Welfare Plans Edition
February 5, 2001
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HIPAA Executive Summary
Excerpt: "[A]ll healthcare organizations that maintain or transmit electronic health information must comply. This includes health plans, healthcare clearinghouses, and healthcare providers, from large integrated delivery networks to individual physician offices. After the final standards are adopted, small health plans have 36 months to comply. Others, including healthcare providers, must comply within 24 months." (QuadraMed)
Delayed Effective Date for Federal Regulations
Excerpt: "Recent regulations not affected by the memorandum include: 1) IRS regulations on cafeteria plans, COBRA, intermediate sanctions for tax-exempt employers, and qualified transportation fringe benefits; 2) OSHA regulations on employer ergonomics requirements; 3) DOL regulations on claims procedures and SPDs; and 4) HCFA regulations on Medicare+Choice notice and appeal procedures ..." (Hewitt Associates)
Ninth Circuit Addresses Vesting of Disability Benefits and Validity of Plan Amendments
Penny Grosz-Salomon v. Paul Revere Life Ins. Co. (9th Cir. 2001). Excerpt: "... we take issue with what we consider to be its overly-broad formulation of the rule that welfare benefits never vest or accrue unless the plan document expressly says they do." (EBIA Weekly)
A Roof Over Their Heads: Employer-Assisted Housing for Employees
Excerpt: "This benefit may look increasingly attractive to employers, thanks to a combination of rising house prices and a tough hiring market." (HR magazine)
Commercial Health Insurance and Medicaid Definitions of Medical Necessity, As Applied to Children
Excerpt: "Results: Commercial insurers are more likely than Medicaid agencies to articulate medical necessity standards that limit coverage to treatment for illnesses and injuries and to include stringent requirements for cost and evidence of effectiveness. Conclusion: To reduce the discretion retained by insurers in determining medical necessity ... much greater clarity and uniformity in medical necessity language will be required in the future." (Ambulatory Pediatric Association)
New Booklet Advises Taking an Active Role in Health Care Decisions
Excerpt: "[AHRQ] announced [on January 31, 2001] the availability of a new resource with practical tips on what people can do to improve the quality of the health care services they receive, including how to avoid medical errors. Improving Health Care Quality: A Guide for Patients and Families focuses on the key health care choices people typically make, such as choices about doctors, hospitals, and treatments, and stresses taking an active role ..." (Agency for Healthcare Research and Quality )
Improving Health Care Quality: A Guide for Patients and Families
Excerpt: "Health care providers and groups are working hard to improve health care quality. You can help, too. You can take steps to improve the quality of your own health care. Research has shown that if you are more involved in your health care, you can get better results and feel more satisfied. Here's what you can do:" (Department of Health and Human Services )
DHHS Delays Effective Date of Recently Published National Medical Support Notice Rule
Excerpt: "The DHHS announced [on January 26, 2001] that the effective date of the 'National Medical Support Notice; Final Rule' ... will be temporarily delayed for 60 days." (EBIA Weekly)
Health Club Fees for Rubdowns and Exercise Usually Not Deductible Under Code Section 213
IRS Information Letter 2000-0405 (Dec. 29, 2000). Excerpt: "In this Information Letter, the IRS responded to a taxpayer's suggestion that the costs of exercise should be deductible from gross income." (EBIA Weekly)
Bush's Health Care Goal: Step By Step
Excerpt: "[President Bush is] ready to sign a patients' bill of rights that strengthens the hand of patients and physicians in dealing with managed-care organizations -- provided that the right to sue health maintenance organizations -- HMOs -- is limited, with a cap on damages." (Sacramento Bee)
Shopping for a Nursing Home
Excerpt: "If you have a relative whose physical or mental condition requires round-the-clock care, residence in a nursing home may, at some point, be the only safe, feasible option.... The following excerpt highlights the key things to look for when selecting a nursing home and overseeing services so that your loved one receives the best possible care." (Consumer Reports)
Opinion: HMO Regulation Turns Into A Smooth Operation in California
Excerpt: "Having served as chief of staff to [California governor Gray] Davis when the governor was state controller, ["HMO czar" Daniel] Zingale knows that Davis prefers a measured, incremental approach in almost all things. HMO regulation is one of them. So Zingale has taken an interesting tack. Instead of sneaking around, taking names and trying to nail companies for screwing up, he has cozied up to the health plan executives ..." (Sacramento Bee)
(Following also appears in Retirement Plans Edition)
Communicating Employee Benefits Information Online
Excerpt: "Overall, most companies--79 percent--choose a company intranet as their primary method for delivering HR-related services to employees and managers, up from 50 percent just two years ago, according to Watson Wyatt." (HR magazine)
A Silent Fiduciary is an At-Risk Fiduciary
Discusses Harte v. Bethlehem Steel Corporation (3d Cir. 5/26/00). Excerpt: "Just what you needed-- a case where a court seemingly requires a fiduciary to peer into a participant's mind in order to avoid fiduciary liability ..." (Nixon Peabody LLP)
10th Cir.: Golden Parachute Program Providing One-Time Lump-Sum Payments Held Not to be ERISA Plan
Lettes v. Kinam Gold, Inc. (10th Cir. 2001). Excerpt: "[T]he Tenth Circuit's approach in this decision may be quite significant for employers in that jurisdiction (which includes Kansas, Oklahoma, Colorado, Wyoming, Utah, and New Mexico)-- their severance programs are now less likely to be treated as ERISA plans if they provide lump-sum payments in connection with one-time reductions in force." (EBIA Weekly)
Golden Parachute Payments Not Illegal Merely Just Because They're Excessive and Grossed Up for Taxes
Campbell v. Potash Corp. (6th Cir. February 02, 2001). Excerpt: "[Appellant] next argues that the golden parachutes violate public policy, and therefore that the assumption agreement promising them is void.... [Appellant] cites no circuit case law supporting its proposition. At most this court has frowned on golden parachutes in past dicta, but we have never held that such severance packages are per se unlawful." (FindLaw.com)
3d Cir.: No Non-Marketability Discount to be Applied to Stock Options After Wrongful Termination
Scully v. US WATS, Inc. (3d Cir. February 01, 2001). Excerpt: "In this appeal, the primary issue is whether US WATS improperly denied Mark Scully the right to exercise his stock option following his wrongful termination, and, if so, whether the District Court, in awarding damages, improperly failed to apply a discount from market value to account for the option shares' lack of marketability." (FindLaw.com)
Graef Crystal: Tyco CEO Needs a Truck to Haul Pay
Excerpt: "The dismal performance didn't stop Kozlowski from raiding Tyco's treasury. He needed a dump truck to cart away his pay package for 2000: Salary of $1.35 million. Bonus of $2.8 million. Miscellaneous compensation of $527,000. And a free-share award of $21.2 million. What a reward for a sub-par performance." (Graef Crystal, on Bloomberg.com)
Choosing The Right Name Can Turn A Bill Into A Law
Excerpt: "Experience has taught politicians legislative success begins with marketing." (St. Petersburg Times)
| Team Manager 401(k) | for Fidelity Investments in TX |
| Manager, Plan Service Team | for ICMA Retirement Corporation in DC |
| 401(k) Client Service Manager - Full or Part Time | for Independent 401(k) Advisory Firm in Harrisonburg, Virginia in VA |
| A TPA Firm Looking to Purchase a Small TPA Firm or Block of Qualified Plan Business | for A small full service consulting firm that provides legal and administrative employee benefit and retirement plan services to employers in ALL STATES |
| Pension producer | for Leading Regional Independent Producers Group in DE, MD, NJ, PA |
| Actuarial Analyst | for Ceridian Retirement Plan Services in CO |
| 20th Annual Conference-Employee Stock Ownership Plans-Stock Options-Employee Involvement | in WA on April 25, 2001 presented by National Center for Employee Ownership |
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