| The BenefitsLink Newsletter - Welfare Plans Edition |  |
May 9, 2001
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Drug Costs Soar in Canada and Australia Despite Efforts to Curb Spending
Excerpt: "Canada and Australia finance healthcare primarily through public programs, yet both counties face the same difficulty as private payers do in the U.S.: paying for lifesaving medications 'without breaking the bank.'" (Reuters via Medscape; free registration required)
Medical Mistakes: Healthcare in Critical Condition
Excerpt: "A new report from the prestigious RAND Corporation says the quality of health care for most Americans is surprisingly poor: The group ranked the U. S. medical establishment 37th in overall performance worldwide.... The biggest problem is that while we have amazing new medical machines and drugs, much of health care relies on ancient technology -- often illegible notes in medical records that get lost." (MSNBC.com)
Managed Care: Reports of Its Demise Are Premature
Contingencies Magazine is published by the American Academy of Actuaries. Excerpt: "Today we may operate at Internet speed, but has managed care really failed so catastrophically and so soon? Do we need a replacement? Or, as I believe, have we simply reached a plateau in managed care effectiveness that requires refined strategy before we move forward again?" (Contingencies Magazine)
Privacy Laws No Match for Modern Technology
Excerpt: "'Privacy in this country is more protected by our social norms than by our laws,' said Northeastern University law professor Wendy Parmet. 'People become extremely distressed when they learn how little legal protection we have.'Despite widespread belief to the contrary, the U.S. Constitution mentions no right to privacy." (Reuters via Excite News)
Court Upholds Gross Misconduct Decision for Violation of Employer's Established Rules of Conduct
Bryant v. Food Lion, Inc. (4th Cir. 2001). Excerpt: "This case is interesting because of the employer's express definition of gross misconduct for COBRA purposes, which was tied to the employer's pre-determined and well-publicized rules of conduct. The trial court also found that the conduct qualified as gross misconduct within the standards articulated by reported decisions ..." (EBIA Weekly)
Plan's Unambiguous Subrogation Clause Not Subject to State Law Rule or "Make Whole" Doctrine
Bill Gray Enterprises, Inc. Employee Health and Welfare Plan v. Gourley (3d Cir. 2001). Excerpt: "This case also illustrates (once again) the importance of plan language. This plan won because its subrogation clause was explicit and detailed." (EBIA Weekly)
University of Pittsburgh Agrees to Study Domestic Partner Benefits; Litigants Suspend Court Action
Excerpt: "The University of Pittsburgh has agreed to study extending health benefits to domestic partners of its gay employees as a step toward settling a bitter 5-year-old lawsuit against the school. In return for creating a campus panel that will make recommendations to Chancellor Mark Nordenberg, seven employees suing the school have agreed to 'temporarily suspend' all litigation in the case." (Pittsburgh Post-Gazette)
State Law Claims Against Plan for "Mixed Eligibility and Treatment" Decisions Not Preempted
Excerpt: "Relying on a recent Supreme Court decision, the Pennsylvania Supreme Court in Pappas v. Asbel, No. 98 E.D. Appeal Dkt. 1996 (Pa. April 3, 2001), concluded that medical malpractice claims against an administrator of benefits under a welfare plan covered by ERISA are not preempted by ERISA.... In a dissenting opinion, Justice Saylor pointed out that the majority may have read too much into Pegram [v. Herdrich, the recent U.S. Supreme Court case on ERISA preemption.]" (Groom Law Group)
Trust Maintained by Multiple Employer Welfare Arrangement Found by DOL to be a Single ERISA Plan
DOL Advisory Opinion 2001-04A (March 22, 2001). Excerpt: "This is the first Advisory Opinion we know of in which the DOL finds a MEWA (the Trust) to be an ERISA plan, at least in form (although we are aware of MEWAs that operate as single ERISA plans). More commonly, where a MEWA provides ERISA welfare benefits to employees of member employers, each employer is treated for ERISA compliance purposes as maintaining its own separate welfare benefit plan." (EBIA Weekly)
Lessons in Absentee Management
Excerpt: "Absenteeism relates directly to an organization's culture. A health-conscious environment and support for work-life balance are two rules for prevention." (Benefits Canada)
HCFA Addresses How Individual Market Rules Apply to Conversion Coverage
Excerpt: "In this Program Memorandum, the Health Care Financing Administration (HCFA) addresses how the guaranteed availability and guaranteed renewability requirements apply to conversion coverage.... HCFA clarifies that although the conversion coverage is available to the individual because of the individual's prior group health plan coverage... it is individual coverage ... so a conversion policy will be subject to HIPAA's guaranteed renewability requirements." (EBIA Weekly)
Shrinking Market, Rising Health Care Costs Contributing to Stop-Loss Premium Increases, Experts Say
Excerpt: "A decline in the number of stop-loss insurance carriers and an increase in health care costs are the two most significant factors contributing to rising stop-loss insurance rates, according to experts within the stop-loss insurance industry. These rates will continue to climb over the next couple of years as the stop-loss insurance market undergoes a metamorphosis in order to return to profitability." (Thompson Publishing Group)
Opinion: Mandated Health Benefits Mean Higher Costs
Excerpt: "Increasingly, the health insurance available to American families is determined not by consumer choice but by government-mandated benefits that limit options and increase costs. In 1965 there were only eight health insurance mandates nationwide. Today there are more than 1,000, covering treatments ranging from acupuncture to hairpieces." (Kansas City Star)
Paying the Price for Infertility
Excerpt: "In the past few years, states have increasingly adopted laws requiring insurance companies to cover such health issues as mental illness, prostate exams, and even contraception. Historically, however, states have been reticent to enact legislation requiring the coverage of infertility ... Insurance companies say if they are hit by yet another coverage mandate they will be forced to raise premiums, which will preclude even more Americans from obtaining affordable health care." (insure.com)
Re-examining Healthcare Costs
Excerpt: "Managing drug costs is a priority for plan sponsors. But managing the drug plan in isolation could do more harm than good." (Benefits Canada)
95 Percent of U.S. Doctors Have Seen Medical Error, But Just 4 Percent See Them Frequently
Excerpt: "Experts said in a 1999 report that medical errors kill between 44,000 and 98,000 people annually, with up to 7,000 of those deaths resulting from mistakes in prescribing or dispensing drugs. [The doctors and nurses] questioned in the survey generally gave high marks to quality of the U.S. health care system in terms of safety, effectiveness, timeliness and other measures." (Reuters via Yahoo! News)
National Retiree Legislative Network Debuts
Excerpt: "The National Retiree Legislative Network, Inc. (NRLN) is a District of Columbia Nonprofit social welfare organization. NRLN was started by several large retiree organization from corporations that are household names.... We are in the process of reaching out to the more than 20,000,000 retirees nationwide who receive or once received pensions, health benefits or both and wish to keep, regain or recover those benefits." (National Retiree Legislative Network)
Newly Posted or Renewed Job Openings (Post Yours!)
| Health and Welfare Associate Consultant | for Arlen Group in CA |
| Pension Plan Administrator | for Benefit Associates, Inc. - Orange, CA in CA |
| Senior Pension Administrator | for The Kagan Company in CA |
| Benefits Manager | for San Joaquin County in CA |
| Retirement Plan Consultant | for A Prestigious Management Consulting Firm in ALL STATES |
Newly Posted Conferences (Post Yours!)
| Qualified Plan Design and Administration | in CO on June 25, 2001 presented by Accountant's Education Services |
| Qualified Plan Design and Administration | in CO on October 1, 2001 presented by Accountant's Education Services |
| Qualified Plan Testing and Advanced Issues | in CO on June 27, 2001 presented by Accountant's Education Services |
| Qualified Plan Testing and Advanced Issues | in CO on October 3, 2001 presented by Accountant's Education Services |
| Executive Compensation | in CO on July 12, 2001 presented by Accountant's Education Services |
| Executive Compensation | in CO on January 17, 2002 presented by Accountant's Education Services |
| What's New In Behavioral Health Care | in CA on May 23, 2001 presented by The Los Angeles Chapter of ISCEBS |
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