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Health & Welfare Plans Newsletter

July 22, 2010

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This one-hour e-learning course will examine the 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 IRS, DOL, HHS Interim Final Regs on Internal Claims and Appeals and External Review Processes under the Patient Protection and Affordable Care Act (PDF)
128 pages, as submitted to the Office of the Federal Register this morning. Scheduled for publication in the Federal Register on July 23. Excerpt: "These interim final regulations generally apply to group health plans and group health insurance issuers for plan years beginning on or after September 23, 2010. These interim final regulations generally apply to individual health insurance issuers for policy years beginning on or after September 23, 2010."
(U.S. Department of Health & Human Services; U.S. Department of Labor; U.S. Department of the Treasury)

[Official Guidance]
Fact Sheet: 'The Affordable Care Act: Protecting Consumers and Putting Patients Back in Charge of Their Care' (PDF)
5 pages. Excerpt: "Today, the Obama Administration is announcing new regulations that will allow consumers to appeal decisions made by their health plans and the availability of resources that will be used to help give consumers more control of their health care decisions. Today's announcements include: . . . . [f]or the first time, the right to appeal decisions made by their health plan to an outside, independent decision-maker, no matter what State they live in or what type of health coverage they have."
(U.S. Department of Health & Human Services; U.S. Department of Labor; U.S. Department of the Treasury)

[Guidance Overview]
Employers Face Penalties with New Nondiscrimination Rules Under Health Insurance Reform
Excerpt: "[T]he consequences of failing to meet the nondiscrimination requirements for insured health plans will be different than taxation to employees, as under self-insured plans. For both insured and self-insured plans, an employer will be prohibited from discriminating."
(Employee Benefit News; free registration required)

[Guidance Overview]
Elimination of Retiree Drug Subsidy Deduction Under Health Care Reform
Excerpt: "Employers that decide to retain retiree prescription drug benefits should ensure they incorporate the future tax liability of these benefits into their current and projected earnings. Employers that decide to eliminate retiree drug benefits should prepare for the likely negative responses and potential litigation associated with that decision."
(McDermott Will & Emery)

[Guidance Overview]
What Do Employers with HIPAA-Covered Health Plans Really Need to Know About Recently Proposed Revisions to HIPAA Regulations?
Excerpt: "Employers should note that [HIPAA] applies only to a narrow subset of employee health information, i.e., individually identifiable health information created or received by, or on behalf of, a group health, dental, vision, or pharmacy benefit plan, employee assistance program, health care reimbursement flexible spending account, or certain long-term care plans."
(Littler Mendelson P.C.)

[Guidance Overview]
Grandfathered Plan Rules Clarified with New Regulatory Guidance (PDF)
A chart shows which changes affect grandfathered plan status under the rules provided under the new regulations."
(Kelly, Hannaford & Battles P.A.)

[Guidance Overview]
New Interim Final Rules Address Pre-Existing Condition Exclusions, Annual and Lifetime Limits, Rescissions, and Other Patient Protections
Excerpt: "If a plan has a network of providers, the regulations contain the following rules: If a participant must choose a primary care provider (PCP), it must allow the participant to select any available participating PCP. For a child, the plan must allow a participating pediatrician to be chosen as a PCP. No preauthorizations or referrals are permitted in order for a participant to have access to an OB/GYN provider."
(Davis Wright Tremaine LLP)

[Guidance Overview]
Mental Health Parity and Addiction Equity Act Compliance Alert (PDF)
Excerpt: "The Emergency Economic Stabilization Act of 2008 included provisions for permanent inclusion of the Mental Health Parity Act . . . as part of ERISA regulations."
(William Gallagher Associates)

Employers Initiate Medication Adherence Initiatives
Excerpt: "Some employers, after years of simply helping cover the cost of prescription medications, are experimenting with financial and behavioral strategies to persuade workers to actually take the drugs, in the hope that a lower investment upfront will ward off strokes and other costly medical problems later."
(Workforce Management; free registration required)

Health Insurance Tax Credits for Small Business
Excerpt: "For this study, Families USA and Small Business Majority commissioned The Lewin Group to analyze data on business sizes and wages from the U.S. Agency for Health Care Research and Quality and the U.S. Census Bureau in order to quantify the number of employers who will be eligible to receive help from this provision. Lewin was then asked to use its Health Benefits Simulation Model to quantify the number of employers who will be eligible for the maximum tax credit."
(Families USA)

Report Gauges Impact of Health Reform on Small Group Plans
Excerpt: "According to the paper's author . . . some of the factors impacting small group and individually purchased health insurance are the characteristics of the health insurance markets prior to reform, whether plans are grandfathered or are newly created under reform, the health status and claims experience of the covered group or individual, individual coverage decisions, policy decisions that will be made at the state level, and success of cost containment efforts."
(Wolters Kluwer)

Assessing Health Reform's Impact on Four Key Groups of Americans
Excerpt: "Examining the new law from the perspective of four groups of Americans can help explain the potential and the challenges ahead."
(Health Affairs)

New Rules Guarantee Patients' Right to Appeal Insurance Claim Denials
Excerpt: "The regulations guarantee consumers the right to appeal denials -- directly to their insurers and then, if necessary, to external review boards."
(Henry J. Kaiser Family Foundation)




The nation's workforce and health care system are constantly evolving and so are the legal issues. Law Journal Press helps you handle any benefits law question with up-to-date, authoritative books on all aspects of the field. Get legal and practical advice from leading experts on everything from COBRA to ERISA, "contingent" employees to family and medical leave, and more. Browse our product listings for detailed information and special offers.
Sponsored by ALM

Benefits in General; Executive Compensation

[Guidance Overview]
New Corporate Governance, Executive Compensation and Proxy Voting Provisions Apply to All Public Companies
Excerpt: "[M]any of the Financial Reform Act's provisions require rulemaking either by the SEC, the national securities exchanges or both, and some provisions include deadlines for the promulgation of SEC rules. The table . . . summarizes the actions needed to effect each of the provisions . . ., the deadline (if any) for those actions to be taken and any available exemptions."
(Perkins Coie LLP)

[Guidance Overview]
Financial Reform Bill and New Corporate Governance Requirements (PDF)
5 pages. Excerpt: "'Say on Pay' has been applicable for some time in Europe and for certain TARP companies in the United States, and may have a significant effect on disclosure practice and executive compensation structures."
(Morgan, Lewis & Bockius LLP)

[Guidance Overview]
IRS Continues to Rule Favorably on VEBA Domestic Partner Benefits (PDF)
Excerpt: "A VEBA may provide an otherwise permissible 'life benefit' (including a monthly survivorship benefit), payable by reason of the death of an employee, to a designated beneficiary who is a domestic partner without further limitation."
(Sutherland Asbill & Brennan LLP)


Webcasts and Conferences

Evaluating Your Third-Party Administrator: Are You Getting What You're Paying For?
Nationwide on August 9, 2010
presented by Lorman Education Services

Is Your Health Care Plan Grandfathered Under the Health Care Reform?
Nationwide on August 18, 2010
presented by Lorman Education Services


Press Releases

RPAG Inks System Deal With OneAmerica
Retirement Plan Advisory Group


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