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The BenefitsLink Newsletter -
Welfare Plans Edition

November 21, 2000

Today's sponsor is 2e Corporation
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Fact Sheet on New Health Plan Claims Regulations
Excerpt: "The patients' rights claims procedure regulation, which is now being issued in final form, creates new important patient protections that will ensure that group health plan participants in today's managed care environment have access to a faster, fairer, fuller process for benefit determinations." (U.S. Department of Labor)

Labor Department Issues Final Rules on Health Plan Appeals
Excerpt: "The Clinton administration issued regulations Monday that give 130 million private sector employees the right to have faster decisions on their health care claims and more time to appeal when their health plans deny coverage." (New York Times; free registration required)

New Rules Issued on Health Appeals
Excerpt: "The regulations, due to take effect in January 2002, are meant to streamline significantly a claims process that can leave frustrated patients waiting months for approval of health procedures. The new rules say health plans must notify patients about their claims within 45 days and render decisions within 60 days on appeals of denied claims." (New York Times; free registration required)

Link to PDF Version of Health Plans SPD Final Regulation
(U.S. Department of Labor)

Link to Text Version of Health Plans SPD Final Regulation
(U.S. Department of Labor)

Link to PDF Version of Health Plan Claims Final Regulation
(U.S. Department of Labor)

Link to Text Version of Health Plan Claims Final Regulation
(U.S. Department of Labor)

DOL Announces New Health Plan Claims Processing Rules; Regs Due Out on Tuesday
Excerpt: "The final rule provides for: (1) faster decisions on initial claims and appealed claims, with time frames based on whether the claims are pre-service and post-service; (2) special rules requiring expeditious consideration of claims involving 'urgent care'; (3) more time for patients to appeal denied health claims; (4) different decision maker to handle appeals ..." (U.S. Department of Labor)

Cover One, Cover All? - Casting Doubt On A Common Retiree Medical Benefit Practice
Excerpt: "The ... Third Circuit recently issued a decision holding that an employer who provides health benefits to Medicare-eligible retirees through an HMO, while providing greater benefits to non-Medicare-eligible retirees through a separate point-of-service plan, may violate the Age Discrimination in Employment Act ... Such a ruling constitutes a complete reversal from the widely-held belief that ... limiting age-65 retirees to a Medicare supplement plan is permissible." (Alan J. Laska and John A. Reade, Jr. of Kelley Drye & Warren LLP)

OSHA's Ergonomics Standard Causes Lawsuits and Controversy
Excerpt: "Insurance trade groups, including the Alliance of American Insurers (AAI), the Independent Insurance Agents of America (IIAA), and the National Association of Independent Insurers (NAII), together with employer trade associations, say the new regulations are too vague and will be expensive to implement." (insure.com)

Health Plan for Uninsured Proposed
Excerpt: "Six years after President Clinton's failed attempt to provide health insurance to all Americans, groups that battled relentlessly over the issue proposed a program Monday to cover millions of the nation's uninsured." (Associated Press, via Yahoo!)

Audio, Video Clips of Joint Press Conference of Families USA, HIAA, American Hospital Association
Press conference held November 20, 2000. A service of Kaisernetwork.org's "Healthcast." (Kaisernetwork.org)

Finding Common Ground For Expanded Health Coverage To The Uninsured (PDF)
Excerpt: "As organizations representing the breadth of the health care community, we stand together to forge common ground to end the gridlock over extending health care coverage to the uninsured millions living in America today. As a nation faced with unprecedented prosperity, we have a duty to marshal our resources to help uninsured working Americans." (Health Insurance Association of America)

"Strange Bedfellows" Join Forces On Agreement For Uninsured Americans
Excerpt: "Countering a trend of increased political acrimony and partisanship, three leading organizations with divergent points of view in the health policy arena - the Health Insurance Association of America (HIAA), Families USA, and the American Hospital Association (AHA) - have joined forces to expand health coverage for a substantial portion of America's 43 million uninsured." (Families USA)

Seniors Dropped from Medicare HMOs Shouldn't Rejoin Others, Weiss Says
Excerpt: "Due to market volatility, the chairman of a major ratings company is urging seniors to drop their Medicare HMO coverage. Because of the lack of options and the financial weakness of many managed care organizations, seniors who are being dropped from their Medicare HMOs shouldn't rejoin others, says Martin Weiss, chairman of Weiss Ratings Inc., an independent company that issues safety ratings on more than 16,000 financial institutions." (insure.com)

(Following also appears in Retirement Plans Edition)

DOL Gets $5.5 Million in Settlement with Time Warner in Independent Contractor Dispute
Excerpt: "'This settlement compensates misclassified independent contractors and temporary employees for their failure to be properly recognized as eligible participants under these plans,' said Secretary of Labor Alexis M. Herman." (U.S. Department of Labor)

Job Openings Newly Posted or Reposted on EmployeeBenefitsJobs.com

401(k) Plan Administratorfor Polycomp Administrative Services, Inc.
in CA
in TX
Daily Valuation Team Leaderfor Ceridian Retirement Plan Services
in CO
401(k) Account Processorfor Invesmart, Austin, Texas
in TX
Employee Benefits Paralegalfor Briggs & Morgan, P.A.
in MN
Client Relationship Officerfor John Hancock Funds
in MA
Pension Administratorfor Mid Atlantic Pension Services
in NJ
Compliance Analystfor Leggette & Company, Inc.
in TX

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