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July 18, 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] District Court Clarifies Standard for Providing Notice of Plan Limitations Provisions
Excerpt: "A recent decision from the U.S. District Court for the District of Arizona raises important drafting and administrative issues for employers to consider when adding a plan-based statute of limitations provision to their benefit plans. In Solien v. Raytheon Long Term Disability Plan #590, the court refused to uphold a plan-based one-year limitations period for challenging benefit claims in court because the limitation period was not adequately disclosed in the summary plan description (SPD) and was not communicated to the participant as part of the plan's claim denial determination." (McDermott Will & Emery)

Medical Loss Ratios: Evidence from the States (PDF)
8 pages. Excerpt: "In March and April 2008, Families USA conducted a 50-state survey that determined which states have laws or regulations that establish a minimum medical loss ratio (see table on page 3). Individual market results are reported in Failing Grades: State Consumer Protections in the Individual Health Insurance Market (June 2008). This memo supplements the report with additional data." (Families USA)

The Facts about Prior Approval of Health Insurance Premium Rates (PDF)
4 pages. Excerpt: "Without state intervention, health insurance companies can and often do charge very high premiums to individuals and small businesses, and they spend an embarrassingly low proportion of the premium dollars they collect on health care services. In the face of double-digit increases in health insurance premiums, insurance companies should be required to demonstrate that their premium rate increases are reasonable and necessary, and that they are not retaining an excessive margin for profit and administration. Most states address these issues by regulating insurance company premium rate increases." (Families USA)

Employers Hear Details of McCain and Obama Health Plans
Excerpt: "Representatives of the presumptive Republican and Democratic presidential nominees met with employers on Tuesday, July 15, in Chicago to discuss each candidate's health care plan, exposing differences in how they would close the coverage gap, reduce health care costs and affect employers." (Workforce Management; free registration required)

Testimony: The Potential Benefits and Costs of Increased Adoption of Health Information Technology (PDF)
9 pages. Testimony presented before the Senate Finance Committee on July 17, 2008. Excerpt: "In this testimony, I will use HIT to include an electronic medical record that replaces the paper medical record and includes such associated functions as clinical decision support for facilitating evidence-based medicine, patient tracking and reminders for preventative services, computerized physician order entry to facilitate prescribing and other physician orders, and electronic connectivity of providers (and, in some cases, among providers and patients)." (RAND Corporation)

Disease Prevention and Wellness Programs Yield Greater Returns, Report Finds
Excerpt: "The report from the Trust for America's Health, a nonprofit health advocacy group, found that programs encouraging physical activity, healthy eating and no smoking were a better investment than those concentrating primarily on treatment. The results are laid out in a state-by-state breakdown." (The Washington Post; free registration required)

CBO Testimony: The Overuse, Underuse, and Misuse of Health Care (PDF)
14 pages. Excerpt: "The most important factor influencing the federal government's long-term fiscal balance is the rate of growth in health care costs. CBO projects that, without any changes in federal law, total spending on health care will rise from 16 percent of gross domestic product (GDP) in 2007 to 25 percent in 2025 and 49 percent in 2082; net federal spending on Medicare and Medicaid will rise from 4 percent of GDP to almost 20 percent over the same period." (U.S. Congressional Budget Office)

CBO Testimony: Increasing the Value of Federal Spending on Health Care (PDF)
10 pages. July 16, 2008, Testimony before the Committee on the Budget, U.S. House of Representatives. Excerpt: "This statement reprises a presentation given at the Senate Finance Committee's 'Health Reform Summit,' in Washington, D.C., on June 16, 2008." (U.S. Congressional Budget Office)

States That Allow Individuals to Deduct Health Savings Accounts Contributions, 2008
Excerpt: "New 2008 information from Thomson West's Health Policy Tracking Service (HPTS) on states that allow individuals to deduct health savings accounts contributions on their state income tax returns. Also available from HPTS is new information on state authorization of tax credits or deductions for small employers offering health insurance." (Kaiser Family Foundation)

Average Single Premium Per Enrolled Employee for Employer-Based Health Insurance, 2006
Excerpt: "Updated data on employer-based insurance premiums from the Agency for Healthcare Research and Quality (AHRQ)'s Medical Expenditure Panel Survey (MEPS) are now available by state. These include the average annual cost for single coverage, family coverage, and employee-plus-one coverage for 2006. The average share of the premium contributed by employee and employers are also available for all coverage types." (Kaiser Family Foundation)

CMS Officials Provide Informal Views on HIPAA Security Issues
Excerpt: "The Joint Committee on Employee Benefits (JCEB) of the American Bar Association has reported on its May 5, 2008 Q&A session with officials from the Centers for Medicare and Medicaid Services (CMS)." (Employee Benefits Institute of America)

[Opinion] Health Insurance Companies and the Managed Care Roller Coaster
Excerpt: "'Managed care' is, to many, a nasty phrase. But the truth is that the insurer who understands that 'managing care' means making sure that customers get the high-quality care they need, when they need it, will save money. When it comes to health care, low cost and high quality go hand-in-hand. At the same time, 'managing care' means avoiding ineffective care." (The Century Foundation)

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Links to Items on Executive Comp, Benefits in General

[Guidance Overview] IRS Grants Tax Relief to Victims of Storms and Flooding in Missouri
Excerpt: "The IRS has announced special tax relief for taxpayers within a seven-county disaster area in Missouri affected by severe storms and flooding on June 1, 2008." (Wolters Kluwer)

ERISA Reform Legislation Effort
Excerpt: "Professor Colleen Medill at the University of Nebraska College of Law has agreed to help the Amschwand family identify members of Congress who may be interested in sponsoring legislation to amend Section 502(a)(3) of ERISA so that 'equitable' relief includes monetary relief designed to make a plan participant or beneficiary whole for injuries caused by a breach of fiduciary duty." (Workplace Prof Blog)

Newly Posted Events
(Post Yours!)

HEART Act - Complimentary Overview
Nationwide on July 17, 2008
presented by Convergent Retirement Plan Solutions, LLC

Pension, Profit-Sharing, Welfare, and Other Compensation Plans
in District of Columbia on October 2, 2008
presented by ALI-ABA (American Law Institute-American Bar Association)

Retirement, Deferred Compensation, and Welfare Plans of Tax-Exempt and Governmental Employers
in District of Columbia on September 4, 2008
presented by ALI-ABA (American Law Institute-American Bar Association)

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Employee Benefits / ERISA Attorney
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Senior Retirement Plan Consultant
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in TX

Actuarial Analyst
for Acuff & Associates, Inc.
in TN

Retirement Sales Consultant
for The Standard
in OR

Defined Contribution Client Management Specialist
for Prudential Financial
in PA

Pension Administrators
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in FL

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