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April 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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[Guidance Overview] CMS Releases 2009 Medicare Part D Benefit Parameters (PDF)
Excerpt: "The Centers for Medicare and Medicaid Services (CMS) has updated the Medicare Part D standard benefit parameters and the cost thresholds and limits for qualified retiree prescription drug plans for 2009." (Buck Consultants)

[Guidance Overview] Eleventh Circuit Joins Tenth on Production of 'Appeal-Level' Medical Reviews
Excerpt: "In this recent decision, the Eleventh Circuit added its weight to that of the Tenth on an important aspect of the standard of 'full and fair review'. The Eleventh Circuit held that an ERISA plan administrator was not required to furnish a plan participant the report of physician who conducted independent peer review of participant's medical records during review of the initial denial of participant's benefit claim. The court accepted the plan administrator's argument that it had not relied upon the report or used the report in the course of making the benefit determination until its final decision was reached." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Guidance Overview] IRS Issues More Guidance on HSA Comparable Contribution Requirements
Excerpt: "Specifically, the final regulations provide a way for employers to satisfy the comparable contribution requirement for a year with respect to eligible employees who have not established, or who have not told the employer they have established, an HSA by December 31. Additionally, the final regulations permit employers to accelerate HSA contributions for certain employees who have incurred medical expenses without violating the comparable contribution rules." (Deloitte via

[Guidance Overview] Benefit Decisions by 'Conflicted' ERISA Plan Administrators -- U.S. Supreme Court to Decide the Standard of Judicial Review that Applies
Excerpt: "The case before the Supreme Court raises issues with a very standard administrative set-up, in which the plan's insurer is also the entity which decides benefit claims. In this case, the employee was denied a continuation of disability benefits because the insurer determined she was no longer disabled. The employee contends that, because of its dual role, the insurer has an inherent conflict of interest . . . ." (Deloitte via

Sweeping Changes Debated for Landmark Family and Medical Leave Act
Excerpt: "Under proposals being considered by the Labor Department, workers would have to tell their bosses in advance when they take nonemergency leave, instead of being able to wait until two days after they left. They would have to undergo 'fitness-for-duty' evaluations if they took intermittent leave for medical reasons and wanted to return to physically demanding jobs. To prove that they had a 'serious health condition,' they would have to visit a health-care provider at least twice within a month of falling ill. What's more, employers would have the right to contact health-care providers who authorized leave." (The Washington Post; free registration required)

Congressional Democrats Hedge on Health Care Reform Prospects
Excerpt: "For some senators, the promises made by Sens. Barack Obama (D-Ill.) and Hillary Rodham Clinton (D-N.Y.) outside of Washington may not match the political reality on Capitol Hill. 'We all know there is not enough money to do all this stuff,' said Sen. Jay Rockefeller (D-W.Va.), a Finance Committee member and an Obama supporter, referring to the presidential candidates' healthcare plans. 'What they are doing is... laying out their ambitions.'" (The Hill)

Employers Promote Wellness Programs to Skeptical Employees
Excerpt: "Although many more employers are planning a more direct role in managing employees' health, employees are not so sure that they want their employers more involved, according to recent research from Hewitt Associates. In addition, some legal experts urge restraint in wellness program implementation." (Wolters Kluwer)

Transcript for Oral Arguments in MetLife v. Glenn
Excerpt: "You won't want to miss reading the transcript for oral arguments in the case of MetLife v. Glenn argued before the Supreme Court this morning. Access it [at]." (Attorney B. Janell Grenier via

Medicare Part D Accounting Practice Note (PDF)
29 pages. Excerpt: "The purpose of this practice note is to assist actuaries involved in valuation, accounting, and financial reporting work relating to Medicare Part D products." (American Association of Actuaries)

Salt Lake County Council to Vote on Partner Benefits
Excerpt: "Salt Lake County Council member Jenny Wilson has introduced a health insurance plan that would expand coverage to, among others, the partners of g.ay and les.bian county employees. Wilson told the Salt Lake City Tribune that she is modeling her plan after the city's current policy, which was passed two years ago." (Planet Out via Yahoo! News)

Scrapping Health-Care Premiums Means Cash Bonanza for Canadian Province
Excerpt: "The elimination of health-care premiums will pump $1 billion annually into the economy beginning next January, and some of that cash could wind up in employee's pockets, say business and union officials." (The Edmonton Journal)

Health Care Cost Hikes Significantly Lower for Companies With High Enrollment in Consumer-Directed Health Plans
Excerpt: "A consumer orientation in health benefits appears to have a halo effect with advantages that go beyond those enrolled in consumer-directed health (CDH), according to a new study from Watson Wyatt and the National Business Group on Health (NBGH). Health cost increases for companies with high CDH enrollment are about half of those offering only traditional coverage, the authors of the report say." (

Despite Excessive Alcohol-Related Health Costs and Lost Productivity, Available Prescription Drug Therapies Remain Underutilized
Excerpt: "Excessive alcohol use costs U.S. employers billions of dollars annually in health care costs and lost productivity, according to a new study by The George Washington University (GWU) Medical Center. And while employers are starting to push health plans to address the issue, the use of prescription drug therapies to treat alcohol problems remains an underutilized option . . . ." (

Pay for Performance Eliciting Growing Interest from Healthcare Management World
Excerpt: "Hospitals and other facilities are implementing forms of pay for performance in a way that was nonexistent ten or even five year sago. Such programs typically use established ratings methods and indicators to measure levels of quality (such as efficiency or patient satisfaction), then offer incentives or compensation to entities or providers who are rated highly based on these indicators." (Milliman)

Designing Pharmacy Benefits to Reduce Disease and Cut Costs
Excerpt: "Unfortunately, because of [the] focus on cost, today's pharmacy plans miss opportunities to promote health improvement by monitoring the compliance to prescription regimens, particularly for diseases that are high-cost to employers and life-altering for patients." (Employee Benefit News; free registration required)

House Bill Would Grant FMLA Leave for Crime Victims
Excerpt: "Violent crime and domestic violence victims and their families would get time off from work for required court proceedings under a bill introduced in the U.S. House of Representatives." (; free registration required)

Employers Almost Universally Against Universal Health Care, According to Survey
Excerpt: "An overwhelming number of large corporations polled recently by Watson Wyatt and the National Business Group on Health said they have a strong preference for managing their own health-care issues, as opposed to moving toward a 'single-payer' solution, such as universal health care. Specifically, respondents at 380 of the 453 large employers -- or 84% -- said they don't support universal health-care coverage. Instead, they want to provide workers with their own health-care programs." (Financial Week; free registration required)

[Opinion] A Better Way to Pay for Prescriptions
Excerpt: "The pricing plans most people choose for their cell phones are simple: Pay one price and talk as much as you want. What if paying for your prescription drugs were as easy and appealing? It's not as outlandish as it may appear. Paying for drugs the same way we pay for cell phones would encourage people to use as much as they need, not just what they can afford. That could result in better medical care, help avoid hospitalizations and cut medical expenses." (Providence Journal via RAND)

[Opinion] Glenn ERISA Case Oral Argument Transcript Analysis
Excerpt: "The Supreme Court heard oral argument this morning in the ERISA enforcement case of Metlife v. Glenn. The case concerns the issue highlighted here before about structural conflicts of interest (dual-role insurers) in ERISA denial of benefits case under Section 502(a)(1)(B). Here are some thoughts and highlights based on my reading of the Glenn oral argument transcript . . . ." (Workplace Prof Blog)

[Opinion] Can You Increase Employee Satisfaction While Holding Costs in Check?
Excerpt: "For the employee-consumer, their average annual medical cost for a family of four increased by 8.4 percent from 2006 to 2007. What can be done to counteract these rising costs? Annual changes to health benefit plans, along with more significant changes every three to four years, can lead to significant reductions in the annual cost increases borne by employers. These changes can also lead to increased employee appreciation for their health benefits." (Milliman)

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How Do Your Medical Plan's Vital Signs Look?

Are you searching for a new strategy that will contain your health care costs yet distinguish you as an employer of choice? The Health and Welfare Plan Management for Mid-Sized Employers, April 27-30, 2008, in Boston, offers practical, reality-based solutions that will ensure the "health" of your benefit plans.

(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

[Guidance Overview] IRS Draft Instructions to Revised Form 990 (PDF)
9 pages. Excerpt: "Exempt organizations will use these instructions in completing their annual informational returns beginning in fiscal year 2008. Similar in form to instructions used for years past, these draft instructions provide general Form-wide instructions and specific line-by-line instructions. In addition, the draft instructions include a glossary of terms, sequencing lists (which help determine the order for filling out the Form) and compensation tables (which help determine how and where to report items of compensation)." (McDermott Will & Emery)

Update on Stock Option Backdating
Excerpt: "In case you wondered how the backdating matters have been resolved, this week brings news that: The SEC settled with Broadcom Corporation for $12 million civil penalty, in addition to a permanent injunction. . . . A grand jury in Northern California indicted the former Mercury CFO for tax fraud in connection with her role in the Mercury's backdating scheme. Still no word on whether the SEC or prosecutors will act against any of the law firms that seemed to have facilitated the scandal." (Michael S. Melbinger of Winston & Strawn LLP)

Newly Posted Events
(Post Yours!)

All Day Seminar with Sal Tripodi, Esq., APM
in New York on May 1, 2008
presented by ASPA Benefits Council of New York

Amending for the Final 415 Regulations
Nationwide on May 14, 2008
presented by Qualified Pension Consulting, Inc.

Amending for the Final 415 Regulations
Nationwide on May 22, 2008
presented by Qualified Pension Consulting, Inc.

Are You Ready For EGTRRA Restatements?
Nationwide on May 1, 2008
presented by

Newly Posted Press Releases
(Post Yours!)

Video: 18th Annual Retirement Confidence Survey(R): Health Care, Economy Major Concerns in Workers' Record Drop in Retirement Confidence
Principal Financial Group

RolloverSystems Enhances Support for TPAs, Advisors, Plan Sponsors

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