The BenefitsLink Newsletter -
Welfare Plans Edition
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October 10, 2000
The Continuing ERISA Preemption Battle: Are PBMs Next?
Excerpt: "While PBMs have been involved in lawsuits regarding the applicability of state statutes seeking to regulate HMO pharmacy practices, there has been no direct litigation, to date, involving formulary or coverage decisions for certain treatments, even though physicians and consumer advocates have been dissatisfied with the lack of coverage for certain classes of drugs." (Medscape; free registration required)
Dealing with Insurer's Medical Exams (IMEs)
Excerpt: "When you make a claim for insurance benefits, especially for disability insurance, the insurer may demand that you undergo what it calls an 'Independent Medical Exam,' but which we prefer to call an 'Insurer's Medical Exam,' because the doctor is far from independent. Disabuse yourself of any idea that the examiner is there to help you. He is hired to destroy your case, e.g., to ..." (Health Administration Responsibility Project)
Time, Not Pay, Drives Today's Job Changers
Excerpt: "Job switching--long associated with younger workers--is increasing among experienced managers and executives for reasons other than more pay. The reason for the surge in job switching: More of these older employees are in search of family-friendly employers and benefits." (Chicago Sun-Times)
DOL to Issue New Claims Regulations for ERISA-Covered Health Plans
Excerpt: "The regulations, to be published in their final form in the Federal Register next month, would require health plans to decide on a claim within 15 days of receiving it. Health plans also would have 30 additional days to rule on appeals of benefit denials." (Modern Healthcare)
Freedom of Choice: Defined Contribution Health Plans
Excerpt: "To some employers and analysts, defined-contribution health insurance benefits are the logical successors to defined-contribution retirement benefits, such as 401(k) plans, and the best way to curb rising health insurance expenses." (A. M. Best)
New Study Says Business Could Save Billions By Detecting, Treating Stress
Excerpt: "Phyllis Gabriel, author of the ILO Study, says more people leave the workforce because of mental problems than physical problems. 'We found that the leading cause of disability in pensions was related to a mental health problem and specifically depression,' Gabriel said." (Excite Canada)
Rival Questions Ashcroft Motive On HMO Bill
Excerpt: "Even though prescription drugs for Medicare recipients seems to be the top health issue on the campaign trail, the 'patients' bill of rights' to protect people in HMOs and other managed-care plans still has some political kick. That became obvious Friday when Sen. John D. Ashcroft (R-Mo.), who is locked in a difficult reelection fight, appeared at a news conference with champions of a tough managed-care bill to provide the 51st vote for passage of a recent compromise." (Washington Post)
Managed-Care Reform Bill Gains Key Supporter
Excerpt: "Sen. John Ashcroft (R-Mo.) has reversed his previous opposition to the House managed-care reform proposal and may represent the crucial 51st vote in favor of the plan in the 100-member Senate." (Modern Healthcare)
(Following also appears in Retirement Plans Edition)
IRS Field Service Advice 200040001 Addresses Split-Dollar Life Insurance Arrangement
Excerpt: "Issue: Whether the portion of the total purchase price allocated to the customer-based intangible/goodwill can be used to structure a split-dollar life insurance arrangement whereby avoiding taxation of the gain realized." (Internal Revenue Service, Via Tax Analysts (Temporary Link))
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