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Mental Health Parity and Addiction Equity Act of 2008 Regulations Released
Excerpt: "The key issues addressed in the regulations are: Parity in medical management, a framework for parity comparison, and the prohibiting of specific plan designs. Plan sponsors that have already done an analysis and made changes to their design may have to revisit the analysis in light of the specific framework set out in the regulations. They will also have to take a closer look at medical management techniques to make sure they are compatible across all benefits."
New Interim Final Regulations on Mental Health Parity and Addiction Equity Act of 2008
Excerpt: "Overall, the Regulations were more expansive than many had anticipated and contained some surprises. Plan sponsors (many of whom adopted changes to their plan designs to comply with the Act without the benefit of interpretive guidance) will now need to review their plan designs to determine whether their plans are in parity under the rules as set forth in the Regulations -- particularly with regard to non-quantitative treatment limitations (such as medical management tools). Additionally, the parity tests for financial requirements and quantitative treatment limitations are complex and will require in-depth analysis. The Regulations provide a good faith compliance period until the applicability date, but there may be certain aggressive plan designs that plan sponsors may wish to change prior to the applicability date [of January 1, 2011 for most calendar year plans]."
(Groom Law Group)
Overview of Interim Final Regulations on Mental Health Parity Law (PDF)
8 pages. Excerpt: "The Departments of Treasury, Labor, and Health and Human Services have released interim final regulations interpreting the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The regulations contain some complicated rules for determining parity and many employers will likely have to make significant changes in how they provide mental health and substance use disorder benefits to their employees."
Parity Law Expands Mental Health Access
Excerpt: "The law, which took effect for most plans Jan. 1, applies to groups of more than 50 employees . . . . Higher deductibles, steeper co-pays and other restrictions are no longer allowed for mental health and substance abuse treatment."
(Kaiser Health News)
Federal Judge in Pennsylvania OKs FMLA Claims Against Individuals
Excerpt: "[The judge] refused to follow decisions from federal courts in Utah, Minnesota and Kansas that said FMLA's individual liability provisions apply only to corporate officers. . . . In a ruling that defines the scope of individual liability under the Family and Medical Leave Act, a federal judge has refused to dismiss claims against a trio of human resources executives and a manager who allegedly set out to find a reason to fire a worker soon after learning that he needed to schedule a leave for a surgery."
Dependent Child Health Insurance Mandated in Wisconsin
Excerpt: "Employers who have fully-insured plans or governmental/school district self-insured plans are now required to cover adult children meeting the law's requirements on and after January 1, 2010. Employers affected by the new law are now required to offer coverage to adult children in two categories: . . . ."
(Michael Best & Friedrich)
Health Plan's TPA Was an ERISA Fiduciary Despite Contractual Disclaimer of Fiduciary Status
Excerpt: "The third-party administrator (TPA) in this case made payments on infertility and mental health claims in excess of the applicable caps and lifetime maximum limits imposed under the employer's group health plan. The employer, as plan sponsor, sued the TPA, claiming that making overpayments on claims was a breach of fiduciary duty under ERISA. The TPA argued, however, that although it was contractually obligated to determine claims and pay qualifying claims from plan assets, it should not be deemed an ERISA fiduciary because it disclaimed fiduciary status in its contracts with the employer."
(Employee Benefits Institute of America)
COBRA Election Notice Presumed Received Based on Date-Stamped Evidence of Mailing by U. S. Postal Service
Excerpt: "[T]he employer presented evidence that when its TPA received notice of a qualifying event, it processed, printed, and mailed the election notice to the beneficiary. According to the evidence, the TPA then presented a log to a clerk at the U.S. Post Office listing the notices to be mailed, and the post office clerk verified that each item being mailed corresponded to the names on the log and stamped the log to show evidence of mailing. Based on this proof, the court found that there was sufficient evidence that the employee's notice was mailed on a specific date . . . ."
(Employee Benefits Institute of America)
Value of Nondependent Domestic Partner's Retiree Coverage Is Taxable to Employee
Excerpt: "This private letter ruling addresses the tax treatment of contributions required to pre-fund retiree health coverage under a union-negotiated health plan. . . . [T]he trust treated contributions made on behalf of domestic partners as taxable so that the value of coverage for a domestic partner would be included in an employee's gross income in a taxable year if the employee expected to have a domestic partner upon becoming eligible for benefits under the plan."
(Employee Benefits Institute of America)
Senate Bill to Extend COBRA Subsidy Introduced
Excerpt: "A previous congressional extension of the subsidy expired Sunday, February 28. Unless Congress acts, employees laid off as of March 1 no longer are eligible for the subsidy."
COBRA Subsidy Expiration Would Affect Millions, DOL Says
Excerpt: "In all, the Labor Department said Monday that 5 million people who lose their jobs this year would lose the 15-month, 65% federal premium subsidy. . . . Without an extension, employees let go on or after March 1 are ineligible for the subsidy."
Chart of State Legislation Opposing Proposed Healthcare Legislation Mandating Coverage
Updated March 1, 2010. Excerpt: "As part of state-based responses to federal health reform legislation, individual members of at least 32 state legislatures are using the legislative process to seek to limit, alter or oppose selected state or federal actions, including single-payer provisions and mandates that would require purchase of insurance. In general the measures seek to make or keep health insurance optional, and allow people to purchase any type of coverage they may choose. The individual state language varies."
(National Conference of State Legislatures)
GAO Report: Spending, Beneficiary Cost Sharing, and Cost-Containment Efforts for High-Cost Drugs Eligible for a Specialty Tier
43 pages. Excerpt: "GAO was asked to provide information about high-cost drugs eligible for a specialty tier. This report provides information on these drugs including spending under Medicare Part D in 2007, the most recent year for which claims data were available; how different cost-sharing structures could be expected to affect beneficiary out-of-pocket costs; how negotiated drug prices could be expected to affect beneficiary out-of-pocket costs; and information Part D plan sponsors reported on their ability to negotiate price concessions and to manage utilization.' Executive summary is online at http://www.gao.gov/highlights/d10242high.pdf
(U.S. Government Accountability Office)
Mandatory Healthcare Insurance a Bitter Pill for Massachusetts Low-Wage Workers
Excerpt: "Massachusetts' health insurance mandate has more workers getting coverage through their employers but has left many low-wage earners in a financial quandary -- and it hasn't put a dent in rising health care costs. The state's health care experiment offers a cautionary tale for federal health reform efforts."
Research Paper: What Is the Distribution of Lifetime Health Care Costs From Age 65?
Excerpt: "The brief's key findings are:  Health care costs loom as a major risk for retirees, with nursing home care as the real wild card.  A typical couple at age 65 can expect to spend over its remaining lifetime: $197,000 with a 5-percent risk of exceeding $311,000, excluding nursing home care; or $260,000 with a 5-percent risk of exceeding $570,000, including nursing home care.  Households need to figure out how to handle such risk."
(Center for Retirement Research at Boston College)
Runaway Health Costs Are Rocking Municipal Budgets
Excerpt: "A six-month review by the Globe found that municipal health plans, which cover employees, retirees, and elected officials, provide benefit levels largely unheard of in the private sector. Copays are much lower. Some communities do not force retirees onto Medicare at age 65. Many citizens on elected boards -- some after serving as few as six years -- receive coverage for life, too."
COBRA Subsidy Is Both Generous and Necessary
Excerpt: "The COBRA subsidy is a lifesaver for those who get it. But if you never had health insurance or have been paying for an individual plan out of your own pocket, you might wonder why Congress continues to bestow this generous benefit on a select group of people who previously enjoyed group health insurance."
(Kathleen Pender on SFGate.com)
Executive Compensation; Benefits in General
Obama Budget Proposes Major Worker Classification Reforms
Excerpt: "The Administration's proposals would send a strong signal that it supports potential groundbreaking changes -- which are likely to have ripple effects on employee benefit programs, wage and hour laws and many other areas."
(Groom Law Group)
Employee Ownership Update for March 1, 2010
NCEO Executive Director Corey Rosen discusses the following: The UK's Conservative Party is proposing that employees in any public service organization be able to reorganize as an employee-owned company. The NCEO is preparing data on options, ESPPs, etc., in large public companies. ABC News ran a moving story on a new ESOP at Bob's Red Mill. The FED is sponsoring an essay contest on employee ownership. Dan Janich and Elizabeth Dodge have been appointed to the NCEO board.
(National Center for Employee Ownership)
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