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August 8, 2008

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

Today's sponsor is Employee Benefits Institute of America (EBIA)

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[Guidance Overview] Protections Against Discrimination Based on Genetic Information
Excerpt: "[The Genetic Information Nondiscrimination Act of 2008 was enacted] to prevent discrimination in health insurance and employment based on genetic information. GINA imposes new restrictions on group health plans (including both large and small group plans, church plans and non-federal government plans), insurance issuers, employers, employment agencies, labor organizations, and joint labor-management committees." (von Briesen & Roper, s.c.)

[Guidance Overview] Determining the Burden of Proof Under Accidental Death Policies
Excerpt: "The nuances that attend defining the complex of circumstances which may be deemed 'accidental' have served as a staple defense in the denial of claims under accidental death insurance policies. Though the fact patterns of these cases are frequently interesting (at least compared to our standard fare as readers of ERISA cases), Hancock v. Metro. Life Ins. Co presents the issue with more intrigue than most." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Guidance Overview] Seventh Circuit Holds for Insurance Carrier Denying Claims Under 'Arbitrary and Capricious' Standard
Excerpt: "Fibromyalgia claims face long odds in federal court, and this Seventh Circuit decision fits the typical pattern. As a post MetLife v. Glenn decision, the case does nonetheless present some surprise in that it does not address the standard of review in more than a passing manner." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Guidance Overview] Medicare Law Will Impact Private Fee-for-Service Plans (PDF)
Excerpt: "On July 15, Congress overrode President Bush's veto of Medicare legislation that blocked cuts in physician payments and provided enhanced benefits to Medicare beneficiaries. Most significant for employers are provisions that reduce funding for Medicare Advantage plans and that change how private fee-for-service plans must be structured." (Buck Consultants)

[Opinion] British Healthcare System One Import We Don't Need
Excerpt: "In single-payer systems such as Britain's, taxpayers pay higher taxes for universal health coverage and the government pays most of their medical bills. But the fact is that every government-run health-care system struggles to make ends meet. Money for health care in those systems has to compete with money for other government programs like education, defense and pension programs." (The Olympian via Council for Affordable Health Insurance)

[Opinion] Benefits of 'Never Events' Strategy Questionable
Excerpt: "The trend toward refusing to pay medical providers for services where the insurer deems the invoice unjustified may not be as helpful to consumers as has been claimed. . . . First, it isn't always a simple matter to separate legitimate treatment that would have been required in any event from disputed charges. Second, medical providers will not simply agree with the insurer in all cases for a number of reasons, some related to a bona fide disagreement and others related to the legal implications of admitting error." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Opinion] Potential for Paid Sick Leave Mandate in Ohio Warrants Pro-Active Strategy
Excerpt: "With each passing day, it appears more likely that Ohioans will be going to the polls on November 4, 2008 to vote on whether employers that employ at least 25 workers in Ohio will be required by law to provide workers with up to seven days of paid sick leave annually." (Porter Wright Morris & Arthur LLP)

Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries
Excerpt: "While mainstream news coverage is still a primary source of information for the latest in policy debates and the health care marketplace, online blogs have become a significant part of the media landscape, often presenting new perspectives on policy issues and drawing attention to under-reported topics. To provide complete coverage of health policy issues, the Kaiser Daily Health Policy Report offers readers a window into the world of blogs in a roundup of health policy-related blog posts." (Kaiser Family Foundation)

New Mexico Attorney General Upholds Health Coverage Requirement in State Contracts
Excerpt: "Attorney General Gary King issued a decision upholding the authority of the Governor's Office to require state contractors to demonstrate health coverage for their employees. Gov. Bill Richardson issued the executive order, which went into effect in July. It requires contractors with six or more employees to demonstrate that they offer health coverage in order to do work with the state." (New Mexico Business Weekly via; free registration required)

Legislation Aimed at Helping Small Businesses Offer Health Insurance to Their Employees
Excerpt: "The legislation, called the Small Business Health Options Program, or SHOP Act, would establish a nationwide health insurance purchasing pool for small businesses and the self-employed." (

Large Wisconsin Businesses See Reduced Health Care Costs Under New Program
Excerpt: "Health care costs for 18 large employers in southeastern Wisconsin's Business Health Care Group have declined by 9% over the past two years under a plan developed for the group, according to an analysis, the Milwaukee Journal Sentinel reports. The coalition comprises more than 675 businesses and was created to help reduce health care costs for employers in the state. The 18 large employers included in the analysis provide health benefits for 55,000 employees, retirees and family members." (Kaiser Family Foundation)

BCBS Illinois to End Reimbursements to Hospitals for Treatment Related to Serious Medical Errors
Excerpt: "Blue Cross Blue Shield of Illinois recently announced plans to end reimbursements to hospitals for treatment that results from serious medical errors, the Chicago Tribune reports. BCBS Illinois spokesperson Jack Segal said that the health plan has not finalized a list of serious medical errors included under the policy. He said, 'The majority of hospitals do not bill us for never events, but given the complexity of billing, billing systems and billing agencies, some never events may slip through,' adding, 'With this new policy in place, we can work to close the gaps, and also focus on improving quality.'" (Kaiser Family Foundation)

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Links to Items on Executive Comp, Benefits in General

[Opinion] Behavioral Economics: Lessons from Retirement Research for Health Care and Beyond (PDF)
14 pages. A Presentation by CBO Director Peter Orszag to the Retirement Research Consortium. Excerpt: "Research has increasingly shown that decisions are not made in a vacuum. Defaults matter. Perceptions of social norms matter. And policy designs need to account for those factors that, until recently, received little consideration in economic and policy analysis. Current pension policies are at the forefront of efforts to incorporate the lessons of behavioral economics. I hope that the same energy and care can be applied to research and policy development in the health care arena. The endeavor has the potential to yield great insight into how to better contain costs and improve people's health -- perhaps especially the health of those on the lower rungs of the socioeconomic ladder." (U.S. Congressional Budget Office)

[Guidance Overview] Heroes Earnings Assistance and Relief Tax Act of 2008: Impact on Employee Benefit Plans (PDF)
4 pages. Excerpt: "[The Heroes Earnings Assistance and Relief Tax Act of 2008 (the 'HEART Act')] contains mandatory and optional provisions that impact retirement plan benefits and Health FSAs provided to employees performing 'qualified military service' (generally, military service that is covered by USERRA). These provisions are summarized [on the target page]." (Seyfarth Shaw LLP)

[Guidance Overview] Milliman's Monthly Benefit News and Developments, August 2008 (PDF)
2 pages. The newsletter provides a summary of the previous month's legislative, regulatory, and judicial information on employee benefits. (Milliman)

[Guidance Overview] Same-Sex Marriage Issues Complicate Employee Benefit Plan Administration (PDF)
4 pages. Excerpt: "California recently became the second state after Massachusetts to legalize same-sex marriage, but without a residency requirement. Last week, Massachusetts repealed a law that generally limited same-sex marriage to its residents, effectively opening the door for same-sex couples throughout the U.S. to marry on both coasts. This changing legal landscape is complicating plan administration for many employers across the country." (Buck Consultants)

[Guidance Overview] The Heroes Earnings and Assistance Relief Tax Act (PDF)
Excerpt: "This Regulatory Brief summarizes the key retirement plan provisions included in the Act, along with the relevant decision points for plan sponsors. It also provides a brief overview of the provisions in the Act applicable to cafeteria plans." (The Vanguard Group)

[Guidance Overview] Letter From Employee's Attorney Is a Claim for Severance Benefits
Excerpt: "The court noted that although the plan provided that the employee could 'make a claim in writing' to the plan administrator, it gave no guidance as to what type of writing qualified as a claim. The court reasoned that the letter identified an ERISA plan and asserted the employee's entitlement to plan benefits." (Employee Benefits Institute of America (EBIA))

Newly Posted Events
(Post Yours!)

A Company of Entrepreneurs: Getting Employees Involved
Nationwide on November 5, 2008
presented by National Center for Employee Ownership

Acquisitions, Divestitures, and Second-Stage ESOP Transactions
in Colorado on October 2, 2008
presented by National Center for Employee Ownership

Advanced Valuation Issues
Nationwide on September 18, 2008
presented by National Center for Employee Ownership

Beyond Open-Book Management: Ways to Turn Employee Information Sharing into Employee Ideas
Nationwide on September 3, 2008
presented by National Center for Employee Ownership

Communicating Your ESOP
Nationwide on September 25, 2008
presented by National Center for Employee Ownership

Effective Boards of Directors: Best Practices in Governing an ESOP Company
in Maryland on November 18, 2008
presented by National Center for Employee Ownership

ESOP Feasibility
in Washington on November 5, 2008
presented by National Center for Employee Ownership

ESOPs as a Business Transition Tool
Nationwide on September 4, 2008
presented by National Center for Employee Ownership

Executive Compensation for ESOP Companies
Nationwide on November 25, 2008
presented by National Center for Employee Ownership

Fiduciary Issues of Stock Drop Lawsuits in ESOPs and 401(k) Plans
Nationwide on October 7, 2008
presented by National Center for Employee Ownership

Get the Most Out of Your ESOP Three-Day Conference on Best Practices for an Effective ESOP Culture
in Minnesota on October 27, 2008
presented by National Center for Employee Ownership

Handling the ESOP Repurchase Obligation
Nationwide on December 16, 2008
presented by National Center for Employee Ownership

Incentive Plans that Support Employee Ownership
Nationwide on September 11, 2008
presented by National Center for Employee Ownership

Is an ESOP Right for You? Finance, Valuation, and Culture
Nationwide on December 11, 2008
presented by National Center for Employee Ownership

Is an ESOP Right for You? The Basics
Nationwide on December 9, 2008
presented by National Center for Employee Ownership

Learn From Failures: The Dark Side of ESOPs
Nationwide on September 9, 2008
presented by National Center for Employee Ownership

Minimizing Cynicism in Employee-Owned Companies
Nationwide on September 16, 2008
presented by National Center for Employee Ownership

Navigating the 409A Deferred Compensation Plan Rules
Nationwide on December 4, 2008
presented by National Center for Employee Ownership

NCEO/Beyster Institute 2009 Employee Ownership Conference
Nationwide on April 22, 2009
presented by National Center for Employee Ownership (NCEO) and the Beyster Institute

Running an Effective Board
Nationwide on October 15, 2008
presented by National Center for Employee Ownership

S Corporation ESOPs
Nationwide on November 18, 2008
presented by National Center for Employee Ownership

The ESOP Company Symposium (3 day event)
in Georgia on October 21, 2008
presented by National Center for Employee Ownership

Using ESOPs as an Acquisition Strategy
Nationwide on December 2, 2008
presented by National Center for Employee Ownership

What They're Saying: An Overview of Public Pension Research Webcast
Nationwide on September 10, 2008
presented by International Foundation of Employee Benefit Plans

What You Need to Know as an Internal ESOP Fiduciary
Nationwide on December 10, 2008
presented by National Center for Employee Ownership

Newly Posted Press Releases
(Post Yours!)

Pension Rights Center Applauds Treasury Ruling Barring Pension Plan Buyouts
Pension Rights Center

Employee Benefit Plan Officials Are Sentenced
U.S. Department of Justice

More Senior Executives Taking a Role in Managing Employee 401(K) Plans
Cowden Associates, Inc.

PPC™ Designation Approved for Use by AIG Advisor Group Across AIG Network
Financial Service Standards, LLC

New Employee Wellness Program, The 7 Habits of Healthy People, Inspires Individuals to Improve Health, Reducing Employee Healthcare Costs

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Defined Benefits Plan Conversion Specialist
for Lynchval Systems Worldwide Inc.
in TX

Participant Service Center Conversion Project Specialist
for New York Life Retirement Plan Services
in MA

Benefits/ERISA Paralegal
for Reinhart Boerner Van Deuren s.c.
in WI

Benefits Specialist
for The Urban Institute
in DC

Stock Option Plan / EPP VP & Relation Manager
for New York City / Largest Financial Institution
in NY

WRS Relationship Manager I
for Wachovia
in MD

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