Welfare Plans Edition
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August 18 - 21, 2000
Hipaa Data Transaction Rule Finalized
Excerpt: "The first [U.S. Department of Health and Human Services] regulation ... sets national standards for transmitting health plan enrollment information and health plan premium and payment information through electronic networks ... [and] establishes national data communications standards for information about patients' eligibility for benefits; referrals to specialists; health claims; and coordination of benefits from two or more health plans." (National Underwriter Company)
U.S. Not Prepared for Impact of Genetic Testing
Excerpt: "A government bioethicist warned a gathering of genetic scientists Wednesday that American laws and regulations are ill-prepared for the possible deeply negative impact of widespread genetic testing of humans for susceptibility to diseases." (DrKoop.com)
Giant Managed Care Lawsuit Might Be Dead
Excerpt: "High-powered attorneys seeking a national vehicle for grievances against the industry have expanded a case against Humana Inc. to cover the industry, which considers the issues a matter for Congress and not a federal judge. U.S. District Judge Federico Moreno said he would take at least five weeks to decide whether to dismiss the lawsuit." (DrKoop.com)
Fifth Circuit Says Texas Has Authority To Permit Medical Malpractice Claims Against Health Plans
Excerpt: "The Supreme Court decision, in Pegram v. Herdrich, confirms that Texas and other states have the right to expose health maintenance organizations to liability for medical malpractice suits, according to the 5th Circuit Court of Appeals. The decision might also give states the right to put review systems in place to resolve complaints about health plans that fail to meet basic quality standards, the court found." (National Underwriter Company)
Employer Sued For Birth Control Coverage
Excerpt: "A self-insured health plan that does not cover contraception violates federal laws against sex discrimination, a class-action suit filed last month against a Seattle employer contends. Planned Parenthood ... filed the suit in federal district court in Seattle on behalf of Jennifer Erickson, a 26-year-old married employee of Bartell Drug Company. Ms. Erickson eventually plans to have children but is not ready to do so yet, the lawsuit said." (National Underwriter Company)
Incentive Compensation Attracts Job Applicants More Than Other Perks
Excerpt: "Company-sponsored gym memberships don't make job-seekers' pulses race. A company car won't drive them from their current jobs. Private cubicles don't draw them in. What really sells sales workers on jobs is the compensation plan that determines what they have to do to make the most money." (Lexington Herald-Leader)
Watson Wyatt Acquires KPMG's Canadian Compensation And Rewards Practice
Excerpt: "Watson Wyatt Canada ... has acquired the National Compensation Strategy & Rewards (CSR) Group of KPMG Consulting. With this acquisition, Watson Wyatt has considerably strengthened its compensation and human capital consulting practice in Canada. On June 30, Watson Wyatt acquired the Toronto-based Actuarial and Benefits Services of KPMG." (Canada NewsWire)
Frequently Asked Questions About Code Set Standards Adopted Under HIPAA
Excerpt: "Under HIPAA, a 'code set' is any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnosis codes, or medical procedure codes.... Can HCPCS Level 3 codes established on a local basis still be used? No. All local codes will be eliminated." (HIPAAdvisory.com)
Frequently Asked Questions About Electronic Transaction Standards Adopted Under HIPAA
Excerpt: "Congress and the health care industry have agreed that standards for the electronic exchange of administrative and financial health care transactions are needed to improve the efficiency and effectiveness of the health care system. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Secretary of Health and Human Services to adopt such standards." (HIPAAdvisory.com)
What's New in the Final HHS Rules for Electronic Transactions and Code Sets
Excerpt: "Small Health Plan - We amended the definition to be consistent with the requirements of the Small Business Administration. A small health plan is defined as one with a maximum of $5 million in annual receipts." (HIPAAdvisory.com)
Final Rules for Standards for Electronic Transactions and Code Sets Published in Federal Register
This link takes you to the preamble for the final rules; a link at the bottom of the preamble takes you to the text of the final rules. (U.S. Department of Health and Human Services)
Gore Renews Push on Patients' Rights, Prescription Drug Coverage for Seniors
Excerpt: "Comparing his increasingly populist pitch to that of Harry S. Truman, but leaving his running mate to 'give-them-hell,' Vice President Al Gore vowed Sunday to fight drug companies and health maintenance organizations in bringing broader and fairer health coverage to all Americans." (New York Times; free registration required)
New from EBRI: Executive Summary of Issue Brief no. 224, The Working Uninsured (August 2000)
The Working Uninsured: Who They Are, How They Have Changed, and the Consequences of Being Uninsured (With Presidential Candidate Proposals Outlined) (Employee Benefit Research Institute)
Insurance Problems Spread to Employed
Excerpt: "A new survey of Mainers ... finds that a majority of the respondents without health insurance are employed. The survey also found that even many middle- and upper-income families lack health coverage, and that more than half of the uninsured skip taking the medications prescribed for them by their doctors because they are too costly. The results of the telephone survey of 3,059 households suggests that a lack of health insurance is becoming a major middle-class problem in Maine..." (Portland [ME] Press Herald)
Few Follow United's Lead to Do Away With Most Pre-Approval Requirements for HMOs
Excerpt: "...so far, few health insurers have followed suit. And a small but growing number of critics now say United's change of heart has provided little benefit to doctors and could even strengthen HMOs' control over medical decisionmaking. Some have gone as far as to claim the policy change violates anti-racketeering laws." (Modern Healthcare)
(Following also appears in Retirement Plans Edition)
Latest Application Service Provider-Hosted Service: Benefits Administration
Excerpt: "Software that lets employees manage their own benefits from corporate intranets has been available for years, but only recently have application service providers started offering options for companies that don't want to buy the software. This year, a growing number of ASPs have begun offering services that let companies outsource the administration of their benefits programs. Among them are iBenefits.com, Simpata, WebMD.com and Workscape." (CMP Media Inc.)
Cutback of Ancillary Benefits in a Retirement Plan
Excerpt: "Up to three years preceding [the plaintiff's] disability, the plan's disability pension formula provided for an immediate benefit based on the benefit that would have been payable at age 65 assuming the employee's compensation would have remained the same from the date of disability until 65 but giving credit not only for all service actually earned but for service that would have been earned ... [the] formula was then amended to take away the imputed service credit [to age 65]." (Nixon Peabody LLP)
Who is the Proper Beneficiary After Plan Participant Divorces But Does Not Change Designation?
Excerpt: "[In the case of] Engelhoff v. Engelhoff, 23 EBC 2189 (Wash. Sup. Ct. 11/18/99)[, the] Washington court decided that ERISA did not preempt Washington law, that beneficiary determinations are a matter to be determined by state law, and that under Washington state law, the plan's beneficiary designation automatically became invalid upon the dissolution of the marriage. The U.S. Supreme Court has recently decided to hear an appeal of this decision." (Nixon Peabody LLP)
Opinion: Marquis de Sade Would Smile at RCN's Option Plan
Excerpt: "Face it, your standard stock options cost shareholders a bundle and deliver great wealth to scads of CEOs who contribute nothing to deserve them. Now RCN Corp. has set out to change all this.... RCN's plan boldly raises the bar: Executives are to be rewarded only if its shares significantly outperform the stock market, thereby giving its shareholders an exclusive call on all the early stock price appreciation. " (Graef Crystal, on Bloomberg.com)
| Director Employee Benefits | for Palo Alto California Financial Institution in CA |
| Audit/Actuarial Associates & Consultants | for PricewaterhouseCoopers in MA |
| Benefits Coordinator | for Metropolitan Bank and Trust in OH |
| Corporate Benefits Manager | for Payless ShoeSource in KS |
| 401(k)/DC Administrator | for Accrued Benefit Administrators, Inc. in CA |
| Employee Insurance Benefits Analyst | for County of Sacramento CA in CA |
| Director of Client Services - Mid Size Plans | for One of the top defined contribution providers in TN |
| Senior Pension Administrator | for Retirement Alliance, Inc. in NH |
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