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| January 22, 2008 |
| Here are the Web's best new links about compliance and cost aspects of plan operation, design and policy. |
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[Guidance Overview] Coordination of Retiree Health Benefits with Medicare and State Health Benefits
Excerpt: "The final rule creates an exemption from the ADEA and permits retiree employee benefit plans that provide health benefits to be altered, reduced, or eliminated when a participant is eligible for Medicare (or for the health benefits under a comparable state health benefit plan), whether or not the participant actually enrolls in the benefit program." (Littler Mendelson P.C.)
[Guidance Overview] E-Discovery Update - Why Self-Funded Employers and TPA's Should Be Planning Now
Excerpt: "Self-funded employers and the third party administrators acquire voluminous stores of electronic data - claims data, claims adjudication protocols and outcomes, eligibility information, banking and financial records, including employer and employee contributions records, payments to vendors, and so on. From a risk management perspective, however, recent surveys indicate only a vague awareness of very real changes in the requirements imposed by electronic discovery rules." (Health Plan Law blog by Attorney Roy F. Harmon III)
[Guidance Overview] U.S. Supreme Court Grants Certiorari in ERISA Standard of Review Case
Excerpt: "The petition for a writ of certiorari is granted limited to Question 1 presented by the petition and the following question: 'If an administrator that both determines and pays claims under an ERISA plan is deemed to be operating under a conflict of interest, how should that conflict be taken into account on judicial review of a discretionary benefit determination?' The brief of petitioners is to be filed on or before Monday, February 25, 2008." (Health Plan Law blog by Attorney Roy F. Harmon III)
[Guidance Overview] ERISA Preemption in the City by the Bay: It is Time for Congress to Act
Excerpt: "The ERISA preemption debate should instead shift from the courthouses to the Capitol. Unfortunately, many (perhaps most) advocates of state health care laws will view the Ninth Circuit's decision as obviating the need for that shift. It is, however, time for Congress to act by repealing or amending ERISA Section 514(a) to free states and localities from ERISA preemption. Until Congress acts in this fashion, states and localities are threatened with bystander status in our ongoing national debate on health care." (Oxford University Press USA)
[Guidance Overview] Health Plans Did Not Violate ERISA, New Jersey Court Rules
Excerpt: "Six health insurers that allegedly conspired with brokers to steer customers their way in return for hidden commissions did not violate the Employee Retirement Income Security Act, a New Jersey district court judge finds." (Workforce Management; free registration required)
[Guidance Overview] Supreme Court to Rule Whether Disability Insurer in Conflict of Interest
Excerpt: "The dispute centers on whether insurance companies such as MetLife have a conflict of interest when they both administer employee disability plans -- which requires deciding whether employees are eligible for benefits -- and pay benefits under them. If the court rules that handling both functions constitutes a conflict, that could encourage employers to hire separate companies for each function, potentially raising the plans' costs, lawyers for MetLife argue." (AP via Insurance Journal)
[Guidance Overview] Overview: Ninth Circuit Stays Ruling That San Francisco's Fair Share Law Is Preempted by ERISA
Excerpt: "EBIA Comment: The Ninth Circuit ruled only on the City's motion to stay in this appeal. But if the court follows the reasoning laid out in this decision when it rules on the merits, it may create a conflict between the circuits in dealing with this type of law." (Employee Benefits Institute of America)
Drug Licenses - A New Model for Pharma.ceutical Pricing
Excerpt: "We propose a drug-licensing model for health care, which has the promise of increasing drug use without altering patients' out-of-pocket spending, health plans' costs, or drug companies' profits. In such a model, people would purchase annual drug licenses that would guarantee unfettered access to a clinically optimal number of prescriptions over the course of a year. Using the example of statins, we illustrate how such a model could be implemented." (RAND)
National Health Spending in 2006: A Year of Change for Prescription Drugs (PDF)
16 pages. Excerpt: "In 2006, U.S. health care spending increased 6.7 percent to $2.1 trillion, or $7,026 per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than in 2005. Prescription drug spending growth accelerated in 2006 to 8.5 percent, partly as a result of Medicare Part D's impact." (Health Affairs via U.S. House. Committee on Ways and Means)
Consumer Financial Incentives -- A Decision Guide for Health Care Purchasers
Excerpt: "[The guide] is a tool for employers, health plans, and State Medicaid agencies considering or poised to design and implement a consumer financial incentive strategy. The Guide was created in partnership with a panel of purchasers and consumer representatives. The panel was asked to identify questions that need to be addressed when considering or designing a consumer financial incentive strategy; these questions were used to form an outline for the Guide. Responses summarize empirical evidence, when it exists, and incorporate real life case examples to illustrate a breadth of implementation options." (Agency for Healthcare Research and Quality)
Medical Cost Data Put Online by Blue Cross and Blue Shield of North Carolina
Excerpt: "While the service is immediately useful for Blue Cross members who want to track and possibly save for future health-care expenses, it is more important for what it represents as the industry pushes consumers to play a larger role in holding down health-care costs." (The News and Observer)
Ohio Paying Its Workers to 'Take Charge, Live Well'
Excerpt: "On Friday, about 4,000 [public] employees will get the first installment in their paychecks of what could be up to $200 in incentive payments, when spouses are included. In return, they must undergo health assessments and screenings, and get involved in programs to help them exercise, lose weight, stop smoking and reduce stress." (The Columbus Dispatch)
Massachusetts Group Launches Campaign To Regulate Drug Maker Marketing
Excerpt: "The newly formed Massachusetts Prescription Reform Coalition . . . announced an effort to curb pharma.ceutical industry marketing in an attempt to bring down drug costs and health spending, the Boston Globe reports." (Kaiser Family Foundation)
[Opinion] Americans Agree - It Is Time for Action on Health Care
Excerpt: "Americans are definitely ready for the government to play a significant role in solving these health care problems. In the same mid-November Gallup poll, 64 percent of respondents said that it is the responsibility of the federal government to make sure all Americans have health care coverage, compared with only 33 percent who do not." (The Century Foundation)
[Opinion] Presidential Candidates Mostly Sidestep the Issue of Health Care Costs
Excerpt: "To enable employers to have healthy workforces and to ensure the long-term economic future of the nation, now is the time for CHROs and their organizations to demand both government reform and the focus of presidential candidates on the issue, as well as to level with their workers and retirees about the consequences of not changing individual behavior." (Dallas Salisbury via Human Resource Executive Online)
[Opinion] The Single-Payer Remedy Is Worse Than the Disease
Excerpt: "No one denies that America's health sector faces problems. Costs continue to rise, and 45 million people lack insurance. Even worse, many politicians think they've discovered the cure in a single-payer system. But that remedy would be worse than the disease. The government-dominated health systems of Europe and Can.ada are struggling with serious cost pressures, inefficient bureaucracies, and unmet demands for more advanced medical care." (Galen Institute)
[Opinion] Court Panel Overlooks Purpose of ERISA in Ruling on San Francisco Health Care Ordinance
Excerpt: "We think the appeals court panel missed the point. If one city or state is allowed to require employers to spend a certain amount on health insurance, others might impose different requirements and make it very expensive, and perhaps impossible, for a multistate employer to offer uniform health care benefits nationwide -- a key purpose of ERISA pre-emption." (Business Insurance)
[Opinion] Emergency Room Delays Affect the Insured
Excerpt: "The nation's failure to provide health insurance for all Americans seems to be harming even many of those who do have good health coverage. That is one very plausible interpretation of a disturbing increase in waiting times at emergency rooms that are often clogged with uninsured patients seeking routine charity care." (The New York Times; free registration required)
Links to Items on Executive Comp, Benefits in General
[Guidance Overview] Quarantine and Isolation - Selected Legal Issues Relating to Employment (PDF)
Excerpt: "This report examines the employment-at-will doctrine, possible application of the public policy exception in the case of a potential influenza pandemic, the Family and Medical Leave Act (FMLA), and possible application of the nondiscrimination mandates of the Americans with Disabilities Act (ADA)." (U.S. Congressional Research Service)
[Guidance Overview] Third Circuit Weighs in on FICA Status of Severance Payments to Tenured Faculty
Excerpt: "The Third Circuit has determined that certain severance payments to tenured faculty and administrators constitute 'wages' for purposes of §3121, which governs employer and employee contributions under the Federal Insurance Contributions Act (FICA). In University of Pittsburgh v. U.S., No. 06-1276 (3d Cir. 11/2/07), the Third Circuit held that the relinquishment of tenure rights did not alter the payments' character as compensation for services subject to FICA taxes." (The Bureau of National Affairs, Inc.)
[Guidance Overview] Judge Tosses Fee/Commission Conspiracy Case against Workplace Insurers
Excerpt: "After declaring that none of the six major insurance providers accused in a commission conspiracy were fiduciaries under the Employee Retirement Income Security Act (ERISA) a federal judge has cleared the companies of wrongdoing." (PLANSPONSOR.com; free registration required)
[Guidance Overview] Overview: IRS Issues 2007 Version of Publication 970, Tax Benefits for Education
Excerpt: "EBIA Comment: Qualified educational assistance programs allow employers to provide assistance to employees for a broad range of educational expenses, including expenses for graduate-level courses and for courses that are not job-related (subject to certain limitations). Under Code Section 127, amounts paid or incurred by an employer under a qualified educational assistance program are deductible by the employer and are excludable from the employees' taxable income." (Employee Benefits Institute of America)
[Guidance Overview] More on Executive Compensation for Tax-Exempt Organizations
Excerpt: "Periodically, I like to address executive compensation issues for tax-exempt organizations, because some readers work for or advise such organizations and other readers may serve on the board of directors of such organizations. Over the last ten years, the IRS has dramatically stepped up its policing of and enforcement actions against executive compensation at tax-exempt organizations." (Michael S. Melbinger via Winston & Strawn LLP)
Newly Posted Press Releases
U.S. Labor Department Reaches Agreement with Columbus, Ohio, Business to Recover Contributions to Company 401(k) Plan
U.S. Department of Labor, Employee Benefits Security Administration (EBSA)
National Business Coalition on Health Awards Grants to 14 Coalitions for Diabetes Quality Programs
National Business Coalition on Health
Integrated Benefits Institute Study Finds National Surveys Missing Critical Productivity Data
Integrated Benefits Institute
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