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July 3, 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] Towers Perrin U.S. Legislative Tracking Charts -- Health and Welfare -- Updated July 2, 2008 (PDF)
23 pages. Excerpt: "These charts summarize selected federal legislation that would affect employee benefit programs. The bills included on the charts are based on judgments regarding the prominence of the issue, the likelihood of enactment, and the influence of the sponsors." (Towers Perrin)

[Guidance Overview] Supreme Court Presumes Conflict of Interest in 'Dual Role' Benefits Denial Cases (PDF)
Excerpt: "On June 19, 2008, the Supreme Court upheld the application of the deferential abuse of discretion standard of review for benefit decisions under ERISA-governed plans even in instances when the decision-maker on the claim also is responsible for paying benefits or is affiliated with the payer." (Seyfarth Shaw LLP)

[Guidance Overview] Counterclaim for Disability Benefits Properly Framed in Terms of Sereboff Prerequisites
Excerpt: "Professor Roger Baron calls our attention to another recent counterclaim case in which the district court got the analysis right. The case is Killian v. Johnson & Johnson, 2008 U.S. Dist. LEXIS 49580 (D.N.J. June 23, 2008). In that case the defendant in a claim for benefits case filed a counterclaim, asserting that social security benefits received by the plaintiff should have been offset from disability benefits paid to her - resulting in her actually owing the plan, on the defendant's theory, some $45,000." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Guidance Overview] Genetic Information Nondiscrimination Act of 2008 (PDF)
Excerpt: "GINA contains a number of provisions that will be of interest to health plans and plan sponsors . . . ." (Groom Law Group)

Segal Medicare Part D Survey of Multiemployer Health Funds (PDF)
2 pages. Excerpt: "The survey found that most multiemployer health funds continue to take the Retiree Drug Subsidy (RDS). We expect that will change in the coming years as RDS administration becomes increasingly challenging for plan sponsors." (The Segal Group, Inc.)

PHR Vendors Begin Marketing to Employers and Insurers, According to Study
Excerpt: "Personal health record vendors have begun marketing their products to employers and insurers, rather than consumers, in the hopes of expanding PHR adoption, according to a recent study by Chilmark Research, an industry analyst, the American Medical News reports." (California HealthCare Foundation)

Most Patients Happy With German Health Care
Excerpt: "Mention European health care to an American, and it probably conjures up a negative stereotype -- high taxes, long waiting lines, rationed care. It's not that way in Germany. Very little tax money goes into the system. The lion's share comes, as in America, from premiums paid by workers and employers to insurance companies." (Morning Edition via National Public Radio)

Doctors Increasingly in Favor of Major Reforms to the U.S. Health Care System
Excerpt: "Doctors have historically been the watchdogs of the U.S. medical system, with the American Medical Association scaring New Dealers into dropping national health coverage from the Social Security Act and then the AMA shredding Harry Truman's reform efforts in the late 1940s. But a new poll and other significant indicators suggest that doctors are turning against the health-insurance firms that increasingly dominate American health care." (The American Prospect via Physicians for a National Health Program)

European Union Drafts New Health Coverage Rules
Excerpt: "The European Union unveiled draft health insurance coverage rules that aim to ease elective-surgery waits and which could also broaden medical travel by patients living within the EU's 27-nation bloc . . . ." (Modern Healthcare Online; free registration required)

Issues and Measures for Predictive Modeling of Medical Cost
Excerpt: "Milliman actuaries developed a predictive model of medical cost using 2007 medical costs and vital data as independent variables in addition to age and gender. Based on that experience, this paper discusses the issues that every researcher faces when trying to model the medical cost using regression analysis and some possible measures for those issues." (Milliman)

'Patient-Controlled Health IT Act' (PDF)
Excerpt: "To establish a demonstration program to provide financial incentives to encourage the adoption and use of interactive personal health records and to encourage health information exchange networks to link clinical data to such personal health records.' (U.S. House of Representatives via American Benefits Council)

Employers' Health Insurance Cost Burden, 1996–2005 (PDF)
Excerpt: "Data from the Employment Cost Index show that health insurance costs relative to payroll increased 34 percent between 1996 and 2005 and that the increase was largest for businesses paying low wages; simultaneously, data from the Employee Benefits Survey show that benefit packages became less generous, yet cost growth was not paralleled by a commensurate decrease in employer offers." (U.S. Bureau of Labor Statistics)

Workers' Compensation in California and the Nation: Benefit and Employer Cost Trends, 1989 – 2005
Excerpt: " California's workers' compensation system has been the center of intense debate and legislative activity over the past several years. The dramatic reforms of California workers' compensation in 2003-2004 sought to reduce utilization of medical care through evidence-based medical treatment guidelines and the creation of a system of medical provider networks, establish time limits on temporary disability benefits, establish a more objective permanent disability schedule, and provide for transparent fee schedules for out-patient surgery centers, hospitals, and pharma.ceuticals." (National Academy of Social Insurance)

North Carolina Mental Health Parity Law Takes Effect
Excerpt: "North Carolina health care insurers must provide the same amount of coverage for certain mental conditions as they do for physical ailments under a state law that took effect on Tuesday, the Winston-Salem Journal reports." (Kaiser Family Foundation)

More Than 500 Backlogged Whistle-Blower Cases Allege Health Care, Drug Company Fraud
Excerpt: "Whistle-blower lawsuits alleging that pharma.ceutical companies and government contractors defrauded the federal government have created a backlog of more than 900 cases at the Department of Justice, the Washington Post reports. According to the Post, more than 500 of the cases involve the health care and pharma.ceutical industries, as well as Medicare and Medicaid." (Kaiser Family Foundation)

[Opinion] Bad Medicine, Under Guise of Helpfulness, Big Pharma Wants Your Confidential Medical Records
Excerpt: "[A California] bill, SB 1096, was sponsored by Sen. Ron Calderon (D-Montebello) and would have allowed pharmacies to sell patients' prescription and medical information to third-party entities -- including Adheris, Inc., the bill's main business backer. The ostensible goal behind the bill was to allow Adheris and other similar marketing companies to mail 'reminder' notices to patients so they wouldn't forget to take their medication." (San Francisco Bay Guardian via Consumer Watchdog)

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

[Guidance Overview] Towers Perrin U.S. Legislative Tracking Charts -- Human Resources -- Updated July 2, 2008 (PDF)
14 pages. Excerpt: "These charts summarize selected federal legislation that would affect employee benefit programs. The bills included on the charts are based on judgments regarding the prominence of the issue, the likelihood of enactment, and the influence of the sponsors." (Towers Perrin)

[Guidance Overview] Ninth Circuit Links Statutory Penalty Provision to ERISA Regulations
Excerpt: "Typically, the federal courts find that the statute only reaches formal plan documents. By tying the claims regulation to the civil penalty provision, the Ninth Circuit has given ERISA claimants a discovery short cut with statutory sanctions to back up their requests." (Health Plan Law blog by Attorney Roy F. Harmon III)

UnitedHealth Settles Backdating Suit and Also Settles ERISA-Related Litigation
Excerpt: "'The settlement provides UnitedHealth Group with certainty and closure on this lawsuit, avoids potentially costly and protracted litigation and allows us to continue to focus on providing Americans with high-quality, affordable health care solutions.' Separately, UnitedHealth reached an agreement in principle to resolve the Employee Retirement Income Security Act (ERISA) class action litigation relating to the company's historical stock options practices that was originally filed June 2006, in the U.S. District Court in Minnesota against the company and certain current and former officers and directors." (

Decent Pay, Benefits, Job Security, Make Public Sector Jobs Attractive in Uneasy Economy
Excerpt: "As the nation's economy continues to suffer, schools, villages and other areas of the public sector are being viewed as good places to work with traditional pensions and lower-cost health-care benefits making up for what can be reduced annual salaries. That public-sector interest is backed up by national employment trends charted by the U.S. Department of Labor in 2007, the most recent available." (Daily Herald)

DUI Death as Accident Issue Divides Appellate Court
Excerpt: "A sharply divided federal appellate court has upheld a lower court ruling that the widow of a life insurance plan participant killed in a 2002 car accident did not deserve a benefit payout because the alcohol-related crash was not considered an accident." (; free registration required)

Changing Workforce Demographic Reflected in Employer Benefit Choices
Excerpt: "A new report from Unum lays out changing trends in voluntary benefits purchases by employers driven by a changing workforce demographic and rising health care costs, and provides employers with suggestions on how to deal with these factors." (; free registration required)

Newly Posted Events
(Post Yours!)

Answers to the Top 10 Common Payroll Questions
Nationwide on July 21, 2008
presented by

Are you ready for EGTRRA restatements
Nationwide on July 9, 2008
presented by

Background Checks: Follow The Rules, Know The Risks, Reap The Rewards
Nationwide on July 17, 2008
presented by

How to Effectively Communicate with Your Participants
Nationwide on September 26, 2008
presented by TRI-AD
Nationwide on August 13, 2008
presented by

Learn how to use's plan document software
Nationwide on July 10, 2008
presented by

Protecting the Nest Egg in a Turbulent Economy
in District of Columbia on July 11, 2008
presented by Center for American Progress

Refresher Course for Plan Sponsors Considering Automatic Enrollment
Nationwide on November 20, 2008
presented by TRI-AD

Roth 401(k) - Is It Right for Your Plan?
Nationwide on July 31, 2008
presented by TRI-AD

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Benefits Consultant
for Northwestern Benefit Corporation of Georgia
in GA

Client Services Representative
for Summit Retirement Plan Services, Inc.
in OH

EGTRRA Restatement Project Contractor
for Charles Schwab
in OH

International Consulting Associate
for Towers Perrin
in IL

Compliance Analyst
for New York Life Retirement Plan Services
in MA

Retirement Services Consultant
for Administaff
in TX

Manager, Corporate Retirement Plans
for COUNTRY Financial
in IL

Senior Compliance Analyst- Kingwood, Texas (NE Houston)
for Administaff
in TX

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