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August 5, 2008

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

Today's sponsor is SunGard's RELIUS Education

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2008 Chicago Advanced Pension Conference

Downtown Chicago, September 3-5 Leading ERISA experts present the most current analysis of new legislative and regulatory guidance. Join us and learn all about new disclosure mandates for 401(k) fees, EGTRRA updating, IRS and DOL audits, participant disclosure update, cash balance plans for DC administrators, practical advice on 403(b) plans, and much more. Plus, "Ask the Experts" workshop, more concurrent sessions, and over 900 minutes of CE credits. Register by August 8 and save $100.

[Guidance Overview] Another Question is Answered in the Consumer-Driven Healthcare Reimbursement Accounts (HSAs, HRAs, Archer MSAs, Medicare MSAs) Q&A Column
What are the FSA-related requirements under the Heroes Earnings Assistance and Relief Tax (HEART) Act of 2008? (

[Guidance Overview] MetLife v. Glenn Decision Wedges Open Discovery on Use of Outside Consultants
Excerpt: "It was just a matter of time before we saw a case where the district court judge took a fresh view of discovery limitations in view of the Supreme Court's decision in MetLife v. Glenn. In Hogan-Cross, Judge Kaplan rejected MetLife's position that discovery should be limited to the 'administrative' record simply because the policy language contained a discretionary clause. The opinion will likely receive ample use in ERISA discovery disputes on a wide range of issues." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Guidance Overview] Massachusetts Provides Revised Guidance on Minimum Creditable Coverage Requirements (PDF)
5 pages. Excerpt: "Starting January 1, 2009, Massachusetts residents who do not have health coverage that satisfies certain minimum creditable coverage requirements will be subject to tax penalties. The Massachusetts Connector recently issued important new guidance on these minimum creditable coverage requirements. If an employer's plan does not satisfy these requirements, employees and their family members age 18 and older enrolled in the plan will be subject to the tax penalties." (Buck Consultants)

[Guidance Overview] Harsh Consequences of Shoddy Claim Denials and Explanations of Benefits
Excerpt: "Two recent district court decisions highlight the fact that administrators issuing unclear or incomplete claim denial letters do so at their own peril. In both Tinker v. Versata, Inc. Group Disability Income Insurance Plan, No. 2:06-CV-02906 (E.D. Cal. July 13, 2008) and O'Connell v. Northland Lutheran Retirement Community Employee Benefit Plan, No. 07-C-637 (E.D. Wis. July 15, 2008), judges imposed significant penalties on plans for failing to live up to ERISA's standards in their explanations of claim denials." (McGuireWoods LLP)

[Guidance Overview] Seventh Circuit Permits Provider To Assert State Law Claims Over ERISA Preemption Challenge
Excerpt: "In this recent provider reimbursement case, the Seventh Circuit has given ERISA preemption a narrow footprint which signals the continuance of a trend favoring state law remedies for providers based upon the Davila analysis. The case points up a stark contrast between provider claims and those of employees where promised benefits are disappointed." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Guidance Overview] State Law Claim Against ERISA Plan Avoids Preemption
Excerpt: "In the case of Franciscan Skemp Healthcare, Inc. v. Central States Joint Board Health & Welfare Trust Fund No. 07-3456 (7th Cir.)(July 31, 2008), the Seventh Circuit Court of Appeals determined that when a party files a pure state law claim against an ERISA plan, preemption to Federal Court is improper." (Passion for Subro)

Bill in Congress Would Lift Lifetime Health Insurance Benefit Caps to $10 Million
Excerpt: "H.R. 6528, introduced July 17, would stipulate that the lifetime cap on a group health plan would be $5 million for the first two years and $10 million in years three and four. It also would provide an annual adjustment to a group insurance plan's lifetime cap based on the Consumer Price Index in subsequent years." (

Workers' Compensation Insurer Must Pay for Gastric Bypass Surgery
Excerpt: "An obese worker's gastric bypass surgery is compensable under Oregon's workers' compensation law because the procedure was necessary to treat a job-related knee injury, an appeals court rules." (Workforce Management; free registration required)

Saving for Health Care Expenses in Retirement: The Use of Health Savings Accounts (PDF)
Pages 9-13 of 16 pages. Excerpt: "This analysis revisits the savings needed to cover health insurance premiums and out-of-pocket expenses for health care services in retirement and evaluates the use of health savings accounts (HSAs) to save for those expenses. Proponents of HSAs often tout them as a vehicle for funding future retiree health care costs. But, while HSAs represent an important option for consumers seeking more control over their health care spending, statutory contribution limits make it unlikely that these accounts will play more than a minor part in savings for health care costs in retirement." (Employee Benefit Research Institute)

The Impact of Immigration on Health Insurance Coverage in the United States, 19942006 (PDF)
Pages 2-9 of 16 pages. Excerpt: "One factor that has contributed to the increase in the uninsured population is immigration, which has been the focus of previous research. Earlier studies have found that immigrants are disproportionately employed in low-wage jobs, in small firms, and in service or trade occupations, jobs that are less likely to offer health benefits./8/ The relative lack of employment-based coverage is compounded by the fact that the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 imposed a five-year ban on receipt of health and other public programs by most newly arrived legal immigrants." (Employee Benefit Research Institute)

Hearing: Health Benefits in the Tax Code: The Right Incentives
The target page contains links to member and witness statements at the July 31, 2008, hearing. (U.S. Senate Committee on Finance)

Prescription Data Used To Assess Consumers, Aid Insurers
Excerpt: "Health and life insurance companies have access to a powerful new tool for evaluating whether to cover individual consumers: a health 'credit report' drawn from databases containing prescription drug records on more than 200 million Americans." (The Washington Post; free registration required)

[Opinion] Targeting the Tax Treatment of Health Insurance As Key to Health Reform
Excerpt: "The value of the subsidy for job-based health insurance was a whopping $245 billion in 2007, according to Eward Kleinbard, chief of staff of the Joint Committee on Taxation. (This compares to government spending of $372 billion that year for Medicare and $340 billion for Medicaid.) It is a much bigger middle-class subsidy than even the mortgage interest deduction, which checks in at a mere $89 billion. Slowly, slowly it's becoming clear that addressing the tax issue is key to putting the private health sector on a sustainable track." (Galen Institute)

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Links to Items on Executive Comp, Benefits in General

[Opinion] Beware of Beneficiary Provisions in Equity Plans
Excerpt: "This article was recently posted on and on the NASPP website. In this posting, Ed Burmeister speaks candidly about equity plans and beneficiary provisions." (Baker & McKenzie LLP)

Newly Posted Events
(Post Yours!)

23rd Annual National Institute on Compensation for Executives and Directors
in New York on November 10, 2008
presented by ABA Joint Committee on Employee Benefits

Reducing Health Care Costs Without Crossing The Legal Line: Wellness Programs & Other Cost Cutting Strategies Webcast
Nationwide on August 13, 2008
presented by Alexander Hamilton Institute

Newly Posted Press Releases
(Post Yours!) Wins 2008 APEX Award

USAA Launches New Target Retirement Funds

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Defined Benefit Pension Administration Team Leader
for Milliman, Inc.
in NJ

Assistant General Counsel
for American International Group, Inc.
in NY

Retirement Plan Benefits Professional
for Huntington National Bank
in IN, OH, PA

Pension Administrator
for Retirement Alliance
in NH

Sr Compliance, Testing and Design Specialist
for Retirement Alliance
in NH

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