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Welfare Plans Edition

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June 29 - 30, 2000

Health Plan Prevails in Employee Gross Misconduct Case
Excerpt: "By giving advanced notice to all employees of the behavior that will be considered gross misconduct, an employer may enhance its chances of a favorable COBRA outcome in court." (EBIA Weekly)

Opinion: HMOs Win In Court, But They Are Still Covered with Mud
Excerpt: "Congress has given HMOs immunity. The Supreme Court reversed the ruling of the 7th Circuit Court of Appeals in Chicago, which had upheld the unfortunate woman's right to sue the pants off the people who made her wait in agony in a life-threatening situation." (CNNfn.com)

5th Cir: Texas HMO Law Preempted in Part by ERISA, But State Agency Can Regulate "Standard of Care"
Excerpt: "[We at EBIA] do not understand how a state court, faced with a lawsuit under the [non-preempted] standard of care provisions [of the Texas law], will be able to disentangle itself from the [ERISA preempted, federal law-only] question of whether a particular procedure or treatment was medically necessary." (EBIA Weekly)

2d Cir: Severance Plan Amendment Shortly Before Corporate Transaction Is Enforceable
Excerpt: "The employees challenged an amendment to the plan that was adopted shortly before the sale became final but after the purchase agreement was signed. The amendment expressly excluded from coverage employees who continued in employment with a spun-off subsidiary." (EBIA Weekly)

Microsoft Ends Its Era of Permanent Temporary Workers
Excerpt: "Beginning tomorrow, the Redmond software giant's policy is to limit temporary or contract assignments to 365 days. After that, workers must take off at least 100 days before taking a new Microsoft assignment." (Knight-Ridder / Tribune Business News)

Parent Perks Provoking a Backlash Over Workplace Discrimination, Say Childless Employees
Excerpt: "A backlash is building among the child-free who are niggled at having to cross-subsidise working parents--and be uncomplaining about it. They say the child-friendly workplace is often so because of their sacrifice--and that it simply isn't fair." (Deutsche Press-Agentur)

Employer Costs For Employee Compensation - March 2000
Excerpt: "In March 2000, employer costs for employee compensation for civilian workers (private industry and State and local government) in the United States averaged $21.16 per hour worked ... Wages and salaries, which averaged $15.36, accounted for approximately 73 percent of these costs, while benefits, which averaged $5.80, accounted for the remaining 27 percent." (Bureau of Labor Statistics)

US West Retirees Not Yet Satisfied With Benefit Protections in Arizona's Approval of Qwest Merger
Excerpt: "US West retirees say they will challenge a decision by the Arizona Corporation Commission on Wednesday that watered down earlier approved protections for their health and pension benefits." (Arizona Republic)

Senate OKs Limited Patient Rights
Excerpt: "The vote did little to clarify the future of patients' rights legislation, one of two major health-related measures that Congress is considering with in the run-up to the fall campaign." (Associated Press)

Senate Passes Patients' Rights Bill
Excerpt: "The Senate last night narrowly approved a new Republican patients' rights proposal that includes a limited right to sue health plans, as both sides in the long-festering dispute struggled for political as well as legislative advantage on the issue." (Washington Post)

Health Care Cooperatives Have Achieved Limited Success, GAO Study Finds
Excerpt: "Small employer health care purchasing cooperatives have not reached their potential for reducing premiums, attracting and retaining insurers, or avoiding enrollment of a disproportionate share of high-risk individuals. This is one of the conclusions of a recent study conducted by the General Accounting Office..." (Spencernet)

Prescription Drug Coverage For Self-Insured Companies
An excellent discussion among self-funded plan sponsors and their advisors -- excerpt: "There's a lot of good arguments for a coinsurance as opposed to copay--the largest of which is that participants get a reality check on the true cost of their Rx's." (BenefitsBoards.net)

US West Retirees Threaten to Block Qwest Merger
Excerpt: "A group representing more than 16,000 US West retirees is threatening to hold up the phone company's merger with Qwest Communications International because of fears that the companies are trying to 'wiggle out' of their obligation to pensioners." (Knight-Ridder / Tribune Business News)

AHRQ Has New Data About Cost of Health Care
Excerpt: "In 1996, about $554 billion in payments were made for health care services and supplies used by the U.S. population not in the military or living in institutions. The average cost per person who had medical expenses was about $2,400. However, half of these people had medical expenses of less than $559." (Agency for Healthcare Research and Quality)

Plan Participants Can Take Charge of Their Health Care Costs
Excerpt: "'While health care is clearly a major expense, there are many ways a family can control costs without sacrificing quality of care.' To help families get the most from their healthcare dollars, [CIGNA HealthCare Inc. Vice President Dr. Edward J.] Smith offers these tips ..." (News USA)

Insurers Dropping Medicare HMOs; 711,000 Individuals Affected
Excerpt: "More than 711,000 Medicare HMO members will have to switch plans, doctors or both later this year as insurers join the third, and by far the largest, annual exodus from the program." (Associated Press)

Senate Rejects Democrats' Bill for Genetic Privacy Protections
Excerpt: "Senate rejection of broad new workplace and insurance protections against genetic discrimination, including a right to sue, signals a go-slow approach in Congress to the dilemmas posed by the decoding of the human genome." (Associated Press)

No Rush Seen for Genetic Anti-Bias Laws
Excerpt: "A day after President Clinton and leading scientists warned that the great achievement of deciphering human DNA also could lead to discrimination, Republican aides in Congress said that there is no need to pass anti-discrimination protections this year." (Los Angeles Times)

Concern About Genetic Discrimination by Insurers, Employers
Excerpt: "The genes, in effect, could forecast years in advance who will get sick and who will not. Employers and health insurance companies could save millions of dollars by not hiring or enrolling people whose genes show them to be highly susceptible to diseases, experts say." (insure.com)

Opinion: The Solution on Health Care
Excerpt: "The fragmented, for-profit health industry leaves tens of millions of Americans uninsured and underinsured. It gives insurers incentives to discriminate against the sick. It leaves drug prices far higher they ought to be. The solution to all of this is universal coverage. Then no insurance company would spend a nickel on marketing or on dividing the sick from the well or on thinking up incentives to divide doctors from patients, because everyone would be insured." (The American Prospect)

Can Physicians and Health Care Purchasers Collaborate to Improve Health Care Quality? (PDF)
Excerpt: "Describes an alternative to the "consumer choice model" for quality improvement. This new alternative would rely on externally accountable QI programs that are collaborations between purchasers and providers of care." (Economic and Social Research Institute)

Listing of IRS Documents Online Here (Rev Rulings, Rev Procedures, IRS Announcements, etc.)
Here's a short, current listing of all IRS documents reprinted here in HTML (hypertext) format: the principal recent benefits-related revenue rulings, revenue procedures, announcements, notices, news releases, technical advice memoranda and general counsel memoranda. (Also available elsewhere: a longer listing that includes a short description of each document.) (BenefitsLink)

Consumer Group, Insurers Disagree on Aspects of Proposed North Carolina HMO Review Bill
Excerpt: "A consumers group is praising a bill passed by the state House of Representatives that would establish an external board of review for patients who wish to challenge denial-of-service decisions by their HMOs. Still, fears abound over its future." (A. M. Best)

Group Long-Term Care: Choosing and Implementing a Program (PDF)
Excerpt: "Many employers have implemented group LTC plans, while others are seriously considering them, and the number is expected to increase in the near future. This article will discuss the 'whys and hows' of offering LTC coverage from an employer's perspective." (Milliman & Robertson, Inc.'s Benefits Perspectives, Summer 2000 Issue)

Comparing Apples to Apples: Evaluating Managed Care Arrangements (PDF)
Excerpt: "This article describes a new method that addresses the imperfections of current techniques, while also detailing a more robust approach in analyzing MCO contract rates." (Milliman & Robertson, Inc.'s Benefits Perspectives, Summer 2000 Issue)

Arizona Fines Aetna HMO, Says It Failed to Tell Patients About State-Mandated External Reviews
Excerpt: "Aetna U.S. Healthcare repeatedly failed to tell its patients in Arizona that they had a right to an external review when treatment coverage was denied and even misdirected some of them to California to file appeals." (insure.com)

Letter to New Calif. Dept. of Managed Care Director: Be Humble As Servant, Arrogant As Champion
Excerpt: "Most patients in California today have no meaningful legal remedy against an HMO in court. Your office is essentially the sole protector of public safety at California HMOs." (Foundation for Taxpayer and Consumer Rights)

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