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The BenefitsLink Newsletter -
Welfare Plans Edition

October 27, 2000

The International Quality & Productivity Center presents a two-day conference: Employee Benefits Online -- Capitalizing On Online Technology To Radically Streamline Your Benefits Process
(Would your company like to sponsor an issue?)

Supreme Court May Test HMO Members' Right to Seek Second Opinion Under State Laws
Excerpt: "At least 38 states have passed laws giving HMO members the right to seek an independent medical opinion if their insurer denies a treatment or test. But can a state force an HMO to abide by the arbitrator's decision? The answer depends on where you live. In Texas, the answer is no, according to a federal appeals court ruling this summer. In Illinois, the answer is yes, another appeals court declared last week." (Knight Ridder/Tribune)

Miami Retirees Health Feud is Boiling
Excerpt: "A decision by Miami officials more than 20 years ago to arbitrarily raise health insurance rates for retired city employees could cost the city millions of dollars. Some of the city's nearly 1,500 retirees-- firefighters, police officers and administrators-- saw their healthcare costs more than double, said Jerome Wolfson, one of the plaintiff's attorneys in a first-round legal victory against the city." (Miami Herald)

Miami HMO Hearings: Judge Needs Month To Mull Issues
Excerpt: "High-profile plaintiffs' attorneys and managed care defendants wrangled in a Miami hearing Thursday over motions to dismiss class action lawsuits against several publicly traded managed care companies." (Dow Jones, via Excite! News)

Contraception Controversy: Can Employers Refuse to Pay for Birth Control Pills?
Excerpt: "In July, Planned Parenthood brought a class-action federal lawsuit on behalf of women employees of Seattle-based Bartell Drugs, alleging that the company's failure to include female contraceptives in its employee prescription plan was a form of gender discrimination." (Workforce.com)

At Call Centers, Perks Beat Cash
Excerpt: "Casting about for ways to combat a tight labor market, call center executives are loading on employee perks in an attempt to reduce turnover among people who must endure the tedium of answering customer questions or making pesky telemarketing calls.... [E]njoyable activities and helpful touches may make a big difference for service companies that find themselves losing employees to the new jobs being created by the healthy economy." (American Banker)

Chart: Time Off To Vote In Elections Under State Laws

Extra $75 a Month Helps the Medicine Go Down-- Boutique Clinics Dote on Patients Who Pay More
Excerpt: "Doctors have discovered that customer service pays. In these boom times, some patients are willing to buy what was once expected: a relationship with their doctor. For fees ranging from $900 to $20,000 a year, families can have almost-instant access to a doctor, same-day appointments, heck, even house calls." (USA Today)

Designing a Complaint and Grievance System Under Medicaid Managed Care
Excerpt: "Several studies in recent years have considered state managed care consumer protection laws, and at least one study has examined selected state grievance practices. However, there never has been a comprehensive review of existing Medicaid managed care grievance procedures, nor do the state consumer studies measure the extent to which insurance protections are extended to Medicaid beneficiaries enrolled in managed care." (The George Washington University Medical Center)

External Review: Both Sides Benefit
Excerpt: "Few innovations in managed care have caught on as rapidly as members' ability to seek an independent review of their health plans' coverage decisions by a panel of experts. And while health plans' internal processes and coverage policies already rely on experts, plans themselves often refer difficult decisions to external review, even before patients request it." (Medscape; free registration required)

Massachusetts Could See Universal Health Care If Question 5 Passes

DOL Issues Proposed Regs Designed to Stop False Claims of Exemption from State Regulation
October 27, 2000; this is a link to a hypertext version prepared by BenefitsLink, with links to Federal Register document. (U.S. Department of Labor)

Poor Quality Care Costs Employers Billions
Excerpt: "More than one-third of employer health care dollars are spent on medical mistakes, preventable drug interactions, misprescribed medications, unnecessary surgeries, and other poor-quality care, according to a study by the Midwest Business Group on Health (MBGH) and the Juran Institute." (CNNfn.com)

Stacking Up the HMOs-- Many Employees Trying to Decide Which Health-Care Option Is Best
Excerpt: "Wouldn't it be great if there were some objective fact-based information out there to help you decide which HMO was the best for you? Well, there is. Sort of. As consumers become more and more aware of how important it is to choose wisely when it comes to health insurance, more and more sources are offering objective information about the quality of health insurance." (The Hartford Courant)

Opinion: Placebo Politics
Excerpt: "I am extremely skeptical that the sort of incrementalism embodied in the Bush and Gore proposals can work, even though they are targeting bigger pieces of the system than the earlier reforms. In fact, precisely because they are more ambitious yet still piecemeal, they would likely backfire." (The American Prospect, Reprinted by Physicians for a National Health Program)

Presidential Candidates Wary on Health Care Issue
Excerpt: "The thundering crash of President Clinton's Health Security Act of 1993 is still ringing in the ears of the two men campaigning to be Clinton's successor." (Washington Post)

Opinion: Leadership's Tax Plan Reinforces Inequities In Health And Pension Coverage
Excerpt: "Congress will shortly consider a significant tax package developed by the House and Senate Republican leadership. Despite some beneficial provisions in the bill, such as the $1 increase in the minimum wage phased-in over the next two years, the bill's tax provisions will primarily benefit those with high incomes." (Center on Budget Policies and Priorities)

John Hancock Offers Long-Term Care Annuity
Excerpt: "John Hancock Financial Services, in an effort to expand distribution of its long-term-care insurance line, has introduced a fixed annuity for the bank channel with a long-term care benefit." (American Banker)

Florida Probes Possible Illegal Actions by HMOs
Excerpt: "Florida's attorney general is investigating two of the nation's largest HMOs to determine whether the plans illegally denied or limited medical care. Attorney General Bob Butterworth has subpoenaed Hartford, Connecticut-based Aetna Inc. and Louisville, Kentucky-based Humana Inc. as part of a broad-based investigation, his office confirmed. The probe is being conducted under state racketeering laws, known as RICO." (Reuters via Yahoo! News)

Controversy Over Payers' Use of Guidelines Remains Strong
Excerpt: "A new report underscores what many doctors have long believed-- that some treatment guidelines are overly aggressive and could have a negative effect on patient care. But that doesn't mean that doctors can ignore the issue of appropriate, cost-effective care." (Medscape; free registration required)

Hmo Rates To Rise 10 To 13 Percent In 2001, Surveys Say

When Is An ER Visit Reasonable? Depends On Who's Deciding
Excerpt: "Insurance coverage for emergency department visits is less likely to be denied when the claims are reviewed by a physician rather than by a managed care company, according to results of a study." (DrKoop.com)

Welcome to new BenefitsLink advertiser New England Dental Administrators, LLC
With medical plan increases expected to be in the double-digit range, wouldn't you like some versatility in your employee benefit package? Self-funding your dental plan may just be the answer. New England Dental Administrator's (NEDA) makes self-funded dental benefits easy for Massachusetts employers. Let our experts show you. Check out the Web Site at www.nedallc.com, or call Craig Goldsmith, NEDA Sales Manager at 508-752-0119.

Another Question is Answered in the HIPAA Q&A Column
If a person is covered under an individual policy, then enrolls in a group health plan, does the time covered under the individual policy count as "creditable coverage" under the group health plan? (BenefitsLink.com)

IRS Letter Explains Why Weight-Loss Expenses Don't Qualify for Cafeteria Plan Reimbursement (PDF)
Excerpt: "The current IRS position on weight-loss programs is stated in Rev. Rul. 79-151, 1979-1 C.B. 116. This ruling holds that if participation in the program was to improve the participant's appearance, general health, and sense of well-being, the expenses of the program are not for medical care, and therefore are not deductible. Of course, the expenses of a weight-loss program prescribed to treat a specific disease are for medical care and are deductible." (Internal Revenue Service)

(Following also appears in Retirement Plans Edition)

Internet Workforce Compensation Study 2000
Excerpt: "The Standard's first-ever review of compensation, culture and job satisfaction in the Internet workplace." (TheStandard.com)

Graef Crystal: Hindery Profits, Global Crossing Holders Don't
Excerpt: "Leo Hindery stands to make out far better than Global Crossing Ltd.'s shareholders did during his seven months as chief executive. Anyone who wants to know why ought to ask Chairman Gary Winnick." (Graef Crystal, on Bloomberg.com)

Executive Summary of House-Passed Taxpayer Relief Act of 2000 (PDF)
12 pages. (Republican Conference of the U.S. House of Representatives -- GOP.gov)

Text of House-Passed Taxpayer Relief Act of 2000 (PDF)
286 pages. (Republican Conference of the U.S. House of Representatives -- GOP.gov)

Tax-Minimum Wage-Pension Bill in Jeopardy
Excerpt: "Barely 24 hours after offering compromise, President Clinton threatened to veto a Republican tax relief bill that would also raise the minimum wage by $1 and restore some Medicare cuts for health care providers." (Las Vegas Sun)

House Passes Tax-Relief Package
(Las Vegas Sun)

Clinton Explains Why Veto is Forthcoming If House-Passed Tax Bill is Sent to Him for Signature
Excerpt: "[Y]ou have made virtually no attempt to address the concerns my Administration has expressed to you about the pension provisions of your bill. By dropping the progressive savings incentives from the Senate Finance Committee bill, you have failed to address the lack of pension coverage for over 70 million people. Moreover, employers may have new incentives to drop pension coverage for some of the low-and moderate-income workers lucky enough to have pension plans today." (White House)

House Approves Tax-Cut Package
Excerpt: "Brushing aside a White House veto threat, House Republicans on Thursday pushed through 237-174 a massive $240 billion tax-cut package that would raise contribution limits for 401K retirement accounts, compensate health maintenance organizations for lost Medicare revenue and boost the minimum wage $1over two years." (United Press International)

Although House Clears Tax Bill Increasing Pension Contribution Limits, Margin Is Not Veto-Proof
Excerpt: "Proponents hope the proposed adjustments will encourage more companies to sponsor plans and make it easier for workers to take retirement income with them when they change jobs. The Clinton administration, however, objects to the proposed changes because they don't include any special new saving incentives for low-income Americans and because some of the pension-law changes could undermine worker protections." (Dow Jones, via Excite! News)

Estimated Revenue Effects of the "Taxpayer Relief Act of 2000" (PDF)
Sample: Increasing the elective deferral limit to $15,000 over the next five years costs a bit over $2 billion in foregone tax revenues during 2001-2005, according to the report. (Joint Committee on Taxation)

Job Openings Newly Posted or Reposted on EmployeeBenefitsJobs.com

Employee Benefit Tax Senior Accountantfor Deloitte & Touche, Leading Professional Services Firm
in OH
Employee Benefits Analyst / Compliance Specialistfor Leading East Texas Healthcare System
in TX
Employee Benefits - Legal Assistantfor Buck Consultants
in CO
Extended Benefits Specialistfor Administaff
in NJ
Pension Consultantfor Qualified Benefits, Inc.
in CA
Business Development Associatefor PensionOnline
Senior Benefits Analystfor Park Nicollet Health Services
in MN
Director of Individual Qualified Plan Marketingfor MONY Group, Inc.
in NY
Marketing Coordinator/ Channel Managerfor INVESCO Retirement and Benefit Services
in GA

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