February 13, 2002 - 6,451 subscribers Today's sponsor: In Plain English (Click on company name or banner to learn more.) ERISA requires new SPDs by January 22, 2003. Will you be ready? Let In Plain English(R) write and produce your SPDs for print and the Web. Compliant, Correct, Easy-to-Read... Guaranteed! For more information on how we can help you, visit http://www.InPlainEnglish.com or email Ron Wohl at rwohl@InPlainEnglish.Com. To receive our FREE SPD ALERT Newsletter, subscribe at http://www.InPlainEnglish.com/welcome.htm (Help BenefitsLink to provide this newsletter at no charge to you -- our sponsors pay our way. Remember to visit them periodically; we try to make sure their products and services will be of interest to you. Thanks! --Editor) Joint Committee Gives Overview of Current Health Care Tax Provisions and Legislative Proposals (PDF) 22 pages; JCX-4-02, February 12, 2002. Excerpt: "The House Committee on Ways and Means has announced a public hearing on the use of health tax credits to aid displaced workers and reduce the number of individuals without health insurance. This document ... provides a description of present law relating to tax incentives for health care and summarizes selected health care tax proposals providing aid to displaced workers and other uninsured individuals." (Joint Committee on Taxation) Bush's Prescription for Medical Reform Excerpt: "[Medical savings] accounts, Bush said, would afford consumers greater control over how their health-care dollars are spent. Other proponents say such accounts can generate savings for employers, instill cost-consciousness among consumers and create unprecedented competition among providers, while granting unrestricted choice of doctors and eliminating bean-counters from the physician-patient relationship." (Los Angeles Times) Bush Flies Health Care Reform Banner Excerpt: "The president's address further defined the administration's position on health care legislation -- a probable hot topic in the 2002 mid-term elections in which control of the Senate and House will once again be up for grabs." (UPI via Wall Street City) Benefit Denial Based On Experimental Treatment Exclusion Overturned Zervos v. Verizon New York, Inc. (2d Cir. 2002). Excerpt: "[T]he Second Circuit found that the insurer had 'in effect added additional language to the policy' by requiring HDCT to be superior to other treatments while the experimental exclusion required only that the treatment be effective and appropriate, not more effective than alternatives." (EBIA Weekly) Insurer Had No Duty to Inform Participant That Employer's Premium Payment Was Overdue Riley v. HMO Louisiana, Inc. (E.D. La. 2002). Excerpt: "The participant alleged that the insurer had breached its fiduciary duty by pre-certifying the expenses without informing her that the premium was overdue and that coverage would be suspended until payment was made.... [T]he insurer contended that its duties were never triggered because it did not know, when the surgery was pre-certified, that the employer would ultimately fail to pay the premium." (EBIA Weekly) Detailed Reasons for Denying LTD Claim Must Be in Initial Denial Notice Olive v. American Express LTD Benefit Plan (C.D. Cal.). Excerpt: "[I]n the Ninth Circuit (and certain others), the stricter de novo standard can apply even where the plan document confers discretion, where (as here) the administrator has a conflict of interest and procedural irregularities (such as the defective initial denial letter) show that the conflict adversely affected the decision." (EBIA Weekly) Denial of LTD Benefits Based On Conflicting Medical Opinions Not An Abuse of Discretion An insurance company did not abuse its discretion in denying a beneficiary's claim for long term disability benefits based on conflicting medical opinions. This was the ruling of the Eighth Circuit U.S. Court of Appeals in Proctor v. UNUM Life Insurance Company of America (No. 01-3000). (Spencernet) Consumer-Driven Health Plans Counter Criticism Excerpt: "Providers of consumer-driven health plans, which have been touted as a rapidly emerging alternative to managed care, have become sensitive to criticisms that they are merely an elaborate smoke-and-mirrors scheme to make the sickest patients pay more. Many of the companies say they have already anticipated the problems of adverse selection and have built corrections for this possibility into their plan designs, premium payment methodologies, and consumer incentives." (BenefitNews.com) Enron Paid Deferred Compensation to Some, Not All, Executives Excerpt: "In the weeks before it filed for Chapter 11 bankruptcy protection, Enron allowed a small group of executives to withdraw their money from a deferred compensation program, giving them preferential treatment over some former managers who had also requested early withdrawal, according to former and current executives at the company." (New York Times; free registration required) Newly Posted or Renewed Job Openings -
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