October 1, 2002 - 7,276 subscribers
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Medical Expense Reimbursement Accounts Can't Pay Tax-Free for Expenses Before Plan's Adoption
Rev. Rul. 2002-58. Excerpt: "Amounts reimbursed under a self-insured medical expense reimbursement plan for medical expenses incurred by an employee prior to the establishment of the plan are not excludable from the gross income of the employee under section 105(b)." (Internal Revenue Service)
Feds Tell Drug Industry to Stop Gifts to Doctors, Healthplan Managers
Excerpt: "[T]he government said that drug makers could not offer incentive payments or other 'tangible benefits' to encourage or reward the prescribing or purchase of particular drugs by doctors, health plans or companies that manage drug benefits for employers and insurers." (New York Times; free registration required)
Flowchart: Are You a Covered Entity Under the HIPAA Administrative Simplification Rules? (PDF)
12 pages. Includes a flowchart entitled, 'Is a private benefit plan a health plan?" (U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services)
Fourth Circuit Finds Language in Disability Policy Does Not Grant Insurance Company Discretion
Excerpt: "[W]e must determine whether the following language in the plan grants [Reliance Standard Life Insurance Company] discretion to determine Gallagher's eligibility for benefits: 'We will pay a Monthly Benefit if the Insured . . . submits satisfactory proof of Total Disability to us.' ... We conclude that the language of the Plan does not grant Reliance discretionary authority.... Some of our sister circuits [have reached the opposite] conclusion." (U.S. Court of Appeals for the Fourth Circuit, via FindLaw.com)
SPD Trumps Conflicting Language in Plan Enrollment Guide
Bailey v. CIGNA Ins. Co., No. 01-1115 (W. Dist. La. 9/5/02). Excerpt: "[A]lthough the Enrollment Guide did not specify a limit on the number of physical therapy sessions that were covered annually, the SPD did. Under ERISA, when there is a conflict between a plan's SPD and the terms of the policy itself, the SPD's terms will control. The court held that the Enrollment Guide did not meet the requirements of an SPD and therefore did not bind the claims administrator." (EBIA Weekly)
Generic Drug Bill Encounters Growing Fight
Excerpt: "Legislation designed to speed low-cost generic drugs to pharmacy shelves sailed through the Senate in July, but it has run aground in a House committee chaired by Louisiana Congressman Billy Tauzin. Despite a broadly bipartisan Senate vote approving the measure, Tauzin has voiced doubts about the legislation ..." (NOLA.com)
Opinion: Ten Ways Employers and Unions Helped Mess Up Health Care
Excerpt: "It's no big story that health care costs are once again increasing at double digits. Why are costs surging this much? Well, we could round up the usual suspects ... But I have another list, an even more important list, given that employers provide health care coverage to 163 million people-- 76% of all U.S. citizens.... So here is my list of how employers (and let's be honest, unions as well) have messed up the health care system ..." (Richard D. Quinn on BenefitNews.com)
Study Finds Aging Plays Limited Role in Health Care Cost Trends
Excerpt: "Despite widespread belief to the contrary, aging baby boomers are not a major driver of rapidly rising health care costs for Americans under age 65, according to new findings from the Center for Studying Health System Change." (Center for Studying Health System Change)
'Napsterizing' Pharmaceuticals: Access, Innovation, and Consumer Welfare In an All-Generic World
Excerpt: "We analyze the effects on consumers of an extreme policy experiment-- 'Napsterizing' pharmaceuticals-- whereby all patent rights on branded prescription drugs are eliminated for both existing and future prescription drugs ... [P]roviding greater access to the current stock of prescription drugs yields large benefits to existing consumers. However, realizing those benefits has a substantially greater cost in terms of lost consumer benefits from reductions in the flow of new drugs." (James W. Hughes, Michael J. Moore, Edward A. Snyder; working paper published by National Bureau of Economic Research)
Newly Posted or Renewed Job Openings -
for Polycomp Administrative Services, Inc.
Consultant - Retirement Plan Administration & Systems
for MK Consulting, Inc.
in ALL STATES
for Mellon HR Solutions
in MA, NJ, NY
Benefits & Compensation Tax Manager
for American Express Financial Advisors
for Clifton Gunderson LLP
Members Services Coordinator
for Public School Retirement System of the School District of Kansas City, MO
for Search Firm
401(k) Product Specialist
for Master Benefit Group, Inc.
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May 13, 2003
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