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March 31, 2008

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


Today's sponsor is International Foundation of Employee Benefit Plans

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Celebrate National Employee Benefits Day on April 2, 2008!

The International Foundation of Employee Benefit Plans is once again leading the celebrations for National Employee Benefits Day. This year the day has a special focus on health care literacy. The Foundation is encouraging those who are involved in employee benefits to use the day to educate themselves and their plan participants. Visit www.ifebp.org/benefitsday for free informational resources to help you plan your celebration!

[Official Guidance] DOL Advisory Opinion 2008-03A on ERISA Preemption
Excerpt: "Whether ERISA would preempt an action by a State Medicaid Agency to recover Medicaid benefit payments made on behalf of individuals who are also participants in ERISA-covered private health insurance plans that require prior authorization for covered health care items or services." (U.S. Employee Benefits Security Administration)


[Guidance Overview] Coordinating Retiree Health Benefits with Medicare (PDF)
2 pages. (Milliman)


[Guidance Overview] San Francisco Health Care Security Ordinance (PDF)
Pages 1-5 of 8 pages. Excerpt: "For formal guidance regarding the Ordinance, including required forms, please see http://www.sfgov.org/site/olse_index.asp?id=45168." (Trucker Huss)


[Guidance Overview] Split Noted: Can a Cause, as Opposed to a Symptom, of an Illness Create Ambiguity in an ERISA Plan?
Excerpt: "In the course of reviewing this ruling, the D.C. Circuit notes that the circuits are split over whether the cause of an illness can create an ambiguity in an ERISA plan. The CAs 5,8 hold that it is the symptoms, not the causes, that determine whether an illness is physical or mental. The CAs 7,9,11 permit cause-based interpretations. The panel does not decide the issue in this case, however, because there were issues of material fact concerning whether physical factors can cause bipolar disorder and if they did so in this case. It thus reverses the grant of summary judgment and remands for further proceedings." (Appellate Review)


[Opinion] Text of ERIC's Amicus Brief to Ninth Circuit on ERISA Preemption of San Francisco Healthcare Ordinance (PDF)
40 pages. Excerpt: "If the San Francisco Health Care Security Ordinance . . . is allowed to circumvent ERISA's preemption provision, the Ordinance would subvert fundamental policies that Congress sought to advance when it enacted ERISA. Directly contrary to the voluntary employee benefit regime established by ERISA, the Ordinance would (1) require covered employers to provide health coverage, (2) specify how much a covered employer must spend on health care coverage, and (3) prevent covered employers with operations in San Francisco . . . and in any other jurisdiction that adopts similar legislation, from maintaining health care plans that operate uniformly nationwide. The cost of complying with the resulting patchwork quilt of state and local health care laws will be borne by both employers and employees." (ERISA Industry Committee and National Business Group on Health)


[Opinion] A Closer Look at the Procedural Aspects of Delegation of Claims Review
Excerpt: "As noted [previously], the lack of the plan administrator's involvement in the benefits denial decision was cited as the reason for applying a de novo, as opposed to an abuse of discretion, standard of review. In the case discussed there, Shelby County Healthcare Corp. v. Majestic Star Casino, LLC, Slip Copy, 2008 WL 782642 (W.D.Tenn.) (March 20, 2008), the district court concluded that this lack of involvement distinguished this case from those in which deference must be accorded to the plan administrator." (Health Plan Law blog by Attorney Roy F. Harmon III)


[Opinion] American Benefits Council Amicus Brief in Golden Gate Restaurant Association v. City and County of San Francisco (PDF)
33 pages. (American Benefits Council)


[Opinion] DOL Amicus Brief in Golden Gate Restaurant Association v. City and County of San Francisco (PDF)
40 pages. (U.S. Department of Labor via American Benefits Council)


Most Employees Participating In Wellness Programs Do Not Stay Committed, According to Survey
Excerpt: "As wellness programs grow in popularity, employees overwhelmingly see value in these healthy activities, but don't stay committed to them according to a new survey from the Guardian Life Insurance Company of America. Nearly half of employees who have participated in wellness programs in the past three years admit that their commitment trails off after just a few years." (eMaxHealth.com)


Washington, DC's 'Accrued Sick and Safe Leave Act' Likely to Become Law
Excerpt: "The District of Columbia is poised to require employers to provide paid sick leave to their employees and may well be a bellwether for passage of similar bills in other states and localities. San Francisco already has a mandatory paid leave statute on the books, and Alaska, California, Colorado, Connecticut, Massachusetts, Minnesota, North Carolina, Pennsylvania, Ohio, Rhode Island, West Virginia, Wyoming and the City of Milwaukee are considering paid sick leave laws." (Pillsbury Winthrop Shaw Pittman LLP)


Employer-Sponsored Health Insurance: Already Poor Access Dwindles Further for Working Latino Families
Excerpt: "Latinos are more likely to be uninsured than any other major racial or ethnic group in the U.S. This coverage gap is largely due to Latinos' poor access to employer-sponsored insurance (ESI). In 2006, just 40% of all Hispanics were covered by an employer health plan, compared to 66% of non-Hispanic Whites and 49% of non-Hispanic Blacks." (National Council of La Raza)


Employer Health Insurance Mandates Hit Legal Snag, States Continue to Search for Options
Excerpt: "An integral part of some state and local health system reform efforts has hit a major stumbling block. The business community has taken employer mandates to court. These state and local laws require businesses to spend a certain amount on workers' health care coverage or put that money into a fund to provide access for the uninsured. U.S. courts in Maryland, New York and California have sided with the business community and ruled that the federal Employee Retirement Income Security Act trumps these efforts." (American Medical Association)


Excerpt from Omaha World-Herald Article on Hospitals Seeking Fees Before Surgery, Followed by Don McCanne, MD Comments
Excerpt: "The Nebraska Medical Center has joined an increasing number of hospitals nationally that request that patients pay out-of-pocket costs before a scheduled surgery. The trend is driven in part by the popularity of high-deductible insurance plans, which can mean bigger out-of-pocket costs for patients, said Rick Wade, spokesman for the American Hospital Association." (Physicians for a National Health Program)


Improving the Value and Cost of U.S. Health Benefits: Could Shifts in the Employer Role Provide the Solution?
8 pages. Excerpt: "As debate about US health care reform intensifies, employers are re-examining their role in helping employees obtain and maintain health coverage. Traditional -- and still important -- organizational objectives for offering employee health benefits include attracting and retaining qualified workers, driving productivity gains through a healthier workforce and providing a financial safety net for employees and their families. However, rising health plan costs, administrative burdens and employee dissatisfaction with offerings have employers of all sizes asking hard questions: What's the value in offering health coverage? Are there new approaches that might offer better cost and strategic value?" (Mercer LLC)


Legal Fight Against San Francisco's Health Plan Heats Up
Excerpt: "Many groups are closely watching Golden Gate Restaurant Association v. City and County of San Francisco, a lawsuit now before the 9th U.S. Circuit Court of Appeals that challenges the city's Healthy San Francisco program. One of the latest heavy hitters to step into the case is the Small Business Legal Center of the National Federation of Independent Business, which filed an amicus brief March 26 opposing the program's employer mandate: Private employers with more than 20 employees must pay at least $1.17 per hour per covered worker toward employees' health care or pay a fee based on the number of employees and hours worked to the city." (1105 Media Inc.)


Health Insurance - Most College Students Covered through Employer-Sponsored Plans; Some Colleges/States Are Taking Steps to Increase Coverage (PDF)
51 pages. Excerpt: "GAO was asked to report on uninsured college students, student insurance plans, and efforts to increase the number of insured students. GAO reviewed (1) college students' insurance status, (2) uninsured college students' characteristics, (3) the extent to which colleges offered student insurance plans and the characteristics of available plans, and (4) efforts to increase the number of insured students. GAO analyzed data from a national survey on college students' insurance status and uninsured college students' characteristics." (U.S. Government Accountability Office)


Study Finds Many Patients Dissatisfied with Hospitals
Excerpt: "Many hospital patients are dissatisfied with some aspects of their care and might not recommend their hospitals to friends and relatives, the federal government said Friday as it issued ratings for most of the nation's hospitals, based on the first uniform national survey of patients. . . . The new data, part of a survey of patient experiences and perceptions of hospital care, is posted at a government Web site, www.hospitalcompare.hhs.gov." (The New York Times; free registration required)



Sponsored by: WorldatWork

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WorldatWork publications in the BenefitsLink Bookstore

WorldatWork, a not-for-profit professional association, is a leading publisher of compensation, benefits and total rewards information. With a portfolio of books, reports, survey briefs, booklets and online learning programs, WorldatWork creates, markets and distributes publications that are critical to improved organizational performance. WorldatWork has contributed to the education and development of business professionals worldwide since 1955.

(Please visit our sponsors. We try to make sure their products and services will be of interest to you. Thanks! --Editor)

Links to Items on Executive Comp, Benefits in General

Is the Executive Pay Model Improving? Depends on Whom You Ask
Excerpt: "Corporate directors are considerably more optimistic than institutional shareholders about the effectiveness and future of the U.S. executive pay model. Both groups think the new proxy disclosures have improved transparency but need more work. These and other findings are from a new study by Watson Wyatt Worldwide, 2008 Report on Directors' and Investors' Views on Executive Pay and Corporate Governance." (Watson Wyatt Worldwide)


NJ High Court Hears Smith Barney Company Stock Forfeiture Challenge
Excerpt: "New Jersey Supreme Court justices are considering whether a Smith Barney company stock policy in which brokers who leave the firm before two years forfeit their rights to company stock runs afoul of public policy.' (PLANSPONSOR.com; free registration required)


[Guidance Overview] Executive Compensation Update, March 28, 2008
Excerpt: "[This edition of the newsletter] features a cover story written by Mr. Melbinger titled 'IRS Reverses Long-Standing Position on Performance-Based Compensation Under Code Sec. 162(m).'" (Winston & Strawn LLP)


Employment at Older Ages and the Changing Nature of Work
Excerpt: "About 7 percent of American workers held highly physically demanding jobs in 2006, and 35 percent held highly cognitively demanding jobs. The share of the workforce in physically demanding jobs fell by about one-sixth between 1971 and 2006, while the share in cognitively demanding jobs increased by more than one-third. Stressful occupations also grew rapidly over the past 35 years. The decline in physically demanding occupations will likely improve employment prospects for older adults, but the growth in cognitive demands may limit options for some older people, especially those with limited education." (Urban Institute)


Congress in no rush to fix Medicare and Social Security
Excerpt: "Lawmakers are preparing to get serious about the long-term solvency of America's Social Security and Medicare programs -- but not until the next Congress convenes. The latest annual report on the prospects for Social Security and Medicare projects a $42.9 trillion shortfall over the next 75 years, at current levels of benefits and taxation. The message Congress is taking away from the report is that there's still time to build bipartisan consensus for reform." (The Christian Science Monitor)


Clinton, Obama Would Require Employers to Negotiate Workplace Lifestyle Demands
Excerpt: "Employers would have a legal obligation to negotiate with individual employees over changes in scheduling and location under a bill cosponsored by both Democratic presidential candidates. The 'Working Families Flexibility Act' (S. 2419), sponsored by Sen. Ted Kennedy (D-MA) would give employees a statutory right to request changes in the number of hours worked and when and where they are worked." (HR Policy Association)


Bear Stearns: Crisis and 'Rescue' for a Major Provider of Mortgage-Related Products, Updated March 26, 2008 (PDF)
12 pages. Excerpt: "This report provides an overview of Bear Stearns, examines the Fed's 'rescue plan,' and JP Morgan's subsequent agreement to acquire the firm." (Congressional Research Service)


When to Hire an ERISA/Employee Benefits Attorney
Excerpt: "This article provides a framework for understanding the proper time for a Plan Sponsor to seek the advice of an ERISA/employee benefits attorney. It discusses the legal framework involving employee benefits, the issues to be aware of, and some specific situations where the use of an attorney is appropriate and helpful." (Jeff Robertson, Barran Liebman LLP, via 401khelpcenter.com)


City of Huntington, West Virginia, Finances Are Critical Election Issue
Excerpt: "A review of city budgets and financial statements from the past 10 years by The Herald-Dispatch shows that spending for many city services has dropped significantly. . . . Yet the city's overall revenues for its day-to-day operations are up 53 percent in real dollars and 15 percent when adjusted for inflation. In 1998, the city's revenue base was $25.3 million. It's grown to $38.5 million today. When adjusted for inflation, the 1998 budget is the equivalent of $32.8 million in today's dollars. So where is all the money going? To personnel costs, primarily health insurance and police and firefighter pensions." (The Herald-Dispatch)


Employee Ownership Update for March 28, 2008
NCEO Executive Director Corey Rosen discusses Bear Stearns and employee ownership, why sharing ownership could be more painful to owners then valuable to participants, how to nominate your company for the Fortune 100 Best Companies to Work For list, and the Great Game of Business conference. (National Center for Employee Ownership)




Newly Posted Events
(Post Yours!)

Eliminate Potentially Discriminatory Behavior Before It's Too Late!
Nationwide on April 9, 2008
presented by Thompson Interactive, A Division of Thompson Publishing Group

FMLA, ADA, ERISA and HIPAA and How They Impact an Employee's Requested Leave of Absence
Nationwide on April 22, 2008
presented by Thompson Interactive, A Division of Thompson Publishing Group

How to Choose a Disease Management Vendor and Measure Outcomes
Nationwide on April 17, 2008
presented by Thompson Interactive, A Division of Thompson Publishing Group

Professional Appearance in the Workplace - Expectations and Enforcement
Nationwide on April 16, 2008
presented by Thompson Interactive, A Division of Thompson Publishing Group



Newly Posted Press Releases
(Post Yours!)

ERIC Urges Appeals Court to Affirm Ruling that San Francisco Ordinance is Preempted by ERISA
ERIC (ERISA Industry Committee)

Council Recommends Numerous Changes To Proposed Plan Fee Disclosure Regulations
American Benefits Council

SPARK Institute Testimony At DOL Hearings On Proposed Fee Disclosure Regulations
SPARK Institute



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