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December 2, 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] New Law Requiring Continued Medical Coverage for Students on a Medical Leave of Absence
Excerpt: "These amendments are effective with respect to plan years beginning on or after October 9, 2009, and to medically necessary leaves of absence beginning during such plans' years." (Mintz, Levin, Cohn, Ferris, Glovsky and Popeo P.C.)


[Guidance Overview] Disclaimer Shields Claims Administrator from Mispresentation Claims in Health Services Case
Excerpt: "This recent case out of the Southern District is one that the payer community can chalk up as a win. The facts are a bit harsh. Tenet did attempt to 'verify' coverage - and the claims administrator did so affirmatively - but with important reservations. So when it turned out that the patient actually had been terminated from coverage, a fact unknown to the claims administrator (it appears), Tenet bore the burden of the loss." (Health Plan Law blog by Attorney Roy F. Harmon III)


[Guidance Overview] The New FMLA Regulations: Leave for Families of Military Personnel
Excerpt: "The key requirements applicable to qualifying exigency leave and military caregiver leave are covered in the . . . article." (Faegre & Benson)


[Guidance Overview] Updating Family and Medical Leave Act Policies to Reflect Rule Changes
Excerpt: "As of January 16, employers should post the new FMLA notice, revise their handbooks to incorporate changes in their FMLA policies -- and be prepared to respond to leave requests by following the new procedure and using the new notice and certification forms. While the . . . article does not attempt to address all FMLA revisions -- especially those of a non-substantive nature -- it provides an overview of some significant changes employers should be aware of under the new rule." (Faegre & Benson)


[Guidance Overview] Summary of Massachusetts Minimum Creditable Coverage Certification Process (PDF)
2 pages. Excerpt: "The Connector has released Administrative Bulletin 01-08, dated November 25, 2008, with much anticipated guidance on the MCC certification process. MCC certification is a new compliance option for health benefit plans that are actuarially equivalent to at least a CommChoice Bronze level plan but fail to meet MCC standards due to a modest deviation from the MCC standards set forth in 956 CMR 5.00." (Parker Brown & Macaulay, P.C.)


Highmark Network Providers Will Begin Having Conversations with Members About Their Actual Cost of Care
Excerpt: "For example, if a Highmark member were scheduled to receive an x-ray, the provider could use Highmark's real-time capabilities to estimate the cost of the x-ray to the member taking in to account their specific health benefit design including deductibles and coinsurance. The member would then have a clear understanding of their financial responsibility for the service and would be prepared to make any necessary payments to the provider." (Blue Cross and Blue Shield Association)


Retiree Health Care in the American States (PDF)
16 pages. Excerpt: "This report examines how state administrators perceive the importance of retiree health care benefits to central human resources (HR) goals -- namely, recruitment, retention, and retirement -- how the states structure retiree health care programs, and which cost sharing and cost shedding measures have been adopted and/or are being considered." (Center for State and Local Government Excellence)


Medicare's Creation May Offer Health Care Clues
Excerpt: "Brandeis professor Stuart Altman is another veteran of the health care wars, going back to his days in the Nixon administration. He says the new president has an opportunity, but advises him to move fast. 'Take advantage of it but do what LBJ did in 1964 and make health care reform one of his first items,' says Altman. 'Don't dilly-dally like Bill Clinton did. Do it quickly. Do it in a way that is consistent with where the majority of the Congress is. And don't overreach and lose a lot of the groups that are now willing to support it.'" (All Things Considered via National Public Radio)


USA Today Examines No-Cost Prescription Drug Samples
Excerpt: "USA Today on Monday examined how no-cost prescription drug samples can influence physicians' prescribing habits and how health systems across the U.S. are beginning to ban or limit the samples. According to a study published in September in the Southern Medical Journal, more than 90% of U.S. physicians receive no-cost samples and more than half of older patients report getting at least one sample in a given year." (Kaiser Family Foundation)


Some Physicians Consider Ending Vaccinations Because of Low Reimbursements, Studies Find
Excerpt: "About one in 10 physicians who provide vaccinations for privately insured children are considering dropping the services because reimbursements are too low, according to a survey published in the December issue of the journal Pediatrics, the AP/Philadelphia Inquirer reports." (Kaiser Family Foundation)


Miracle Drugs Becoming Major Cost Factor for Employer Health Plans
Excerpt: "Developed in biotechnology labs to treat cancers, multiple sclerosis and rare diseases, specialty pharmacy drugs barely existed a decade ago. Today, their costs are growing at nearly twice the rate of other drugs. In 2007, the cost of specialty drugs grew by 12.3%, compared with 6.7% for drugs overall, according to pharmacy benefit manager Medco Health Solutions in Franklin Lakes, New Jersey." (Financial Week)


[Opinion] End Health Insurance Perk for Retired Michigan Legislators
Excerpt: "While more Michigan families face the prospect of no jobs, much less health coverage, they can take solace in the fact that former legislators and their families can enjoy excellent health benefits - at taxpayer expense. Current lawmakers could change this state of affairs. They have chosen to ignore the situation. A wiser course of action also is a simple one: Terminate all health benefits for former legislators, regardless of their time in office. Michigan, frankly, has more important people to help out, such as women and children in true need." (Lansing State Journal)


[Opinion] Alain Enthoven Responds on Reform of the Dutch System
Excerpt: "[In the JHPPL article by Pauline Vaillancourt Rosenau and Christiaan J. Lako, 'An Experiment with Regulated Competition and Individual Mandates for Universal Health Care: The New Dutch Health Insurance System' t]he authors referred to the Dutch reform as 'Enthoven-inspired.' Alain C. Enthoven, [known as the 'father of managed competition,' provides this response:] Don't leap to unfounded conclusions too quickly in this complex and important subject." (Physicians for a National Health Program)



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(Please visit our sponsors. We try to make sure their products and services will be of interest to you. Thanks! --Editor)

Links to Items on Executive Comp, Benefits in General

[Guidance Overview] Planning Guidelines for Employers Giving Gifts to Employees
Excerpt: "Unfortunately, gifts that employers give to their employees are generally treated as supplemental wages, and thus subject to both payroll and income taxes. This means that the value of the gift must be included in the employee's W-2 at year end and included in a payroll period for purposes of income tax withholding and payroll taxes.' (Littler Mendelson P.C.)


[Guidance Overview] The TARP Capital Purchase Program - A Summary of Executive Compensation Requirements
Excerpt: "Limitation on deductions. The financial institution must agree that it will not claim a federal income tax deduction for executive compensation in excess of $500,000 for each [Senior Executive Officer] during the CPP period." (Troutman Sanders LLP)


Executive Pay Bill Picks Up Congressional Support
Excerpt: "A bill that would limit a corporation's ability to write off executive compensation as a business expense has picked up some support in the House. HR 3876, which would cap the deductibility of such compensation to 25 times the pay of that company's lowest-paid worker, now has the backing of 27 members of Congress." (Investment News; free registration required)


Selecting and Measuring a Top Benefits Management System
Excerpt: "A competitive employee benefits program is crucial to attract and retain skilled workers, but the ability to manage such programs is getting increasingly difficult, according to data from the Aberdeen Group benchmark report, 'Taming the Benefits Management Beast: Driving Costs Down and Satisfaction Up,' published in July. The primary reason should come as no surprise: the rapidly rising cost of providing health care and related coverage to workers." (Employee Benefit News; free registration required)


10 Benefits Employers Will Cut Next Year
Excerpt: "Many employers will frantically ax jobs in the coming months in an effort to improve their bottom lines. Other companies will wield a scalpel to whittle out cost savings from employee perks. A whopping 86 percent of companies expect recent financial market changes to affect employee benefits in the next year, according to a recent survey. Here's a look at the where employers are likely to make cuts." (U.S. News & World Report)


Autoworkers Worry More Givebacks Necessary to Help Companies
Excerpt: "[A]ny collective plans from Detroit, if they are to win over Congress, may require additional cost-saving concessions from the U.A.W. While the union has not agreed to reopen contracts at General Motors, Ford and Chrysler, industry analysts say it seems inevitable that it will have to do so, and that some of the U.A.W.'s hardest-fought gains may shrink, if not completely disappear." (The New York Times; free registration required)




Newly Posted Events
(Post Yours!)

403(b) Terminations, Transfers and Exchanges
Nationwide on December 11, 2008
presented by SunGard Relius

Rollovers As Business Startups: Too Good To Be True?
Nationwide on December 16, 2008
presented by SunGard Relius

SEC Executive Compensation Disclosure In 2009: EESA, The CD&A, And More
Nationwide on December 3, 2008
presented by ALI-ABA (American Law Institute-American Bar Association)

The 409A Hammer Strikes: Are You Ready for 2009?
Nationwide on December 9, 2008
presented by SunGard Relius



Newly Posted Press Releases
(Post Yours!)

Securities Lending Loses Its Shine
Watson Wyatt

Compensation Committees Adjusting CEO Pay Programs Prior to Financial Crisis, Watson Wyatt Survey Finds
Watson Wyatt

The SPARK Institute Answers More Technical Questions Regarding 403(b) Plans Information Sharing
SPARK Institute



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for ING, US Financial Services
in WA




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