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January 24, 2008

Here are the Web's best new links about compliance and cost aspects of plan operation, design and policy.

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Complete Benefits Law Guidance from Law Journal Press

The nation's workforce and health care system are constantly evolving and so are the legal issues. Law Journal Press helps you handle any benefits law question with up-to-date, authoritative books on all aspects of the field. Get legal and practical advice from leading experts on everything from COBRA to ERISA, "contingent" employees to family and medical leave, and more. Browse our product listings for detailed information and special offers.

[Guidance Overview] San Francisco's Mandatory Health Care Ordinance - Important Developments
Excerpt: "Employers with employees in San Francisco, take note: A recent decision by the 9th Circuit Court of Appeals has allowed the San Francisco Health Care Security Ordinance to take effect, even while a challenge to its legality is pursued on appeal. Are you prepared to comply?" (Nixon Peabody LLP)

[Guidance Overview] Can I Have an HSA If I Have a Health FSA or HRA?
Excerpt: "Participation in a health flexible spending arrangement (FSA) or health reimbursement arrangement (HRA) may negatively affect an individual's HSA eligibility. Even with HDHP coverage, an individual also covered by a health FSA or an HRA that pays or reimburses qualified medical expenses prior to meeting the HDHP deductible generally cannot make regular HSA contributions. An individual's participation in one of these plans may also disqualify his/her spouse from an HSA." (Wolters Kluwer Financial Services)

[Guidance Overview] More Rules for Massachusetts Health Care
Excerpt: "During the holidays, State regulators were formulating new guidance for sponsors of health plans in Massachusetts. The focal point was continued coverage for children beyond the time when they can be claimed as dependents on a federal tax form. This article explains Bulletin 2008-1 (the 'Bulletin') from the Division of Insurance, and TIR 07-16 (the 'Release') from the Department of Revenue." (

[Guidance Overview] ERISA Preemption on the Run -- San Francisco's Health Ordinance
Excerpt: "In general, ERISA preempts all state laws that 'relate to' an employee benefit plan, other than state insurance laws. In issuing the emergency stay, the three-judge panel of the Ninth Circuit found a 'strong likelihood' that the City will prevail on appeal in showing the SFHCO is not preempted by ERISA. In issuing its ruling, the Ninth Circuit reviewed a number of ERISA preemption cases, most notably the Supreme Court cases of New York State Conference of Blue Cross & Blue Shield Plans v. Travelers Insurance and District of Columbia v. Greater Washington Board of Trade." (Kilpatrick Stockton LLP)

[Guidance Overview] Sixth Circuit Vacates District Court Decision for Failure to Require 'Principled Reasoning'
Excerpt: "Kemper provided Bennett with assistance in obtaining Social Security disability benefits, and under the Plan, was entitled to reduce the amount of benefits it paid to Bennett by the amount Bennett received from Social Security. When Broadspire issued its decision denying LTD benefits, it failed to explain why it reached a conclusion contrary to that of the SSA." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Guidance Overview] San Francisco's New Universal-Access Program
Excerpt: "Impatient with the lack of progress at federal and state levels in reducing the number of uninsured Americans, many counties across the United States are seeking their own solutions to the health care crisis. Unfortunately, local efforts to achieve universal coverage often encounter substantial obstacles, including the high cost of insurance plans, the loss of federal and state revenues that benefit the uninsured, and limited authority to mandate insurance coverage. To broaden access while avoiding these problems, the government of the City and County of San Francisco launched Healthy San Francisco (HSF) in April 2007." (The New England Journal of Medicine)

[Guidance Overview] An Employers' Guide to the 2006 Massachusetts Health Care Reform Act - Updated
Excerpt: "This version of the guide is updated to include the following items: Connector Notice dated November 15, 2007 modifying the definition of 'minimum creditable coverage' in certain respects; Chapter 205 of the Acts of 2007, An Act Further Regulating Health Care Access (adopted November 29, 2007); Massachusetts Department of Revenue, Technical Information Release 07-16 -- relating to 'imputed income' resulting from group health insurance coverage of dependents under the Act's expanded dependent coverage requirement; Massachusetts Department of Revenue (Draft) Notice, dated December 30, 2007 -- imposing penalties for violating the Act's individual insurance mandate for 2008 Massachusetts Department of Revenue emergency regulation 830 CMR 111M.2.1 (December 29, 2007) -- addressing key aspects of the individual mandate and the 1099-HC reporting requirement" (Mintz, Levin, Cohn, Ferris, Glovsky and Popeo P.C.)

[Guidance Overview] Can Financial Organization Charge Annual Fee and Cost of Checks to an HSA? Is There Any Reporting Required?
Excerpt: "If deducting these fees and costs from the HSA, no reporting is required; it is simply a reduction in the HSA's value." (Wolters Kluwer Financial Services)

[Opinion] Health Care in the 2008 Presidential Primaries
Excerpt: "This analysis find that the sharply contrasting health care platforms of the leading Democratic and Republican presidential candidates reflect dramatic differences in the perspectives of their primary voters. The article analyzes a newly released Kaiser/Harvard survey of likely primary voters in 35 states (and the District of Columbia) with January or February primaries or caucuses, as well as data from 10 other recent surveys by national media polling organizations." (Kaiser Family Foundation)

Cost of Massachusetts Health Initiative Up $400M
Excerpt: "Spending on the state's landmark health insurance initiative would rise by more than $400 million next year, representing one of the largest increases in the $28.2 billion state budget the governor proposed yesterday. The biggest driver of the cost increase is projected growth in the number of people signing up for state-subsidized insurance, which now far exceeds earlier estimates." (The Boston Globe)

Analyst Raises Possibility of Steep Costs for California's Health Care Reform Plan
Excerpt: "The compromise health care reform plan (ABX1 1) negotiated by Gov. Arnold Schwarzenegger (R) and Assembly Speaker Fabian Nez (D-Los Angeles) could leave the state with a $4 billion shortfall within five years of being launched if costs were underestimated, according to a report released . . . by the Legislative Analyst's Office, the Sacramento Bee reports." (California HealthCare Foundation; free registration may be required)

Blue Cross and Blue Shield Association Unveils Five-Point Plan for Covering All Americans
Excerpt: "Stating that 'a system that is unaffordable for many today won't work for even more people tomorrow,' Blue Cross and Blue Shield Association (BCBSA) President and CEO Scott P. Serota . . . unveiled a comprehensive five-point plan -- 'The Pathway to Covering America' - for building on the employer-based system to improve quality, rein in costs and expand coverage to all Americans." (Blue Cross and Blue Shield Association)

Medical Tourism As a Health Care Alternative
Excerpt: "For some U.S. workers, the opportunity to undergo hip replacement or cardiac surgery in foreign countries at rates significantly discounted from U.S. hospitals holds great appeal. But relatively few American companies have signed on to offer medical tourism as a healthcare benefit." (Human Resource Executive Online)

Once an Indulgence of Hollywood Jet-Setters, Medical Tourism Is Now Going Places
Excerpt: "For medical services provided outside of the U.S., HSA-eligible expenses generally include inpatient care -- including waiver of copayments, coinsurance and deductibles -- inpatient meals, outpatient care, and other expenses associated with obtaining treatment overseas such as passport and visa expenses, translation services, and communication with U.S. providers while hospitalized." (Inside Consumer-Directed Care via

'Value-Based' Prescription Drug Programs Gain Traction with Several Large Health Plans
Excerpt: "Following the success of some self-funded employer groups, several large health plans are starting to roll out or expand their 'value-based' prescription drug programs, which slash copayments for certain chronic medications as an incentive to improve therapy adherence and hopefully avert more expensive medical treatments." (Health Plan Week via

Employers Put Health Coverage in Workers' Hands
Excerpt: "As health insurance costs continue to rise, some employers are adopting a controversial new approach: ending group coverage and giving employees $50 to $200 or so a month to help them buy their own. The shift is touted as a lower-cost way for employers to offer workers some kind of health coverage, while making smaller and more predictable financial contributions toward that coverage." (USA TODAY)

Group Physicals Eyed As Way to Cut Doctor Costs
Excerpt: "New Englanders notorious for valuing their privacy may not know what hit them when Drop-in Group Medical Appointments, or DIGMA, begins at Harvard Vanguard, because the concept is unprecedented here. Skeptics wonder about its implications for privacy and detailed care. But supporters see the idea as a way to make care more cost-effective by helping patients learn from each other in a friendly, support-group-style setting, while expanding the ability of doctors to see more patients even as a national primary care doctor shortage continues." (Boston Business Journal via; free registration required)

Onsite Health Clinics Pay Off As Employers Gather Quantitative ROI
Excerpt: "Health care is moving closer to home - or the workplace - as companies open onsite primary care facilities, pharmacies and clinics in an effort to better control health care costs." (Employee Benefit Advisor; free registration required)

CDC Says Too Few Adults Get Needed Vaccines
Excerpt: "The numbers of newly vaccinated are surprisingly low, considering how much public attention a trio of new shots -- which protect against shingles, whooping cough and cervical cancer -- received in recent years. Yet many seem to have missed, or forgotten, the news: A survey by the National Foundation for Infectious Diseases found that aside from the flu, most adults have trouble even naming diseases that they could prevent with a simple inoculation." (AP via The New York Times; free registration required)

California's Dept. of Insurance Asked to Pull Plug on United Healthcare's New Notification Protocol
Excerpt: "UnitedHealthcare's 'Advance Notification' protocol is very similar to established preauthorization protocols in that the insurer can deny payment if the process is not followed prior to the provision of health care services. The physician must submit the same information, in advance, that is required for preauthorization. The important difference is that fulfilling this identical notification requirement no longer ensures that the physician will be paid." (California Medical Association via Physicians for a National Health Program)

Disability Insurance Planning for Professionals
Excerpt: "Disability insurance planning has changed dramatically over the last decade. Professionals and their financial advisors have demanded more flexibility when structuring disability policies. The insurance industry has responded by offering myriad options." (The New York State Society of CPAs)

Links to Items on Executive Comp, Benefits in General

Pet Insurance Gaining Popularity As an Employee Benefit
Excerpt: "The growth of this perk comes as pets occupy an increasingly prominent place in the American home. According to the American Pet Products Manufacturers Association, pet owners spent an estimated $9.8 billion on veterinary care in 2007, up from $7.1 billion in 2001." (AP via Connecticut Post Online)

IRS Provides 'Free File' Program Available to 70% of Population; Employers Can Tell Employees About It
Excerpt: "The Internal Revenue Service is working with the Society for Human Resource Management to promote the use of the IRS electronic Free File program, a free online tax preparation service for those earning $54,000 or less. 'It's important for HR managers, and employers in general, to understand that their employees may very well be just like every other American, a little bit confused about the tax system, unsure as to how to deal with it, and wanting to comply with the tax laws but wanting help to do so,' says David Williams, IRS director of electronic administration." (Society for Human Resource Management)

FMLA Expansion for Military Family Headed to White House Again
Excerpt: "Congress has given its final stamp of approval to an expansion of the federal Family and Medical Leave Act (FMLA) to family members of active duty military service personnel." (; free registration required)

State and Local Governments - Growing Fiscal Challenges Will Emerge (PDF)
78 pages. Excerpt: "As happens at the federal level, these subnational governments may also face serious fiscal stress in the future. To provide Congress and the public with a broader perspective on our nation's fiscal outlook, GAO has developed a fiscal model of the state and local sector. This unique model enables GAO to simulate fiscal outcomes for the entire state and local government sector for several decades into the future." (U.S. Government Accountability Office)

The 2007 Legislative Session
Excerpt: "Mental health parity. 401(k) fees. Deferred compensation. COBRA. Carried interest. Medicare. Expatriate taxation. These are just some of the benefit and compensation issues Congress discussed last year. During 2007, lawmakers evinced a continuing desire to enact legislation that would affect employer-sponsored health, retirement and compensation programs -- yet very little of that legislation passed. The year also marked the emergence of new issues that would affect plan investments." (Watson Wyatt Worldwide)

Newly Posted Events
(Post Yours!)

Common 401(k) Plan Mistakes Webcast
Nationwide on February 7, 2008
presented by National Institute of Pension Administrators

Individual Mandates: Requiring Individuals to Purchase Health Insurance - Webcast
Nationwide on January 31, 2008
presented by

Qualified Medical Child Support Orders: Election Changes, Privacy, and Rights of Employees, Children, and Custodial Parents
Nationwide on February 14, 2008
presented by Employee Benefits Institute of America (EBIA)/Thomson Tax & Accounting

Rebroadcast of Final 403(b) Regulations Webcast
Nationwide on January 23, 2008
presented by NAGDCA (National Association of Government Defined Contribution Administrators, Inc.)

Surviving a DOL audit
in California on February 6, 2008
presented by International Society of Certified Employee Benefit Specialists - Orange County Chapter

Newly Posted Press Releases
(Post Yours!)

ASPPA (American Society of Pension Professionals & Actuaries)

Variety of Challenges Make Affordable Health Care Options Elusive for Small Businesses
U.S. House Small Business Committee

2008 Open Enrollment Data Shows That 92.7 Percent of Wal-Mart Associates Now Have Health Coverage
Wal-Mart Stores, Inc.

MassMutual Adds First Retirement Income Withdrawal Benefit

Aon Consulting to Offer ELMsm Annuities to Clients
ELM Income Group, Inc

Mercer's New Pharmacy Benefit Design Improves Compliance

Top 1,000 U.S. Retirement Plan Assets Enjoy Strongest Growth in a Decade
Crain Communications, Inc.

Report Finds Philadelphia's Pension and Health Care Costs for Public Employees Growing at Unsupportable Rates
Pew Charitable Trusts

Benefitfocus Expands Reach to Consumers With ConnectYourCare Partnership

How Can I Afford Retirement? -- A Free Investor Education Program at the Boston Public Library
Boston Public Library

Study Says Allergy Shots Help Children, Reduce Health Care Costs
BioMedEcon, LLC

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Benefits Compliance Manager
for SunTrust Banks Inc.
in GA

Deputy Regional Director
for U.S. Department of Labor, Employee Benefits Security Administration
in GA

Senior Associate/ Consultant compensation
for Buck Consultants
in CT, IL, NJ, NY, PA

Senior Pension Consultant
for Preferred Pension Planning Corporation
in NJ

Qualified Plan Consultant and Manager
for Destel-Bergen Corporation
in CA

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