PowerNotes: May, 2012

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Congratulations to Brandon Scarborough for being Benefits Selling’s 2012 Broker of the Year
Power Group Consultant Wins Top National Honor

SAN ANTONIO, Texas, May 10, 2012  –PRNewswire – Benefits Selling magazine, published by Summit Business Media, announced today that Brandon Scarborough has been named the 2012 Broker of the Year at the 8th Annual Benefits Selling Expo in San Antonio, Texas. Benefits Selling’s Broker of the Year is one of the industry’s most prestigious awards and identifies brokers and consultants who have influenced the benefits industry in a positive way.

Brandon Scarborough, co-founder of Power Group worksite division and PowerEnroll at Power Group Cos. in Overland Park, Kansas, founded Benefit Design Group, because it allowed him to focus strictly on providing voluntary benefits to low-wage workers employed by nursing homes. Scarborough continued his business until he merged with Power Group Cos. in 2007 when the company wanted him to run a new worksite division. For Scarborough, the appeal of the benefits industry centers on the opportunity to help a wide range of clients. Whether a group is small or large, Scarborough can help that client find a plan that fits best for its unique needs.Read more.  See the VIDEO!

Compliance Exceptions Allowed for Health Benefit Summaries
Issued May 11
Three federal agencies said in guidance issued May 11 that they will not take enforcement action against group health plans and insurance issuers in a number of circumstances for failure to fully comply with requirements for providing a standardized summary of benefits and coverage during the first year of applicability of new rules under the Patient Protection and Affordable Care Act. For example, instead of requiring combined benefit information with respect to a plan that uses two or more issuers to provide various types of coverage, the agencies will allow “multiple partial SBCs that, together, provide all of the relevant information.” The agencies also posted updated versions of an SBC template and a sample completed SBC.

Obesity Increases Worker’s Compensation Costs
Gaining too much weight can be as bad for an employer’s bottom line as it is for a person’s waistline
 
A Duke University Medical Center analysis found that obese workers filed twice the number of workers’ compensation claims, had seven times higher medical costs from those claims and lost 13 times more days of work from work injury or work illness than did non-obese workers.

Workers with higher risk jobs were found to be more likely to file workers’ compensation claims, and obese workers in high-risk jobs incurred the highest costs, both economically and medically.

Although workers’ compensation plans vary from state to state, they all require that employers carry insurance policies to cover their employees should they be injured on the job. The plans can pay for employee medical costs, compensation for loss of current or future wages, or compensation for pain and suffering.

“We all know obesity is bad for the individual, but it isn’t solely a personal medical problem — it spills over into the workplace and has concrete economic costs,” said Truls Ostbye, MD, PhD., professor of community and family medicine. Read More. Read More.
Fees to Fund Patient-Centered Outcomes Research Institute
Insurance Standards Bulletin
Effective for group health plan years ending after Sept. 30, 2012, and before Oct. 1, 2019 (the seven calendar plan years from 2012 through 2018), employers that have self-insured plans and health insurance issuers that offer insured plans and policies must pay annual fees to fund the Patient-Centered Outcomes Research Institute, a nonprofit corporation established by PPACA. The Institute compares and evaluates the clinical effectiveness of medical procedures, services, and treatments to help individuals and health care providers make informed health care decisions.

Fees must be paid by employers that sponsor self-insured plans and issuers of insured group health plans, such as commercial insurance companies. Fees do not apply to excepted benefit plans, such as vision-only, dental-only, disability income, long-term care, nursing home care, and other limited scope benefit plans.

Employers and issues calculate PCORI fees by multiplying the average number of lives covered under plans by the applicable dollar amount which is:

• $1 for plan years ending on or after Oct. 1, 2012, and before Oct. 1, 2013; and
• $2 for plan years ending on or after Oct. 1, 2013, and before Oct. 1, 2014.  Read More.

It’s a mod, mod, mod, mod world:
Split plan creates chance to reduce premiums
Assessing experience ratings is about to change in most states. Contrary to what many employers believe, they can control their premiums by controlling their experience modifications, according to a veteran experience rating analyst. The experience modification factor, or ex-mod, represents a company’s payroll and losses and is used in most states to determine workers’ comp premiums. A higher mod results in higher premiums. Companies that understand how their ex-mods are calculated stand a better chance of lowering their workers’ comp premiums, especially with the upcoming changes to the so-called split plan.Read More.

IRS Issues Proposed Regulations on Research Fees
The Affordable Care Act
The Affordable Care Act (ACA) created the Patient-Centered Outcomes Research Institute (Institute) to help patients, clinicians, payers and the public make informed health decisions by advancing comparative effectiveness research. The Institute’s research is to be funded, in part, by fees paid by health insurance issuers and sponsors of self-insured health plans.

On April 17, 2012, the Internal Revenue Service (IRS) issued proposed regulations on the research fees. The proposed regulations address many important details regarding which health insurance issuers and plan sponsors are subject to the fees and how the fees are calculated and paid. Comments on the proposed regulations are due by July 16, 2012.

Although the proposed regulations are not final, issuers and plan sponsors may rely on the guidance provided in the proposed regulations pending the IRS’s issuance of final regulations. If future IRS guidance on the research fees is more restrictive than the proposed regulations, the future guidance will not be applied retroactively.

This Power Group Companies Legislative Brief provides an overview of the research fees to be paid by health insurance issuers and sponsors of self-insured plans under ACA, including the guidance provided in the proposed regulations.Read More.

The Workers Compensation Audit:
How Employers Should Prepare
The annual premium audit determines your company’s actual Workers’ Compensation insurance premium for the policy period, as opposed to the estimated premium originally used on the policy. Sometimes there can be dramatic changes in premium based on audit results, and not at all of these changes are welcomed by insured employers. Often these unwelcome changes are not truly correct and legitimate, per the rules that govern Workers’ Compensation insurance. (AKA Workman’s Comp.) Read More.

STATE COMPLIANCE ALERTS:
ARIZONA
New-Hire Procedures—Effective on the 91st day after adjournment of the Arizona State Fiftieth Legislature’s second regular session, the new-hire reporting requirements are revised to comply with new federal requirements that add a new data element for new-hire reports for the date on which new hires first perform paid services.
CALIFORNIA
Meal and Rest Breaks—On April 12, the California Supreme Court ruled that employers must relieve nonexempt employees of all duties during legally required meal breaks, but employers are not required to ensure that such employees do not perform any work during that time (Brinker Rest. Corp. v. Superior Court, Calif., No. S166350, 4/12/12).
DISTRICT OF COLUMBIA
Equal Employment Opportunity—Under provisions that are expected to be effective May 23, 2012, employers cannot fail or refuse to consider for employment or fail or refuse to hire applicants who are unemployed. Employers also cannot publish job vacancy advertisements or announcements that include provisions that disqualify unemployed persons from consideration for such jobs.
EEO Enforcement—Under provisions that are expected to be effective May 23, 2012, the retaliation prohibition, administration/enforcement, and penalties/remedies provisions are revised regarding the employment status discrimination prohibitions.
DELAWARE
Health Benefit Mandates—Effective for insured group health plans issued, renewed, or amended on or after Jan. 1, 2013, plans that provide coverage for prescription drugs and anti-cancer medications must provide coverage for orally administered prescription anti-cancer medications and comply with certain cost-sharing requirements.
GEORGIA
Unemployment Insurance—Effective Jan. 1, 2013, the taxable wage base is $9,500.
MAINE
Unemployment Insurance—Effective July 17, 2012, former employees who are disqualified for a third falsification or misrepresentation to obtain benefits can be penalized 100 percent of the benefits wrongfully obtained.
MARYLAND
Deductions From Wages—Effective June 1, 2012, employers that have a wage deduction program for collecting employees’ voluntary contributions to campaign finance entities must include employees’ addresses when transmitting contributions.
Personal Information Protection—Effective Oct. 1, 2012, employers cannot ask or require employees and applicants to disclose usernames, passwords, or other means for accessing personal accounts or services through electronic communications devices. Employers also cannot retaliate against employees and applicants for refusing to comply with such requests or requirements.
Unemployment Insurance—Effective Oct. 1, 2012, former employees who leave employment to prevent themselves, their spouses, minor children, or parents from becoming domestic violence victims are not disqualified from receiving benefits.
Workers’ Compensation—Effective July 1, 2012, certain amounts payable under settlement agreements are exempt from second-injury assessments.
MINNESOTA
Unemployment Insurance—Effective July 1, 2013, employers’ accounts are charged for overpaid benefits and such benefits can apply to future tax rates if employers or their agents do not timely or adequately respond to requests for benefit claim information from the Minnesota Department of Employment and Economic Development.
MISSISSIPPI
Unemployment Insurance—Effective July 1, 2012, certain direct sellers are exempt from coverage under Mississippi’s unemployment insurance law.
NEW YORK
Health Benefit Exchange—Effective April 12, 2012, eligible individuals can enroll in health insurance coverage and certain small employers can claim tax credits through the New York Health Benefit Exchange when the exchange becomes operational.
Income Tax Withholding—Effective July 1, 2012, to Sept. 30, 2012, the late payment interest rate is 7.5 percent.
OKLAHOMA
Health Care Continuation Coverage—Effective Nov. 1, 2012, employers that are covered by Oklahoma’s health care continuation coverage law must permit employees, their spouses, and employees’ dependents to elect to continue group policy coverage when coverage terminates for any reason except employees’ employment termination for gross misconduct or termination of group policies. In addition, continuation coverage notification and election requirements are revised.
RHODE ISLAND
New-Hire Procedures—Effective April 13, 2012, the new-hire reporting requirements are revised to comply with new federal requirements that define “newly hired employees.”
TENNESSEE
Military Leave—Effective April 23, 2012, the military leave provisions are revised.
UTAH
New-Hire Procedures—Effective July 1, 2012, the new-hire reporting requirements are revised to comply with new federal requirements that define new hires, including rehires, and add a new data element for new-hire reports for the date on which new hires first perform paid services. In addition, the filing deadline requirements are revised.
WEST VIRGINIA
Wireless Communications Devices Use—Effective June 8, 2012, drivers, including employees of private-sector employers who drive as part of their job duties, cannot use hand-held wireless communications devices while driving on public streets or highways in West Virginia.
WISCONSIN
Unemployment Insurance—Effective April 22, 2012, certain provisions relating to claimant disqualification for unemployment insurance benefits are revised.

IN CASE YOU MISSED IT:
State Compliance Alerts from April: Read more about the Department of Labor Model CHIP Notice. EEOC Issues Final Regulation Under Federal Age Discrimination Law  Read more.