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April 8, 2008

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

Today's sponsor is Employee Benefits Institute of America (EBIA)

(Click on company name or banner to learn more.)
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EBIA's InPerson Seminar Series

EBIA's InPerson seminars provide education on employee benefits topics to professionals, including TPAs, attorneys, benefits consultants, human resources managers, plan administrators, insurance professionals, and accountants. For information about CE credit, course materials, speakers, locations, and agenda details, and to register, please visit EBIA's InPerson Seminars.

[Official Guidance] Massachusetts Individual Mandate Penalties for Tax Year 2008
Excerpt: "Pursuant to G.L. c. 111M, § 2, the Department of Revenue is releasing for public comment the penalty schedule for individuals who fail to comply in 2008 with the requirements under the Massachusetts Health Care Reform Act." (Commonwealth of Massachusetts Department of Revenue)

[Guidance Overview] Supreme Court Ends AARP Challenge to EEOC's ADEA Exemption for Retiree Medical Benefits
Excerpt: "It has been a long time coming, but the U.S. Supreme Court finally has brought to an end the longrunning legal and political saga involving the ability of employers to coordinate their retiree medical plans with Medicare eligibility. Without elaboration or explanation, the Court on March 24, 2008 announced it would not review the AARP's challenge to an Age Discrimination in Employment Act (ADEA) exemption for such arrangements promulgated by the Equal Employment Opportunity Commission (EEOC). The EEOC's ADEA exemption took effect on December 26, 2007." (Deloitte via

[Guidance Overview] Exhaustion of Administrative Remedies Defense Precludes Judicial Review
Excerpt: "Failure to exhaust of administrative remedies provided the decisive factor for the plan in this claim for benefits dispute. The case highlights the typical analysis that supports a finding for the plan administrator and provides a cautionary tale for those advancing claims for benefits in the face of initial claims denial." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Guidance Overview] Insurer Seeks Indemnification from TPA for Not Providing Timely Notice of Qualified Beneficiary's COBRA Election
Excerpt: "The COBRA statute does not apply directly to insurers. Rather, an insurer's COBRA obligations will be dictated by the terms of its contract, which will often impose conditions, such as timely notice requirements, that must be met before the insurer will be obligated to provide COBRA coverage. As this case demonstrates, it is crucial to be clear about what notices are required and who is responsible for providing them, especially when, as here, COBRA administration is outsourced to a TPA." (Employee Benefits Institute of America)

[Guidance Overview] Proposed Regulation on TRICARE Incentive Prohibition Addresses Treatment of Cafeteria Plans
Excerpt: "EBIA Comment: The TRICARE incentive prohibition applies beginning January 1, 2008 to all employers (except those with fewer than 20 employees). The DoD had previously indicated that the TRICARE incentive prohibition regulation would not consider a Code Section 125 cafeteria plan to be an unlawful incentive so long as all plan participants are treated the same . . . . Although the regulation is only proposed at this point, employers that are subject to the prohibition may want to familiarize themselves with the regulation and its preamble. The prohibition against offering financial or other incentives must be taken seriously -- civil penalties of up to $5,000 can be imposed for each violation." (Employee Benefits Institute of America)

Studies Show It's Often Cheaper To Let People Get Sick
Excerpt: "Even when prevention greatly reduces future cases of a particular illness, overall cost to the health-care system typically goes up when lots of disease-preventing strategies are put into practice. This is usually true whether treating the preventable diseases is cheap or expensive." (The Washington Post; free registration required)

New Jersey Lawmakers Approve Paid Leave for Workers
Excerpt: "New Jersey moved another step closer on Monday to becoming the third state in the country to give employees the right to take paid leave to care for a newborn or a sick relative. The State Senate voted 21 to 15 to approve a bill that would offer such employees up to six weeks' paid leave. The Assembly approved the plan last month, and Gov. Jon S. Corzine said he would soon sign it." (The New York Times; free registration required)

A Strategic Plan for Integrating Cost-Effectiveness Analysis into the U.S. Healthcare System
Excerpt: "Understanding resistance to cost-effectiveness analysis (CEA) in the United States has been the topic of numerous papers, books, and conferences. The Panel on Integrating Cost- Effectiveness Considerations into Health Policy Decisions was convened to build upon these efforts in 2 ways: (1) to explore the views of health plan purchasers on the value and use of CEA in their organizations and (2) to develop a strategic plan for policymakers to address obstacles and to integrate CEA into health policy decisions, drawing on stakeholders as part of the solution." (The American Journal of Managed Care)

Abstract of Winter 2008 Report of Results from the Healthy Campus Survey
Excerpt: "For colleges and universities, strategically coordinated healthy campus programs can pay off with significant return on investment (ROI), making a strong case for the investment as a smart use of often tight budget dollars. Given the ROI potential of campus health initiatives, Sibson Consulting invited colleges and universities across the country to participate in a Healthy Campus Survey. The survey captured information about current practices. It also examined the relationship between them and outcomes, such as faculty and staff turnover and vacancy rates, absence rates, health care costs and use of short-term disability benefits." (The Segal Group, Inc.)

2008 Dartmouth Atlas of Health Care: Tracking the Care of Patients with Severe Chronic Illness (PDF)
184 pages. Excerpt: "This edition of the Dartmouth Atlas will focus on disentangling the phenomenon known as 'unwarranted variation,' or variation in different regions of the country that is not explained on the basis of illness, patient characteristics or preferences, or the dictates of evidence-based medicine. Like the last edition, it focuses on supply-sensitive care delivered to chronically ill Medicare beneficiaries in the last two years of life." (The Dartmouth Institute for Health Policy and Clinical Practice)

Employer Strategies Helped Slow Prescription Drug Benefits' Cost Increases Since 2000
Excerpt: "More than three-fourths of the respondents (77%) offer members copayment incentives to obtain their maintenance drugs from the mail-order service pharmacy, while some employers penalize members when they fail to do so -- in those circumstances, 6% require additional copayments after a specified number of retail fills, and another 10% will not cover retail fills at all. Another 13% of employers use no mail-order incentives or penalties." (Wolters Kluwer)

Shepherding Major Health System Reforms: A Conversation With German Health Minister Ulla Schmidt (PDF)
10 pages. Excerpt: "During her tenure with the German health ministry, Ulla Schmidt has overseen major system reforms, balancing social solidarity with fiscal responsibility." (Health Affairs)

A Living Model of Managed Competition: A Conversation With Dutch Health Minister Ab Klink (PDF)
8 pages. Excerpt: "The Dutch government's centrist approach to health reform with an individual insurance mandate could provide another model for U.S. reform efforts." (Health Affairs)

IOM Review Recommends Centralized Agency to Study Comparative Effectiveness of Alternative Treatments
Excerpt: "The proposed agency would conduct comparison tests of existing and new therapies and help avoid having health insurers and not-for-profit groups from duplicate each other's work, according to CQ HealthBeat." (Kaiser Family Foundation)

Kentucky Lawmakers Approve Bill To Allow Unmarried Adult Children To Remain on Parents' Insurance Policies
Excerpt: "The Kentucky General Assembly on Wednesday approved a bill (HB 440) that would require health insurers to allow parents to keep unmarried children on their health plans until age 25, the Louisville Courier-Journal reports." (Kaiser Family Foundation)

Same Judges to Rule Again on San Francisco Health Law
Excerpt: "The three-judge appeals court panel that earlier this year allowed San Francisco to temporarily implement its controversial health care spending law will decide the fate of the ordinance. The 9th U.S. Circuit Court of Appeals disclosed Monday that Judges William Fletcher, Alfred Goodwin and Stephen Reinhardt will hear oral arguments April 17 on a lower court ruling that found that the federal Employee Retirement Income Security Act pre-empted the San Francisco law that requires employers to spend a certain amount of money on employees' health care coverage or pay certain fees." (Business Insurance)

Sponsored by: ALM

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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.

(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

Benefits Interference Suit Given New Life by Federal Court
Excerpt: "A federal appellate court has reinstated an employee's lawsuit over whether his former employer fired him to avoid paying for his shoulder surgery. The 8th U.S. Circuit Court of Appeals threw out a ruling by an Arkansas federal judge dismissing Danny Fitzgerald's lawsuit against Action Inc. over an alleged violation of the Employee Retirement income Security Act (ERISA). The appellate panel sent the case back to the trial court for further proceedings." (; free registration required)

Workplace the Primary Financial Supermarket for Many
Excerpt: "A MetLife news release about its Annual Employee Benefits Trends Study, said the research found that the workplace has become the dominant starting point for building a strong financial safety net. Growing financial concerns among employees are also creating a greater interest in advice and guidance at the workplace." (; free registration required)

[Opinion] The Interaction of LaRue, Bruch, and MetLife v. Glenn
Excerpt: "The courts are already clogged with a myriad of litigation on countless subjects. It makes no sense to turn every benefit denial or administrative error immediately into a federal lawsuit without, at least, attempting to pursue participant rights through the administrative review process. If that process is not administered in an objective and responsible manner, then it should be reformed and its decisions will not be upheld by courts until it is." (Pension & Benefits Blog)

Newly Posted Events
(Post Yours!)

Calculating HR's Impact On The Bottom Line: Measuring Return On Investment From HR Initiatives
Nationwide on April 15, 2008
presented by

Deductibility of Performance-Based Compensation under IRS Code Section 162(m) - Webcast
Nationwide on April 10, 2008
presented by West LegalEdcenter

FMLA: Effective Strategies for Limiting Leave
Nationwide on April 23, 2008
presented by

Healthy, Wealthy and Wise?
in Vermont on April 28, 2008
presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

Trim the Fat and Shape Up Your Bottom Line: Weight Loss Programs that Work
Nationwide on April 28, 2008
presented by

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401(k) Plan Administrator
for Pollard & Associates, Inc.
in MD

Assistant 401(k) Administrator
for Pollard & Associates, Inc.
in MD

Retirement Plan Specialist
for Growing TPA Firm
in IL

Retirement Plan Services Administrator
for Associated Bank
in MN, WI

Trust Department Business Analyst
for New York Life Retirement Plan Services
in MA

Second Shift Retirement Plans Service Center Supervisor
for New York Life Retirement Plan Services
in MA

Client Service Consultant - Regional
for Standard Insurance Company
in CA

Client Employee Benefits Advisor
for Morgan, Lewis & Bockius LLP
in PA

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