is one key immediate effect of the [ACA] is to 'induce some employers to hire more workers or to increase the hours of current employees' during the 2014-16 period. Over the longer run, CBO finds that because of this law, individuals will be empowered to make choices about their own lives and livelihoods, like retiring on time rather than working into their elderly years or choosing to spend more time with their families." (The White House Blog)

White House Pushes Back on CBO Report about ACA Effect on Jobs
"[T]he White House argued that the aspects of the law discouraging Americans from work weren't necessarily a problem. Chairman of the Council of Economic Advisors Jason Furman told reporters that the law would not reduce the hours being offered by employers. Instead, Furman said, ObamaCare allowed greater 'choice' -- for workers to scale back their hours to spend more time with their children, or to leave their jobs to launch a small business or startup.... The White House also called the CBO analysis incomplete, noting that it did not account for factors that could boost the economy or encourage workers to stay at their jobs." (The Hill)

Newark Expected to Enact Paid Sick Leave Ordinance
"Under the Ordinance, full- and part-time employees of private-sector employers will begin to accrue leave immediately upon being hired, although they will not be eligible to use the leave until after their 90th day of employment. Sick leave will accrue at a rate of one hour for every 30 hours worked. Employees who work for employers with 10 or more employees and those who work for employers in the child care, home healthcare, and food service industries will be able to accrue a maximum of 40 hours of sick leave per calendar year. Employees who work for employers with less than 10 employees and who do not work in the aforementioned industries will be able to accrue a maximum of 24 hours of sick leave per calendar year." (Morgan Lewis)

Employer Costs for Health Benefits Rise 3% in Year Ending December 2013
"Employer costs for health benefits in private industry increased 3.0 percent from December 2012 to December 2013. In the prior year, the increase was 2.1 percent. The 12-month increases in employer costs for health insurance for private industry workers ranged from 2.1 to 3.0 percent in 2012 and 2013. That compares with increases that ranged from 3.4 to 11.4 percent from 2001 to 2011." (U.S. Bureau of Labor Statistics)

Potential Effects of the ACA on Income Inequality
"The [ACA] will improve the well-being and incomes of Americans in the bottom fifth of the income distribution.... [I]ncomes in the bottom one-fifth of the distribution will increase almost 6%; those in the bottom one-tenth of the distribution will rise more than 7%. These estimated gains represent averages. Most people already have insurance coverage that will be left largely unaffected by reform. Those who gain subsidized insurance will see bigger percentage gains in their income." (The Brookings Institution)

GAO Report: The Range of Base Premiums for Individuals Age 19 and 64 in the Individual Market by State in January 2013 (PDF)
116 pages. Excerpt: "[GAO is] reporting the range of base premiums that were displayed for young adults (age 19), and older adults not yet eligible for Medicare (age 64). For both age categories, we are reporting the range of base premiums displayed for nonsmoking and smoking individuals in each of the 50 states and the District of Columbia on the HealthCare.gov Plan Finder in the month of January 2013.... Because insurers may have established different rates for individuals for a variety of factors, the data represent base premium amounts prior to underwriting, rather than the actual premium amount an individual may have been charged. Actual premium amounts could have been higher than the base rates[.]" (U.S. Government Accountability Office)

Map of Health Insurance Exchange Enrollment by State as of January 31, 2014 (PDF)
"This map provides an update on the federal government's periodic reports of the number of individuals who have selected a health insurance exchange health plan as of December 28, 2013. The map also includes a breakdown of state-based, state-partnership and federally-facilitated exchanges." (Deloitte Center for Health Solutions)

Four Keys to Calculating Full-Time Employees Under ACA
"[1] Add up the low-hanging fruit first.... [2] Decide how you'll track hours for variable-hour or seasonal employees.... [3] Review your plan's eligibility definition.... [4] Assess the potential impact to your company." (HR Benefits Alert)

'In the News' Newsletter by the National Business Group on Health, February 2014
Topics include: [1] Another modest rise for health care costs; [2] Drug shortages still have major impact on patient care; [3] E-cigarettes spark debate; [4] Employers focus on financial wellness; and [5] Health care costs higher for smokers after surgery. (National Business Group on Health)

House Oversight Committee Hearing: 'Why the Need for an Insurance Company Bailout?'
Page includes video of the hearing, with links to testimony by U.S. Senator Marco Rubio of Florida; John C. Goodman, Ph.D., President and CEO National Center for Policy Analysis; Doug Badger, former Senior White House Adviser for Health Policy to President George W. Bush; and Prof. Timothy S. Jost, Washington and Lee University. Written testimony was submitted by America's Health Insurance Plans (AHIP) and the American Academy of Actuaries . (Committee on Oversight and Government Reform, U.S. House of Representatives)

Three Surprising Hazards of Worksite Wellness Programs
"[The author's] belief in the importance and the difficulty of prevention is precisely why ... we must call out poorly-designed programs that prey on well-meaning employers and other purchasers. Those programs apply equal measures of coercion and disparagement toward the people they are supposed to help, and that discredits employer benefits programs and undermines employee loyalty and trust. Employers deserve better for the investment they make in the well-being of their employees." (Leah Binder in Forbes)

Michael Murphy joins Mercer as National Sales and Marketing Leader, Benefits Administration Mercer

Retrofit Names Former Yahoo! and Real Simple Executive Tanya Singer as Vice President of Engagement Retrofit Inc.

Commonwealth Financial Program Is Certified For Fiduciary Excellence Centre for Fiduciary Excellence (CEFEX)

PBGC to Pay Benefits for Constar Inc. Employees Pension Benefit Guaranty Corporation (PBGC)

The Entrust Group Introduces Complimentary Self-Directed IRA Transfers and Rollovers Entrust Group

Schwab Retirement Plan Services Becomes First Major Firm to Launch Full-Service 401(k) Program Based on Exchange-Traded Funds Charles Schwab Corporation

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