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June 30, 2008

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

Today's sponsor is University Conference Services

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Trimming the Benefits Tab Without Cutting the Value

If you’re like most employers, you struggle with how to contain the cost of your health care programs without diminishing their value to employees. There are many remedies to consider, but you do you know what’s best for your organization? Health and Welfare Plan Management for Mid-Sized Employers, September 7–10, at Caesars Palace in Las Vegas, is the perfect place to find out if you have the right "dosage" for your benefit plans.

[Guidance Overview] New Guidance Addresses HSA Eligibility
Excerpt: "The IRS issued additional guidance relating to health savings accounts (HSAs) on June 25. Notice 2008-59 consists of 42 questions and answers on a variety of topics, including eligibility, high-deductible health plans (HDHPs), contributions, distributions, prohibited transactions, establishing an HSA and administration." (Thompson Publishing Group Inc.)

[Guidance Overview] Sixth Circuit Says Independent Medical Examination Results Doom Plaintiff's Disability Claim
Excerpt: "The bottom line is that the use of examining physicians can seriously affect the outcome of an ERISA claim. Indeed, in Lupo v. Daimlerchrysler Corp., 2008 U.S. App. LEXIS 13658 (5th Cir. Jun. 24, 2008), the use of an examining physician became entirely conclusive." (The Wood Law Firm)

[Guidance Overview] Hewitt Federal Legislation Quick Guide Updated June 25, 2008, for Health and Welfare Plans (PDF)
11 pages. This Federal Legislation Quick Guide provides short updates on federal legislation that is currently under active consideration by Congress or has recently been enacted into law regarding health and welfare benefit plans. (Hewitt Associates)

[Guidance Overview] Supreme Court Declines To Hear Amschwand
Excerpt: "The Supreme Court has denied cert in Amschwand v. Spherion - the Fifth Circuit decision which denies death benefits as an impermissible attempt to collect money damages." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Guidance Overview] Seventh Circuit Holds That Sereboff Supports Disability Carrier's Counterclaim
Excerpt: "This recent Seventh Circuit opinion in an ERISA disability case addresses the language needed to avoid de novo review, conflicting evidence of disability and an interesting counterclaim argument based upon Sereboff principles." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Guidance Overview] In Metropolitan Life v. Glenn: The Supreme Court Weighs in on Weight to Be Given to Benefit Decisions
Excerpt: "Because this case may well result in more lawsuits filed over denied benefit appeals, plan sponsors and administrators must become more attuned to the necessity of fully documenting their claims review processes, ensuring that all relevant materials (particularly those submitted by the claimant) are addressed in the denial letter, and avoiding inconsistent or irreverent comments in e-mails and other correspondence relating to benefit claims." (Littler Mendelson P.C.)

[Guidance Overview] COBRA Election Notice Was Required for Employee on Leave for Work-Related Injury
Excerpt: "Here is another cautionary tale for employers who may be tempted to take COBRA requirements lightly. While it may be difficult, particularly in leave of absence cases, to determine when the COBRA qualifying event occurs, this does not excuse an employer from its obligations. As shown here, the consequences can be severe, and may include statutory penalties, medical expenses, and more." (Employee Benefits Institute of America)

[Guidance Overview] Court Upholds Benefit Denial of Post-Gastric Bypass Plastic Surgery Based on Lack of Medical Necessity
Excerpt: "As this case illustrates, plan language and consultation with appropriate medical experts are critical in withstanding the close scrutiny that courts typically give to medical plan denials based on lack of medical necessity. Notably, the DOL claims procedure regulations require that group health appeals involving medical judgment (including determinations of medical necessity) be decided in consultation with a medical expert. And if a medical expert is consulted at the initial level of the claims procedure, then a different expert must be consulted regarding the appeal of the claim." (Employee Benefits Institute of America)

[Guidance Overview] U.S. Supreme Court Rules on Plan Conflict of Interest and the Standard of Review in ERISA Benefits Litigation
Excerpt: "This Capital Checkup provides background for the decision and an overview of the facts in the case. The decision should not have any immediate impact on plan operations." (The Segal Group, Inc.)

Breastfeeding Accommodation in California Enforced
Excerpt: "From the Sacramento Bee via CCH Workweek, comes the news that the California Labor Commission last week fined a Santa Clara-based company $4,000 for violating state law that requires employers to reasonably accommodate employees who are breastfeeding. The law requires that employees be given reasonable privacy and reasonable breaks to allow them to express milk." (Workplace Prof Blog)

New Standards for Digital Medical Record Released
Excerpt: "A coalition of employers, health insurers and health care providers released a set of policy and technical guidelines that they say makes storing personal health records online easier and more secure." (Workforce Management; free registration required)

EBSA Seeks Nominations for ERISA Advisory Council
Excerpt: "The terms of five members of the Council expire on November 14, 2008. The groups or fields they represent are as follows: (1) Employee organizations; (2) employers; (3) corporate trust; (4) investment management; and (5) the general public. The Department of Labor is committed to equal opportunity in the workplace and seeks a broad-based and diverse ERISA Advisory Council." (Employee Benefits Security Administration, U.S. Department of Labor)

Massachusetts Health Insurance Experiment Still Faces a Huge Challenge — Costs
Excerpt: "Most of the newly insured are lower income residents who qualify for low- or no-cost coverage through the state and there were more uninsured than the state anticipated. Both factors pushed costs to $625 million the first year, up from estimates of $472 million, according to figures from the state agency overseeing the program." (USA TODAY)

Leave Benefits in the United States, Updated May 7, 2008 (PDF)
24 pages. Excerpt: "The report closes with results from a federal government survey of the average direct cost to businesses of different types of leave." (U.S. Congressional Research Service)

Innovations Lacking in Provider Payment Reform for Chronic Disease Care
Excerpt: "While there is broad agreement that existing provider payment methods are not well aligned with optimal chronic disease care, there are significant barriers to reforming payment for chronic disease care, including (1) fragmented care delivery; (2) lack of payment for non-physician providers and services supportive of chronic disease care; (3) potential for revenue reductions for some providers; and (4) lack of a viable reform champion." (Center for Studying Health System Change)

New Hampshire Governor Mulling Bariatric Surgery Insurance Mandate
Excerpt: "One measure requires health insurers to offer bariatric surgery as an option. Patients must pass a number of medical and psychological hurdles first. Not surprisingly, health insurers oppose the measure sponsored by state Sen. Bob Clegg, who lost over 100 pounds after having bariatric surgery at his own expense. They argue the mandate could result in higher premiums. Supporters claim the procedure can cure diabetes and other ailments that cost insurers more over time." (AP via Geo. J. Forster Company)

Burgeoning Insurance Benefits Could Send Hordes of U.S. Patients Abroad for Care
Excerpt: "Once the province of the poor and uninsured, medical tourism is gaining attention of industry giants such as CIGNA, Aetna and Blue Cross/Blue Shield, who say they either have begun or are considering pilot programs that provide limited coverage for foreign care. One Montana firm, Employee Benefit Management Services Inc., recently began offering medial tourism plans to its 120 self-insured clients in the Northwest." (MSNBC)

Eating Disorder Coverage Agreement Gets Court OK
Excerpt: "A federal judge in New Jersey has given her preliminary seal of approval to the settlement of a class action lawsuit that requires Aetna Insurance Co. to cover some claims for eating disorder treatments." (; free registration required)

Minnesota Court Blocks Retiree Health Changes
Excerpt: "A Minnesota judge has blocked the city of Duluth from making any changes to the health coverage of two of its retirees and a third retired employee's spouse." (; free registration required)

Baltimore Sun Examines Google, Microsoft Personal Health Record Systems
Excerpt: "The Baltimore Sun on Thursday examined 'two of the most-likely-to-be-huge' personal health records services: Google Health and Microsoft's Health Vault. According to the Sun, some experts believe that within four years PHRs 'will be ubiquitous,' and people will be able to 'store information in one digital location, and then share it with whomever [they] choose.'" (Kaiser Family Foundation)

[Opinion] Some Additional Reflections on the MetLife Decision
Excerpt: "Look first at the majority opinion. Here is the two sentence version of the majority opinion: in deciding whether a conflicted plan decision-maker's rejection of a benefit claim is an abuse of discretion, a district judge should consider and weigh all factors, of which a conflict is one factor. The conflict is not too important, though, if the plan has structural safeguards against decision-maker bias, such as erecting a wall between the 'claims administrators and those interested in firm finances.' Here are three problems with the majority opinion." (Pension & Benefits Blog)

[Opinion] Tame Health-Care Gorilla With New Medical Plan
Excerpt: "When it comes to health care, we're heading into an economic cul-de-sac. Health care will become one of the most onerous personal- finance issues in coming years unless the system is changed to ensure universal access, cost control and long-term financing." (Bloomberg)

[Opinion] The Battle to Save Medicare
Excerpt: "Reader Jack Wajda, 69, of Orlando, a retired AT&T executive and financial planner, identifies the single greatest problem with the American health-care system as well as anyone. He writes: 'To allow private for-profit insurance companies to decide whether and what type of care we receive is incomprehensible to me.'" (Saul Friedman via Newsday)

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Links to Items on Executive Comp, Benefits in General

[Guidance Overview] Hewitt Federal Legislation Quick Guide Updated June 25, 2008, on Human Resources & Employment Law (PDF)
9 pages. This Federal Legislation Quick Guide provides short updates on federal legislation that is currently under active consideration by Congress or has recently been enacted into law regarding human resources and employment law. (Hewitt Associates)

New Jersey High Court Approves Forfeiture of Executive Incentive
Excerpt: "New Jersey's Supreme Court gave its stamp of approval to employee stock-purchase compensation plans that carry forfeiture provisions if participants quit before fully vesting." (; free registration required)

Is It Worth Ramping Up Relocation Packages to Entice People to Move?
Excerpt: "In the Weichert study, 27 percent of companies said they are increasing relocation benefits in 2008 to entice new hires into new locations. In a similar study of 50 companies surveyed by Valhalla, N.Y.-based Prudential Relocation's Global Consulting Group, 58 percent said they have made changes or plan to change their relocation policies to address today's market." (Human Resource Executive Online)

Employers Try to Ease Workers' Commuting Costs (PDF)
4 pages. Excerpt: "[A] growing number of companies have undertaken a variety of initiatives to ease the commuting burden for employees." (Hewitt Associates)

[Opinion] Susan Mangiero Asks: Will Tubbies Get Fewer Benefits?
Excerpt: "While I'm the last to make a value judgement about weight, some disturbing thoughts come to mind. How are longevity patterns (and the related cost of offering healthcare benefits and a traditional pension) impacted when plan participants are officially deemed overweight? Do employers experience lower costs if their pension plan covers mostly unhealthy participants? For employers that offer both health insurance and a defined benefit plan, do they deem an 'optimal' mix of healthy versus not so healthy plan participants? (This assumes that healthier individuals who live longer push pension costs up but keep a lid on healthcare benefit expenses.) Should employers figuratively serve 'in loco parentis' or does this expose them to allegations of discrimination?" (Pension Risk Matters)

Newly Posted Events
(Post Yours!)

403(b) Plan Workshop
in Texas on July 22, 2008
presented by SunGard Relius

403(b) Plan Workshop
in Illinois on July 23, 2008
presented by SunGard Relius

Cash Balance Plans Workshop
Nationwide on August 22, 2008
presented by SunGard Relius

Cross-Tested Plans Workshop
Nationwide on August 21, 2008
presented by SunGard Relius

EGTRRA Pre-approved Plan Workshop
in California on July 11, 2008
presented by SunGard Relius

EGTRRA Pre-approved Plan Workshop
in Virginia on July 14, 2008
presented by SunGard Relius

EGTRRA Pre-approved Plan Workshop
in Massachusetts on July 16, 2008
presented by SunGard Relius

HIPAA Privacy Refresher - Team Training Webcast
Nationwide on July 10, 2008
presented by International Foundation of Employee Benefit Plans

Preparing for FSA and COBRA Open Enrollment
Nationwide on July 24, 2008
presented by TRI-AD

Newly Posted Press Releases
(Post Yours!)

U.S. Labor Department Obtains Court Approval of Settlement Restoring $2.2 Million to Delphi Corp. Retirement Plan
U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

Company Celebrates 75th Anniversary - And Shares the Secret behind their Success
McCready & Keene, Inc.

Unum Expands ''Simply Unum'' Offering to 41 States

TRS Named “Public Pension Fund Investor of the Year”
Teacher Retirement System of Texas (TRS)

OpenSRI to Launch the First Collaborative Web Platform on Socially Responsible Investments

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Retirement Plan Consultant
for Weaver and Tidwell, LLP
in TX

Retirement Plan Sales Consultant
for Charles Schwab
in TX

Retirement Plan Compliance Specialist
for Alliance Benefit Group-Mid Atlantic, LLC
in MD

Benefits Analyst
for Catholic Healthcare Partners
in OH

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