Health & Welfare Plans Newsletter |
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| October 26, 2009 \ Compliance \ Costs \ Administration \ Design \ Policy | ||
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[Guidance Overview]
CMS Proposes Policy and Technical Changes to Medicare Part D Regulations, Including COB and MSP Provisions
Excerpt: "CMS has proposed policy and technical changes to the regulations for the Medicare Part D program that are intended to clarify participation requirements, strengthen beneficiary protections, improve payment rules, and implement new policy. As discussed below, some of the proposed changes affect group health plan sponsors that provide prescription drug coverage for Part D eligible individuals (including active employees, disabled employees, COBRA participants, retirees, and their covered spouses and dependents). In particular, changes have been proposed to the regulations on MSP procedures for coordination of benefits (COB) between Part D plans and other providers of prescription drug coverage (including group health plan sponsors). For example, the regulations would include a requirement for Part D plans to report credible new or changed primary payer information to the CMS Coordination of Benefits Contractor." (Employee Benefits Institute of America)
[Guidance Overview]
Employer That Did Not Comply with Health Plan's COBRA Notice Requirements Is Not Entitled to Stop-Loss Reimbursement
Excerpt: "EBIA Comment: Because COBRA does not apply directly to insurers and stop-loss carriers, these entities are generally not obligated to provide COBRA coverage (or stop-loss coverage for COBRA claims) unless they enter into a contract requiring them to provide that coverage. The policies issued by group health insurers and by stop-loss insurers will generally include provisions requiring them to cover (or provide stop-loss coverage for) qualified beneficiaries who elect COBRA. But such policies often include provisions that allow the insurer to refuse payment unless certain conditions, including notices being given pursuant to the terms of the plan, are met. Employers that fail to follow the terms of their plan may, therefore, end up with no insurance coverage for an individual's COBRA claims." (Employee Benefits Institute of America)
[Guidance Overview]
Infant Formula for Healthy Baby Was Not a Medical Care Expense, IRS Rules
Excerpt: "In this private letter ruling, the IRS concluded that infant formula for the healthy baby of a woman who could not breastfeed due to a double mastectomy was not a medical care expense under Code Section 213(d). As support, the IRS cited a 1955 revenue ruling holding that amounts spent on special foods or beverages would qualify as medical care expenses only if they are prescribed by a doctor to treat or alleviate a specific illness, are in addition to the individual's normal diet, are not part of the individual's nutritional needs, and the need for them is substantiated by a doctor. That ruling also held that amounts spent on special foods or beverages taken as substitutes for food or beverages normally consumed by an individual to satisfy nutritional requirements are personal expenses, not medical care expenses." (Employee Benefits Institute of America)
Small Businesses Want to Be Able to Buy Insurance Together for Less
Excerpt: "Having a national plan as an option in the exchange is 'really important,' said Republican Senator Olympia Snowe, because it would provide efficiencies of scale and more choices to small businesses in states where the small-group market is dominated by one or two insurers. The National Federation of Independent Business and the U.S. Chamber of Commerce agree. They contend giving small businesses the ability to shop for insurance across state lines is vital to increasing competition in the health insurance marketplace." (Portfolio.com)
Small Business Faces Sharp Rise in Costs of Health Care
Excerpt: "Insurance brokers and benefits consultants say their small business clients are seeing premiums go up an average of about 15 percent for the coming year -- double the rate of last year's increases. That would mean an annual premium that was $4,500 per employee in 2008 and $4,800 this year would rise to $5,500 in 2010." (The New York Times; free registration required)
Employer-Based Insurance: Employees Are Paying More, Getting Less
Excerpt: "Changes to 2010 health benefits, which reflect the first chance employers have had to restructure their plans since the economy started tanking in September 2008, look to be even more daunting than usual. Surveys indicate that in 2010, 40% of employers will shift more premium costs onto employees and 39% will increase deductibles, co-payments, co-insurance or out-of-pocket maximums. More employers are steering workers toward catastrophic health policies with deductibles as high as $5,000 or $10,000." (Time Inc.)
Congressional Analysis Finds Health Care Plan Excise Tax Would Hit 34 Percent of Group Plans in 2019
Excerpt: "U.S. Rep. Joe Courtney, R-Connecticut, who requested that the Joint Committee on Taxation analyze the provision in health care reform legislation that the Senate Finance Committee passed last week, released the results Tuesday, October 20. Under the provision, the excise tax would apply to that portion of a group health care plan premium that exceeds $8,000 for individual coverage and $21,000 for family coverage. For plans covering early retirees and employees in certain high-risk professions, the tax threshold would be $9,850 for individuals and $26,000 for families." (Workforce Management; free registration required)
The State of Health Care Quality Report, 2009
Excerpt: "NCQA's State of Health Care Quality report is produced annually to monitor and report on performance trends over time, track variations in patterns of care and provide recommendations for future quality improvement. Now in its 13th year, the report provides an exclusive look at the performance data submitted by more than 800 health plans around the country. The report answers questions such as: How does the rising cost of health care and the economic downturn affect the quality of health care? How does the quality of care differ from one part of the country to another? What do we need to do to improve quality for all Americans?" (National Committee for Quality Assurance)
Measurement of Healthcare Quality and Efficiency: Resources for Healthcare Professionals
Excerpt: "The objective of this report is to serve as a resource on quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area." (Society of Actuaries)
New Study Finds Highest Rate of Smokers Are in Food-Service Industry: What Does That for Mean for Employers?
Excerpt: "A new study by the U.S. Substance Abuse and Mental Health Services Administration reveals that 33.6 million full-time employees ages 18 to 64 -- or 28 percent of workers -- reported they smoked cigarettes in the past month, based on survey data from 2006 to 2008. . . . 'The workplace is an ideal location for programs to educate employees about the risks of smoking and programs to promote smoking cessation to reduce risks of illnesses such as heart disease and cancer,' said the acting administrator at SAMHSA, Eric Broderick, in announcing the findings. 'The study provides important insight and updated information that can be used to assist in the developing or refining of smoking-cessation efforts to specific workplace groups,' he said." (Human Resource Executive Online)
The Comprehensive Congressional Health Reform Bills of 2009: A Look at Health Insurance, Delivery System, and Financing Provisions
Excerpt: "This report provides an overview of key provisions of the two separate comprehensive health reform bills passed by the five committees of jurisdiction in the U.S. Congress: the Finance Committee and the Health, Education, Labor, and Pensions (HELP) Committee of the Senate, and the Ways and Means, Education and Labor, and Energy and Commerce committees of the House of Representatives. While the general frameworks of the bills are very similar -- all bills include provisions intended to improve and expand coverage and all would create a comprehensive and coherent strategy for improving health care quality -- they differ in a few key respects. Most important, the Senate Finance Committee bill does not include a public plan option or a requirement that employers offer coverage, nor does it reform for more than one year Medicare's formula for setting physician fees; the House bill includes all of these features." (The Commonwealth Fund)
Fight Erupts Over Health Insurance Rates for Businesses with More Women Employees
Excerpt: "Insurers say women under the age of 55 cost more to cover because they use more health services, and not just for maternal and infant care. But Bettinazzi, the president and CEO of Visiting Nurse Association of Indiana County, believes there's something inherently wrong in charging her company more because it hires a lot of women. 'There's a great sense of unfairness,' Bettinazzi says. 'I feel angry, and maybe betrayed would be a good word.' Gender rating is the norm today, part of a complex formula of risk factors - including health history and age -- insurers say has been necessary to fairly price policies. But advocacy groups for women argue that charging more for women than men is discriminatory and should be illegal. The battle is playing out on Capitol Hill through the debate on health overhaul legislation." (Kaiser Family Foundation)
Righting Wrongful Denials of Health Insurance Coverage
Excerpt: "The problem starts with the 35-year-old Employee Retirement Income Security Act, a federal law that regulates the pensions, retirement savings programs and other benefits provided by private employers, guilds or unions. ERISA imposes two of the same requirements on employers' group insurance policies that Congress wants to apply to the individual insurance market: no denials of coverage and no increase in premiums for individuals with preexisting conditions. But it also exempts employers from state rules mandating which types of treatments must be covered and protects employers and their insurance partners from most damages if a policyholder's treatment is wrongfully delayed or denied. Patients can go to federal court and try to force the insurer to pay for the treatment, but, as Times staff writer Lisa Girion has pointed out, that's cold comfort for the families of those who die waiting for the dispute to be resolved." (Los Angeles Times)
More Legal Issues Raised by Health Insurance Exchange Legislation
Excerpt: "([This post] is part of a memorandum on legal and policy issues raised by health insurance exchanges, which will be presented at the O'Neill Center's Legal Issues in Health Care Reform conference on Monday, October 26. The full paper from which it is taken is available at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1493369)" (O'Neill Institute for National and Global Health Law)
[Opinion]
American Benefits Council Comments on Interim Final Rule on Breach Notification for Unsecured Protected Health Information (PDF)
4 pages. Excerpt: "The Council strongly supports the 'harm threshold' HHS adopted in its Interim Final Rule, requiring a covered entity to consider a number of factors to determine whether a particular disclosure poses a 'significant risk of financial, reputational, or other harm to the individual.' 45 CFR 164.402 (definition of 'breach'). If a disclosure meets the 'harm threshold,' the covered entity is required to provide notice to the affected individuals, the media (where applicable) and HHS." (American Benefits Council)
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Links to Items on Executive Comp, Benefits in General
[Guidance Overview]IRS Guidance on the Taxation of Employment-Related Settlement Payments
Excerpt: "In an internal memorandum dated October 22, 2008, but released only in July of this year, the Internal Revenue Service (IRS) Office of Chief Counsel has outlined information necessary to determine the correct tax treatment of employment-related settlement payments. See Office of Chief Counsel Internal Revenue Service Memorandum, PMTA-2009-035, dated October 22, 2008, Income and Employment Tax Consequences and Proper Reporting of Employment-Related Judgments and Settlements (the 'IRS Counsel Memorandum'). The IRS Counsel Memorandum outlines both the income and employment tax consequences, as well as the appropriate reporting, of settlement payments and contains useful information for companies settling employment-related lawsuits." (Tax Management Inc.)
Prevalence and Design of Executive and Director Stock Ownership Guidelines Among the Top 250 Companies (PDF)
21 pages. Excerpt: "The past year may prove to be another important year in the evolution of stock ownership guidelines and their prevalence among the Top 250 companies. The dramatic market decline has once again refocused investor attention on reinforcing alignment of interests between executives and directors and long-term shareholders. In addition, the fall in stock prices has affected executives' and directors' abilities to comply with stock ownership guidelines, encouraging companies to reexamine their policies. As presented in this report, the Top 250 companies commonly employ value-based ownership guidelines under which the number of shares required to be owned fluctuates based on changes in stock prices." (Frederic W. Cook & Co., Inc.)
Firms Boost Workplace Benefits to Attract and Retain Tech-Savvy Workers
Excerpt: "Pingpong and pool, free lunches on Fridays, fully stocked refrigerators, on-site yoga, generous vacation time, telecommuting options and employer-paid health coverage: If the list of perks sounds like a throwback to the dot-com boom, think again. At a time when many businesses are slashing benefits to the bone, a growing number of Chicago-area companies are bucking the trend. Those fortunate employers who can afford to go the extra mile for their workers can boost productivity and ultimately gain market share, said Joe Dwyer, chief executive at Brill Street + Co., an Internet matchmaker for job seekers and employers. 'These companies go all out to attract and retain the best and brightest,' he said." (Chicago Tribune)
Webcasts and Conferences
19th Annual National Health Benefits Conference & Expo (HBCE)in Florida on January 25, 2010
presented by Health Benefits Conference & Expo
Announcing the Results of Buck Consultants' 2009 Global Wellness Survey
Nationwide on November 18, 2009
presented by Buck Consultants, an ACS Company
Eligibility Audits for Health Plans (including Health FSAs and HRAs): Protect Your Plans From Covering Ineligibles
Nationwide on October 22, 2009
presented by EBIA / Thomson Reuters
(Click to post your webcast or conference)
Press Releases
benefitsCONNECT® Announces Real-Time Integration with Colonial Life’s Harmony® PlatformTranscend Technologies Group, Inc.
(Click to post your press release)
EmployeeBenefitsJobs.com (Sponsor)
(Click on banner to learn more.)
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