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July 23, 2003 - 8,417 subscribers
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Second Generation Consumer-Directed Health Plans Unveiled
Excerpt: "[We] talked with seven employers that went live with a CDH plan last January or earlier. Here's a look at how the plans are working so far, and some of the changes employers plan to make for 2004:" (Inside Consumer-Directed Care via AISHealth.com)

Some Question Savings from Consumer-Directed Health Plans
Excerpt: "[T]he concept has its critics. 'The idea just throws people to the wolves,' said Dirk Carson, an executive with Patient Choice, a Minnesota-based health insurer attempting to enter the Wisconsin market. 'You don't want to have people avoiding care because of costs. That could cost more in the long run,' he said." (Milwaukee Journal Sentinel via International Foundation of Employee Benefit Plans)

Presidential Commission Urges Major Changes in Mental Healthcare
Excerpt: "Mental health care in America is often inadequate and needs 'fundamental transformation,' a presidential commission reported yesterday." (New York Times; one-time registration required)

Employer-Sponsored Health Insurance and Drug Coverage for New Retirees: Dramatic Declines Occurring
Excerpt: "Employer-sponsored health insurance is often described as the most reliable private source of Medicare supplementation, particularly for prescription drug benefits. This study's findings show that employer coverage is becoming an increasingly less dependable source of coverage for new retirees, and the problem is likely to get worse. We found that the proportion of Medicare beneficiaries ages 65–69 with employer coverage declined from 46 percent in 1996 to 39 percent in 2000." (Health Affairs)

Overview: Study Says Fewer Retirees Get Drug Coverage From Employers
Excerpt: "The study shows that future decreases in the number of retirees covered under their employers plans is 'starting from a base that is lower than most people believe,' Bruce Stuart, one of the study's authors, said." (New York Times; one-time registration required)

FDA Commissioner Criticizes Drug Reimportation Legislation
Excerpt: "FDA Commissioner Mark McClellan issued a 'scathing condemnation' of drug reimportation legislation (HR 2427) by Rep. Gil Gutknecht (R-Minn.), in a letter McClellan sent July 18 to House Energy and Commerce Chair Billy Tauzin (R-La.), CongressDaily/AM reports ..." (KaiserNetwork.org)

Opinion: Just Say No to Drug Reimportation
Excerpt: "One of the tasks of conservatism, perhaps the chief one, is to oppose ideas that would provide an attractive payoff now but would be harmful in the long run.... Of course they're attacked for being cruel and hard-hearted. But that comes with being a conservative.... Which brings us to the subject of drug reimportation, set for a vote in the House of Representatives this week." (The Weekly Standard)

No Emotional Distress Damages for Employer's Alleged Failure to Forward COBRA Premiums to Insurer
Habib-Stevens v. Trans States Airlines, Inc., No. 4:02CV328-DJS (E.D. Mo. June 26, 2003). Excerpt: "EBIA Comment: This case is in accordance with a long line of cases holding that ERISA generally restricts a benefit claimant to recovering denied benefits (plus interest and attorneys' fees)." (EBIA Weekly)

Provisions of State Insurance Law That Become Part of ERISA Plan May Be Enforced Only Under ERISA
Singh v. Prudential Health Care Plan, Inc. (4th Cir. 2003); Arana v. Ochsner Health Plan (5th Cir. 2003). Excerpt: "ERISA preemption buffs out there will be happy to learn of these recent cases addressing the tricky interaction between two basic preemption rules.... These two new cases address the interaction between these rules when a plan participant attempts to enforce rights created by a state insurance law that is protected (or arguably protected) from preemption by ERISA's savings clause." (EBIA Weekly)

Analysis: Fifth Circuit Says ERISA Wins Over Louisiana State Antisubrogation Statute (PDF)
At p.1 of 2-page document. Excerpt: "In a rare move, the 5th Circuit, sitting en banc, reversed a 3-judge panel's decision made almost a year ago to rule that ERISA preempts the enforcement of Louisiana's statutory prohibition against health plans asserting subrogation claims for health benefits provided by plans against the tort recoveries of their insureds." (Jenkins & Gilchrist)

State Law Claims Against HMO Must Be Resolved As ERISA Claims, Fourth Circuit Rules
ERISA completely preempted a beneficiary's state law claims that an HMO plan's subrogation provision was illegal under Maryland law, but the beneficiary's claims must be resolved in federal court as claims arising under ERISA. These were the conclusions of the Fourth Circuit U.S. Court of Appeals in Singh v. Prudential Health Care Plan (No. 01-1102). (Spencer Benefits Reports)

Orthodontic Dental Coverage Increasing
Excerpt: "Even at a time when employers are looking for the best benefits value, orthodontic coverage is steadily gaining plan sponsor approval." (BenefitNews.com)

Overview: EEOC Proposes Regs Allowing Reduction of Health Benefits for Medicare-Eligible Retirees
Excerpt: "The proposed regulations would exempt from all of the ADEA's prohibitions the practice of changing, reducing, or eliminating health benefits when retirees become eligible for Medicare.... However, we remind employers that the regulations are not effective until they are issued in final form. As a result of the fluid state of the law on the issue of Medicare coordination and the ADEA, cautious employers facing this issue should consult with legal counsel." (EBIA Weekly)

Shopping for Drugs
Excerpt: "As Congress debates ways to lower the cost of prescription drugs for seniors, and state governments debate ways to lower drug costs for almost everyone else, it may be time to consider a commonsense solution: smart shopping. Seniors, the uninsured and others who pay for drugs out-of-pocket do not have to wait for political solutions to the problem of rising drug prices. By becoming aggressive consumers in the marketplace, they can cut their costs substantially." (National Center for Policy Analysis)

The Relationship Between Quality and Employers' Choice of Health Plan
Working paper. Excerpt: "We seek to understand the relationship between employer decisions regarding which health plans firms choose to offer to their employees and the performance of those plans.... We find that employers are more likely to offer plans with strong absolute and relative HEDIS and CAHPS performance measures. Our results are consistent with the view that large employers are responsive to the interests of their employees." ( Michael Chernew, Gautam Gowrisankaran, Catherine McLaughlin, Teresa Gibson via the National Bureau of Economic Research)

Congressional Budget Office's Report Challenges Medicare Reform Bill Assumptions
Excerpt: "Medicare legislation is unlikely to prompt older Americans to sign up for private health plans, a central goal of bills passed last month to transform the nation's insurance program for the elderly, the Congressional Budget Office told lawmakers yesterday." (Washington Post)

How Many on Medicare Will Lose Retiree Health Benefits if Medicare Covers Prescription Drugs? (PDF)
Special Report, July 18, 2003. Excerpt: "We believe it is possible that between 2 percent and 9 percent of current Medicare beneficiaries with employment-based retiree health benefits for prescription drug coverage would lose those benefits if Medicare provides outpatient prescription drug benefits, solely as a result of that change in the program. This translates into between 1 and 3 percent of all Medicare beneficiaries." (Dallas L. Salisbury and Paul Fronstin of the Employee Benefit Research Institute)


Links to Items on Executive Comp, Benefits in General

Participants Not Required to Comply With Undisclosed Claim Filing Requirements
Excerpt: "Although the [DOL's SPD] regulations do not explicitly mention the ability to impose a time limit for filing benefit claims, reasonable time limits appear to be permissible. But once such limits are imposed, they will not be enforced unless a plan also complies with ERISA's SPD rules, which require a description of the plan's claims procedures (including procedures to be followed in presenting claims for benefits) to be timely provided to participants and beneficiaries." (EBIA Weekly)

Overview: FASB Speaks on Stock Option Expensing
Excerpt: "The Financial Accounting Standards Board (FASB), the accounting profession's primary rule-making body, tentatively decided on April 22 that stock-based compensation of all forms -- including stock options -- should be recognized as an expense in company financial statements." (Thompson Publishing Group)

Another Question is Answered in the Stock Options, Restricted Stock and Other Long-Term Employment Incentives Q&A Column
I have heard about deferred stock, but it seems about the same as restricted stock. What are the differences? (BenefitsLink.com)


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Newly Posted Conferences
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The Current Legislative Environment
in MO
December 11, 2003
Kansas City Chapter of ISCEBS

Guidance on Work Visas -- An Audio Conference for Employers
in ALL STATES
August 7, 2003
Thompson Publishing Group
Newly Posted Press Releases
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Wright & Co. Aligns with ARAG Group
(ARAG Legal Insurance Company)


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