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September 22, 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] Hospital May Sue Health Plan for Misrepresenting That Coverage Was Available for Non-Paying COBRA Patient
Excerpt: "EBIA Comment: This case illustrates the pitfalls of poorly managed communications between plans and health care providers. Not only are plans required under the IRS COBRA regulations to provide complete information to inquiring providers about COBRA status, but there also may be potential liability under state law for amounts not otherwise payable under the plan's terms based on misrepresentations about coverage made to third parties." (Employee Benefits Institute of America)

[Guidance Overview] Ninth Circuit Opinion Holds Structural Conflict Exists Where Employer Pays Benefits Out of a Trust
Excerpt: "The Ninth Circuit, in the case of Burke v. Pitney Bowes Inc. Long-Term Disability Plan, weighed in on the interpretation of MetLife v. Glenn in another disability case, appearing to disagree (but not citing) one of the holdings in the recent Eleventh Circuit opinion of Frankie White v. Coca-Cola Bottling Co. . . . (Rather, the court stated it disagreed with the pre-MetLife decision of Gilley v. Monsanto Co., Inc., 490 F.3d 848, 856 (11th Cir. 2007) relied upon by the Eleventh Circuit in the White case.)" (Attorney B. Janell Grenier via

[Guidance Overview] Prohibitions on Health Plan Opt-Out Incentive Options (PDF)
Page 6 of 7 pages. Excerpt: "Both Medicare and TRICARE prohibit employers from offering any financial or other incentives to Medicare or TRICARE eligible employees to not enroll, or to terminate enrollment, in an employer-sponsored group health plan that is or would be primary to Medicare or TRICARE." (Miller & Chevalier Chartered)

CRS Report Highlights Enforcement of HIPAA Privacy and Security Rules
Excerpt: "EBIA Comment: The CRS report provides a useful overview of how the HIPAA privacy and security rules are enforced. It also serves as a good reminder to health plans and other covered entities to remain vigilant about ongoing compliance with HIPAA's requirements and to avoid being lulled into complacency. Health plan sponsors and administrators should also keep in mind that while there is no private cause of action for individuals under the HIPAA privacy and security rules, complaints relating to privacy and security violations may be filed with OCR and CMS, respectively." (Employee Benefits Institute of America)

Treasury and Small Business Administration Launch New HSA Website for Small Businesses and Their Employees
Excerpt: "The Treasury Department and the federal Small Business Administration (SBA) have announced a new SBA website that provides small business owners and their employees with information about health savings accounts (HSAs). And the White House has simultaneously issued a fact sheet that describes how HSAs are helping small businesses provide health benefits to their employees." (Employee Benefits Institute of America)

Trends and Innovations in Health Information Technology: An Update from America's Health Insurance Plans (PDF)
16 pages. Excerpt: "In the process of building an interconnected health care system, health plans are implementing online health tools that are increasingly interactive and tailored to the needs of consumers and physicians. To explore these trends in health IT, AHIP conducted phone interviews with chief information officers and other health IT leaders at eight member health plans. In addition, we gathered information from member companies that participated in an AHIP health innovations event . . . ." (America's Health Insurance Plans)

Consumers Cut Health Spending, As Economic Downturn Takes Toll
Excerpt: "In a survey by the National Association of Insurance Commissioners last month, 22% of 686 consumers said that economy-related woes were causing them to go to the doctor less often. About 11% said they've scaled back on prescription drugs to save money. Some of the areas being hit include hip and knee replacements, mammograms, and visits to the emergency room, according to a survey conducted by D2Hawkeye Inc., a Waltham, Mass., medical data analytics firm, on behalf of The Wall Street Journal." (The Wall Street Journal)

How Does the Benefit Value of Medicare Compare to the Benefit Value of Typical Large Employer Plans?
Excerpt: "This analysis finds that, even with its new drug benefit, Medicare on average provides less generous benefits to seniors than they would receive under a typical large-employer health plan or the most popular plan available to federal employees. The study compares the traditional fee-for-service Medicare benefit package, including the drug benefit, with a typical large employer PPO plan and with the Blue Cross/Blue Shield standard national PPO plan available to federal workers under the Federal Employees Health Benefits Plan, which covers about half of all federal workers." (Kaiser Family Foundation)

HSAs, FSAs, HRAs: Which Consumer Driven Health Care Option Should You Choose? (PDF)
2 pages. Updated for 2008 and 2009 Excerpt: "Unfortunately, many consumers and employers are confused about the differences between the various consumer-driven plans and which option would be best for them. The Council for Affordable Health Insurance (CAHI) has prepared this analysis [in chart form] in an effort to help people make informed choices." (The Councial for Affordable Health Insurance)

HIPAA Privacy Rule Enforcement Leans Toward Voluntary Compliance and Correction
Excerpt: "Criminal convictions for violations of the Health Insurance Portability and Accountability Act's privacy rules have been obtained only in three cases involving employees of covered entities who improperly obtained protected health information, the Congressional Research Service (CRS) reported to members of Congress in Enforcement of the HIPAA Privacy and Security Rules, issued on August 11." (Wolters Kluwer)

Health Savings Accounts and High-Deductible Health Plans: A Data Primer (PDF)
6 pages. Excerpt: "Before analysts can evaluate the effects of HSAs, they must decide which data source(s) to use. This primer provides basic guidance in that direction. The primer also provides the most recent data available from each source on enrollment, premiums and deductibles for HSAs, HSAs and HRAs combined, and HDHPs." (U.S. Congressional Research Service)

Health Care Reform Goes to Voters in Three States
Excerpt: "As presidential contenders John McCain and Barack Obama push different plans to help cover more uninsured Americans, voters in Arizona, Colorado and Montana will have the chance to make dramatic changes to their own states' health care systems when they go to the polls Nov. 4. All three measures are unprecedented, but would affect these three states in very different ways." (

Supreme Court Prepares To Hear Pre-Emption Case That Could Give Pharma.ceutical Companies Protection Against Liability
Excerpt: "The case of a Vermont women who won a $6 million award from Wyeth for failure to adequately warn her of the risk of one of its products is the 'latest in a brisk parade of similar ones' in which the U.S. Supreme Court will examine the principle of pre-emption, which states that FDA approval of drugs or medical devices pre-empts the ability for individuals to sue manufacturers for liability in state courts, the New York Times reports." (Kaiser Family Foundation)

House Leaders Say They Will Consider Mental Health Parity as Stand-Alone Bill Next Week
Excerpt: "House leaders on Thursday told mental health lobbyists that mental health parity legislation will be taken up as a stand-alone bill next week under suspension of the rules, a procedure that prohibits amendments and requires a two-thirds majority for the bill to pass, CongressDaily reports . . . ." (Kaiser Family Foundation)

[Opinion] That Elusive Health Care Cost Containment - The Massachusetts Health Care Plan (PDF)
2 pages. Excerpt: "CAHI Executive Director Merrill Matthews writes about the difficulties the Massachusetts health care plan has had with holding down costs." (Post-Gazette via The Councial for Affordable Health Insurance)

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Links to Items on Executive Comp, Benefits in General

[Guidance Overview] 11th Cir. Follows Glenn in Denial of Benefit Case
Excerpt: "In Doyle v. Liberty Life Assurance Co. of Boston, No. 07-10348 (11th Cir. Sept. 18, 2008), the Eleventh Circuit abandoned the heightened arbitrary and capricious review for denial of benefit claims under ERISA which have structural conflicts." (Workplace Prof Blog)

[Guidance Overview] Posting SPD on Company Intranet does not Satisfy ERISA's Disclosure Requirements (PDF)
Pages 4 of 7 pages. Excerpt: "As illustrated by a recent unpublished Ninth Circuit Court of Appeals decision (Gertjejansen v. Kemper Insurance Companies, Inc., No. 06-563929 (9th Cir. 2008)), employers should use caution in determining how to distribute required disclosure documents - such as Summary Plan Descriptions (SPDs) - to plan participants, particularly when considering the use of electronic means." (Miller & Chevalier Chartered)

[Guidance Overview] Reporting Requirements for Statutory Stock Options and Updates ESPP Regulations (PDF)
5 pages. Excerpt: "The IRS recently issued two sets of proposed regulations on employee stock plans. The first set addresses IRS return and employee information statement requirements related to statutory stock options, i.e., incentive stock options under Internal Revenue Code Section 422 (ISOs) or employee stock purchase plans under Section 423 (ESPPs). The second set essentially updates previous regulations to provide a comprehensive set of rules for statutory stock options granted under ESPPs, and conforms them, where appropriate, to the regulations for ISOs." (Buck Consultants)

Presentation on Tax Withholding on Restricted Stock and Unit Transactions
45 pages. An outline of the Agenda of the presentation: Tax Treatment of Restricted Stock and Units; Tax Withholding and Reporting Requirements; Tax Payment Methods; International Considerations; Acceleration of Vesting on Retirement; Dividends; and, Best Practices. (Computershare Limited)

International and Cross-Border Retirement and Fringe Benefit Plans: IRS Advisory Committee Survey Seeks Opinions of Employers, Administrators, Practitioners, Consultants
2-page Word survey questionnaire; September 30 deadline. Excerpt: The IRS Advisory Committee on Tax Exempt and Government Entities (TE/GE) (the 'ACT') is undertaking a study to identify international and cross-border activities, issues, challenges, impediments and barriers in connection with the design, coverage, portability, and tax administration of US employee retirement (qualified and non-qualified) and fringe benefit plans. (IRS Advisory Committee on Tax Exempt and Government Entities)

New York's Governor Seeks Study of Benefits at Long Island Rail Road
Excerpt: "Gov. David A. Paterson said on Sunday that he would give Andrew M. Cuomo, the state's attorney general, broad powers to investigate the Long Island Rail Road as part of a wide-ranging review his administration would seek of how disability and pension benefits were potentially manipulated by L.I.R.R. supervisors, workers and retirees." (The New York Times; free registration required)

11th Circuit Backtracks on Benefits Denial Review Standard
Excerpt: "Falling in line with a U.S. Supreme Court ruling earlier this year, the 11th U.S. Circuit Court of Appeals reversed its earlier decision relating to how employee benefit plan denials should be judged. The appellate court's latest holding deals with instances when the benefits denials were made when plan administrators operate under a conflict of interest and was driven by the Supreme Court's decision in Metropolitan Life Insurance Co. v. Glenn . . . ." (; free registration required)

DOL Website Provides Updated Contact Information for Hurricane Victims
Excerpt: "The DOL announced that it has updated its website to give plan sponsors a way to provide updated contact information for hurricane victims: 'The U.S. Department of Labor's Employee Benefits Security Administration (EBSA) today updated its Web site to give sponsors of retirement, health and other benefit plans a way to update their contact information following the disruption of operations due to Hurricanes Gustav and Ike. This information will allow employees, plan participants and their families, as well as the many support organizations that assist victims of the hurricanes, to reach plan administrators with questions and information related to their benefits." (ERISA Rules and Regulations)

ERISA Gives District Court Discretion To Award Attorney's Fees To Either Party
Excerpt: "In Pannebecker v. Liberty Life Assur. Co. of Boston, Case No. 06-16654 (9th Cir. Sept. 18, 2008), the Ninth Circuit remanded an ERISA case after determining that the appellant did establish rights to benefits for a period of time. Because this demonstrated that appellant achieved some success, remand was required for the district court to consider whether attorney's fees were awardable to appellant." (California Attorney's Fees)

Newly Posted Events
(Post Yours!)

DOL Update: Investment Advice and Participant Fee Disclosure Proposals Webcast
Nationwide on September 25, 2008
presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

EPCRS Workshop: Preventing & Correcting Qualified Plan Problems
Nationwide on September 24, 2008
presented by ALI-ABA (American Law Institute-American Bar Association)

Health Insurance Reform: A Public Policy Debate at the State Level: What is the Employer's Role?
in Maryland on October 2, 2008
presented by Worldwide Employee Benefits Network (WEB) - Baltimore Chapter

Newly Posted Press Releases
(Post Yours!)

Business Roundtable Unveils Health Care Policy Plan
Business Roundtable

Entegril Signs Partnership Deal with Key Benefit Resources

Voice Authentication Capability Enhanced on Omni Retirement Platform

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Employee Benefits Attorney
for Hershner Hunter, LLP
in OR

401(k) / Defined Contribution Administrator
for Pension Investors Corp.
in FL

Account Manager
for Nova 401(k) Associates
in TX

HR Manager
for Taft-Hartley Joint Trust Funds
in DC, MD

Retirement Plan Specialist
for Diversified Investment Advisors
in MN

Defined Benefit Pension Administrator
for Lurie Besikof Lapidus
in MN

Pension Administrator
for Lurie Besikof Lapidus
in MN

Corporate Brokerage Services Support Senior Manager
for Charles Schwab & Co.
in AZ

Manager, Defined Contribution Client Management
for Prudential Financial
in PA

401(k) Administrator
for TPA Firm
in FL

Employee Benefits/ERISA Attorney
for Keating Muething & Klekamp PLL
in OH

Plan Document/ Research Manager
for Niles Lankford Group, Inc.
in IN

Human Resources Specialist III (Benefits Communication Specialist)
for Montgomery County Government, Maryland
in MD

Senior Account Manager
for Nemco Brokerage, Inc.
in NY

Health and Wellness Coordinator
for Nemco Brokerage, Inc.
in NY

Manager, Defined Contribution Client Management
for Prudential Financial
in PA

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