| The BenefitsLink Newsletter - Welfare Plans Edition |  |
June 19, 2001
Today's sponsor: DATAIR (click)
PC-based BENEFIT ADMINISTRATION SOFTWARE for Pensions, Profit-Sharing, 401(k), and Cafeteria plans used by TPAs and Plan Sponsors for proposals, enrollment, documents, administration, trust accounting, voice response, task management, government and participant reporting. Modules operate independently or fully integrated for data sharing, speed, accuracy, efficiency & savings. Visit www.datair.com or click on the link above!
Group Health Plan Must Cover Prescription Contraceptives
Erickson v. The Bartell Company (W.D. Wash. 2001). Excerpt: "The parties to the case all agreed that the plan was generous in most of its coverage provisions; however, it excluded prescription contraceptives. At issue was whether this exclusion resulted in discrimination on the basis of sex in violation of Title VII of the Civil Rights Act, as amended by the Pregnancy Discrimination Act." (EBIA Weekly)
Plan's Interpretation of "Usual, Customary, and Reasonable" Clause Found to be Unreasonable
Schwartz v. Oxford Health Plans, Inc. (S.D.N.Y. 2001). Excerpt: "This case involves an employee receiving long-term treatment at a major cancer center. The treatment was covered by the health insurance plan offered by her employer, underwritten by a major insurance company. Later, her employer switched to a plan offered by the defendant, Oxford Health Plans." (EBIA Weekly)
Medicare Secondary Payer Statue Does Not Operate to Reorder COB Priorities Between Two ERISA Plans
Harris Corp. v. Humana Health Ins. (11th Cir. 2001). Excerpt: "This case involves a coordination of benefits dispute between two ERISA plans, in which one of the plans, the Harris plan, attempted to use the ordering provisions of the Medicare Secondary Payer ('MSP') statute to make the other plan, the Humana plan, the primary payer on expenses incurred by a covered individual." (EBIA Weekly)
HMO Must Use Providers' Discounted Rates When Calculating Co-Payments
Corsini v. United HealthCare Services, Inc. (D.R.I. 2001). Excerpt: "This class action was filed by a group of participants to challenge their HMO's practice of calculating co-payments as a percentage of health care providers' billed rates, even though the HMO had negotiated discounted rates with the providers." (EBIA Weekly)
Supreme Court Denies Review of Case Involving ERISA Preemption of State No-Fault Insurance Law
The U.S. Supreme Court has denied a petition to review the decision of the Sixth Circuit U.S. Court of Appeals in American Medical Security, Inc. v. AAA Michigan). In that case, the Sixth Circuit ruled that ERISA did not preempt a provision of Michigan insurance law specifying that where no-fault auto insurance coverage and health care coverage are coordinated, the health insurer is primarily liable for the insured's medical expenses. (SpencerNet)
IRS Discusses Transportation Fringe Benefits in Information Letter
Excerpt: "In response to an inquiry regarding whether the distribution of metrocards to employees violates an IRS regulation addressing gifts to employees, the IRS issued this Information Letter assuring the taxpayer that no current regulations would bar employers from providing transit passes to employees." (EBIA Weekly)
Jury Still Out On Employer-Subsidized PCs
Excerpt: "It has been more than a year since Corporate America embraced the idea of the so-called wired work force, creating programs that offer free PCs and subsidized monthly Internet access fees to employees. Workers ranging from factory workers to pilots praise the programs. They credit them for boosting computer literacy, enabling them to work from home and even helping spouses and children learn about the Internet." (CNet News.com via Yahoo! News)
Betting on Benefits
Excerpt: "It's getting more costly for top employers to stay ahead of the competition with their benefits packages. But they know large investments in employee perks will reap huge payoffs." (ComputerWorld.com)
Patients' Rights Lobbyists Take Costly Right-to-Sue Battle to a Few Key Legislators
Excerpt: "Lobbyists on both sides are focusing on fewer than 50 members of the House of Representatives, and no more than a dozen senators. Unlike the Clinton health care debate of 1993-94, neither side is trying to sway public opinion. The issue has been debated since 1997, and strategists on both sides believe the public has already made up its mind or is not focused on the subject. As a result, the lobbying and the ad campaigns are aimed at opinion leaders and lawmakers themselves." (Knight Ridder / Tribune)
Congress Debates Patients' Rights
Excerpt: "The opposing sides tested their arguments in television interviews Tuesday." (Associated Press)
Once Again, Congress Will Tackle HMO Liability Issues
Excerpt: "While waiting for Congress to act, Texas and eight other states have approved laws allowing suits against HMOs in state courts. And federal court decisions have chipped away at the immunity that insurers can claim when patients sue them. Advocates say a national bill is still needed because protections differ in each state. In addition, state laws don't apply to companies that pay their employees' medical bills without insurance." (The Dallas Morning News)
Q&A on Debate of Patients' Rights
Excerpt: "The bill favored by Democrats would extend patients' rights to clinical trials, give patients more opportunities to sue over denied care, grant more damages for injuries and create a more independent appeals system. Some questions and answers about the issue: ..." (Associated Press)
Mandatory Coverage Laws Can Save You Money and Save Your Life
Excerpt: "In her book 'Making Them Pay: How To Get the Most from Health Insurance and Managed Care' (St. Martin's Press), Washington lawyer Rhonda D. Orin, a partner with Anderson Kill & Olick, offers advice on how to evaluate health plans and maximize consumer benefits. She adapted this article from a chapter in her book." (Washington Post)
Senate Republicans May Delay HMO Debate
Excerpt: "Top Senate Democrats hoped to start debate Tuesday on their bill, which would give patients sweeping new rights to sue health maintenance organizations and insurers for treatment decisions that result in injury or death. But Republican leader Trent Lott of Mississippi objected, demanding time to review changes that would shield doctors and insurance agents from lawsuits and could make it harder for some patients to take disputes to court." (Reuters via Excite News)
Inside the Battle Over the Patients' Bill of Rights
Excerpt: "The Senate takes up a controversial bill this week that will make it easier for you to sue when you get bad medical treatment. White House correspondent John F. Dickerson and congressional correspondent Douglas Waller preview the fireworks." (Time.com)
HMO Bills See Heavy Lobbying In Senate
Excerpt: "Congress is expected to spend the next two weeks almost exclusively on the legislation. In this pressured environment, both sides aren't even trying to sway the public. Instead, they are focusing their energies on only enough lawmakers to prevail, spending millions of dollars on lobbying and advertising to change just a few minds." (The Detroit Free Press)
Opinion: Patients' Recourse
Excerpt: "The country has adapted itself to this system in an effort to rein in health-care costs. But patients, physicians, and insurers are still finding their way to checks and balances that will prevent individuals from being victimized by third-party decisions to withhold or limit treatment.... The Lott concession [that he could accept state court jurisdiction for claims] is a signal lawmakers are willing to make changes in legislation that is both important and complex." (Boston Globe)
Opinion: Patients' Rights Get Some Life
Excerpt: "President Bush's campaign pledge to be 'a uniter, not a divider' has been a bust in the early going of his administration.... Now Bush will soon face another test of his ability to bring warring sides together on another divisive matter: a patient's bill of rights." (Las Vegas Sun)
Would Federal Law Preempt Washington State's New Patients' Rights Bill?
Excerpt: "If Congress passes a patients'-rights law, how will it affect patients in Washington state, where the Health Care Patient Bill of Rights is to take effect next month? The answer is far from clear, but either of the two proposals being debated in the U.S. Senate this week will do one major thing the state law doesn't: regulate the health-insurance plans offered by self-insured companies." (The Seattle Times)
New Model of Health Care Service Gives Patients More Power
Excerpt: "Employees will soon play a bigger role in managing their own health care - and its cost - through what's being touted as the next big thing in health coverage ... This new plan is just entering the marketplace, but it is still so new that no one can agree what to call it. 'Defined contribution,' 'health banks'' and 'self-directed care' are some of the terms being tossed around." (New York Times Syndicate)
HMO Bill Tests Democrats
Excerpt: "The national debate over managed health care reaches the floor of Congress this week, bringing broad agreement on new rights for patients but sharp differences over allowing more lawsuits. The health care bill, the first the Senate's new Democratic leadership has called up, will be a test of the Democrats' strength and unity." (The Atlanta Constitution)
Patients' Rights Rise In Senate
Excerpt: "It's being called a test case for the new balance of power in the nation's capital. How the White House and the Senate work together - or don't - on a patients' bill of rights will speak volumes about the unfolding relationship between the new Republican president and a Senate suddenly controlled by the opposition." (Christian Science Monitor)
Opinion: Bush Picks the Wrong Fight in Debate on Patients' Rights
Excerpt: "Mr. Bush, however, is picking the wrong fight: Instead of restricting the legal rights of Americans, he should ask Congress to adopt competitive strategies for controlling the skyrocketing cost of medical insurance." (The Detroit News)
Opinion: "Patients' Rights" Misses Today's Issues
Excerpt: "Members of Congress, like old generals, keep fighting the last war. They get a notion in their heads that such-and-such is a big problem, and keep trying to fix it long after it has stopped being an issue. Appearing on 'Meet the Press,' Sen. Joe Lieberman, former vice presidential candidate, was adamant in support of the Patients' Bill of Rights, as crafted by Sens. Ted Kennedy and John McCain." (New York Post)
Lott Seeks Delay on Patients' Rights Debate
Excerpt: "Senate Republicans threatened today to hold up debate on a far-reaching bill to define patients' rights, saying they needed more time to study changes made by Democrats in the last few days." (New York Times; free registration required)
Rising Drug Costs and Use Are Fueling HMO Cost Increases
Excerpt: "When your employer hits you with the bad news about a double-digit increase in health insurance premiums next year, resist the urge to take a pill to reduce your stress: That's part of the problem." (St. Petersburg Times)
HCFA Becomes Centers For Medicare and Medicaid Services
The Health Care Financing Administration, the federal agency that administers the Medicare and Medicaid programs, has a new name and a new structure. The HCFA's new name is the Centers for Medicare and Medicaid Services, to be know as the CMS. (SpencerNet)
HHS Announces Rise In User Fee For Medical Fraud Queries, Seeks Input On Drug Firm Guidance
In a notice published in the June 11 Federal Register, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has announced an increase in the user fee assessed for queries to the Healthcare Integrity and Protection Data Bank. The new $5 fee per medical provider name, up from $4, is effective on October 1. (SpencerNet)
CEO Perks Good; Severance Packages Even Better
Excerpt: "Think salary, bonus, restricted stock awards, stock options and even long-term incentive plans are the only way executives are compensated? Think again. Companies can be quite creative in compensating their top people." (The Sacramento Bee)
Newly Posted or Renewed Job Openings (Post Yours!)
| Executive Compensation & Benefits Consultant | for Clark Bardes Consulting/Compensation Resource Group, Inc in CA, DC, GA, IL, NY, OH, TX |
| Pension Consultants/Administrators; F/T & P/T | for Northern NJ Mid-Size Pension Consulting Firm in NJ, NY |
| 401(k)/Pension Administrator | for Great Lakes Pension Administrators, Inc. in MI |
| Benefits Assistant | for Morrison & Foerster in CA |
| Senior Benefits Administrator | for Lyondell Chemical Company in TX |
| Non-Qualified Benefits Plan Administrator | for Winged Keel Group in NY |
| Health & Welfare Specialist | for Towers Perrin in NY |
| 401(k) / Retirement Plan Administrator | for Howard Simon & Associates, Inc. in IL |
| Pension Professional | for BMI in MO |
| Retirement Plan Services Operations Manager | for KeyCorp in OH |
| Manager, Benefits | for Dynegy in TX |
| ERISA Litigation Attorney | for Katz, Kutter, Haigler, Alderman, Bryant & Yon, P.A. in FL |
| Director of Benefits & Compensation - Bellevue, WA | for VoiceStream Wireless in WA |
Newly Posted Conferences (Post Yours!)
| Employee Benefits Conference | in NY on August 23, 2001 presented by The Foundation for Accounting Education a division of the NYSSCPA |
Newly Posted Press Releases
| Emplanet, Inc. Joins with 401kExchange! (401kExchange.com) |
| Cambridge Investment Research, Inc. Joins with 401kExchange! (401kExchange.com) |
| LifeMap Communications and Human Resource MicroSystems Launch New Partnership Programs (LifeMap Communications, Inc.) |
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