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September 4, 2003 - 8,548 subscribers
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Feds Approve Using Pretax Cash for Over-The-Counter Drugs
Excerpt: "Until now, most plans did not allow reimbursement for nonprescription drugs, mainly because these drugs are not deductible as an itemized medical expense on tax returns.... The reason for the ruling is the growing number of drugs becoming available without a doctor's prescription.... Some plans expressly exclude over-the-counter drugs. These plans must be amended before employees can be reimbursed." (SFGate.com)
Employer Assessed Attorney's Fees in COBRA Asset Sale Case
Excerpt: "Not only must a successor employer assume the seller's obligation to provide COBRA coverage, it also must pay a former employee's attorney's fees, a federal district court in Washington, D.C. held. The case is Risteen v. Youth For Understanding, Inc., 2003 WL 22011766 (D.D.C., Aug. 19, 2003)." (Thompson Publishing Group)
COBRA Election Notice Sent by Certified Mail and Returned "Unclaimed" Satisfies Notice Requirement
Holmes v. Scarlet Oaks Ret. Cmty. (S.D. Ohio 2003). Excerpt: "The plan administrator in this case sent a COBRA election notice by certified mail to an employee who had been terminated a little more than a week earlier. The letter was addressed to the employee and her husband at their home address, but it was returned to the plan administrator marked 'unclaimed.'" (EBIA Weekly)
Escape Clause In Health Plan Enforced; Shifted Costs To HMO When Dual Coverage Existed
Excerpt: "In arguing that the employer plan's escape clause was unenforceable, the HMO cited two Third Circuit cases which had voided escape clauses in ERISA qualified plans. Those cases had stated that such clauses violated plans' fiduciary duties to participants, in that they were contrary to the policy underlying ERISA preventing a plan's coverage and its participants' expectations of coverage from being so misaligned. The court rejected this argument." (CCH News & Information Library)
Unfunded Vacation Benefits Were ERISA-Exempt Even When Combined With ERISA Benefits in General
Miller v. PPG Industries Inc. (W.D. Ky. 8/22/03). Excerpt: "This case addressed whether an unfunded vacation benefits plan acquired ERISA status just because it was included in a general benefits package that included ERISA benefits. The employee, who brought a state-law claim for unpaid vacation benefits, argued that the vacation plan was not subject to ERISA, based on the DOL's regulatory safe harbor for payroll practices ..." (EBIA Weekly)
HMO May Calculate Co-Payments Using Billed Charges Rather Than Providers' Discounted Rates
Lefler v. United HealthCare of Utah, Inc. (10th Cir. 2003). Excerpt: "The participants in this class action challenged their HMO's practice of calculating co-payments as a percentage of health care providers' full billed charges, rather than as a percentage of the lower discounted rate negotiated by the HMO." (EBIA Weekly)
Cigna, Doctors Reach Settlement in Suit
Excerpt: "Doctors suing Cigna Corp. have struck a deal worth at least $85 million in cash to settle a class action lawsuit against the U.S. health insurer accusing it of breaching contract terms, both sides said on Wednesday." (Reuters via Washington Post)
Domestic Partner Benefits for County Employees Approved; First in North Carolina
Excerpt: "Durham commissioners quietly voted 5-0 Tuesday morning to make their county the first in the state to offer health insurance to the same-sex domestic partners of its employees." (The (Raleigh, N.C.) News & Observer via International Foundation of Employee Benefit Plans)
Opinion: End Game for Pharmaceutical Kickbacks
Excerpt: "Taking inducements to prescribe certain drugs is more than ethically questionable. It's against the law, says HealthLeaders member Kenneth Nolan, and healthcare leaders had better know what the penalties are and how to avoid any trouble in the first place." (HealthLeaders)
Qwest Non-Union Retirees Upset at Decision to Shift 20% of Health Costs to Them
Excerpt: "Beginning Jan. 1, nonunion retirees who left the company after 1990 will have to pay 20 percent of their health care premiums. In the past, the phone company covered all of those costs, as it will continue to do for nonunion retirees who left before 1990." (Denver Post)
California Bill to Mandate Employer-Paid Health Coverage Might Be Preempted by ERISA
Excerpt: "If it becomes law, SB 2 by state Senate President Pro Tem John Burton would make California the first state to compel employers to pay for medical insurance and to spell out the type of coverage offered in the three decades since Congress passed a law preventing states from regulating employee health benefits.... Several state legislators at the conference committee hearing acknowledged there might be court challenges to SB 2 [due to ERISA] ..." (Sacramento Bee)
The Magnitude and Nature of Risk Selection in Employer-Sponsored Health Plans
Working paper. Excerpt: "We find that people who switched from a non-HMO to an HMO plan used 11 percent fewer medical services in the period prior to switching than people who remained in the non-HMO plan, and that this relatively low use persists once they enroll in an HMO. Furthermore, people who switch from an HMO to a non-HMO plan used 18 percent more medical services in the period prior to switching than those who remained in an HMO plan." (Sean Nicholson, Kate Bundorf, Rebecca M. Stein, Daniel Polsky; made available by the National Bureau of Economic Research)
Drug Cost Projected to Rise 15% to 16% for Next Five Years
Excerpt: "Per member per month ingredient costs are expected to continue to rise at a double-digit but stable rate of growth over the next few years, according to projections by Express Scripts ... Annual per member per year (PMPY) cost increases from 2003 to 2007 are expected to range between 15% and 16% ..." (Drug Benefit Trends via Medscape; one-time registration required)
Overview and Full Text: DOL Issues Compliance Guide for QMCSOs (PDF)
35 pages. Excerpt: "The U.S. Department of Labor has issued a new compliance guide to assist employers, plan sponsors, and state officials in understanding qualified medical child support orders (QMCSOs). The new guide, Compliance Guide for Qualified Medical Child Support Orders, answers questions about QMCSOs in general and about National Medical Support Notices used by state child support enforcement agencies in obtaining health care coverage for children." (Buck Consultants)
Wal-Mart to Offer Free Diabetes Screenings Nationwide
Excerpt: "Licensed health screeners will be on hand to handle the tests free of charge, a process that can cost up to $30. The American Diabetes Foundation estimates that 17 million Americans have diabetes, but approximately 33% are undiagnosed." (BenefitNews.com)
Opinion: Employers Should Be Required to Provide Basic Health Coverage for All Employees
Excerpt: "We need to provide health insurance for all. Employers should be required to provide a basic level of health care coverage to their workers." (Richard D. Quinn in BenefitNews.com)
Some Successful Models Ignored as Congress Works on Drug Bill
Excerpt: "Yet for all its apparent success, lawmakers have disregarded the [Veterans Administration] model -- and others like it that use the government's immense power to negotiate lower prices -- as they try to give older Americans relief from rising drug costs while reshaping how the elderly get medical services." (New York Times; one-time registration required)
Links to Items on Executive Comp, Benefits in General
Text of DOL Amicus Brief Supporting Money Damages Against Employer as Fiduciary in Life Ins. Case
Callery v. The United States Life Insurance Company in New York, No. 03-4097 (filed with 10th Cir. on Aug. 20, 2003). Excerpt: "Star Buffet offered life insurance coverage to its employees through a policy issued by United States Life Insurance Company ... Callery was never provided with a summary plan description that outlined the life insurance policy's scope of coverage and exclusions, nor had the insurance policy itself been distributed to Callery or other Star Buffet employees." (U.S. Department of Labor, Office of the Solicitor)
Overview: IRS Proposes Regulations on Statutory Stock Options (PDF)
Excerpt: "The IRS has proposed new regulations concerning statutory stock options, that is, incentive stock options and employee stock purchase plans. The proposed regulations would update previously issued final and proposed regulations for statutory changes and would incorporate other prior IRS guidance. The proposed regulations would also provide clarification of certain qualification requirements for these programs." (Buck Consultants)
Fill Out the 2003 Spencer Survey of Benefit Managers
Aspen Publishers Spencer Benefits Reports currently is collecting information for the 2003 Spencer survey of benefit managers and employee benefits departments. This 9th biennial survey requests information concerning compensation, organization, and functional responsibilities of corporate employee benefits departments. The information provided will be collated and published by Spencer Benefits Reports. All survey respondents will receive a copy of the published survey at no charge. (Spencer Benefits Reports)
Newly Posted or Renewed Job Openings
Pension Plan Administrator
for Tycor Benefit Administrators, Inc.
in PA
Account Executive
for Transamerica Retirement Services
in GA
Account Executive
for Transamerica Retirement Services
in CA
Client Service Regional Manager
for ADP
in NH
Senior Technical Applications Consultant
for Charles Schwab & Co., Inc.
in NC
Newly Posted Press Releases
(Post Yours!)
Fortune Magazine Ranks National Medical Health Card Systems Among 'America's 100 Fastest Growing Companies'
(NMHC)
CEBS Program Accepts Exam Transfer Credit
(International Foundation of Employee Benefit Plans)
New Principal Financial Group Nonqualified Defined Benefit Plan Bridges Key Employee “Retirement Gap”
(Principal Financial Group)
Henry Loubet Joins Keenan & Associates As Senior Vice President, Strategic Planning
(Keenan & Associates)
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