Health & Welfare Plans Newsletter |
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| May 26, 2009 \ Compliance \ Costs \ Administration \ Design \ Policy | ||
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[Official Guidance]
DOL Explanation to Employees: Appealing a Denial of COBRA Premium Subsidy, Including Online Filing Procedure
Excerpt: "If you believe you are eligible for COBRA continuation coverage and for this premium reduction through a private sector health plan sponsored by an employer generally with at least 20 employees, but your request for these benefits or the reduced premium has been denied, you may apply to the U.S. Department of Labor to review the denial. If your continuation coverage is provided through a Federal, State or local government plan, or if it is provided pursuant to State insurance law, you should direct your request for review to the [United States] Department of Health and Human Services." (Employee Benefits Security Administration, U.S. Department of Labor)
[Guidance Overview]
HHS Guidance on Securing Protected Health Information and Avoiding Breach Notification
Excerpt: "The first guidance implementing the breach notification rules was published by HHS in April 2009.1 The guidance sets forth a safe harbor rule that plan sponsors can follow to secure PHI and therefore avoid the breach notification requirements. In the guidance, HHS clarifies when information is secure (and therefore not subject to the breach notification rules) or unsecure." (The Segal Group, Inc.)
[Guidance Overview]
Wisconsin Legislature Passes Act Creating Extended Election Right for Wisconsin COBRA
Excerpt: "On May 15, 2009, Governor Doyle signed 2009 Wisconsin Act 11 (the 'Wisconsin Act') into law. Although the Wisconsin Act primarily deals with bailout money obtained from the federal government, it also has an impact on employers: it clarifies and expands an employer's obligations with regard to Wisconsin COBRA continuation coverage, it expands the situations in which an individual who voluntarily terminates employment can immediately receive unemployment benefits, and it extends the period over which benefits may be available when the percentage of unemployed workers is high. The health continuation requirements became effective on May 19, 2009. Employers subject to the Wisconsin COBRA notice provisions must comply by May 29, 2009." (Michael Best & Friedrich LLP)
[Guidance Overview]
Fitness-for-Duty Certification Under the FMLA
Excerpt: "A fitness-for-duty certification may be required only when the employer has a uniformly-applied policy that requires all similarly situated employees (i.e., same occupation, same serious health condition) to provide a fitness-for-duty certification as a condition of reinstatement. Further, a fitness-for-duty certification may be required only when the need for FMLA leave is based on the employee's own serious health condition. Finally, the employer may seek certification only for the condition that necessitated the leave." (Faegre & Benson)
[Guidance Overview]
1st Circuit Refines Benefits Denial Case Law
Excerpt: "After tweaking their standard for how federal judges should handle employee benefits denial cases involving a conflicted plan administrator, federal appellate judges have ordered more hearings in just such a case. The 1st U.S. Circuit Court of Appeals sent back to a lower court Denmark v. Liberty Life Assurance Co. of Boston with instructions to gather more evidence on the issue of why disability benefits were denied in a case that has made several trips through the federal judicial system. In Denmark the lower court found the denial of long-term disability was supported by substantial evidence and within the plan administrator's discretion, and ruled for the insurance company." (PLANSPONSOR.com; free registration required)
[Guidance Overview]
Fiduciary Liability Insurance Policy Does Not Cover COBRA Violation
Excerpt: "In a recent case, a federal appeals court held that a fiduciary liability insurance carrier was not liable to an insured-employer for litigation expenses incurred by the employer in the defense of a lawsuit based (in part) on the employer's alleged failure to offer COBRA coverage. . . . In this case, the employer was left with no coverage for the costs of the kind of lawsuit it might reasonably have foreseen when it purchased the policy. Employers that maintain fiduciary coverage should conduct a careful review of all policy provisions and exclusions to ensure there are no gaps in coverage. (Mary Kay Holding Corp. v. Federal Insurance Co., 5th Cir. 2009)" (Hodgson Russ LLP)
Wisconsin Insurance Coverage Mandate for Ear-Implants Draws Dissent
Excerpt: "A law signed Thursday will make Wisconsin the second state in the nation to require insurers to cover the costs of cochlear implants for children. But advocates for the deaf are among those criticizing the measure." (Wausau Daily Herald)
Getting Healthy, with a Little Help from the Boss
Excerpt: "According to a January survey by the benefits consulting firm Hewitt Associates, nearly two-thirds of large employers planned to transfer more costs to employees. At the same time, one-third planned to put greater emphasis on wellness plans -- programs that encourage employees to adopt healthier lifestyles. (So long, Big Macs). Congress is climbing onto the wellness bandwagon, too. Senator Tom Harkin, the Iowa Democrat who is a leader of the Congressional health reform movement, recently proposed giving tax incentives to companies that offer comprehensive wellness programs to their employees. The focus on healthier lifestyles makes sense. Unhealthy employees use significantly more medical services than healthy ones and cost employers more money." (The New York Times; free registration required)
Committees Prepare for Health Reform Markups As Congress Enters Recess
Excerpt: "The Memorial Day recess is underway and many members of Congress will be spending time in their states and districts over the next ten days. The Senate is scheduled to reconvene on June 1 and the House will return on June 2. . . . In the days leading up to the Memorial Day recess, more than 300 bills were introduced in the Senate and the House, including several that address notable health care issues. [The target page reviews some of the bills introduced to date.]" (America's Health Insurance Plans)
New Jersey Governor Orders Review of Public Employee Health Insurance Plans to Stem Rising Costs
Excerpt: "Forecasting a 'double-digit increase' in health care premiums next year for local employers enrolled in the state's public employee health insurance plans, Gov. Jon Corzine today ordered a review of possible steps to hold down the costs. The governor directed two state commissions overseeing health benefits for public employees to consider a series of controls on employers that participate in the state plan. The proposed reforms would help reduce the burden on local school districts and other employers as the state grapples with declining funds and rising health care costs, Corzine said." (NJ.com)
Senate Committee Unveils Proposal for Modifying HSAs Under Health Reform
Excerpt: "A policy option paper released by the Senate Finance Committee on May 19 discusses proposed health system savings and revenue options, including modifications to HSAs. . . . The full document, Financing Comprehensive Health Care Reform: Proposed Health System Savings and Revenue Options, can be viewed at http://tinyurl.com/pc579e." (AISHealth.com)
Recession Effects and Premium Costs Forcing Small Companies to Drop Health Insurance or Lay Off Workers
Excerpt: "As the Obama administration wrestles with broader questions of health-care overhaul, tough economic times are forcing more businesses to grapple with stressful questions about discontinuing coverage. Health-insurance premiums for single workers rose 74% for small businesses from 2001 to 2008 . . . . About 10% of small businesses are considering eliminating coverage over the next year, up from 3% in 2005, according to a recent survey by National Small Business Association." (The Wall Street Journal)
Including Employer Financing in State Health Reform Initiatives: Implications of Recent Court Decisions (PDF)
12 pages. Excerpt: "In the last three years, federal courts of appeal have reached different conclusions about whether ERISA preempts employer 'pay or play' laws in Maryland and California. This Issue Brief discusses implications of these court cases for state health reform. After outlining the reasons states may want to include employers as a source of health care financing, the paper discusses ERISA's preemption principles, describes state and local laws that have imposed employer fees, and notes the key findings and conclusions from the court of appeals opinions." (State Coverage Initiatives via National Academy for State Health Policy)
Legislation Introduced Mandating Paid Vacation
Excerpt: "Representative Alan Grayson of the U.S. House of Representatives has introduced the Paid Vacation Act of 2009 (HR 2564). If passed, this bill would amend the Fair Labor Standards Act to require that employers with 50 or more employees provide a minimum of one week paid annual leave to employees after one year of service. Employers with 100 or more employees would be required to offer employees at least two weeks of paid vacation each year." (International Foundation of Employee Benefit Plans)
New Maryland Law Requires Insurers To Provide Incentives for EHR Adoption
Excerpt: "Maryland Gov. Martin O'Malley (D) on Tuesday signed a bill making the state the first to require private insurance companies to offer physicians financial incentives for adopting electronic health records, the Baltimore Sun reports. Starting in 2011, insurers will have to provide physicians who adopt EHRs with increased reimbursements, a single sum payment or in-kind services that have monetary value. According to the Sun, physicians who do not adopt EHR systems by 2015 could face penalties. The bill also requires Maryland to establish a health information exchange that eventually will link all the state's physicians, hospitals, medical laboratories and pharmacies." (Kaiser Family Foundation)
Connecticut House Approves Two Health Insurance Pooling Bills
Excerpt: "The first measure would create a public health insurance pool open to all residents. The pool, intended to compete with rather than replace private insurance, would be based on the existing pool for state workers . . . . The second measure would allow local governments, small businesses and not-for-profit groups join the state employee insurance plan. The bill would increase the current pool's membership from 200,000 to an estimated 300,000." (Kaiser Family Foundation)
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Links to Items on Executive Comp, Benefits in General
[Official Guidance]Text of IRS Notice 2009-48: Q&A on Entities Subject to Information Reporting Requirements for Employer-Owned Life Insurance (PDF)
14 pages. From an IRS-provided summary: 'Section 101(j) was added to the Internal Revenue Code by the Pension Protection Act of 2006 to ensure that employees whose lives are insured by their employers are adequately informed of that coverage and its consequences. Section 6039I sets forth corresponding reporting obligations applicable to those employers who obtain life insurance coverage on their employees. This notice provides guidance in the form of questions and answers concerning what entities are subject to the information reporting required for employer-owned life insurance contracts and how those entities can provide that information." (Internal Revenue Service)
Employee Benefits Research Tips and Techniques
Excerpt: "[B. Janell Grenier has posted her] outline for a presentation given to the Louisville Employee Benefits Council on March 10th of this year." (ERISA Fiduciary Guidebook)
White House Memo on Preemption
Excerpt: "The White House has issued a general Memo [at http://www.whitehouse.gov/the_press_office/Presidential-Memorandum-Regarding-Preemption/] to 'Heads of Executive Departments and Agencies' relating to the issue of federal preemption of state law. ERISA lawyers will want to read it and reflect on how the policy might or might not impact an already complicated and tangled ERISA preemption regime." (Attorney B. Janell Grenier via Benefitsblog.com)
Announcing a New Blog: ERISA Fiduciary Guidebook
Excerpt: "For some time now, I have had a great interest in starting a website devoted to following legal developments related to ERISA fiduciary law as the whole area seems to be exploding with developments and it is difficult to cover them all at this site. The new site can be found at www.fiduciaryguidebook.com and is called 'The Fiduciary Guidebook.' It is, of course, a work in progress. . ." (Attorney B. Janell Grenier via Benefitsblog.com)
American Diplomats' Same-S.ex Partners to Get Benefits
Excerpt: "The State Department will offer equal benefits and protections to same-s.ex partners of American diplomats, according to an internal memorandum Secretary of State Hillary Rodham Clinton sent last week to an association of g.ay and les.bian Foreign Service officers. Mrs. Clinton said the policy change addressed an inequity in the treatment of domestic partners and would help the State Department recruit diplomats, since many international employers already offered such benefits." (The New York Times; free registration required)
Webcasts and Conferences
401(k) UpdateNationwide on June 18, 2009
presented by McKay Hochman Co.
Designated Roth: Contributions, Distributions, Rollovers and Reporting
Nationwide on June 25, 2009
presented by McKay Hochman Co.
Form 5500 for Health and Welfare Plans: A Guided Tour for Employers, Preparers, and Advisors
Nationwide on May 21, 2009
presented by EBIA / Thomson Reuters
Hearing on Target Date Funds and Similar Investment Options
in District of Columbia on June 18, 2009
presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)
(Click to post your webcast or conference)
Press Releases
U.S. Labor Department and SEC to Hold Hearing on Target Date Funds and Similar Investment OptionsU.S. Department of Labor, Employee Benefits Security Administration (EBSA)
IRS Names 10 New Members to ACT Advisory Panel; ACT to Submit Recommendations at June Meeting
Internal Revenue Service (IRS)
Reed Group Launches New MDGuidelines Web Site with 6th Edition of Medical Disability Advisor
Reed Group
Rarely Used Closed Doors Slammed Again In U.S. Senate Health Care Reform
Consumer Watchdog
(Click to post your press release)
Employee Benefits Jobs
Branch Manager (TPA/Insurance)for Zenith Administrators
in NV
(Click to post your job opening | View all jobs |
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EmployeeBenefitsJobs.com (Sponsor)
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Handy Links:
- View Today's Active Message Threads
- Using the Web for Employee Benefits Research (hypertext article)
- Employee Benefits Library
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