Welfare Plans Edition
January 17, 2001
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Text of Amicus Brief of American Benefits Council in Erie County Retiree Health ADEA Case (PDF)
From an ABC press release: "In our brief we petition for a hearing by the Supreme Court, arguing that the lower court erred in its conclusion that retirees are covered by ADEA or the Older Workers Benefits Protection Act (OWBPA). We also argue that the court's ruling inappropriately mandates identical benefits for all groups of workers, which we believe the law does not require and which would be extremely problematic for plan sponsors." (American Benefits Council)
Health Plan Not Required to Provide Equal Mental Health Benefits
Morrill v. Lorilard Tobacco Co. (N.H. 2000). Excerpt: "The court reviewed numerous cases concluding that mental health limitations in disability policies do not violate the ADA. Then the court found for the plan, stating simply that 'Morrill has failed to persuasively argue that a different analysis is required for ADA challenges to health insurance plans.'" (EBIA Weekly)
Analysis: IRS Finalizes Cafeteria Plan Election Change Regulations
Excerpt: "Final guidance has just been issued by the IRS on when cafeteria plan participants may change their elections outside of annual open enrollment. The 2001 final regulations modify a few provisions in the 2000 final regulations and substantially change several provisions in the 2000 proposed regulations. Generally, the 2001 regulations have expanded the possible election changes." (EBIA Weekly)
Analysis: Final COBRA Regulations Adopt 1999 Proposals But Make Changes to 1999 Final Regs
Excerpt: "The new regulations add a definition of what constitutes an insignificant shortfall in a COBRA premium payment to trigger the special rules for such shortfalls added by the 1999 final regulations. Under the definition, an amount will be considered insignificant if it is not greater than the lesser of $50 or 10% of the required premium amount." (EBIA Weekly)
Corrected Link: The Independent Medical Examiner/Transferable Skills Analysis Swindle
Excerpt: "). In the world of ERISA, IME's are seldom 'independent,' and TSA's almost never contain any kind of an 'analysis.' These are fictions, but they're fictions that insurance companies are allowed to create and rely upon in the context of ERISA-governed claim denials." (Opinion, by Michael A. McKuin, Esq.)
Analysis: IRS Issues Final Regulations Governing Qualified Transportation Fringe Benefits
Excerpt: "Cash reimbursement for transit passes is only permissible 'if a voucher or similar item which may be exchanged only for a transit pass is not readily available for direct distribution by the employer to the employee.'" (EBIA Weekly)
Buying Your Own Health Insurance
Excerpt: "If you work for yourself, retire before medicare kicks in, or don't have health insurance through your job, finding individual coverage that you can afford is as much a function of the state in which you live as it is the state of your health. It often comes as a rude awakening to look for insurance on your own, especially if you've been spoiled by years of relatively carefree coverage through your employer." (Kiplinger)
Analysis: HIPAA Nondiscrimination Regulations Issued
Excerpt: "A [Preexisting Condition Exclusion, or PCE] is permissible even though such clauses (by definition) discriminate based on health factors, so long as the PCE applies uniformly to individuals within the same group and is not directed at individuals based on a health factor (e.g., a plan cannot waive the PCE if no claims are filed in 90 days or impose a PCE for the first time after a big claim is filed)." (EBIA Weekly)
Building Consensus for Expanding Health Coverage
Excerpt: "... while the public s support for health coverage expansions is encouragingly broad, it is discouragingly thin and, as a result, is susceptible to a well-financed opposition campaign. Meaningful health coverage expansions, therefore, require broad-based support, transcending ideological, partisan, and interest-group boundaries." (Medscape; free registration required)
Another Question is Answered in the HIPAA Q&A Column
Our newly-hired employee just announced that she is two months along in her pregnancy. Our self-funded health plan covers employees after three months of employment. To what extent is the plan required to cover her pregnancy and childbirth expenses? (BenefitsLink.com)
| Sr. Benefit Administration Specialist-Multiple Locations | for Towers Perrin in PA, VA |
| 401(k) / Retirement Plan Administrator | for Howard Simon & Associates, Inc. in IL |
| Communications Consultant | for Persumma Financial, 401(K) Innovative Web Based Provider of Retirement Services in MA |
| Senior Communications Consultant | for Leading Retirement Benefits Outsourcing Company in GA |
| Retirement Plan Analyst - Temporary (16-18 months) | for HR Fundamentals Inc. in NJ |
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