Headlines about "Health plan admin - misc"
Gathered from the web by the editors at BenefitsLink.com.
Putting Benefit Plans Out to Bid May Reap Savings
Excerpt: "Scouting for a way to rein in health benefit costs, Florida Power & Light, the state's largest electric utility, decided to start using a more open, competitive bidding process for its health and benefit plans. FPL kicked off its new bidding system in late 2004 and promptly struck gold. By forcing providers of plans for vision, dental and other benefit components to openly compete for its business through an auction-style process where players can see one another's offers, FPL figures it has saved $1.1 million annually in benefit costs." (Workforce Management; free registration required)
Employee Benefits Update, June 2009 (PDF)
The nine-page newsletter presents select compliance deadlines and reminders; retirement plan developments; and, health and welfare plan developments, with comments from Reinhart. (Reinhart Boerner Van Deuren s.c.)
[Guidance Overview] Health Plan Participant's Emotional Distress Charge Preempted by ERISA
Excerpt: "The U.S. District Court for the District of New Hampshire has dismissed an employee's charge that her employer negligently inflicted emotional distress on her by long delays and not responding to her inquiries when processing her medical claims. The court pointed out that both parties agreed that Louise Polley's Harvard Pilgrim Health Care Inc. medical benefits were provided under an Employee Retirement Income Security Act (ERISA) plan. 'ERISA preempts all state laws that 'relate to' employee welfare benefit plans,' Chief Judge Steven J. McAuliffe wrote in the court opinion. He rejected Polley's argument that she was not claiming a loss of benefits, but was asserting that Harvard Pilgrim knew or should have known she was emotionally vulnerable and its handling of her claims would make her condition worse. According to the opinion, Polley sued Harvard Pilgrim in state court for negligent infliction of emotional distress." (PLANSPONSOR.com; free registration required)
Health Care Reform Update as of June 17, 2009
Excerpt: "This is one of a series of regular health care reform updates from Spencer's Benefits Reports. Included are links to items already covered, brief summaries of actions taken by the federal government, recent reports and studies on health care reform, policy statements by major stakeholders, and other recent health care reform activity." (Wolters Kluwer)
[Guidance Overview] Are Stop Loss Carriers Subject to Prompt Pay Statutes?
Excerpt: "Stop loss insurance is frequently the subject of inquiry that borders on the metaphysical. Is it a form of accident and health insurance? Property and casualty insurance? Is it 'reinsurance'? This recent legal opinion from the New York Insurance Department is interesting. It required classification of stop loss insurance in the first instance. The ultimate question was whether stop loss carriers are subject to New York's prompt pay laws." (Roy Harmon III via Health Plan Law)
IRS and DOL Priorities: Spring 2009 Regulatory Agenda
Excerpt: "In the first Semiannual Regulatory Agenda released during the Obama Administration, the Department of Labor and the Internal Revenue Service list their priorities for the coming year." (Deloitte via BenefitsLink.com)
Key Health IT Definition Expected Soon
Excerpt: "The Office of the National Coordinator for Health Information Technology's number-two man, Charles Friedman, told industry members that an official definition of the term 'meaningful use' of health information technology is 'in the works' and they should expect its release 'in the not too distant future.' " (Kaiser Health News)
How Safe Are Your Medical Records?
Excerpt: "Stealing medical data has become more attractive to hackers and identity thieves as banks and individuals have become more sophisticated about protecting credit-building information." (Forbes.com)
How The White House Hopes to Control Health Care Costs
Excerpt: "Senate sources confirm that the president argued in favor of a genuinely major Medicare reform -- a reform that could make Medicare the nation's most important laboratory for health care reforms." (Washington Post; free registration required)
GM Retirees Face An Uncertain Future
Excerpt: "As a last resort, pensions are somewhat guaranteed by the Pension Benefit Guaranty Corp., a federal outfit. Pensions for retirees 65 and older are guaranteed for up to $54,000 a year. Coverage is lower for younger retirees." (BusinessWeek)
[Guidance Overview] Untapped Opportunities for Actuaries in the Health Industry
Excerpt: "In 2006 and 2007, two separate surveys, as well as interviews with actuaries in senior level positions in the health industry, pointed out a significant risk to our profession: actuaries with health actuarial technical skills, and especially those with comprehensive health care knowledge, are in short supply." (Society of Actuaries)
[Guidance Overview] Fiduciary Exception Eclipses ERISA Fiduciary's Claim of Attorney Client Privilege
Excerpt: "This opinion involves consideration of the dimensions of the fiduciary exception to attorney-client and work product privileges. The issue arose in the context of district court review of plaintiffs' objections to a magistrate judge's ruling on a motion to compel." (Attorney Roy F Harmon III in the Health Plan Law blog)
Putting Healthcare Plans Out to Bid Can Reap Savings
Excerpt: "Forcing vendors to aggressively bid against one another in an open, eBay-like platform such as the one that HighRoads operates invariably drives down prices, she says. The trick is to demystify the health plan shopping process and treat it more like a straightforward procurement effort similar to the way companies buy office supplies. The result is usually a reduction in costs, Dustin says." (Workforce.com)
[Guidance Overview] District Court Within Ninth Circuit Holds That Priority Language in Health Plan Overrides Make-Whole Rule
Excerpt: "A recurring issue for health plan subrogators is what language is sufficient to override the make whole rule. On the one hand, Circuits like the Fifth Circuit have held that no particular language is required to overcome the make whole rule. In the Fifth Circuit (and others like it), plan language simply providing for 100% recovery is sufficient. (Clear Direction blog)
[Guidance Overview] Lack Of Due Diligence Resulted In ERISA Fiduciary Liability For Defaulted Loans from Welfare Trust
Excerpt: "This recent Ninth Circuit opinion provides a textbook example of imposition of fiduciary liability based upon imprudent investments. The presentation of the issue is facilitated by the complete absence of any due diligence by the defendant. The United Public Workers ('UPW') is a union that represents employees who work for either governmental employers or in the private sector. The Mutual Aid Fund trust ('MAF') was an employee benefit plan that provided hospitalization and related benefits for participating UPW members, UPW employees, and their dependants. . . ." (Attorney Roy F Harmon III in the Health Plan Law blog)
[Guidance Overview] Allegations Were Insufficient To Assert Equitable Relief In ERISA Reimbursement Case
Excerpt: "After some success in the Sereboff case, attorneys for plan administrators have frequently assumed too much in pursuing reimbursement claims. This case is another example of the risks of that presumption." (Attorney Roy Harmon III in Health Plan Blog)
[Opinion] American Benefits Council Comment Letter to FTC Regarding Protected HITECH Health Information Guidance (PDF)
5 pages. Excerpt: "The American Benefits Council . . . appreciates the opportunity to comment on the Federal Trade Commission's . . . Notice of Proposed Rulemaking and Request for Public Comment . . . , which provide rules for personal health record (PHR) related entities with respect to the security breach notification requirements under the Health Information Technology for Economic and Clinical Health . . . ." (American Benefits Council)
GM Files for Bankruptcy Protection; 17.5% Ownership by VEBA Is Proposed
Excerpt: "Under the proposed restructuring, about 60 percent of the new GM would be owned by the United States, about 12 percent by the governments of Canada and Ontario, 17.5 percent by a union health trust, and 10 percent by the company's current bondholders." (Washington Post; free registration required)
[Guidance Overview] 6th Circuit Says ERISA Does Not Preempt State Laws Preventing Insurers From Including Discretionary Language in Insurance Policies
Excerpt: "Two more courts have concluded that ERISA does not block the enforcement of state laws that prohibit 'discretionary' language in insurance policies issued under ERISA plans. (As background, discretionary language reserves discretion to interpret the plan and is required for an insurer to receive a more favorable standard of review if benefit denials go to court.) In these latest cases, insurers (or their representatives) challenged the state laws on ERISA preemption grounds." (EBIA)
The Massachusetts Commonwealth Health Insurance Connector: Structure and Functions
Excerpt: "This issue brief describes the structure and functions of the Connector, providing a primer to policymakers interested in exploring similar reforms at the state and national level. The authors describe how the Connector works to promote administrative ease, eliminate paperwork, offer portability of coverage, and provide some standardization and choice of plans. National policymakers looking to achieve similar policy goals may find some of the structural components and functions of the Connector to be transferable to a national health reform model, say the authors." (The Commonwealth Fund)
EBSA Semiannual Regulatory Agenda Addresses Mental Health Parity
Excerpt: "The Employee Benefits Security Administration (EBSA) has released its semiannual regulatory agenda, which outlines regulations that have been selected for review or development during the next year, as well as any regulations that have been finalized during the last six months. . . . [Among t]he prerule and proposed rule EBSA agenda items are . . . The review of the plan assets-participant contributions regulation in accordance with section 610 of the Regulatory Flexibility Act; The development of regulatory guidance pursuant to ERISA ?712, as amended by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (P.L. 110-343) . . . ." (Wolters Kluwer)
IRS Semiannual Regulatory Agenda Includes Filing Solution for Schedule SSA
Excerpt: "The IRS has released its semiannual regulatory agenda for Spring 2009, which includes pension and benefit regulations that are currently under development or review." (Wolters Kluwer)
[Guidance Overview] Steps for Ending a Health Plan or Health Benefit Option
Excerpt: "Faced with shrinking workforces, business shutdowns, cash-flow problems or other challenges, some employers are considering trimming health and welfare benefit offerings or terminating a plan altogether. This Update provides a checklist of steps to take when discontinuing a health plan or benefit option for active employees. The checklist focuses on common compliance activities but does not cover every scenario." (Mercer LLC)
[Guidance Overview] DOL Unveils COBRA Appeals Process
Excerpt: "The U.S. Department of Labor has announced the appeal process individuals can use if they are denied a premium subsidy for their group health plan continuation coverage. . . . The appeal process allows applicants who are denied the subsidy to request a review by the Labor Department's Employee Benefits Security Administration (EBSA). Individuals seeking a review must complete the department's appeal form in order to begin the review process. [A]pplicants can submit the completed application online, by mail or fax. [The application is at http://www.dol.gov/ebsa/COBRA/main.html.]" (PLANSPONSOR.com; free registration required)
Management Analysis of Approaches for Expanding Access to Health Care
Excerpt: "Analyses of proposals to expand health coverage generally focus on their programmatic or policy impact. This emphasis is understandable, since many proposals provide only sketchy information about management, and administrative costs represent only a small portion of the total costs of a proposal. Nonetheless, failure to address matters of implementation can result in policies or programs that cost too much or fail to achieve their goals. This project examines the management and administrative issues that are likely to arise as part of efforts to expand health coverage. It is the product of a study panel convened jointly by the National Academy of Public Administration (NAPA) and the National Academy of Social Insurance (NASI). As part of its work, the study panel has published ten working papers . . . ." (National Academy of Social Insurance)
What Does It Cost Physician Practices to Interact with Health Insurance Plans?
Excerpt: "Physicians have long expressed dissatisfaction with the time they and their staffs spend interacting with health plans. However, little information exists about the extent of these interactions. We conducted a national survey on this subject of physicians and practice administrators. Physicians reported spending three hours weekly interacting with plans; nursing and clerical staff spent much larger amounts of time. When time is converted to dollars, we estimate that the national time cost to practices of interactions with plans is at least $23 billion to $31 billion each year." (Health Affairs)
Milliman's Monthly Benefit News and Developments, May 2009 (PDF)
2 pages. The newsletter provides a summary of the previous month's legislative, regulatory, and judicial information on employee benefits. (Milliman)
[Guidance Overview] EEOC Warns Employers about ADA Impact of Health Assessments
Excerpt: "The Equal Employment Opportunity Commission (EEOC) has indicated that requiring workers to undergo a health risk assessment that includes disability questions likely violates the Americans with Disabilities Act (ADA). Peggy R. Mastroianni, EEOC associate legal counsel, asserted in an 'informal discussion letter' that the scenario of undergoing such an assessment as a prerequisite for coverage 'does not appear to be job-related and consistent with business necessity, and therefore would violate the ADA.'" (PLANSPONSOR.com; free registration required)
[Guidance Overview] Towers Perrin Monthly Health & Welfare Regulatory Round-Up, April 2009 (PDF)
9 pages. Excerpt: "The Monthly Regulatory Round-Up is a high-level summary of legal and regulatory developments that occurred during January 2009 that may be relevant to large employers. Developments are sorted according to federal legislative developments, federal regulatory guidance, other developments (e.g., significant litigation, studies, select state law developments)." (Towers Perrin)
From Managed Care to Higher Costs for Patients to Insurer's Provider-Cost-Containment Measures to Provider Backlash
Excerpt: "Insurers have focused on business practices that include delaying payments to providers, 'bundling' several procedures and then reimbursing at a lower rate, and underpayment of services provided outside the network. These newer cost-containment measures have now raised the ire of providers. According to an article written by Maureen Glabman in the February 2009 issue of Managed Care, class-action lawsuits filed by providers against all of the major health plans have nearly tripled from the late nineties to the first five years of this century. According to Glabman, these suits already have resulted in combined, multi-billion dollar settlements-- and there are many similar cases still working their way through the court system. Angry providers, backed up by the American Medical Association (AMA) and state medical societies, are 'empowered as nearly anonymous members of class action lawsuits,' observes Glabman, to try and fight carrier business practices they feel are depriving them of income." (The Century Foundation)
[Guidance Overview] FTC Proposes Health Breach Notification Rule
Excerpt: "Vendors of personal health records and related entities ? although not covered by HIPAA's privacy or security rule ? will soon be required to provide notice to the Federal Trade Commission (FTC) and to affected individuals when personal health records are acquired without the individual's authorization. Personal health records are broadly defined, and include information that relates to the 'payment for the provision of health care' (e.g., a database containing names and credit card information), and the mere fact of having an account with a vendor whose products relate to a particular health condition." (Deloitte via BenefitsLink.com)
[Official Guidance] DOL, HHS Request Nominations for Members of New Children's Health Insurance Program Working Group (PDF)
2 pages. Excerpt: "[T]he Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) . . . directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish a Medicaid, CHIP, and Employer-Sponsored Coverage Coordination Working Group ('the CHIP Working Group'). . . . The purpose of the Working Group shall be to: [d]evelop a model coverage coordination disclosure form for plan administrators of group health plans to complete for purposes of permitting a State to determine the availability and cost-effectiveness of coverage available under group health plans to employees who have family members who are eligible for premium assistance offered under a State plan under titles XIX or XXI of the Social Security Act (the Act) and to allow for coordination of coverage for enrollees of such plans." (U.S. Department of Labor, U.S. Department of Heatlh & Human Services)
Sebelius Clears Senate Hurdle to Get HHS Seat
Excerpt: "Kansas Governor Kathleen Sebelius has won Senate confirmation to serve as the nation's health and human services secretary. The 65-31 vote came after Democrats urged quick action so that Sebelius could get to work leading the federal response to the swine flu outbreak . . . ." (PLANSPONSOR.com; free registration required)
[Guidance Overview] The Imminent New Mandatory Medicare Secondary Payer Reporting Rules (PDF)
5 pages. Excerpt: "We recommend the following steps for each provider of liability or no-fault insurance, workers' compensation programs or insurance, and each person who self-insures such risks, including TPAs: Become familiar with the MMSEA reporting requirements. Determine whether you are a Responsible Reporting Entity. Design a process to capture required information. Register online with the Medicare Coordination of Benefits Contractor before June 30, 2009. Begin testing." (Drinker Biddle Reath LLP)
[Guidance Overview] Health Care Claims and the Transition to the ICD-10 Coding Standard (PDF)
Pages 7-8 of 12 pages. (Milliman)
[Guidance Overview] A Periodic Snapshot of What's Happening in the Multiemployer Health Plan Environment (PDF)
1 page. Excerpt: "This report: Provides information about recent developments in health care and the multiemployer marketplace. Presents data including consumer price index (CPI) and Segal health trends. Provides context for what's happening to health plans." (The Segal Group, Inc.)
Consolidating Benefits Administration a Top Priority for Multinationals
Excerpt: "A new report from MetLife says 59% of U.S. corporations with multinational operations consider 'consolidating all benefits administration onto a common platform' to be one of their top priorities ? compared with 45% of their peer U.S. domestic-only corporations. 'Managing Global Benefits: Challenges and Opportunities' recognizes that as U.S. companies continue to expand globally, they are being challenged to develop benefits programs for their international workforce that are not only competitive in local communities around the world, but also cost-effective to implement and manage in a wide number of countries." (PLANSPONSOR.com; free registration required)
[Guidance Overview] Towers Perrin Monthly Health & Welfare Regulatory Round-Up, March 2009 (PDF)
12 pages. Excerpt: "The Monthly Regulatory Round-Up is a high-level summary of legal and regulatory developments that occurred during January 2009 that may be relevant to large employers. Developments are sorted according to federal legislative developments, federal regulatory guidance, other developments (e.g., significant litigation, studies, select state law developments)." (Towers Perrin)
[Guidance Overview] New Laws And Drafting Tips for Welfare Plans In 2009
52 slides from the firm's March 26 presentation. Excerpt: "Federal COBRA Premium Subsidy for Involuntary Terminations; Children's Health Insurance Program (CHIP) Reauthorization Act; Centers for Medicare and Medicaid (CMS) Reporting Changes; Drafting Tips: Strengthen Litigation Protections; Plan Statute of Limitations and Venue; Plan Definition of 'Spouse'." (Sidley Austin LLP)
[Guidance Overview] Health Plan's Appeals Process Failure to Substantially Comply With ERISA's Claims Procedure Requirements
Excerpt: "EBIA Comment: The Fifth Circuit evaluated this claim using the substantial compliance standard, under which technical noncompliance with the DOL's claims procedure regulations is excused so long as ERISA's purpose (i.e., explaining a benefits denial to a claimant in a way that ensures 'meaningful review' of the denial) is satisfied. This is consistent with DOL statements noting that certain inadvertent deviations from a plan's claims procedures don't justify proceeding directly to court. The more difficult question is where to draw the line between inadvertent minor deviations from procedures and deviations sufficient enough (like the ones in this case) to require a remand." (Employee Benefits Institute of America)
[Guidance Overview] ERISA Insurer Entitled to Offset Settlement on 2nd Medical Condition
Excerpt: "The 4th Circuit reasoned that the insurer was the fiduciary, as defined by ERISA, and had discretionary authority to interpret the plan and its terms. The court found the insurer acted reasonably in the interpretation of the plan's language. The court noted that the insurer's interpretation was consistent with the plan's design, which was to assure 'an income stream for the disabled employee during the period of disability rather than an independent benefit quantified by a specific disability.'" (Risk & Insurance)
[Guidance Overview] Judicial Development - Gertjejansen v. Kemper Ins. Co.
Excerpt: " A ruling by the 9th U.S. Circuit Court of Appeals emphasizes the importance of complying with the U.S. Department of Labor's regulations on delivering plan documents electronically." (The Precept Employee Benefits Blog)
House Passes H.R. 1253, the Health Insurance Restrictions and Limitations Clarification Act of 2009
Excerpt: "[On March 31, 2009], the House passed (422 Ayes, 3 Nays) 'H.R. 1253, the Health Insurance Restrictions and Limitations Clarification Act of 2009' which amends ERISA, the Code, and the Public Health Service Act to require that limitations and restrictions on coverage under group health plans be timely disclosed to group health plan sponsors and timely communicated to participants and beneficiaries under such plans in a form that is 'clear and explicit.'" (Attorney B. Janell Grenier via Benefitsblog.com)
Strategies to Maximize Your Health Care Vendor Relationships
Excerpt: "As part of their constant quest to purchase high-quality health care coverage at the most economical price, employers should keep in mind that all vendor relationships are business arrangements, every aspect of which is open to negotiation. This article discusses strategies for the negotiation of better and mutually beneficial health care vendor relationships." (The Segal Group, Inc.)
[Guidance Overview] Bankrupt TPA Is a Fiduciary, and ERISA Plan Assets Held in Its Bank Accounts Can't Be Reached by Non-ERISA Creditor
Excerpt: "EBIA Comment: This case illustrates what can happen when employers deposit ERISA plan assets in TPA-controlled accounts, especially when TPAs go bankrupt (an increasingly real possibility in a down economy). While the issue in this case was whether the TPA's creditor could access the funds in the TPA's accounts, the accumulation of ERISA plan assets in a TPA account also raises issues for employers under ERISA's trust and Form 5500 reporting requirements. For this reason, employers may prefer to set up an arrangement under which the TPA has checkwriting authority on an account in the employer's name, rather than paying benefits from an account in the TPA's name." (Employee Benefits Institute of America)
[Guidance Overview] Employer Must Provide Claims Administrator's Internal Guidelines Relied on in Denying Participant's Claim
Excerpt: "EBIA Comment: This case drives home the point that if an employer hires a TPA to administer claims but remains the 'plan administrator' for ERISA purposes, then the employer should ensure that its contract with the TPA grants the employer access to all documents subject to disclosure under ERISA. Addressing this issue in the TPA's contract would be prudent." (Employee Benefits Institute of America)
[Guidance Overview] EEOC Proposed Regulations Clarify Definitions and Prohibitions of GINA
Excerpt: "Title II of GINA prohibits employers and other covered entities from discriminating [in insurance and employment] on the basis of genetic information. The proposed regulations are designed to provide additional guidance regarding a covered entity's obligations pursuant to Title II. " (McGuireWoods)
Public Sector Strategic Health Care Plan Design (PDF)
3 pages. Excerpt: "The Government Finance Officers Association (GFOA) recommends that [public sector] plan sponsors consider developing and formally adopting a long-term, strategic plan that includes guiding principles and key objectives for managing health-care costs and improving participant wellness. The strategic plan design should consider both incremental changes and major initiatives to establish an efficient and effective structure that will enable the plan sponsor to provide the desired level of health-care coverage while maintaining those costs atsustainable levels." (Government Finance Officers Association of the United States and Canada)
[Guidance Overview] CMS Delay of MSP Mandatory Reporting for HRAs and Provision of Other Guidance for Group Health Plans
Excerpt: "CMS has updated the User Guide for group health plans on its Medicare Secondary Payer (MSP) mandatory reporting website. Like the earlier versions of the guide . . ., the updated version covers a wide range of topics relevant for the 'responsible reporting entities' (RREs) who must provide information to CMS in order to help CMS identify situations in which the plans are (or have been) primary to Medicare." (Employee Benefits Institute of America)
Equal Employment Opportunity Commission Proposes Rule Implementing Title II of Genetic Information Nondiscrimination Act
Excerpt: "The EEOC is seeking public comment on the proposed rule until May 1, 2009, and will publish a final GINA rule by May 21, 2009. The law's employment provisions take effect Nov. 21, 2009." (Mercer LLC)
[Guidance Overview] Towers Perrin Monthly Health & Welfare Regulatory Round-Up, February 2009 (PDF)
8 pages. Excerpt: "The Monthly Regulatory Round-Up is a high-level summary of legal and regulatory developments that occurred during January 2009 that may be relevant to large employers. Developments are sorted according to federal legislative developments, federal regulatory guidance, other developments (e.g., significant litigation, studies, select state law developments)." (Towers Perrin)
Employers Review Who Is Covered Under Health Care Plans
Excerpt: "With cost savings in mind, some employers are conducting dependent eligibility audits to accurately determine who is covered under their plan; according to the IFEBP: 26% of U.S. employers conduct eligibility audits for their health care plans." (Wolters Kluwer)
Benefit Plan Oversight During a Recessionary Economy
Excerpt: "During this current recessionary economic cycle, most general counsel are focused on maintaining their companies' core business. While keeping the organization competitive, or even functional, during this unprecedented phase of American business, GCs must not overlook the qualified benefit plan review. Consistent review of the qualified benefit plans will provide a better standard of review if a decision is challenged in court, offer structure for the plan fiduciary to implement his Employee Retirement Income Security Act duties, and afford the opportunity to address any administrative or operational challenges before being audited by the Internal Revenue Service or the Department of Labor." (Law.com)
[Guidance Overview] CHIPRA: How it Affects Your Group Health Plan
Excerpt: "On February 4, 2009, the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) was signed into law by President Obama. CHIPRA allows states to subsidize premiums for employer-provided group health coverage for eligible children, but it also imposes certain requirements on plan sponsors. . . . Plan sponsors should notify their employees with regard to their special enrollment rights as soon as possible, but no later than April 1, 2009. They should provide disclosures to employees once HHS issues its model notice, and provide disclosure to state agencies once HHS and the Department of Labor issue model forms." (McDermott Will & Emery)
EEOC Seeking Public Comment on Proposed Rules to Implement Genetic-Discrimination Law Passed Last Year
Excerpt: "The Equal Employment Opportunity Commission is seeking public comment as part of its rulemaking process to implement employment provisions of the Genetic Information Nondiscrimination Act, which was signed into law in May 2008. 'The addition of genetic information discrimination to the EEOC's mandate is historic and represents the first legislative expansion of the EEOC's jurisdiction since the Americans with Disabilities Act passed in 1990,' said Acting EEOC Chairman Stuart J. Ishimaru at a hearing on February 25 that presented the proposed rules." (Human Resource Executive Online)
Data Use Will Set TPAs Apart in the New Economy
Excerpt: "With more than 1,800 third-party administrators (TPAs) vying for market share, this business segment has become very competitive. Where TPA clients were once satisfied with solid benefits administration, much more is now expected - no less than proving the value the TPA provides to the client. This includes sophisticated data analysis to identify and manage risk through new programs that advance the plan's performance and lowers employer health care costs by improving member health." (Employee Benefit Adviser; Registration may be required)
[Guidance Overview] New Jersey Insurance Regulation Restricting Discretionary Clauses Fails to Affect ERISA Standard of Review
Excerpt: "This unpublished Third Circuit opinion provides some interesting insight on discretionary clause prohibitions. Notwithstanding New Jersey's regulation restricting use of such clauses, the Court applied an abuse of discretion standard in reviewing the case. How is that possible? New Jersey's regulation is a bit odd. Wilson Elser summarizes the law's pecularities in a July 2007 ERISA Alert. By emphasizing the restriction in terms of 'sole' discretion, the insurance department left open the gap that MetLife took advantage of in Evans." (Health Plan Law)
[Guidance Overview] New Federal Laws Affecting Group Health Plans (PDF)
5 pages. Excerpt: "This bulletin provides a summary of two federal laws that will impact group health plans. The American Recovery and Reinvestment Act of 2009 has been passed by the House, and is expected to be passed by the Senate and signed by President Obama no later than Presidents' Day. The Children's Health Insurance Program Reauthorization Act of 2009 was signed into law on February 4, 2009." (Thompson Hine LLP)
IRS Employee Plans FY 2009 Work Plan of Operating Priorities (PDF)
15 pages. Excerpt: "The work plan provides the strategic Operating Priorities for Employee Plans (EP) for FY 2009, as well as specific program guidance for Examinations, Rulings & Agreements and Customer Education & Outreach employees. In fulfilling EP's mission of protecting retirement plan assets and the benefits of plan participants, it is incumbent that the EP organization fosters and promotes plan sponsors compliance with the applicable Internal Revenue Code provisions. While the Determination, Voluntary Compliance and Technical Activities programs are designed to assist plan sponsors compliance with the Internal Revenue Code (IRC), EP Examinations and the EP Compliance Unit also play an integral role in ensuring compliance through their enforcement actions." (Internal Revenue Service)
[Guidance Overview] Employee Wins Claims for Breach of Fiduciary Duty Against Employer That Failed to Pay Health Plan Premiums to Insurer
Excerpt: "EBIA Comment: This case, which involved ten separate counts for breach of fiduciary duty against the employer and its owners, outlines the panoply of arguments that an employee can make under ERISA when an employer allows health insurance to lapse by failing to make premium payments. Importantly, the court held both the employer and its owners responsible for the consequences. Thus, in addition to illustrating the many potential fiduciary duty claims that can arise from a failure to pay over premiums, this case serves as a stark reminder in a harsh economy that individual officers and employees of a plan sponsor may be subject to personal liability if they are automatic or functional fiduciaries under ERISA." (Employee Benefits Institute of America)
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