Health & Welfare Plans Newsletter |
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| October 13, 2009 \ Compliance \ Costs \ Administration \ Design \ Policy | ||
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[Guidance Overview]
Employer Liability for Termination of Group Life Insurance Coverage
Excerpt: "Generally speaking, employers are not familiar with the responsibility and potential liability for failing to notify employees of their right to convert group life insurance coverage to an individual life insurance policy upon termination of employment, or their right to apply for a waiver of premiums if they are disabled and absent from work. Within the past few years, there has been a wave of litigation brought by former employees and their beneficiaries complaining about the loss of group life insurance coverage due to misrepresentations made by employers about their group coverage and the failure of employers to inform terminated employees about their rights under the group life insurance plan documents." (Ford & Harrison LLP)
Agencies Aim to Issue Mental Health and Substance Abuse Parity Regulations by January
Excerpt: "Regulators missed an Oct. 3 deadline to issue guidance on the federal mental health and substance abuse parity law. The head of the Department of Health and Human Services, one of three agencies charged with giving guidance, said that the agencies' goal is to issue regulations by January 2010. The law generally takes effect for plan years beginning on or after Oct. 3, 2009; for most calendar year plans, the law's effective date is Jan. 1, 2010. Self-funded and fully insured employer group health plans may need to decide how to comply without regulatory guidance." (Mercer LLC)
Audio and Text: How Drug Ads Changed Health Care
Excerpt: "Prescription drug spending is the third most expensive cost in our health care system. And spending seems to grow larger every year. Just last year, the average American got 12 prescriptions a year, as compared to 1992, when Americans got an average of seven prescriptions. In a decade and a half, the use of prescription medication went up 58 percent. This has added about $180 billion to our medical spending. While there are more medicines on the market today than in 1992, researchers estimate that around 20 percent of the $180 billion increase has absolutely nothing to do with the number of medications available, or increases in the cost of that medication." (Morning Edition via National Public Radio)
Arizona's Domestic-Partner Benefit Remains in Effect
Excerpt: "State employees in Arizona can take advantage of domestic-partner benefits for the next 12 months even though the Legislature's last budget took them away. The Department of Administration says the benefit will be available until October 2010, because cutting it before then might put the state in violation of contract laws. The benefit was to be cut off when the state's insurance plan began Oct. 1, but the budget won't take effect until nearly two months into the contract period. An opinion by the Attorney General's Office concluded the benefit's elimination during this fiscal year would conflict with employees' expectations." (KMSB-TV)
Regulations on Parity for Federal Mental Health Benefits May Be Delayed
Excerpt: "[Federal agencies have received more than 400 written comments in response to an April notice requesting input from the public on key issues associated with The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.] Among other things, federal regulators sought comment on which provisions in the law require regulatory clarification, how out-of-network coverage for mental disorders differs from out-of-network coverage for other medical disorders, and whether special consideration should be given to small employers." (Workforce Management; free registration required)
Senate Finance Committee Votes Today on Health Care Reform Bill (PDF)
8 pages. Excerpt: "This Hewitt bulletin discusses the health insurance reform, Medicare and revenue provision changes the Baucus bill would make to the United States' health care system." (Hewitt Associates)
Comparing the Small Business Tax Credit Provisions in the House, Senate Help Committee, and Senate Finance Committee Bills (PDF)
3 pages. (Families USA)
Senate Finance Committee Adopts New Pharmacy Benefit Management Disclosure Provision
Excerpt: "The SFC approved an amendment to its comprehensive health reform bill that would require pharmacy benefit managers (PBMs) to disclose contract provisions with payers and drug companies. But committee members rejected other controversial amendments, such as those that would have authorized the HHS secretary to negotiate drug prices or create an overall public option to compete with private insurers." (AISHealth.com)
Congress Is Split on Effort to Tax Costly Health Plans
Excerpt: "A proposed tax on high-cost, or 'Cadillac,' health insurance plans has touched off a fierce clash between the Senate and the House as they wrestle over how to pay for legislation that would provide health benefits to millions of uninsured Americans. Supporters, including many senators, say that the tax is essential to tamping down medical spending and that over 10 years it would generate more than $200 billion, nearly a fourth of what is needed to pay for the legislation. Critics, including House members and labor unions, say the tax would quickly spiral out of control and hit middle-class workers, people more closely associated with minivans than Cadillacs." (The New York Times; free registration required)
Insurance Providers Dropping Out of Federal Employee Health Program
Excerpt: "OPM has provided agencies with a full list of changes to FEHBP health plans. Health care providers that are lowering coverage or dropping areas entirely are responsible for informing enrollees of those changes, McGettigan said, but agencies should follow up with employees anyway, in case insurers miss workers due to changes in contact information." (GovernmentExecutive.com)
White House Blasts Health Insurance Sector Report
Excerpt: "The White House on Monday blasted a report from the health insurance industry that said Senate healthcare legislation would lead to increases in annual insurance premiums of as much as $4,000 by 2019. The report for the industry trade group America's Health Insurance Plans represented a shot across the bow at Democratic plans to overhaul the $2.5 trillion healthcare system as President Barack Obama has been gaining momentum on the issue. A top goal of Obama in seeking to revamp healthcare is to rein in costs that have soared in recent decades. The report, prepared by consultants PricewaterhouseCoopers and posted on the industry group's website over the weekend, said costs would increase for Americans rather than decline." (The New York Times; free registration required)
Employers Are Pushing Ineligible Dependents Out of Health Insurance Plans
Excerpt: "Dependent eligibility audits, where employers demand that workers and retirees show documents proving that their claimed dependents qualify for health benefits, are quickly becoming the norm, said Jeri Stepman, a senior adviser at Watson Wyatt, an Arlington-based benefits consultancy. More than 60 percent of large U.S. companies conducted such audits this year, compared with fewer than half in 2007, according to the firm's survey of 489 employers. Even more companies are expected to conduct such audits next year." (The Washington Post; free registration required)
Audio and Text: How the Modern Patient Drives Up Health Costs
Excerpt: "[Modern patients are] the people who come in with specific requests for medications and procedures. And oftentimes they get what they ask for, whether they need it or not. This consumer-driven health care is part of what's driving up costs across the country." (Morning Edition via National Public Radio)
Congressmen Want HIPAA Harm Threshold Eliminated
Excerpt: "Six members of the House of Representatives signed a letter written to HHS Secretary Kathleen Sebelius that urges HHS to repeal or revise the harm standard provision in HHS' interim final rule on breach notification. . . . The Congressmen, all but one of whom are Democrats, wrote they are 'deeply concerned' about the harm provision because it gives covered entities and business associates (BAs) a 'breadth of discretion' as they determine the level of harm to an individual whose PHI was inappropriately disclosed." (HealthLeaders Media)
Health Insurance Mandates Draw Flak from Both Sides
Excerpt: "The idea of an 'individual mandate' to carry insurance is an integral part of Democratic efforts to expand health coverage to nearly every American. Any final legislation is likely to include some type of annual penalty for those who forgo health insurance and are deemed able to afford it. Many Republicans charge that such an unprecedented requirement could violate the Constitution. Some Democrats are concerned it would penalize people for not buying something they simply couldn't afford." (The Wall Street Journal)
Democrats and Health Reform Advocates Lash Back at Insurers
Excerpt: "Reactions and Democratic push back are beginning to be evident after the release Monday of an insurance industry-sponsored report (.pdf) that warns premiums could wind up costing $4,000 more by the end of decade if a proposed health overhaul is implemented, the Associated Press reports. The report isn't 'worth the paper it's written on,' AARP Executive Vice President John Rother said. The retiree's association has supported health reform . . . ." (Kaiser Family Foundation)
Developments of Interest in the Multiemployer Health Plan Environment (PDF)
1 page. Excerpt: "This report includes: Recent developments in health care and the multiemployer marketplace. Data including consumer price index (CPI) and Segal health trends. A context for what's happening to health plans." (The Segal Group, Inc.)
[Opinion]
Potential Impact of Health Reform on the Cost of Private Health Insurance Coverage (PDF)
26 pages. Excerpt: "America's Health Insurance Plans engaged PricewaterhouseCoopers (PwC) to examine the impact of four components of the health reform bill being proposed by the Senate Finance Committee as introduced. These include: Insurance market reforms and consumer protections that would raise health insurance premiums for individuals and families if the reforms are not coupled with an effective coverage requirement. An excise tax on employer-sponsored high value health plans (or 'Cadillac plans') that in a few years could also raise premiums for some moderate value plans. Cuts in payment rates in public programs that could increase cost shifting to private sector businesses and consumers. These changes are expected to more than offset the potential reduction in cost shifting resulting from providing coverage to the uninsured. New taxes on health sector entities that are likely to be passed through to consumers." (America's Health Insurance Plans)
Opal Events (Advert.)
The Future of Medicare Advantage under the New Administration Opal Events brings together the best and brightest of the Medicare Advantage community to discuss the problems and solutions facing the managed care industry today. Topics to be covered include: logistics of transitioning members from PFFS to a network; MIPPA interpretations; risk-adjusted reimbursement issues; compliance specific to Part D; and HR6331. |
Links to Items on Executive Comp, Benefits in General
Executive Pay Reform: Beyond the Corporate and Financial Institution Compensation Fairness Act of 2009Excerpt: "Compensation committees serving public companies are facing unprecedented scrutiny as they react to recent executive pay reform efforts led by federal lawmakers and agencies, institutional shareholders and corporate governance watchdogs. Most recently, leaders of the G-20 endorsed reforms that, among other things, would curb bonuses at financial firms and grant regulators greater power over those firms' compensation practices. In this Q&A, Pillsbury Executive Compensation & Benefits partner Scott Landau explores the issues Compensation Committees of public companies must consider under the rapidly evolving landscape of compensation design and implementation." (Pillsbury Winthrop Shaw Pittman LLP)
DOL Rejects Bush Administration LM-2 Union Reporting Changes
Excerpt: "In a generally anticipated move, the U.S. Department of Labor's Office of Labor-Management Standards (OLMS) will publish a rule [today] rescinding the Bush administration's most recent changes to the LM-2 union report filed under the Labor-Management Reporting and Disclosure Act (LMRDA). This development confirms the Obama administration's interest in reducing the administrative burden on unions, and may signal the beginning of a focus shift to certain aspects of employer reporting under the LMRDA. In particular, many believe that OLMS will soon enhance scrutiny on employer and consultant reporting of so-called 'persuader' activity." (Morgan, Lewis & Bockius LLP)
Aligning Public Employee Benefits' Costs with the Fiscal Reality
Excerpt: "The boom days of the millennium decade's early years are over, but the now unsustainable benefits packages negotiated by California state and local governments and their employees remain - some representing as much as 40 percent of overall budget costs. Our discussions with local government managers and their advisors suggest a tremendous amount of confusion and misinformation about their ability to align employee benefits costs with their fiscal realities. This article discusses one source of much of the confusion - interpretations by California courts of the Constitutional prohibition against impairment of contracts - and why local governments have more latitude than they think." (Chang, Ruthenberg & Long PC)
Webcasts and Conferences
Aggregation Aggravation with Derrin Watson, Esq., APMin Ohio on October 20, 2009
presented by ASPPA Benefits Council of Cleveland
(Click to post your webcast or conference)
Press Releases
New IRS Retirement Plan Navigator Aims to Help Small BusinessesInternal Revenue Service (IRS)
Veteran Advisory Team Joins CAPTRUST Financial Advisors
CAPTRUST Financial Advisors
(Click to post your press release)
Employee Benefits Jobs
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