As background, under PPACA, employers are required to report the aggregate cost of applicable employer-sponsored group health plan coverage on each employee’s Form W-2. The employer must report the cost of coverage on a calendar year basis, regardless of the plan year used for the health plan. The reporting is intended for informational purposes for the employee (to provide employees with the cost of their health care coverage). The W-2 reporting requirement does not cause the cost of such coverage to be included in the employee’s income or otherwise become subject to federal taxation.

 The reporting requirement will first apply with respect to coverage provided in 2012. This means that most employers must begin reporting the costs of employees’ health coverage for 2012 and report that value on the Form W-2, which generally will be provided to employees in January 2013.

Clarifications to Previous Guidance

Small Employer: Employers required to file fewer than 250 Forms W-2 for the preceding plan year are exempt from the reporting requirement for 2012 Forms W-2. For this purpose, Notice 2012-9 clarified that the limit of 250 includes Forms W-2 filed by an employer’s agent under IRC § 3504. For example, if an employer would have filed 300 Forms W-2 in 2011 had it not used an agent, that employer would be subject to the reporting requirement for 2012. (Q&A 3)

Federally Recognized Indian Tribes: Federally recognized Indian tribal governments are exempt from the reporting requirement. The notice expands this exemption to cover tribally chartered corporations wholly owned by federally recognized Indian tribal governments. (Q&A 3)

Health FSA Reporting: The notice clarifies that the amount of a health FSA is not required to be included in the aggregate reportable cost reported on Form W-2 if the amount of the health FSA is funded only through employee salary contributions. (Q&A 19)

Dental and Vision Plan Reporting: The notice also clarifies that the cost of coverage under a dental or vision plan is not included in the aggregate reportable cost if the plan satisfies the requirements for being a HIPAA-excepted benefit. (Q&A-20)

105(h) Clarification and S Corporations: The notice modifies the guidance on excess reimbursements to clarify that the aggregate reportable cost does not include excess reimbursements of highly compensated individuals that are included in income, because a self-funded plan violates the nondiscrimination rules in IRC § 105(h). In addition, a similar rule applies to coverage provided to 2 percent shareholder-employees of S corporations. (Q&A 23)

Multiple Employers: Notice 2012-9 clarifies that if related employers employ the same employee, but do not use a common paymaster, the employers may either report the total aggregate on a single W-2 or allocate the cost between the employers and report the divided cost on separate Forms W-2. (Q&A 7)

Use of Composite Rates: The notice clarifies that an employer who uses a composite rate for active employees but not for COBRA beneficiaries may use either rate for determining the applicable cost to be reported, as long as it is used consistently. (Q&A 28)

New Guidance

Employee Assistance Program (EAP), Wellness Program or On-site Medical Clinic: Coverage provided under an EAP, wellness program or on-site medical clinic is not required to be reported if the employer does not charge a premium for the cost of this coverage to COBRA beneficiaries. On the other hand, if a COBRA premium is charged, then the employer must report the value of the coverage. An employer who is not subject to any federal continuation coverage requirements (such as ERISA or the Public Health Service Act) is not required to include the cost of coverage under an EAP. (Q&A 32)

Reporting Benefits Exempted Under Interim Relief: An employer may include in the aggregate reportable cost the cost of coverage that is not required to be included in the aggregate reportable cost under applicable interim relief, including coverage under an HRA, a multiemployer plan, an EAP, a wellness program or an on-site medical clinic, provided such coverage is calculated using a permissible method as outlined in the notice, and is applicable employer-sponsored coverage. (Q&A 33)

Reporting Methods When Program Includes Non-Covered Benefits: For a program where an employee receives benefits that constitute applicable employer-sponsored coverage as well as benefits that do not constitute applicable employer-sponsored coverage (such as long-term disability), an employer may use any reasonable method to determine the cost of the portion of the program providing applicable employer-sponsored coverage. (Q&A 34)

Retroactive Changes to Coverage After Year-end: The notice provides that the aggregate reportable cost for a calendar year may be based on information available to the employer as of Dec. 31 of that year, without regard to any election or notification made after such date that retroactively affects coverage. Therefore, any election or notification that is made or provided in the subsequent calendar year that has a retroactive effect on coverage in the earlier year is not required to be included in the calculation of the aggregate reportable cost for the calendar year. (Q&A 35)

Coverage Covering Two Reporting Years: New guidance is provided concerning how to report the cost of coverage that spans two taxable years. Where a coverage period extends beyond Dec. 31 of a reporting year, the employer has the option to:

• Treat the coverage as provided under the calendar year that includes Dec. 31;
• Treat the coverage as provided during the calendar year immediately subsequent to the calendar year that includes Dec. 31; or
• Allocate the cost of coverage for the coverage period between each of the two calendar years under any reasonable allocation method, which generally should relate to the number of days in the period of coverage that fall within each of the two calendar years.

Whichever method the employer decides to use must be applied consistently to all employees. (Q&A 36)

Hospital Indemnity/Specific Disease Coverage: The notice provides that the exclusion from applicable employer-sponsored coverage for hospital indemnity plans, fixed indemnity insurance and coverage for a specific disease does not apply if the employer makes any contribution to the cost of coverage that is excludable from income, or if the employee purchases the policy on a pre-tax basis under a cafeteria plan. On the other hand, the cost of coverage for hospital indemnity plans, fixed indemnity insurance and coverage for a specific disease is not required to be included if the benefit is offered as an independent, noncoordinated benefit and is paid for with after-tax dollars or is includible in gross income. (Q&A 37 38)

Third-party Sick Pay Providers: Generally, a third-party provider that makes payments of sick pay to employees on the employer’s behalf has no responsibility for reporting such payments on a W-2. However, a Form W-2 furnished by an employer must include the aggregate reportable cost even if that Form W-2 includes sick pay or if a third-party provider is furnishing a separate Form W-2 reporting the sick pay. (Q&A 39)

IRS Notice 2012-9

On Dec. 16, 2011, HHS released a “pre-rule” bulletin to provide information and solicit comments on the regulatory approach that HHS plans to propose to define essential health benefits (EHB) under PPACA, § 1302(b). Non-grandfathered plans in the individual and small group markets inside and outside of the exchanges must cover EHB beginning in 2014. Section 1302(b)(1) provides that EHB include items and services within the following 10 benefit categories:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care

Under HHS’ intended approach as announced in the bulletin, states would have the flexibility to select an existing health plan to set the benchmark for the items and services included in the EHB package. States would choose one of the following health insurance plans as a benchmark:

• One of the three largest small group plans in the state
• One of the three largest state employee health plans
• One of the three largest federal employee health plan options
• The largest HMO plan offered in the state’s commercial market

To meet the EHB coverage standard, HHS intends to require that a health plan offer benefits that are “substantially equal” to the benchmark plan selected by the state and modified as necessary to reflect the 10 coverage categories.

The bulletin addresses only the services and items covered by a health plan, not the cost sharing, such as deductibles, copayments and coinsurance, which will be addressed in future bulletins. Final rules are expected to be issued sometime next year. HHS is accepting comments on the proposal, which are due by Jan 31, 2012, and may be sent to EssentialHealthBenefits@cms.hhs.gov.

Essential Health Benefits Bulletin

Fact Sheet

IRS Releases Fall Edition of Retirement News for Employers

On Nov. 23, 2011, the IRS released the fall 2011 edition of Retirement News for Employers, as well as FAQs on Form 8955-SSA reporting. The newsletter contains a number of articles, citations and links related to retirement plans, including:

• “Paying Retirement Plan Benefits”: Distribution methods depend on the plan, participant and beneficiary elections
• “Maximize Your Retirement Savings in 2012″: Making salary deferral contributions
• “SEPs and SIMPLEs”: Amendment procedures and contribution limits
• “Disaster Relief for Retirement Plans and IRAs”
• “Priorities for the Current Fiscal Year”: From the IRS exam director
• Webinars available
• Revised Forms, including Form 5300, 5558 and 8955-SSA
• Recurring Columns, including “Mark Your Calendar” and “DOL News”

Click here to view the newsletter

FAQs on Combined Form 8955-SSA Reporting for 2009 and 2010

FAQs on Large Form 8955-SSA Filings

On Dec. 5, 2011, the Colorado Department of Labor and Employment (DLE) issued a press release relating to a partnership with the DOL aimed at reducing misclassification of employees as independent contractors. The press release announces that the DOL and the Colorado DLE recently signed a memorandum of understanding on such misclassification, and that the two entities will embark on new efforts to protect the rights of employees by reducing the practice of misclassifying employees. According to the press release, the memorandum of understanding arose as part of the DOL Misclassification Initiative. Ten other states have also signed such memorandums, including Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Missouri, Montana, Utah and Washington. Employers should be aware of the increased attention given to the misclassification issue by the DOL and by state agencies.

Colorado DLE Press Release

DOL Misclassification Web Page

IRS Announces 2012 Standard Mileage Rates

On Dec. 9, 2011, the IRS announced in IRS Notice 2012-1 the 2012 optional standard mileage rates that employees, self-employed individuals and other taxpayers may use to calculate deductible costs of operating automobiles (including vans, pickups and panel trucks) for business, medical, moving and charitable purposes.

Beginning on Jan. 1, 2012, the standard mileage rates for cars, vans, pickups or panel trucks will be:

• 55.5 cents per mile for business miles driven (unchanged from the midyear adjustment that became effective on July 1, 2011)
• 23 cents per mile driven for medical or moving purposes (a 0.5-cent decrease from the rate of 23.5 cents that was in effect for the last six months of 2011)
• 14 cents per mile driven in service of charitable organizations (unchanged from the midyear adjustment that became effective on July 1, 2011)

IRS Notice 2012-1 contains the standard mileage rates, the amount a taxpayer must use in calculating reductions to the basis for depreciation taken under the business standard mileage rate, and the maximum standard automobile cost that a taxpayer may use in computing the allowance under a fixed and variable rate plan. Additional information about using the standard mileage rate may be found in Revenue Procedure 2010-51.

Finally, use of the standard mileage rate is not mandatory, and taxpayers always have the option of calculating the actual costs of using a vehicle rather than using the standard mileage rates.

IRS Notice 2012-1

Revenue Procedure 2010-51

Press Release

The DOL, HHS and IRS issued a new set of FAQs addressing PPACA’s summary of benefits and coverage (SBC) requirement, plus mental health parity implementation. The first section of the FAQs addresses the timing of the application of the SBC requirement, since an applicability date beginning March 23, 2012, was initially proposed, but final regulations on the SBC requirement have not yet been issued. The FAQ clarifies that since final regulations have not yet been issued on the SBC requirements, plans and issuers are not yet required to comply. The FAQ notes that it is anticipated that the departments’ final regulations, once issued, will include an applicability date that gives group health plans and health insurance issuers sufficient time to comply.

The second section of the FAQs answers a number of questions regarding the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), focusing primarily on providing clarification regarding nonquantitative treatment limitations, such as medical management standards limiting or excluding benefits based on medical necessity. As background, under the MHPAEA, generally the processes, strategies, evidentiary standards or other factors used in applying any nonquantitative treatment limitations with respect to mental health or substance use disorder benefits must be comparable to, and applied no more stringently than, the processes, strategies, evidentiary standards or other factors used in applying the limitation with respect to medical/surgical benefits. There have been many questions surrounding how to apply nonquantitative treatment limitations, in part because the parity standard for nonquantitative treatment limitations is not expressed numerically. The FAQs answer a number of questions in an attempt to provide clarification in this area.

The MHPAEA section of the FAQs also addresses a common question regarding whether a group health plan is always limited in the amount that it may charge for all mental health/substance use disorder providers to the same rate as medical/surgical generalists. The FAQ answers that group health plans are not always limited in this regard, noting that the standard for determining the maximum copayment that can be applied to mental health/substance use disorder benefits is determined by the predominant copayment that applies to substantially all medical/surgical benefits within a classification. Therefore, if the copayment that meets this standard is the one charged for a medical/surgical specialist, that copayment can be charged for all mental health/substance use disorder benefits within that classification. On the other hand, if the copayment that meets this standard is the one charged for a medical/surgical generalist, then that is the copayment that can be charged to all mental health/substance use disorder benefits within that classification.

FAQs

Treasury Report Finds Few Claimants Using Small Business Tax Credit

The Treasury’s Inspector General for Tax Administration released a report regarding the utilization of the Small Business Health Care Tax Credit, showing the volume of claims has thus far been much lower than originally anticipated. In general, the credit is available only to small employers who pay at least half the cost of health insurance coverage for their employees, and was designed, in large part, to encourage small employers to offer health care insurance.

According to the report, as of mid-May 2011, the IRS reported that slightly more than 228,000 taxpayers had claimed the credit, for a total of more than $278 million, substantially lower than the up to $2 billion the Congressional Budget Office estimated taxpayers would claim. The report cites a number of reasons for the low utilization rate, including the complexity of the legislation and the process for claiming the credit.

Report

 Additional Information About the Credit

The most common image of bullying brings to mind a big kid picking on a smaller kid on a playground. In reality, however, the act of bullying isn’t limited to interactions between children. Bullying can occur between people of any age and in any environment, including the workplace.

At times, it can be difficult to differentiate between workplace bullying and an isolated incident that might otherwise be categorized as an office disagreement between employees. Human resource professionals must listen carefully to the details of a complaint and identify legitimate claims. Consider this example of a complaint in a traditional office setting:

Bill, an account executive employed by your company, comes to you in confidence to report that he has been having continuing problems with an account executive named Frank, who works in the same department. Bill explains how Frank interrupts him constantly in departmental meetings and that he disagrees with every idea Bill presents to the group. In fact, Bill tells you, Frank rolls his eyes when Bill speaks.

According to Bill, this behavior isn’t limited to internal interaction. He reports that Frank hassles him during meetings at client sites and in front of business prospects. Frank dominates the conversations in such meetings and blocks any opportunity Bill might have to offer input. Worse, Bill notes, Frank frequently addresses him publicly as “Little Billy” or “Billy Bob,” and now other members of the staff are following his lead.

As a result, Bill says he has a hard time sleeping at night because not only does he feel frustrated and degraded, he can’t help but replay the events of each day and all of Frank’s hassling over and over in his head. He says he constantly worries about what he should have said to Frank in response to his behavior toward him.

Bill notes that he recently tried to address these issues with Frank. It didn’t go well. He says Frank yelled at him and told him to stop being so emotional. Since then, Bill has tried to ignore Frank’s comments, but he admits he has had enough. He says he is sick and tired of being picked on every day.

Is Frank bullying Bill? And, if so, what do you need to do?

Defining Workplace Bullying

The Workplace Bullying Institute (WBI) defines “workplace bullying” as “repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators that take one or more of the following forms”:

• Verbal abuse.
• Offensive conduct or behaviors, including nonverbal, that are threatening, humiliating or intimidating.
• Work interference-sabotage-that prevents work from getting done.

Among other things, this definition could encompass such actions as having work product criticized constantly, yelling, being reminded constantly of past mistakes, spreading rumors or lies and being avoided or excluded intentionally.

When evaluating complaints like the one made by Bill, it’s important to look at the big picture, or in legal terms, the totality of the circumstances. Repeated mistreatment is a key element of the WBI definition of workplace bullying. Bullying isn’t a one-time altercation. Rather, it is persistent harassment or abuse. Another key element of the definition is that the mistreatment must cause harm to the target’s health. Based on the scenario detailed by Bill, you might have an office bully on your hands.

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Standard Guides Organizations in Preventing Workplace Violence

Employers looking to implement policies and practices that help them prevent workplace violence and intervene more quickly when it does happen have a new standard to guide them.

The Society for Human Resource Management (SHRM) and ASIS International-formerly the American Society for Industrial Security-issued a joint Workplace Violence Prevention and Intervention American National Standardin October 2011.

It is designed to help organizations evaluate their practices and develop or enhance programs aimed at workplace violence. It defines the recommended scope of an organization’s efforts to prevent and manage workplace violence; describes the key stakeholders within an organization who will be responsible for this issue; delineates the components of a workplace violence prevention and intervention program; outlines intervention techniques, and addresses post-incident issues, according to SHRM and ASIS.

“HR and the security communities have created an enduring and comprehensive approach for business professionals to manage the risk of violence and to better assure the safety of employees,” said Lee S. Webster, SPHR, GPHR, who is SHRM’s director of HR standards.

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The IRS’ Employee Plans Compliance Unit (EPCU) has begun to implement the “Form 5500 Non-Filer Project,” which is designed to contact plan sponsors who are required to file either Form 5500 or 5500-SF with the DOL, or Form 5500-EZ with the IRS, but who have not filed these forms for plan years ending in 2010 or later.

If the plan sponsor is required to file Form 5500 but does not, the IRS will send the sponsor a delinquency notice asking for a response within 30 days. If a response is not received, the IRS will send a subsequent notice requesting a response within 30 days.

In terms of late filing penalties, there is an IRS penalty for filing a Form 5500 late of $25 per day until filed, up to a maximum of $15,000. The DOL may also assess civil penalties for the late filing of the same Form 5500 of up to $1,100 per day, with no maximum. The EPCU does not evaluate “reasonable cause” explanations it receives during a nonfiler compliance check. However, the IRS and DOL may reduce penalties if there were mitigating circumstances or conditions that adversely affected the plan’s ability to file a return. If a plan sponsor has not filed Form 5500, but is required to, there may be an opportunity to reduce DOL penalties under the DOL’s Delinquent Filer Voluntary Compliance Program.

Additional Information

Health Coverage Tax Credit Amended

President Obama signed the Trade Adjustment Assistance Extension Act of 2011, which generally reauthorizes the Trade Adjustment Assistance (TAA) program through Dec. 31, 2013. The legislation increases the health coverage tax credit (HCTC) to 72.5 percent of the health insurance premiums of certain eligible individuals and their qualifying family members for eligible coverage months beginning after Feb. 12, 2011. This is an increase from the 65 percent credit that had been in effect since the expiration of the 80 percent credit put in place under the American Recovery and Reinvestment Act (ARRA).

The HCTC is generally available to eligible individuals under the TAA and Alternative Trade Adjustment Assistance programs, which assist individuals who have become unemployed as a result of increased imports from, or shifts in production to, foreign countries, and to retirees receiving certain pension benefits, who have lost their employer-sponsored health coverage. Employers should keep in mind, though, that the HCTC applies in limited circumstances and should not be confused with the 65 percent COBRA premium subsidy under the ARRA, which was not extended by this legislation.

Additional Information

Facebook, the U.S. Department of Labor and the National Association of Colleges and Employers (NACE) are among organizations joining forces to create a Social Jobs Partnership to facilitate employment for America’s jobless through the use of social networks.

According to a survey by NACE, more than 70 percent of college career centers have a Facebook page. In addition, a poll conducted in 2010 by recruiting technology vendor Jobvite showed that 92 percent of respondents have recruited or plan to recruit via social networks.

“Facebook is about connecting people so that they can share what’s important to them, and that is the driving force behind the Social Jobs Partnership,” said Marne Levine, Facebook vice president of global public policy. “We’ve brought employers, recruiters, college career services and government agencies together to help the millions of Americans who use Facebook [to] find jobs.”

“Given the current economy and its impact on the job market for college students, the National Association of Colleges and Employers is pleased to be a part of the Social Jobs Partnership,” said NACE executive director Marilyn Mackes in a statement. “NACE’s thousands of college career center and employer members are at the center of the growing social media phenomenon as they interact directly with student and alumni users of social media. This new coalition will connect a great team of organizations in meeting a critical need for strengthening national employment resources with social media.”

Several Initiatives Planned

The partnership reportedly will pursue a number of initiatives designed to leverage social networks in the job market more effectively. Among them:

Launch a central page on Facebook, facebook.com/socialjobs, that features resources and content designed to help job seekers and employers.

Public service announcements will be featured on Facebook to promote the page in the 10 states with the highest unemployment rates and in Puerto Rico, which has an unemployment rate of 16 percent.

Conduct in-depth survey research about the ways in which job seekers, college career centers and workforce recruiters are using the social web.

Explore and develop systems where new job postings can be delivered virally through the Facebook site at no charge.

Promote government programs and resources for job hunters.

Distribute educational materials about leveraging the power of the social web to recruiters, government agencies and job seekers.

“Linking American job seekers with the resources they need to get back to work is a top priority of the Obama administration and my department,” said U.S. Secretary of Labor Hilda L. Solis in a statement. “By leveraging the power of the social web, this initiative will provide immediate, meaningful and ready-to-use information for job seekers and employers and a modern platform to better connect them.”

1st Century Social Engineering Called Huge Threat to Corporations

The e-mail from Bob Smith was very conversational:

It was great playing racquetball with you at the club Saturday. I guess we’ll need to schedule a rematch since you beat me by 22 points. I was thinking about that report you asked me for, so I’ve attached it. Again, let’s set up that rematch real soon! – Bob Smith.

There’s just one problem. While the receiver remembers the racquetball game (he won after all), he doesn’t recall asking Bob for a report. He’s wondering, too, why Bob is writing him from an e-mail address he doesn’t recognize.

These are two red flags the receiver picks up on, but he ignores them and clicks the link in the e-mail anyway.

This is just one form of social engineering-called phishing. Hackers use trust in an attempt to fool employees into opening e-mails or clicking links that could install viruses or malware onto company computers.

Here’s another scenario:

A stranger walks into an office filled with cubicles and approaches an accountant’s desk. The accountant has never seen him before, but he is well dressed, has a clip board in one hand and is wearing a fake company badge.

“I’m here to make your computer run faster,” he tells the accountant, a young woman. She brightens up, swivels her chair away from her work station and thanks the hacker as he inserts a thumb drive and uploads a virus.

Today, data security experts say, the first scenario is far likelier than the latter one-after all, it’s relatively easier to get an unsuspecting person to click on a link in a spoofed e-mail, on Twitter or on a Facebook page promising to show photos of Osama bin Laden’s mangled body.

What HR Should Know

Employees can combat such tactics-if they remain observant.

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When a covered employee is terminated for gross misconduct, there is no qualifying event for the covered employee, or for the employee’s spouse or dependent children. This means that the covered employee is not entitled to a COBRA election. However, the regulations do not define the term “gross misconduct”; therefore, case law can provide some direction in this regard.

In Berry v. Frank’s Auto Body Carstar, Inc., 2011 WL 4360075 (S.D. Ohio 2011), the U.S. District Court for the Southern District of Ohio considered whether employee conduct met the definition of “gross misconduct” for purposes of COBRA.

The employee in this case was terminated after an altercation with another employee. The employee maintained that the employer terminated him in retaliation for his son’s large health insurance claims. The employer, on the other hand, claimed that the employee was terminated due to a threatening argument with a co-worker.

The court noted that case law has generally defined gross misconduct as conduct so outrageous that it shocks the conscience, or as misconduct that is “intentional, wanton, willful, deliberate, reckless or in deliberate indifference to an employer’s interest.” Therefore, the court concluded that screaming profanities at another employee, making hand gestures toward the employee, saying the employee would “get hers” and generally appearing out of control was conduct so manifestly outrageous and extreme as to constitute gross misconduct. Because there was no qualifying event, the court held that the employee, his spouse and his children were not entitled to a COBRA election notice.

While this case held that these facts rose to the level of “gross misconduct,” because there is not a definition of gross misconduct in the regulations, and employees who are denied COBRA rights may pursue costly litigation, employers should continue to exercise extreme caution in denying COBRA election rights due to “gross misconduct.”

Berry v. Frank’s Auto Body Carstar, Inc.

Social Security Administration Announces Increases for 2012

On Oct. 19, 2011, the Social Security Administration (SSA) announced that monthly Social Security and supplemental security income (SSI) benefits will increase 3.6 percent in 2012, based on a cost-of-living adjustment (COLA). The 3.6 percent COLA will begin with the January 2012 benefit payments, and increased payments for SSI beneficiaries will begin on Dec. 30, 2011. According to the SSA, the purpose of the COLA is to ensure that the purchasing power of Social Security and SSI benefits is not eroded by inflation.

In addition to the 3.6 percent COLA, the maximum amount of earnings subject to the Social Security tax (also sometimes called the taxable maximum) will increase from $106,800 to $110,100 for 2012. Employers should review their payroll practices to ensure that the increased taxable maximum is appropriately applied for 2012.

SSA Press Release

COLA Information for 2012

Everyone’s heard it a million times – eating nutritious and being physically active is the key to maintaining a healthy weight. Yet, we’re all seeking the next fad diet that will somehow help us lose weight and stay fit by watching Grey’s Anatomy marathons and eating chips and dip, cookies, and ice cream. Right? Unfortunately and fortunately, our bodies don’t work like that. A nutrient-filled diet keeps us from illness and disease, improves mental functioning, enhances mood, and gives us energy. Exercise is important for very similar reasons.

On the subject of dieting, every person has a different ideal weight and a different basal metabolic rate (BMR). A person’s BMR is influenced by several factors, including: age, gender, current weight, activity level, muscle-to-fat ratio, and heredity. Personal BMR also changes as these variables change.

The way our bodies regulate the balance of caloric intake and energy expenditure is quite amazing. Each year, a typical adult consumes about 900,000 to 1 million calories. If you subtract the amount of calories one generally expends in a given year from this amount, you are left with a difference of 1% or less. This means that most people could make the long-term, healthy changes they want by merely taking a 15 minute walk each day or eating a few bites less at each meal (both equal to about 100 less calories that get stored as fat per day). This could be a great key-point to remember this holiday season. Enjoy your favorite foods, but don’t take that extra helping, or opt for a brisk walk after dinner each night. Making these small, consistent changes over a long period of time is what will make a difference. According to the “set-point hypothesis”, everyone has a body weight “thermostat” that adjusts our metabolism and eating to maintain weight. Starvation often results in a plateau over time as the BMR lowers to accommodate the minimal caloric intake. Short periods of overeating, like around the holidays, cause an increase in fat cells (adipocytes), which tends to increase feelings of hunger in the lateral hypothalamus. Also, when a person decides they want to lose that weight, the depleted fat cells actually arouse hunger and the body is confused as it tries to replenish the adipocytes. Furthermore, weight cycling (pattern of repeated weight gain and loss) is unhealthy and hinders the body’s goal of homeostasis.

The concept of the food pyramid has been hammered into our heads since grade school. There is good reason for this. For example, in several heart studies, its been found that poor nutrition is a leading factor of heart disease. A diet rich in fruits, vegetables, and lean meats is ideal. In addition, limiting fats and sugars, avoiding saturated fats, and eliminating trans fats is the other part of the nutrition equation. Consuming more of the good and less of the bad makes it so the body has the nutrients it needs to protect and repair itself; plus, proper nutrition gives the body sufficient energy to live well each day. In fact, our body needs 46 nutrients to remain healthy. Thus, paying attention to the Food Guide Pyramid is important to ensure we receive these 46 nutrients on a regular basis. (Visit the link above to get a calculated estimate of the daily needs!)

Many people get the idea that carbs are bad. This is not necessarily true. Its which carbohydrates you eat that make the difference. The Glycemic Index (GI) is a tool that rates carbohydrates based on how quickly the body converts them to sugar, from 1 to 100. Foods closer to the 100 mark cause the most rapid rise in blood sugar. This may be appealing due to the surge of energy; however, this energy surge will usually quickly turn to increased fat storage, lethargy, and even more hunger! Foods that rate lower on the GI take longer to convert to sugar, resulting in a more constant state of blood sugar and energy– which is when the body performs at its best. These foods lower on the GI are lower in calories and fats, rich in fiber, nutrient-packed, and often contain antioxidants. So, take a look at a Glycemic Index and be sure to add the lower rated items to your next grocery list!

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“Food & Fitness: Build a Healthy Lifestyle”

The ABC’s of Good Nutrition

Aim for fitness.

Build a healthy base.

Choose sensibly.

National Nutrition Month® (NNM) is a nutrition education and information campaign sponsored annually by the American Dietetic Association (ADA) and its Foundation. The campaign is designed to focus attention on the importance of making informed food choices and developing sound eating and physical activity habits.

Food & Fitness: Build a Healthy Lifestyle” reinforces the importance of nutrition and physical activity as key components of a healthy lifestyle. The slogan communicates the flexibility of nutrition recommendations, dietary guidelines, and the Food Guide Pyramid as the framework for daily food choices that can be personalized to each individual’s food preferences, nutritional needs, health status, and lifestyle.

It is a call to action that challenges Americans to take responsibility for their food, nutrition, and physical activity habits.

What is “fit”? To many people “fitness” relates to physical activity – perhaps a rigorous daily exercise regimen. To some, the term may mean a trim or muscular body or the ability to finish a 10K run. Others may think of fitness simply as being free of disease and other health problems. According to the American Dietetic Association, the true definition of fitness is far broader and more personal. It refers to optimal health and overall well-being. Fitness is your good health – at its very best.

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The Institute of Medicine (IOM), a federal advisory panel, released a 297-page report that set forth the criteria that HHS should use in drafting the requirements relating to PPACA’s essential benefits package. HHS will follow, with final regulations outlining the specific essential benefits requirements likely to be released next spring.

The IOM said HHS must consider both cost and effectiveness of the package, making affordability a key tool in the decision-making process. The report laid out broad goals: “The (package) must be affordable, maximize the number of people with insurance, protect the most vulnerable individuals, promote better care, ensure stewardship of limited financial resources by focusing on high value services of proven effectiveness, promote shared responsibility for improving our health, and address the medical concerns of greatest importance to us all.”

When deciding on benefits, the panel said, HHS should take into account whether they would result in “meaningful improvement in outcomes” and are “supported by a sufficient evidence base.”

The IOM stated that the packages should be defined initially by what is typical in the small employer market, and that only medically necessary services should be covered. The IOM noted a strong preference for evidence-based medicine, excluding experimental treatments. The IOM also recommended that the methodology include an initial determination of the cost target followed by a determination of what services could be purchased within those cost constraints.

The rules will apply to all policies sold to individuals and small businesses within the state exchanges and the private market. We are still waiting to see whether larger employers will be affected by the list of essential benefits in the form of minimum essential coverage. The IOM said that the federal government should allow states that administer their own exchanges to make changes to the list of essential benefits as long as those variations are consistent with PPACA and are as comprehensive as the required benefits list. Under PPACA, states can continue to impose coverage requirements not included in the essential benefits package – but they would be responsible for paying insurers the additional costs for those benefits in policies sold through state exchanges.

The IOM recommended using a structured public process to identify priorities. HHS Secretary Kathleen Sebelius said she will seek public comment before making any decisions.

IOM Report

Colorado Update

On Sept. 29, 2011, the Colorado Division of Insurance issued Bulletin No. B-4.40, and reissued Bulletin No. B-4.31. Bulletin No. B-4.40 is directed toward insurers and other interested parties, and is meant to provide the minimum benefit amount for mammograms. As background, Colorado Revised Statutes (CRS) Section 10-16-104(18)(b)(III)(B) specifies that the minimum benefit amount will be adjusted based on the consumer price index (CPI). The bulletin states that effective Jan. 1, 2012, the minimum benefit amount for mammograms is $103.50.

Reissued Bulletin No. B-4.31 announces the annual maximum benefit amount for early intervention services for 2012. As background, CRS Section 10-16-104(1.3)(b)(II) specifies that the annual maximum benefit amount will be adjusted by the division based on the CPI. The bulletin states that effective Jan. 1, 2012, the maximum benefit amount for early intervention services is $6,249.

Bulletin No. B-4.40

Reissued Bulletin No. B-4.31