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December 17, 2002 - 8,030 subscribers
Today's sponsor: International Foundation of Employee Benefit Plans

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   New! International Foundation Books Available on BenefitsLink.

   When you have the right resources, you can answer the questions
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   Whether you're managing pharmacy benefit costs, designing a cash
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(Help BenefitsLink to provide this newsletter at no charge to you -- our sponsors pay your way. Remember to visit them periodically; we try to make sure their products and services will be of interest to you. Thanks! --Editor)
Web Emerging as Health Insurance Sales Tool
Excerpt: "[H]ealth plans including Health Net of California, PacifiCare, Oxford Health Plans, Health Alliance Medical Plans, Health Alliance Plan, and several Blues plans are using the Internet to help sell new policies online directly or through agents/brokers.... [W]hile actual sales of group policies over the Internet has been limited to date, this seems to be changing." (Healthplan via Medscape; free registration required)

Time Frame to Appeal Enforced Against ERISA Benefit Claimant
Alford v. DCH Foundation Group Long-Term Disability Plan (9th Cir. 2002). Excerpt: "Although decided under the 'old' claims regulations, this case emphasizes (1) the importance, for claimants, of acting within the prescribed time limits for making claims and appeals; and (2) the importance of the administrative record in limiting the scope of judicial review." (EBIA Weekly)

Fifth Circuit Rejects Participant's State-Law Challenge to Plan's Pre-Authorization Delay
Haynes v. Prudential Health Care (5th Cir. 2002). Excerpt: "[U]nder the new claims regulations, a plan may not enforce its pre-authorization requirements if obtaining prior approval is impossible or if 'application of the prior approval process could seriously jeopardize the life or health of the claimant.' Had this case arisen under the new regulations, the participant presumably could have obtained coverage for the needed hospitalization even without the required ... referral." (EBIA Weekly)

Analysis: Birth Control Battle in the Courts
Excerpt: "In a move that sets up the latest exchange in the long fight over coverage of contraceptives by employer-sponsored health-care plans, a federal judge in Georgia has certified a class action lawsuit against Wal-Mart Stores Inc." (PLANSPONSOR magazine; free registration required)

Institute of Medicine Recommends Several Projects For Health Care Reform
The nation's mounting health care problems--such as rapidly rising costs, growing numbers of uninsured, and safety and quality gaps--threaten to destabilize the system, making quality improvements necessary. The Institute of Medicine (IOM) initiated the Rapid Advance Demonstration Project in June 2002 to identify some demonstration projects that have the potential to improve the delivery of health care within a few years. (SpencerNet)

Implementing the Federal Health Privacy Rule in California: December 2002 Update Available Online
Excerpt: "The Bush Administration has proposed modifications to the Federal Health Privacy Rule. The December 2002 updates to these guides are available below, along with the original guides." (California HealthCare Foundation)

Overview: DHHS Issues New Frequently-Asked Questions on HIPAA Privacy
Excerpt: "The new guidance focuses largely on issues specific to health care providers and restates positions that were clear from prior guidance. However, the new guidance does offer some needed clarifications and 'real-world' examples. Here are some highlights: ..." (EBIA Weekly)

Incentives Stabilize Health Care Costs at Pharmaceutical Company
Excerpt: "Five years ago, Hoffmann-LaRoche launched a series of wellness programs in an attempt to improve the overall health of the company and focus more dollars on early detection and self-management of health risks.... The company also offers incentives through GiftCertificates.com to employees who take advantage of a certain number of programs." (Workforce.com)

On-Site Clinic Saves Company $400,000
Excerpt: "Two days a week, the clinic is staffed by a doctor and an assistant who can take care of any medical need, short of surgery. 'Because it is so convenient, many employees go to the clinic for conditions they wouldn't normally go to their own doctors for' ... That means employees are detecting health risks, such as high blood pressure or heart conditions, sooner and managing them before serious problems occur." (Workforce.com)

More States Flirt With Universal Healthcare
Excerpt: "Nearly a decade after President Clinton turned 'universal healthcare' into perhaps the most dreaded phrase in the American political vocabulary, the topic is beginning to reemerge in states nationwide." (The Christian Science Monitor)

White Paper: Public Policy Issues in Direct-to-Consumer Advertising of Prescription Drugs
Excerpt: "Direct-to-consumer advertising of prescription drugs differs from almost all other advertising in two respects. The first is the requirement for consumers to obtain a physician's prescription before purchase, a requirement that (significantly for an understanding of FDA regulation) was not originally dictated by legislation. This requirement has several effects...." (American Enterprise Institute)

Addressing the Problem of the Uninsured: Can the Individual Health Insurance Market Respond?
Excerpt: "As policy makers in Washington consider the use of tax credits to encourage uninsured Americans to buy health insurance, researchers and policy experts debated the merits of the individual health insurance market ... A proposal that intrigued many conference attendees is to have the federal government serve as a reinsurer of the individual market 'by assuming responsibility for most of the costs of people in the highest 2 percent to 3 percent of the national spending distribution.'" (Center for Studying Health System Change)

White Paper: the Need for Regulation of Health Insurance Renewal Premium Increases (PDF)
7 pages. Excerpt: "State and federal laws prevent insurers from canceling health insurance coverage when people become sick and/or make medical claims-- a practice that, if allowed, would defeat the very purpose of having health insurance as protection against unexpected illness. However, some insurers try to circumvent these laws by raising premiums so high that people drop their coverage. This problem can exist in both the individual and small group markets." (FamiliesUSA)

Critics Decry UK Plans for Private Firms to Run Hospitals
Excerpt: "The British government could be heading for a political storm over moves that may allow private health firms, including foreign companies, to run failing National Health Service (NHS) hospitals." (Reuters Health via Medscape; free registration required)

HIPAA Privacy Rule Guidance Clarifies Issues of Business Associates, Privacy Notices
On Dec. 3, 2002, the Office of Civil Rights for the Department of Health and Human Services released new guidance on the HIPAA privacy rules. The guidance, 'Standards For Privacy Of Individually Identifiable Health Information,' includes a brief introduction and frequently asked questions on the following topics: Incidental Uses and Disclosures, Minimum Necessary, Personal Representatives, Business Associates, Marketing, Public Health, Research, HIPAA Privacy Notice, and Government Access. (SpencerNet)

Opinion: Viewing Long-Term Care Insurance as an Essential Employee Benefit
Excerpt: "The benefits of LTCI are compelling for employers seeking to build a strong and stable workforce and increase the quality of life for workers. LTCI helps employees protect their assets and retirement savings. Not making this coverage available takes its toll, according to workplace productivity studies.... Employers looking into LTCI can expect to find a wide assortment of benefits. Here are some of the features and benefits one can expect." (Employee Benefits Journal via Insurance News Net)

Links to Items on Executive Comp, Benefits in General

Tapes and CDs Available for Hewitt Associates Teleconferences
Tapes and CDs of recent teleconferences available for ordering online from Hewitt Associates-- at no charge-- include 'Six Decisions To Take Control of Future Health Care,' 'Employers Blaze New Trails With Consumer-Driven Health Care,' 'Considerations and Implications of Expensing Stock Options,' and 'How to Maximize Retirement Returns by Monitoring Total Plan Cost.' (Hewitt Associates)

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Newly Posted Webcasts
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2002 Health Care Legislation: The Year in Review
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Editor and Publisher: David Rhett Baker, J.D.