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November 23, 2009 \ Compliance \ Costs \ Administration \ Design \ Policy

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[Guidance Overview]
Insurer's Untimely Claim Denial Leads to Loss of Deferential Review

Excerpt: "EBIA Comment: Two aspects of the Tenth Circuit's decision merit further mention. First, the court expressly rejected the insurer's request that the claim be returned to the plan administrator (as opposed to the trial court) for further review. The court noted that the insurer had already been given a chance to exercise its discretion in accordance with the claims regulations -- and had failed to do so. Second, the Tenth Circuit instructed the trial court, in reviewing the claim de novo, to supplement the administrative record with additional evidence as necessary to determine the extent of the participant's disability. (In contrast, under the arbitrary and capricious standard, the courts generally limit their review to the existing administrative record.)" (Employee Benefits Institute of America)



[Guidance Overview]
Attorney's Letter Stating 'Intention to Appeal' Was Not an Appeal

Excerpt: "EBIA Comment: We agree that the DOL claims regulations impose no duty to respond to insufficient appeals. However, the consequence for an ERISA participant of missing an appeal deadline is draconian (it precludes any further consideration of a disputed claim). In addition, the case law has been mixed on what constitutes an appeal (e.g., in one case, a letter stating that the participant 'wishes to appeal' was found to be adequate, while in another, a letter requesting information on how to lodge an appeal was held inadequate because it did not actually request administrative review (see our Checkpoint Newsstand articles)). As a result, when feasible, a more formal response to insufficient appeals is probably the most advisable course and might have saved the insurer from this litigation." (Employee Benefits Institute of America)



Some Employers With Health Clinics Get H1N1 Vaccine
Excerpt: "Public health officials are distributing the H1N1 vaccine only to medical clinics, but that includes clinics based at employer work sites. Employers that do not offer work-site medical care will not be able to get the shot for high-risk employees, health officials say." (Workforce Management; free registration required)



New Health Reform Amendment Could Siphon Employer Health Care Money
Excerpt: "Employees whose incomes are below 400 percent of the federal poverty level and whose premiums are between 8 and 9.8 percent of their total income would be allowed to buy insurance on a proposed health exchange with their employer's money." (Workforce Management; free registration required)



Hawaii's Mandated Healthcare Coverage Experience Offers Some Insight Into Debate About National Healthcare Reform
Excerpt: "Many don't realize that our 50th state is first in healthcare coverage. Hawaii has provided its workers with minimum healthcare benefits for the last 35 years. The PrePaid Healthcare Act requires employers to provide healthcare coverage to employees who work at least 20 hours per week for four consecutive weeks and who earn 86.67 times the current Hawaii minimum wage a month ($7.25 x 86.67 = $628). Companies may either pay the entire monthly premium or share the cost with their workers, but the employees' share cannot exceed the lesser of 50 percent of the premium cost or 1.5 percent of the employees' monthly gross earnings." (Human Resource Executive Online)



Analysis of Health System Reform Provisions of House of Representatives and Senate Health Reform Bills
Note: This page offers an executive summary and related charts. The complete report is forthcoming. Excerpt: "[The executive summary presents] the key changes that the House and Senate bills would make to help ensure long-run cost containment and improve the quality of health care." (The Commonwealth Fund)



The Future Points to Health Insurance Plans That Provide Solid Coverage for Just About Every American
Excerpt: "After health reform, a few years from now, nearly all Americans would be required to have coverage -- at a minimum, a 'qualified' health plan, designed to Uncle Sam's specifications and providing a core of comprehensive protection. Most likely, you'd get hospitalization, emergency services, rehabilitation, prescriptions, mental-health and substance-abuse services, maternity care, and well-child services. Preventive care recommended under medical practice guidelines, such as vaccinations, abdominal aortic aneurysm screening in men ages 65 to 75 with a history of smoking, and mammograms every one to two years for women starting at age 40, would be covered. Basic qualifying plans would be grouped into tiers based on how costs are shared between plan and member. A bottom-tier plan would offer the lowest premiums, but copayments would be higher, and the insurer would pay less of the bill. Healthier people who expect to use fewer services might find such a plan appealing. A top-tier plan would have higher premiums, but members would pay less for care." (U.S. News & World Report)



Judge Orders Federal Agency to Add Same-S.ex Wife to Family Health Plan
Excerpt: "The chief federal appeals court judge in San Francisco bluntly ordered the Obama administration Thursday to stop resisting his finding that the wife of a les.bian court employee was entitled to government insurance coverage. The federal agency that oversees benefits for government employees 'shall cease at once its interference with the jurisdiction of this tribunal,' Judge Alex Kozinski said in response to the Office of Personnel Management's rejection of his earlier ruling in the case." (San Francisco Chronicle)



[Opinion]
The Ban on Genetic Discrimination Goes Into Force

Excerpt: "It is rare when antidiscrimination law is extended to a whole new group of people, but that happened on Saturday, when a federal ban on discriminating on the basis of genetic background took effect. The new law is an important step in protecting people who have inherited a predisposition to disease. It removes a significant obstacle to genetic testing, which can help prevent and treat serious illnesses. Genetic testing can warn people that they have a disposition for diseases like cancer, and it can help doctors adapt courses of treatment to particular patients." (The New York Times; free registration required)




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Links to Items on Executive Comp, Benefits in General

[Guidance Overview]
Publicly Held Corporations Should Evaluate Bonus Compensation Arrangements Before 2010

Excerpt: "We are approaching the end of the transition relief period under the Revenue Ruling for publicly held corporations that provide bonus compensation based on calendar year performance periods that is intended to be 'performance-based compensation' under Section 162(m). Such corporations should review and, if necessary, revise, in accordance with applicable amendment procedures, the terms of their performance-based bonus plans, employment agreements, severance agreements, change of control agreements and similar arrangements not later than December 31, 2009." (Cooley Godward Kronish LLP)


[Guidance Overview]
Year End Tax Planning: Consider Accelerated Recognition of Accrued SERP Benefits for FICA Purposes

Excerpt: "Under Treas. Reg. § Reg. §31.3121(v)(2)-1(e)(4), the plan sponsor/employer under a nonaccount balance plan - such as a defined benefit SERP - may delay taking into account for FICA purposes the benefit amounts accrued until the amounts are 'reasonably ascertainable.' An amount deferred under a nonaccount balance plan is not 'reasonably ascertainable' as long as it is necessary to use any assumptions other than interest, mortality, and cost of living assumptions to value the benefit. In practice, this means a defined benefit SERP or excess plan often provides a benefit that does not need to be taken into account until the employee retires. Ordinarily, this is good, as it avoids withholding taxes before earnings are paid to the employee." (Michael Melbinger via Winston & Strawn LLP)


Summary of New Rules Affecting Benefits in 2009
Excerpt: "During 2009 numerous new rules have been issued and/or gone into effect that may impact your benefit programs. Other rules require compliance by the end of 2009 or in 2010. Legislation ranging from a complete overhaul of our health care system to additional pension funding relief is pending[.] [This] alert is intended to provide an overview of some of the employee benefit issues you should consider before year-end." (Thorp Reed & Armstrong, LLP)


House Committee Approves Federal Employee Same-S.ex Partner Benefits
Excerpt: "After a heated debate over g.ay rights and extending benefits in an economic downturn, the U.S. House Oversight and Government Reform Committee on Wednesday passed 23 to 12 legislation that would provide health care and other employment benefits to the same-s.ex domestic partners of federal employees, Govexec.com reports. The 2009 Domestic Partnership Benefits and Obligations Act (H.R. 2517) would provide all of the employment benefits made available to the spouses of heterose.xual federal employees, including health insurance, retirement, disability, and other benefits . . . . The provisions apply to partners of current employees, former employees, and retirees." (PLANSPONSOR.com; free registration required)


Change in Federal Rules Regarding Time Computation (PDF)
Excerpt: "On December 1, 2009, the time computation amendments to Rule 6 of the Federal Rules of Civil Procedure will take effect, simplifying the computation of deadlines and changing the timing requirements of many rules. Under amended Rule 6, every day, including weekends and holidays, will now be counted in calculating filing deadlines. Under the soon-to-be-old rule, for time periods of less than 11 days, intervening Saturdays, Sundays and holidays were not counted. In addition, the response time periods in more than 20 rules have been changed, with most time periods adjusted to the nearest multiple of seven. Generally, one-, three-, and five-day time periods will become seven days; 10- and 11-day time periods will become 14 days; and 20-day time periods will become 21 days." (Sutherland Asbill & Brennan LLP)


New York Court OKs Out-of-State G.ay Marriage Benefits
Excerpt: "New York state's top court ruled on Thursday that public officials have the authority to recognize out-of-state g.ay marriages and pushed state lawmakers to decide whether to legalize same-s.ex marriage. G.ay marriage opponents had challenged decisions in 2006 by the New York State Department of Civil Service and Westchester County to give health insurance and other benefits to same-s.ex couples legally married in other states or countries. The ruling by the New York State Court of Appeals upheld the decision of lower courts, which had dismissed the challenge." (Reuters via Yahoo! News)


New York High Court Upholds Benefits Rights for Same-S.ex Married Couples
Excerpt: "New York's top court on Thursday rejected a Christian legal group's challenge to the provision of public employee benefits to same-s.ex couples legally married elsewhere. In a 4-3 decision the Court of Appeals did not address whether the state must recognize same-s.ex marriage, according to a news report on Leagle.com. However, with Thursday's court decision, legally married same-s.ex couples will be entitled to public employee health insurance coverage and certain other benefits provided to heterose.xual couples. The court ruling noted that while same-s.ex marriage isn't legal in New York under the state Constitution, it doesn't address whether New York can recognize a same-s.ex marriage legally performed in another state. In its decision the court urged lawmakers to clear up the matter." (PLANSPONSOR.com; free registration required)


[Opinion]
Wall Street Bonuses: Where's the Outrage?

Excerpt: "So institutional shareholders are upset at the bonuses Goldman Sachs Group is planning to shell out, as we read in today's WSJ. But what about investors at other financial institutions? Where is the outrage there? The complaint of Goldman shareholders is simple: Despite record net income, Goldman's per-share earnings will be 22% lower this year than in 2007 and roughly equal to its 2006 earnings, according to Thomson Financial. Goldman is, of course, the whipping boy of the moment. Whether the criticism is fair or not, Goldman has come to symbolize the perceived inequity between Wall Street and Main Street. And while the government bailed out Wall Street, unemployment stands above 10%, while Goldman's per-employee compensation reaches $717,000." (The Wall Street Journal)


[Opinion]
It's Time to Kill Stock Options

Excerpt: "With Silicon Valley clawing its way back from the great recession, I want to make a radical proposal. It's time to kill the stock option. I know such a notion seems unthinkable. Even mild criticism of them in these parts gets labeled as heresy. The stock option is so deeply embedded in the culture and mythology of Silicon Valley that it seems hard to imagine how the world's leading hub of innovation could exist, much less thrive, without it. But hear me out. The evidence is clear to me that stock options have outlived their purpose, and have actually become a liability to the valley's innovation economy. At a moment when the economy stands at a crossroads, the time feels right to fundamentally rethink the incentives the valley offers to employees for their risk-taking and inventiveness." (San Jose Mercury News)



Webcasts and Conferences

Beyond the Bad Economy: Jobs, Retirement, Health and Social Insurance
in District of Columbia on January 21, 2010
presented by National Academy of Social Insurance

Decumulation and Defined Contribution Plans & EFAST2 Is Around the Corner: Will You Be Ready?
in Illinois on December 17, 2009
presented by ASPPA Benefits Council of Chicago

Get Smart Fiduciary Training Event
in Michigan on December 9, 2009
presented by Freedom One Financial Group

(Click to post your webcast or conference)

Press Releases

Transamerica Announces New Fund Platform for Company-Sponsored Retirement Plans
Transamerica Retirement Services

Medication Compliance Is a Key Concern for Employers, According to New Survey
National Pharmaceutical Council

(Click to post your press release)

Employee Benefits Jobs

Pension Administrator
for Pension Administration Firm located in Westchester, NY
in NY

Pension Administrator
for Jordan & Associates
in CA

Daily Valuation Manager
for PensionTrend, Inc
in MI

Account Manager
for Alliance Benefit Group
in KS, MO

401(k) Administrator
for Iron Administration, LLC
in IL

(Click to post your job opening | View all jobs | RSS feed for jobs RSS feed of all jobs )


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