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Health & Welfare Plans Newsletter

June 23, 2010

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This webcast will examine the just-released grandfathered health plan regulations that determine whether health plans have to comply with the full scope of PPACA, or whether certain important provisions can be avoided. You'll learn the 12 main ways grandfathered status can be lost, special rules for collectively bargained plans and whether the law applies to retiree-only plans, dental, vision and more.

[Official Guidance]
Text of Interim Final Regulations Under the Affordable Care Act's New Patient's Bill of Rights, Including Application of Preexisting Condition Exclusions, Annual/Lifetime Limits, and Rescissions
196 pages. These regulations will be published in the Federal Register on June 28.
(Internal Revenue Service; Employee Benefits Security Administration; U.S. Department of Health & Human Services)

[Official Guidance]
Fact Sheet: The Affordable Care Act's New Patient's Bill of Rights
Excerpt: "The new regulations will prohibit insurance plans from denying coverage to children based on a pre-existing conditions. This ban includes both benefit limitations (e.g., an insurer or employer health plan refusing to pay for chemotherapy for a child with cancer because the child had the cancer before getting insurance) and outright coverage denials . . . ."
(U.S. Department of Health & Human Services)

[Official Guidance]
Text of DOL Wage and Hour Division Administrator's Interpretation No. 2010-3: FMLA Definition of 'Son and Daughter'
3 pages. Excerpt: "It is the Administrator's interpretation that the regulations do not require an employee who intends to assume the responsibilities of a parent to establish that he or she provides both day-to-day care and financial support in order to be found to stand in loco parentis to a child. For example, where an employee provides day-to-day care for his or her unmarried partnerís child (with whom there is no legal or biological relationship) but does not financially support the child, the employee could be considered to stand in loco parentis to the child and therefore be entitled to FMLA leave to care for the child if the child had a serious health condition."
(Wage and Hour Division, U.S. Department of Labor)

[Official Guidance (DOL News Release)]
U.S. Department of Labor Clarifies FMLA Definition of 'Son and Daughter'
Excerpt: "The U.S. Department of Labor [on June 22] clarified the definition of 'son and daughter' under the Family and Medical Leave Act to ensure that an employee who assumes the role of caring for a child receives parental rights to family leave regardless of the legal or biological relationship."
U.S. Department of Labor

[Guidance Overview]
The Definition of 'Grandfathered Status' Under the New Health Care Reform
Excerpt: "A 'grandfathered plan' is a group health plan was in existence on the date of enactment of Health Care Reform, March 23, 2010. Regulations published June 14, 2010 provide guidance on what will cause an existing group health plan to lose grandfathered status."
(Troutman Sanders LLP)

HHS, DOL and Treasury Issue New Interim Final Regulations in a 'Patient's Bill of Rights'
Excerpt: "The interim final regulations address . . . provisions that generally apply to all health plans, including grandfathered health plans . . . ."
(Hewitt Associates)

Obama Warns Health Insurers Against Using Reform to Boost Premium Rates
Excerpt: "''Insurance companies ... shouldn't see it as an opportunity to enact unjustifiable rate increases,' Obama said ... ' He also 'said companies must publicly justify any rate increases on both the federal health Web site and their own sites, adding that there are 'genuine cost drivers that are not caused by insurance companies'' . . . ."
(Henry J. Kaiser Family Foundation)

Are State Challenges to Legality of Patient Protection and Affordable Care Act Likely to Succeed?
Excerpt: "This brief examines the [state] officials' arguments against PPACA and concludes the mandate rests on firm legal footing but has two vulnerabilities: (1) the Supreme Court could set new precedent and (2) enforcement provisions must be strengthened to preserve the government's ability to ensure insurance coverage."
(Urban Institute)

Gains from Choice in Health Insurance
Excerpt: "The value of choice is explored in a recent study [titled: Let Them Have Choice: Gains from Shifting Away from Employer-Sponsored Health Insurance.]"
(National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)

Tax Breaks for Employer-Sponsored Health Insurance
Excerpt: "This tax exclusion is extremely costly -- it reduces federal and state tax revenues by $260 Billion per year and is the government's third largest expenditure on health care, after Medicare ($400 Billion) and Medicaid ($300 Billion)."
(National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)

State Health Care Reform Update, June 23, 2010
Excerpt: "Twenty states so far have rejected federal funds to administer a high-risk insurance pool, as designed by the Patient Protection and Affordable Care Act."
(Wolters Kluwer)

New Website on Meeting Federal Requirements for 'Meaningful Use' of Electronic Health Record Systems
Excerpt: "Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of EHRs will qualify for Medicare and Medicaid incentive payments . . . ."
(California HealthCare Foundation)

Bariatric Surgery: The Benefits and Risks for Plan Sponsors (PDF)
Excerpt: "Recent studies demonstrate that bariatric surgery offers health benefits to many morbidly obese individuals, forcing increasing numbers of plan sponsors to consider covering it as part of the group medical plan. However, plan sponsors covering bariatric surgery should consider limiting their coverage to include only proven centers of excellence, as explained in this article."
(WorldatWork via Aon Consulting)

Senator Scales Back Proposed COBRA Subsidy Extension Plan
Excerpt: "Under the amendment that Sen. Casey proposed last week to tax extension legislation, employees laid off from June 1 through Nov. 30, would be eligible for the 65% federal premium subsidy for six months."
(Business Insurance)

Most Americans Say Paid Sick Days a Basic Worker's Right
Excerpt: "Researchers at the National Opinion Research Center at the University of Chicago found 75% of survey respondents consider paid sick days a basic worker's right, and 75% believe that employers should be required by law to provide paid sick days to workers."

High-Deductible Health-Insurance Plans Grow More Attractive to Employers
Excerpt: "High-deductible health plans and the health savings accounts (HSAs) that link to them are becoming a familiar fixture on the insurance landscape, even though they get mixed reviews from many consumers and health-policy experts."
(The Washington Post; free registration required)

Using a HSA to Pay for Retirement Medical Costs
Excerpt: "If distributions are spent on qualified medical expenses no taxes will be due upon withdrawal."
(U.S. News & World Report)

Facing New Pressure, Health Plans Beef Up Customer Service
Excerpt: "Cutting inscrutable health-insurance jargon out of their communications. Opening retail stores to answer people's questions and offer wellness classes. Measuring customer-service efforts to give callers a better experience."
(MarketWatch, Inc.)

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Executive Compensation; Benefits in General

Letting Employees Define Their Own Rewards May Be the Only Way to Keep Them, Says New Book
Excerpt: "[W]hile employees increasingly want personalized jobs, most companies continue to offer their workers standardized pay, benefits, perks, and training -- to their own detriment . . . ."

ERISA Plans' Ultimate -- and Criminal -- 'Prohibited Transaction' Rule
Excerpt: "We all have a general knowledge that kickbacks and racketeering schemes of any sort are illegal. But many do not realize that there is a specific 'anti-kickback' rule applying to ERISA plans that is NOT found in ERISA, but instead under criminal law."
(Business of Benefits)

Webcasts and Conferences

Employee Driven Health Care: A Checklist for Employers
Nationwide on July 29, 2010
presented by Lorman Education Services

Total Compensation Statements as a Tool to Communicate Total Value
Nationwide on July 8, 2010
presented by Lorman Education Services

Press Releases

ASPPA & NTSAA Request Guidance on 403(b) Plan Terminations
ASPPA (American Society of Pension Professionals & Actuaries)

PBGC Protects Penn Traffic Co. Pension Plans
Pension Benefit Guaranty Corporation (PBGC)

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