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| January 15, 2009 |
| Here are the Web's best new links about compliance and cost aspects of plan operation, design and policy. |
Today's sponsor is BeneCom Associates, LLC
(Click on company name or banner to learn more.)
| Reenrollment is over. Now, is your SPD up-to-date? |
| If your health or retirement plan has undergone major changes in the last five years, your SPDs may be out of date. If so, BeneCom has the experience and resources you need to bring them into compliance. Since 1992 we’ve been helping employers like you create and distribute their SPDs efficiently and cost effectively, often by using WebSPD, our own easy-to-navigate online reference tool.
No matter what media your SPD requires, print or online, BeneCom has the capability. Call (860) 674-2626 or visit us at www.benecomassociates.com. We’re here to help. |
[Guidance Overview]
Philadelphia Ordinance Requiring Unpaid Leave for Victims of Domestic or Se.xual Violence and Their Families (PDF)
2 pages. Excerpt: "The City of Philadelphia has enacted a new ordinance requiring that employers provide up to eight weeks of unpaid leave annually to victims of domestic abuse, se.xual assault, or stalking. All employers within the City of Philadelphia-including employers that are not subject to the federal Family and Medical Leave Act (FMLA)-are required to comply with the new ordinance and post a notice summarizing the new leave entitlement." (Morgan, Lewis & Bockius LLP)
[Guidance Overview]
Neglect of Treating Physicians' Opinions Leads to Decision for Plaintiff
Excerpt: "In rejecting a per se 'treating physician rule', the Supreme Court's opinion in Black & Decker Disability Plan v. Nord did not hold that treating physician opinions can be neglected. This recent Eighth Circuit opinion demonstrates an application of an important caveat in Nord - that the administrator must take into account treating physicians' opinions in reaching its conclusions. The case involved a claim to long term disability benefits. The initial claim was denied and a claim for benefits filed in the district court." (Health Plan Law)
[Guidance Overview]
Segal's Multiemployer Health Plans 1st Quarter 2009 TRENDS Report (PDF)
1 page. Excerpt: "This report includes recent developments in health care and the multiemployer marketplace and data including consumer price index (CPI) and Segal health trends." (The Segal Group, Inc.)
[Guidance Overview]
Deadline for Submission of Creditable Coverage Disclosures to CMS (PDF)
2 pages. Excerpt: "Group health plan sponsors that provide prescription drug coverage to Medicare Part D eligible individuals must annually disclose to the Centers for Medicare & Medicaid Services (CMS) whether such coverage qualifies as creditable or non-creditable prescription drug coverage. All plan sponsors that provide prescription drug coverage are required to make this disclosure, even if they do not make coverage available to retirees. Calendar year plans must submit the disclosure to CMS by March 1, 2009." (Buck Consultants)
Blues Plans Use Evidence-Based Measures to Improve Cancer Care Quality and Outcomes
Excerpt: "With cancer treatments growing increasingly expensive, several Blue Cross and Blue Shield plans are stepping up efforts to improve the quality of oncology care and reduce expenses. The Regence Group, CareFirst BlueCross BlueShield and Blue Cross Blue Shield of Michigan (BCBSMI) are among Blues plans working with cancer clinics in an attempt to improve adherence to evidence-based guidelines." (AISHealth.com)
Efforts to Cut Waste from Health Care May Require a New Reimbursement Model
Excerpt: "The National Priorities Partnership's (NPP) 28 members include such heavy hitters as CMS, America's Health Insurance Plans (AHIP), AARP, AFL-CIO, the American Nurses Association, the Joint Commission and The Leapfrog Group. The partnership late last month released a 72-page agenda aimed at reforming the health care system 'from the inside out.' The elimination of waste and overuse is one of six 'national priorities' addressed by the group." (AISHealth.com)
WellPoint Is Latest Blues Plan to Invest in Medical Tourism
Excerpt: "WellPoint, Inc.'s decision in November to launch an international medical tourism pilot with Serigraph, Inc. reflects rising costs for domestic surgery and the potential for international medical centers to provide quality care at a lower cost. The giant Blues plan follows in the footsteps of other insurers, such as BlueCross BlueShield of South Carolina, which launched medical tourism subsidiary Companion Global Healthcare last year and is expanding the network to include more foreign destinations." (AISHealth.com)
Settlement Between UnitedHealth Group Subsidiary Ingenix Inc. and State of New York Raises Compliance and Cost-Containment Challenges for Self-Funded Plans and Third-Party Administrators
Excerpt: "Employers and TPAs that used Ingenix will have to decide on an alternative method of reimbursing out-of-network providers. Some steps plans can take to achieve objective reimbursement include 1) comparing provider bills to other payers' out-of-network rates; 2) basing reimbursement on a percentage of Medicare fees; and 3) calculating the plan's own UCR by examining its history of claims, taking into account overhead and administrative costs." (Thompson Publishing Group Inc.)
Rail America in Court over an Injured Worker and COBRA Coverage
Excerpt: "The employee was injured in March 2001 which prevented him from returning to work. The employer continued to pay wages to the employee and health benefits through the end of 2001. For reasons that are not entirely clear, later that year the employer mailed a COBRA election notice to the employee. He never returned the election form requesting COBRA coverage." (Infinisource)
Health IT Investments that Improve Health Care: Critical Information Policy and Technology Attributes and Expectations (PDF)
4 pages. Excerpt: "Federal policy makers are debating health information technology (health IT) investments as part of economic stimulus and broader health reform efforts. Strategic health IT investments can improve health care, spur innovation and promote long-term economic growth by: Expanding employment in areas of health care that can produce quality and productivity improvements. Stimulating innovation in care delivery models. Achieving cost-effectiveness in delivery of care. Improving health outcomes. Enhancing consumer trust in use of information and greater consumer participation in health and health care." (Markle Foundation)
Massachusetts Health Reform: Solving the Long-Run Cost Problem
Excerpt: "Since its inception in 2006, many of Massachusetts's health reforms have brought about positive change: the number of uninsured has fallen by half, access to needed care has increased, and private insurance has not been 'crowded out' by public insurance programs. But the Massachusetts initiative has also seen higher than anticipated costs. In a new analysis by the Urban Institute, researchers John Holahan and Linda Blumberg summarize the state's accomplishments, examine the challenges, and suggest four options for addressing long-term costs." (The Robert Wood Johnson Foundation)
Coca-Cola Proposes Retiree-Health Funding Plan
Excerpt: "Coca-Cola Inc. has asked for regulatory approval for a plan under which it will fund its retiree health benefits through an insurance arrangement involving its in-house insurer. A Business Insurance news report said the arrangement was described in a regulatory filing with the U.S. Department of Labor (DoL). According to the report, the beverage maker would use $187 million now held in a voluntary employee beneficiary association (VEBA) to buy medical stop-loss policies from Prudential Insurance Co. of America that would pay health claims of about 4,000 retirees and dependents. Coca-Cola established the VEBA in 2006." (PLANSPONSOR.com; free registration required)
Capping the Tax Exclusion for Employment-Based Health Coverage: Implications for Employers and Workers (PDF)
20 pages. Excerpt: "With health reform a major priority of the new 111th Congress and President Barack Obama, this Issue Brief examines the administrative and implementation issues that arise from one of the major reform proposals: Capping the exclusion of employment-based health coverage from workers' taxable income." (Employee Benefit Research Institute)
Walgreen Plans Network of On-Site Health Centers for Corporate and Government Employees
Excerpt: "Drugstore chain Walgreen is planning to target corporate and government employers with a new program that would establish on-site health centers for employees, the Wall Street Journal reports. Participating employees would be able to receive preventive care, checkups and other services, such as dentistry and optometry, while at work." (Kaiser Family Foundation)
[Opinion]
Why Employer-Based Health Insurance Doesn't Cut It
Excerpt: "Instead of a patchwork of private insurance companies that functions as a market-based regulator of costs, covered services and providers, the single-payer system has a public or quasi-public agency pay medical providers. Costs are controlled through bulk purchasing, negotiated fees with suppliers and service providers, and global budgeting, which pays providers from a pooled budget versus a system of itemized, one-by-one claims." (Women's eNews via California Nurses Association / National Nurses Organizing Committee)
EmployeeBenefitsJobs.com (Sponsor)
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Links to Items on Executive Comp, Benefits in General
Recent Developments in Four States Regarding Same-Sex Marriage and Civil Unions (PDF)
3 pages. Excerpt: "Following the changing developments in same-sex marriage and civil union laws is important for employers, plan sponsors, and insurers to ensure that benefit plans comply with state and local laws that are not preempted by ERISA. Generally, insured benefit plans will be required to cover same-sex spouses, and self-insured plans, because of ERISA preemption, may elect whether to cover same-sex spouses. Employers may also be interested, for plan design purposes, in what benefits other employers are offering to same-sex spouses and partners. [W]e briefly summarize recent developments in California, Connecticut, New Hampshire, and New York regarding same-sex marriage and civil unions." (Groom Law Group)
How Do Federal Employees Rate Their Pay and Benefits?
Excerpt: "The 2008 Federal Human Capital Survey results released last week indicated that while employees are fairly satisfied with pay, health insurance benefits and paid time off, they have more lukewarm opinions of other programs -- such as long-term care insurance, flexible spending accounts, telework and alternative work schedules." (GovernmentExecutive.com)
Growth in Federal Entitlement Programs Outpacing Tax Revenues, Treasury Department Reports
Excerpt: "[T]he largest contributors to government's net cost are the Department of Health and Human Services (19.6%), the Department of Defense (20.3%), the Social Security Administration (18.2%), and interest paid on debt held by the public. Federal employees' and veterans' benefits payable in 2008 have exploded from $90.1 billion in 2007 to $549.8 billion." (Wolters Kluwer)
Number of ERISA Class Action Suits Expected to Increase
Excerpt: "If 2008's figures on ERISA and FLSA lawsuits are any indication, employers can expect even more legal filings this year, as employees continue to lose their jobs in the economic recession, predicts international law firm Seyfarth Shaw. According the 5th Annual Workplace Class Action Litigation Report compiled by Seyfarth Shaw, the top ten ERISA class action settlements entered into or paid in 2008 totaled $17.7 billion, up from the $1.818 billion settlement tally of the previous year." (Employee Benefit News; free registration required)
Testimony: A Framework for Crafting and Assessing Proposals to Modernize the Outdated U.S. Financial Regulatory System (PDF)
30 pages. Excerpt: "[The statement is based on the GAO report, 'Financial Regulation: A Framework for Crafting and Assessing Proposals to Modernize the Outdated U.S. Financial Regulatory System'], which (1) describes how regulation has evolved in banking, securities, thrifts, credit unions, futures, insurance, secondary mortgage markets and other important areas; (2) describes several key changes in financial markets and products in recent decades that have highlighted significant limitations and gaps in the existing regulatory system; and (3) presents an evaluation framework that can be used by Congress and others to shape potential regulatory reform efforts." (U.S. Government Accountability Office)
Newly Posted Events
403(b) Plan Documents Webcast
Nationwide on January 21, 2009
presented by ftwilliam.com
TRI-AD's Free Web Seminars: Legislative Updates for Retirement Plans and Health & Welfare Plans
in California on January 22, 2009
presented by TRI-AD
Update On State And Local Legislation Affecting Employers And The Uninsured
in Maryland on February 5, 2009
presented by Worldwide Employee Benefits Network (WEB) - Baltimore Chapter
Newly Posted Press Releases
Study Examines Issues in Capping Tax Exclusion of Health Coverage
Employee Benefit Research Institute (EBRI)
Reminder for Funding Opportunity: Dissertation Fellowship
Center for Retirement Research at Boston College
Middle-Income Americans Benefit from 401(k) Plans
American Society of Pension Professionals & Actuaries (ASPPA)
Newly Posted or Renewed Job Openings
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Corporate Retirement Services Supervisor
for Fiserv ISS
in CO
Taft-Hartley Relationship Manager
for New York Life Retirement Plan Services
in MA
Business Analyst - OmniPlus
for Recruiting & Placement firm
in CO, CT, GA, KS, MA, NC, NJ
Client Service Consultant
for The Standard
in IL
Senior Retirement Plan Analyst and Supervisor
for Mid Size New York City TPA
in NY
ERISA Attorney
for Law Offices of Gary V Webster
in TN
Retirement Plan Administrator
for The Paragon Alliance Group
in PA
Education Coordinator
for Milliman
in TX
Consulting Actuary
for Van Iwaarden Associates
in MN
Pension Administrator
for Retirement Strategies Inc.
in GA
Handy Links:
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- Using the Web for Employee Benefits Research (hypertext article)
- Employee Benefits Library
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