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October 29, 2008

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

Today's sponsor is Health Benefits Conference & Expo (HBCE)

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Banner ad for Health Benefits Conference & Expo (HBCE)

Nat'l Health Benefits Conference & Expo (HBCE), Feb. 3-4, Tampa, FL

Sessions by: Intel, Corning, Toyota, TECO Energy, State of Florida, Burger King, SAS, Gulf Power/Southern Company, Pinellas County Schools, Univ. of Pittsburgh Medical Center, U.S. Xpress, PSEG, Mayo Clinic, University of Rochester, Pinellas County, CEO Roundtable on Cancer, City of Clearwater, C-Change...and more, including the Impact of the Election on Health Benefits. Best Value in Health Benefits Continuing Education (HBCE) - highest quality and registration only $295 - $345. SHRM credits.

[Guidance Overview] Medicare Part D Creditable Coverage Notices are Due and Mandatory Insurer Reporting is Forthcoming (PDF)
3 pages. Excerpt: "For group health plans that have insurers, or third-party administrators that pay or adjudicate claims, the third-party administrator (or insurer) is the responsible reporting entity that must meet the filing deadlines and requirements. Employers should make sure their third-party administrator (or insurer) is taking steps to comply with the program. For group health plans that already participate in a voluntary data sharing agreement or a voluntary data exchange agreement with CMS, electronic registration began in October 2008, and reporting begins in the first quarter of 2009. For all other group health plans, electronic registration begins in April 2009 and reporting will begin on July 1, 2009." (Seyfarth Shaw LLP)

[Guidance Overview] Michelle's Law and Continuation of Group Health Coverage for Certain Dependents
Excerpt: "In addition to extending coverage, Michelle's Law creates a new notice requirement. If and when a plan requests certification of student status, it must include with that request a description of the requirements for continued coverage under the law. This description must be in language that the typical plan participant can understand." (Nixon Peabody LLP)

[Guidance Overview] 'Unexplained Gap' in Reviewing Physician's Opinion Results in Decision for ERISA Plaintiff
Excerpt: "The Fifth Circuit carefully noted that the reviewing physician, though finding the claimant not disabled, failed to engage the opinion of the treating physician on the key points offered in justification of the disability claim. . . . The 'unexplained gap' resulted in a substantial defect in the reasoning of the plan administrator's benefit denial. The Court reversed the decision of the district court and remanded for entry of judgment in favor of the claimant." (Health Plan Law blog by Attorney Roy F. Harmon III)

[Guidance Overview] Congress's New Benefit Standards for Group Health Plans (PDF)
8 pages. Excerpt: "For the first time in nearly ten years, Congress passed not one, but three new benefit standards for group health plans. In recent months, Congress passed the Mental Health Parity and Addiction Equity Act, Michelle's Law (providing medical leave for college students), and the Genetic Information Nondiscrimination Act. Further, this trend appears poised to continue. The House recently passed two more group health plan standards: the Health Insurance Source of Injury Clarification Act of 2008 (H.R. 6908) (requiring pre-enrollment disclosure of source of injury limitations) and the Breast Cancer Patient Protection Act of 2007 (H.R. 758) (requiring minimum hospital stay after a lumpectomy or mastectomy). The Senate has yet to address either of these bills. The three new benefit mandates are discussed [in the target document]." (Groom Law Group)

How McCain Would Change Health Care
Excerpt: "If McCain is elected president next week, he has said, he would work to remove the tax preference for company health benefits and offer Americans tax credits to put toward any health plan they choose. He wants to let people buy health plans from insurance companies anywhere in the country, preempting state regulations that spell out whom insurance carriers must cover and what kinds of benefits they must provide." (The Washington Post; free registration required)

How Obama Would Change Health Care
Excerpt: "Obama says he would keep the familiar arrangement in which most Americans get health insurance through their jobs, as Massachusetts is doing. Yet he also favors profound -- and controversial -- changes that Massachusetts also is putting in place: Expanding government insurance programs and subsidies. Requiring employers to offer their workers coverage or face penalties if they do not. Forbidding insurance companies to reject anyone or charging more if they are sick. Creating a national health insurance exchange to help people to find and compare private insurance policies on their own." (The Washington Post; free registration required)

Prescription Drug Benefit Design: The Building Blocks and Their Impact on Cost (PDF)
5 pages. (International Society of Certified Employee Benefit Specialists via Milliman)

Experts Say Keys to Wellness Program Growth Include Strong Incentives Like Cash or Health Insurance Discounts Coupled with Company Encouragement
Excerpt: "Companies that offered $100 in cash five or six years ago for health assessment participation could expect about 75 percent of their employees to sign up. By 2006, that had fallen to around 50 percent for the same reward, said Jessica Grossmeier, research director for wellness program developer StayWell Health Management. 'I think you need a little bit more money now to get the same level of attention,' she said. The dollar doesn't buy what it used to. But more companies also have started linking incentives to things like a premium reduction. In those cases, the employer has to offer larger incentive amounts to grab attention, Grossmeier noted. Gift cards and cash lured most Stimson Lumber Co. employees to its wellness program initially. But participation soared to 90 percent after the company dangled a health insurance rebate." (AP Online via NewsEdge via Human Resource Executive Online)

The Rise of the Personal Health Record: Panacea or Pitfall for Health Information (PDF)
8 pages. Excerpt: "This article provides an introduction to PHRs and identifies issues that arise with their increased adoption and use." (American Health Lawyers Association via Gray Plant Mooty)

At Walt Disney World, New Employee Medical Clinic Has a Few Disney-Like Flourishes
Excerpt: "For the first time, Disney World is offering on-site medical care to its tens of thousands of employees. The Walt Disney World Center for Living Well comes loaded with a broad collection of medical and wellness services and resources. It offers primary-care doctors and nurses, urgent care, lab facilities, digital-radiology services, a full-service pharmacy (which can provide 90-day supplies of medication), behavioral-health services -- even an insurance office with agents available for face-to-face benefit and billing consultations." (Orlando Sentinel)

'Boutique' Plans Enrich Care for Some But Exclude Many
Excerpt: "The physicians at Charter Internal Medicine in Columbia are overhauling the practice, ditching the insurance-dependent model and instead charging a flat yearly fee in exchange for the promise of 24-hour access to doctors, unhurried appointments, home visits and state-of-the-art annual physicals. Known as 'boutique' medicine or 'concierge' care, the national trend appears to be sweeping across Maryland as primary-care doctors feel the financial crush of rising costs and low insurance reimbursement rates. Physicians say the model allows them to trim their patient loads and give patients quality care without worrying whether insurance will cover it." (The Baltimore Sun)

Austin American-Statesman Series Examines Issues Related to Medical Tourism
Headlines and summaries and links to the articles are on the target page. (Kaiser Family Foundation)

Investigating the Effectiveness of Consumer-Driven Health Plans (PDF)
Pages 5-7 of 12 pages. (Milliman)

Alternative Risk Financing Emerges for Group Health Plans (PDF)
Pages 1-4 of 12 pages. (Milliman)

[Opinion] Help, I've Fallen Into the Doughnut Hole and I Can't Get Up: The Problems with Medicare Part D (PDF)
8 pages. Excerpt: "This issue is so important that the president elect, as well as the members of the new Congress, should be pushed to develop concrete proposals for helping seniors escape the doughnut hole well in advance of the inauguration. For once in office, the president will be so busy dealing with the extremely volatile global economy, what looks like a recession in this country, and the conflicts in Iraq and Afghanistan that addressing the problem of the coverage gap could fall by the wayside, becoming the subject of commissions and task forces rather than action." (The Century Foundation)

[Opinion] American Benefits Council Comments to Senators Regarding W-2 Reporting of Employer-Provided Health Care Costs Proposal (PDF)
5 pages. Excerpt: "We believe that allowing employers to continue to choose the method of communication that works best for their workforce will ensure that employees receive health care cost information when it is most helpful to them and in a format that they are most likely to read and use." (American Benefits Council)

[Opinion] On John McCain Campaign Website: 'The Truth about the McCain-Palin Health Care Plan'
Excerpt: "Barack Obama And Joe Biden Have Consistently Lied To Americans About John McCain's Plan. Their claims have failed every fact-check - from CBS to the Washington Post. John McCain is not going to raise taxes on middle class families. Barack Obama and Joe Biden are the only ones in this race that plan to raise taxes." (McCain-Palin 2008)

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Links to Items on Executive Comp, Benefits in General

[Guidance Overview] EESA Allows Bicycle Commuter Fringe Benefits
Excerpt: "In an effort to encourage fuel-free commuting, the recently enacted Emergency Economic Stabilization Act (EESA) includes a provision allowing fringe benefits for bicycle commuters. Under the act, employers may provide tax-free reimbursement of up to $20 a month to employees for qualified bicycle commuting expenses. Allowed expenses include 'reasonable expenses incurred Ö for the purchase of a bicycle and bicycle improvements, repair and storage' if the bicycle is regularly used for a substantial portion of the employees' commute to work." (Watson Wyatt Worldwide)

[Guidance Overview] Executive Compensation under the Emergency Economic Stabilization Act of 2008 - Troubled Asset Relief Program
Excerpt: "If Treasury acquires the assets through an auction process, the financial institution may not enter into any new employment contracts with senior executive officers that provide a golden parachute in the event of involuntary termination, bankrup.tcy filing, insolvency, or receivership. If Treasury purchases troubled assets at auction from a financial institution, there are limits on the ability of the institution to deduct as a business expense any compensation over $500,000 to certain executives. These auction related restrictions only apply with a financial institution that sells troubled assets under the TARP in an aggregate amount exceeding $300 million." (Troutman Sanders LLP)

[Guidance Overview] Recuperating from Nonqualified Deferred Compensation Plan Failures (PDF)
Pages 8-11 of 12 pages. (Milliman)

House Committee Chair Requests Compensation and Bonus Information for Employees of Major Banks
Excerpt: "In letters to nine major banks that will receive $125 billion of taxpayer funds, Chairman Waxman requested information on their compensation and bonus plans in 2008." (U.S. House Committee on Oversight and Government Reform)

McCain vs. Obama: The Candidates Respond to an Employee Benefit Questionnaire
Excerpt: "This year, 12 esteemed associations joined forces with the Pension Forum, Pension & Investment Magazine, and Pension & Benefit Power Magazine to create The 2008 Presidential Candidate Employee Benefit Questionnaire -- a comprehensive list of essential policy position questions for the candidates. Here, we share the series of important questions posed and we gain perspective on our candidates' vision regarding employer provided health care and retirement issues." (Pension & Benefit Power)

Are Older Men Healthy Enough to Work?
Excerpt: "In determining whether people will be able to work longer, it is not simply measuring how long they will live, but rather how much longer they will be capable of working. Life expectancy may be increasing, but can the same be said for healthy, disability-free life expectancy? This brief uses the National Health Interview Survey to estimate trends in disability-free life expectancy for men at age 50..." (Center for Retirement Research at Boston College)

Work Expectations, Realizations, and Depression in Older Workers
Excerpt: "We explore the impact on depressive symptoms of deviation in actual labor force behavior at age 62 from earlier expectations. Our sample of 4,241 observations is drawn from the Health and Retirement Study (HRS)." (National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)

[Opinion] Wooten and ERISA Preemption: When History and Current Desires Collide
Excerpt: "Quite simply, rulings and arguments by commentators that ERISA preemption should be read more narrowly than has been the case, and concomitant decisions like the Ninth Circuit ruling on the San Francisco act, may be understandable as an argument for or exercise in some sort of normative cum Dworkian cum Judge Hercules decision making, where the courts are to bring an aging statute into compliance with current circumstances, but they certainly cannot be justified as an accurate interpretation of congressional intent itself." (Stephen Rosenberg of The McCormack Firm, LLC)

Newly Posted Events
(Post Yours!)

Mid-Sized Retirement & Pension Plan Management Conference
in Florida on January 25, 2009
presented by University Conference Services

Winds of Change - Special Strategy Forum
in Florida on November 13, 2008
presented by Employers Council on Flexible Compensation (ECFC)

Newly Posted Press Releases
(Post Yours!)

NIPA Announces Distribution Administrator Certificate Program
National Institute of Pension Administrators

Reno Businessman Sentenced to Prison for Stealing from Pension Plan
U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

Councilís 10-Point Plan Aids Retirement Savings, Promotes Economic Recovery, Protects Jobs
American Benefits Council

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in NJ, NY

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in CA

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Assistant Manager, Health Plan Operations
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in MO

Transition Manager - Retirement Services
for MassMutual Financial Group
in MA

Sr. Pension Administrator - Defined Benefits Plans
for Shore Tompkins Actuarial Resources, LLC
in IL

Senior Client Consultant, Emerging Corporate
for Prudential Financial
in IA

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for Wal-Mart Stores, Inc.
in AR

HR/PR Outsourcing Service Delivery Manager
for Constantin Control Associates
in MN, NC

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