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January 13, 2003 - 7,947 subscribers
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Supreme Court Case to Test 'Any Willing Provider' Laws Applicable to HMOs
Excerpt: "A case scheduled to be argued before the U.S. Supreme Court next week could have major implications for the future of the nation's healthcare system, managed care officials said [on January 8, 2003]. If the Supreme Court upholds a Kentucky 'any willing provider' law, they said, and if other states follow Kentucky's lead, health plans will be deprived of a major cost-containment tool." (Reuters Health via Yahoo! News)
Hartford Courant Coverage: Patient Choice Faces Test in U.S. Supreme Court
Excerpt: "A Kentucky law designed to assure patients more choices of health care professionals is facing Supreme Court scrutiny in a case with nationwide implications for insurers and health maintenance organizations." (The Hartford Courant)
Prudential Withdraws Voluntary Benefits Program
Excerpt: "Even as voluntary benefits become more attractive to both employers and employees, Prudential Financial recently - and surprisingly - became one of the few insurance companies to withdraw from that field." (BenefitNews.com)
What's Better for Dependent Care Expenses -- Using Cafeteria Plan or Using Tax Credit?
Excerpt: "Determining which approach produces the greatest tax benefits will ultimately depend on a number of variables unique to the individual, such as tax filing status (e.g., married, single, head of household), number of dependents, earned income, tax bracket, etc. Below is a simple rule of thumb that we developed by calculating the relative tax benefits for a large number of hypothetical taxpayers ..." (EBIA Weekly (Question of the Week))
Supreme Court to Hear Case Testing FMLA Application to State Employers
Excerpt: "The legal question specifically asks whether state workers can sue for money damages when states turn down their leave requests. That presents the court with another test of its recent trend of protecting state sovereignty in the face of federal rules. A five-justice majority has repeatedly said state employees cannot sue for damages when their employers deny them benefits under certain federal laws ..." (USA Today via International Foundation of Employee Benefit Plans)
University of Pittsburgh and ACLU Still at Odds Over Benefits for Domestic Partners
Excerpt: "The benefit remains controversial in places and is far from universal. For instance, the Post-Gazette does not offer domestic partner health benefits. But experts say that employers are increasingly opting to proceed after learning from other firms that it has not substantially increased their health care costs. In its most recent survey, Hewitt Associates found that of nearly 600 major U.S. companies, 20 percent offered the benefit as of 2000 ..." (The [Pittsburgh] Post-Gazette)
Court Upholds Denial of Benefits for Sex-Change Procedure Based on Lack of Medical Necessity
Mario v. P & C Food Markets (2d Cir. 2002). Excerpt: "The participant in this case underwent a sex-change operation and sought reimbursement from his employer's self-funded ERISA health plan for the surgery and related hormone therapy. His employer denied the claims for lack of 'medical necessity.' The participant brought suit claiming the denial of benefits violated ERISA and constituted sex discrimination under Title VII." (EBIA Weekly)
Contributions to Retirees' Medical Insurance Based on Unused Sick Leave Not Taxable Income
Excerpt: "In this Private Letter Ruling, the IRS considered the tax treatment of benefits that a school district wished to provide to eligible employees as part of a proposed early retirement benefits plan ... [E]ligible employees who retired before age 65 ... would be provided with various benefits, the amount of which depended partly on the unused amounts in an employee's sick and personal leave account at retirement ..." (EBIA Weekly)
From the Physicians' Perspective: Health Plans Subject To New Federal Appeals Rules
Excerpt: "Federal regulations that dictate rapid turnaround times for health plan claims and appeals quietly went into effect this month ... They require employer-sponsored health plans ... to return decisions on claims and appeals faster than before and extend the time claimants, including physicians, have to file appeals to 180 days. Plans also are given even shorter time frames to review claims that are deemed 'urgent' by the treating physician." (American Medical News)
New Study Cites Lack of Health Insurance Purchasing Power by Midsized Companies
Excerpt: "In the Pacific Region-- which includes California, Oregon, Washington, Alaska and Hawaii-- employers with 200 to 999 employees saw the cost of their health benefits rise 11.5 percent in 2001 to an average of $5,005 per worker, according to the Marsh/Mercer Mid- sized Employer Health Plans Survey." (Los Angeles Daily News via International Foundation of Employee Benefit Plans)
Rep. Bernie Sanders Slams Glaxo for Decision to Stop Selling to Canadian Pharmacies Who Sell to U.S.
Press release. Excerpt: "Glaxo sent letters to each of its wholesalers, distributors and retailers in Canada this week threatening to cut off their supply of life-saving drugs if they sell any of Glaxo's products to U.S. consumers or to any one of 27 Canadian retailers who sell prescription drugs to U.S. consumers.... Sanders ... pledged to introduce legislation to prevent Glaxo and other drug companies from strong arming Canadian pharmacies and wholesalers." (U.S. House Rep. Bernie Sanders (I-Vt.))
GAO Report: Effects of Using Pharmacy Benefit Managers on Health Plans, Enrollees, and Pharmacies
GAO was asked to examine how pharmacy benefit managers participating in the federal program affect health plans, enrollees, and pharmacies. Excerpt: "The PBMs reviewed produced savings for health plans participating in FEHBP by obtaining drug price discounts from retail pharmacies and dispensing drugs at lower costs through mail-order pharmacies, passing on certain manufacturer rebates to the plans, and operating drug utilization control programs." (U.S. General Accounting Office)
Opinion: Bill Frist's Long List of Corporate Vices
Excerpt: "Frist was born rich, and got richer-- thanks to massive criminal fraud by the family business.... Frist's pandering to the lobbyists of the voracious health-care industry knows no bounds." (LA Weekly)
Opinion: Looming Threat to Consumer-Driven Healthcare is Excessive Billing of Self-Pay Patients
Excerpt: "Excessive charges to patients who must pay their own health care bill is presently one of the least-known, but most egregious cost-shifting offenses of the American health care system. The fact that it most prominently affects the segment of our population who can least afford it-- the 41.2 million uninsured-- is inexcusable, and intolerable." (U.S. Freedom Foundation)
Consumers Consider Direct-To-Consumer Drug Ads 'Useful,' Survey Indicates
Excerpt: "Most consumers find prescription drug advertisements 'useful' and 'don't want limits put on them,' according to a survey conducted by the National Consumers League, the Boston Herald reports." (KaiserNetwork.org)
Two Largest PBMs' Profits Enhanced by Large Rebates from Drug Companies, Report Says
Excerpt: "Rebates and fees paid by drug companies to pharmacy benefit managers to promote the companies' drugs were the 'keys to profit' for some PBMs, according to a General Accounting Office report expected to be released Jan. 10, the New York Times reports." (KaiserNetwork.org)
Consumer Groups Say Public Being Misled About Role of Malpractice in Health Insurance Premiums
Excerpt: "Consumer groups Thursday said the nation's physicians and insurance companies are conspiring to mislead the public about the true causes of the current spike in malpractice insurance premiums in an effort to pass damage award caps that would not fix the problem." (Reuters Health via Yahoo! News)
Links to Items on Executive Comp, Benefits in General
Online Reference Guide Names BenefitsLink One of 50 Best Recruiting Web Sites in U.S.
Toot, toot! Please allow us to blow our own horn as we celebrate this wonderful designation. Excerpt: "We are pleased to release our 50 Best of the Best-- a list of the leading job and resume web sites." (CareerXRoads.com)
Frequently Asked Employee Benefits Questions for Reservists Being Called to Active Duty
Excerpt from an associated press release: '[The updated web page] provides basic information about how retirement benefits of reservists are protected during service to our country. It also describes the rights of family members to maintain health coverage, including the right to keep coverage under the Consolidated Omnibus Budget Reconciliation Act-- known as COBRA continuation coverage -- as well as the various health benefit options available to family members." (U.S. Department of Labor, Pension and Welfare Benefits Administration)
Claimant Not Required to Exhaust Claims Procedure If SPD Interpreted to Make Exhaustion Optional
Watts v. Bellsouth Telcoms., Inc. (11th Cir. 2003). Excerpt: "EBIA Comment: ... [T]he SPD claims procedure description should plainly warn claimants that they will lose their right to sue if they fail to follow the procedures in a timely fashion. Likewise, claim denial notices should explain the need to exhaust plan procedures and the consequences of failing to do so." (EBIA Weekly)
Some CEOs Would See Windfall Under Bush Dividends Proposal
Excerpt: "When President Bush announced his plan to eliminate the tax on corporate dividends, he said was doing so in part to help senior citizens who rely on the quarterly checks for steady income. But among those seniors would be the likes of Citigroup chairman and chief executive Sanford I. Weill, who could stand to save about $6.9 million in taxes under the plan." (Washington Post)
Half of St. Louis Employer's Eligible Workforce Accept Early Retirement Offer Despite Health Co-Pays
Excerpt: "[E]mployees who took the voluntary retirement offer will have to pay 10 percent of their own [health insurance] premiums in 2004, and that will increase to 25 percent by 2009 ... They also will bear 25 percent of the premium cost for their spouse's heath coverage in 2004, which will gradually rise to 50 percent by 2009." (St. Louis Post-Dispatch)
Newly Posted or Renewed Job Openings
Senior DC / 401(k) Administrators
for L.A. Area TPA with Ocean View
in CA
Pension Plan Administrator
for Elliott Davis, LLC
in SC
Director of Benefits
for Diversified Entertainment Company
in CT, NJ, NY
Actuary
for Mellon Financial
in GA
Senior Product Specialist - Retirement Plan Marketing
for Edward Jones
in MO
Benefits Administrator
for SunTrust Bank - Atlanta
in GA
Retirement Resources Senior Consulting Assistant
for RSM McGladrey, Inc.
in MN
Director, Compensation and Benefits
for Infirmary Health System
in AL
Director of Pensions and 401(k) Plans
for Publisher in Northern California
in CA
Defined Benefit/412(i)/ESOP Plan Administrator
for NC TPA firm
in NC
Trustmark/SRT Senior Administrator
for New England-based TPA
in
Defined Contributions Technical Analyst
for Mellon HR Solutions
in NY
Defined Contributions Operations Analyst
for Mellon HR Solutions
in NY
Newly Posted Press Releases
(Post Yours!)
National Association of Government Defined Contribution Administrators Kicks Off 2003 NAGDCASTS Series with CREF and INVESCO Representatives
(National Association of Government Defined Contribution Administrators, Inc. (NAGDCA))
Pension Reporter (5500) System from DATAIR-- Year 2002 Forms Released
(DATAIR Employee Benefit Systems, Inc.)
Evolution Benefits' Benny(tm) Card Named Top 10 HR Product
(Evolution Benefits)
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