BenefitsLink Health & Welfare Plans Newsletter for July 26, 2010

[Guidance Overview]
Interim Final Regulations for Health Plans for Internal Claims, Appeals, and External Review (PDF)
2 pages. Excerpt: "Consumers in states where review processes fail to meet federal standards will have access to a federal external review program, if their state fails to adopt the new standards in the regulations by July, 2011."
(Brucker & Morra, APC)

[Guidance Overview]
DOL's Guidance on FLSA Lactation-Break Requirement
Excerpt: "DOL has not specified any minimum number of, frequency of, or duration for these breaks. It says only that the amount of time must be 'reasonable', and that the breaks must be permitted 'as frequently as needed' by the employee."
(Fisher & Phillips LLP)

[Guidance Overview]
Guidelines for Appeals and External Claims Review in 2010 Health Reform
Excerpt: "Six new requirements have been added for internal claims procedures and appeals, including a 24-hour notice requirement for benefit determinations, according to new interim final rules issued jointly by the Internal Revenue Service, the Department of Labor's Employee Benefits Security Administration . . ., and the Department of Health and Human Services' Office of Consumer Information and Insurance Oversight . . . ."
(Wolters Kluwer)

[Guidance Overview]
The New Paradigm for Health Care Financing under Health Care Reform (PDF)
6 pages. Excerpt: "[This advisory] provides the timeline for which major guidance has been issued. . . . The remainder of this Advisory is split into three key topics - Decisions and To Dos for 2010, The Grandfather Advantage and Requirements, and 2014 Full Implementation = Play or Pay. Plus there is an insert containing a timeline for Plan Sponsors with some financial impacts."
(CHEIRON, Inc.)

[Guidance Overview]
Interim Final Rules on Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Patient Protections, and Preventive Care (PDF)
8 pages. Excerpt: "Under the Law, group health plans are subject to new requirements related to coverage offered under such plans, including a prohibition on the application of preexisting conditions for individuals under age 19, no lifetime or annual limits, restrictions on rescissions, mandatory patient protections, and coverage of preventive care services."
(Morgan, Lewis & Bockius LLP)

[Guidance Overview]
Implementing Preventive Services under Health Reform
Excerpt: "The Affordable Care Act . . . requires insurers to cover specific preventive services without cost sharing, thus making the services more accessible and increasing the likelihood that individuals will take them up."
(Health Affairs)

[Guidance Overview]
What It Means to Be a Grandfathered Health Plan Under Healthcare Reform (PDF)
10 pages. Excerpt: "Changes to a plan made between March 23, 2010 and June 17, 2010 that would take a plan out of grandfathered status can be revoked until the first day of the first plan year beginning on or after September 23, 2010. If the changes are revoked, the plan remains in grandfathered status."
(Saul Ewing LLP)

[Guidance Overview]
Agencies Issue Regulations on Coverage of Preventive Services
Excerpt: "[I]t looks like more guidance may be coming -- according to the preamble, the agencies are developing additional guidelines on the use of value-based insurance designs involving preventive services and are seeking comments on this topic."
(Employee Benefits Institute of America)

Analysis Calculates Costs of Family Health Insurance
Excerpt: "The analysis . . . found that of employees nationwide who enroll in health care plans sponsored by their employers, 50% opt for single coverage, 30.5% select family coverage and 19.5% enroll in employee-plus-one-dependent coverage."
(Business Insurance)

For Chronic Care, Try Turning to Your Employer
Excerpt: "Your employer may seem like an unlikely choice. Chronic conditions account for 25 percent of all medical costs, studies show, and an employee with a longstanding illness can mean higher health care expenses and lower productivity to company bean counters."
(The New York Times; free registration required)

Quantifying the Benefits Workshifting Has for Employers, Employees and the Community (PDF)
23 pages. Excerpt: "Workshifting, and in particular, home-based work, offers a relatively simple, high return-on-investment solution to some of the nation's most vexing problems . . . ."
(Telework Research Network / Aerodite, Inc.)

Guidance on Appeals Process and External Review Rules Under Health Care
Excerpt: "These rules, which include extensive new requirements that expand upon those in the existing DOL claims procedure regulations, are scheduled to be published in the Federal Register on July 23, 2010."
(Employee Benefits Institute of America)

For Insurers, Health Care Fight Is Now Over Details
Excerpt: "The law requires health insurers to spend at least 80 cents out of every dollar they collect in premiums on the welfare of patients, a critical issue for the companies' bottom lines. But state regulators are only now deciding what precisely that means . . . ."
(The New York Times; free registration required)

Benefits in General; Executive Compensation

[Guidance Overview]
The Dodd-Frank Act Executive Compensation and Corporate Governance Reforms
Excerpt: The Dodd-Frank Act requires the SEC to amend its rules to modify the executive compensation disclosure requirements to include 'pay versus performance' and 'internal pay disparity' disclosure.'"
(Nixon Peabody LLP)

[Guidance Overview]
Secondment, Deferred Compensation, and Subpart F Income: A Potential Trap
Excerpt: "This article points out that while a secondment agreement, that is properly worded and implemented, may act as an effective shield against Code section 457A, it may also inflict a detrimental blow to the US company's subpart F income. Accordingly, any US company that seconds its employees to related foreign-based entities should re-evaluate that arrangement to assure that it is obtaining the desired tax outcome."
(Miller & Chevalier Chartered)

Executive Compensation Provisions of the Dodd-Frank Wall Street Reform and Consumer Protection Act (PDF)
8 pages. Excerpt: "The Act has broad implications for the executive pay and corporate governance practices of all public companies. Although it will take some time for regulators to issue guidance under the Act, companies should begin to assess and consider how the Act will impact their executive pay practices and the planning process for the 2011 proxy season."
(Thompson Hine LLP)

What Your Board Needs to Know About Corporate Governance and Executive Compensation Provisions in the Dodd-Frank Act (PDF)
7 pages. Excerpt: "While many of the corporate governance-related measures in the Dodd Frank Act are similar to those contained in the RAFSA, the final legislation does differ from the RAFSA in a number of areas, including requirements with regard to non-binding shareholder votes on 'golden parachutes,' the frequency of Say on Pay votes and the elimination of the RAFSA's majority voting standard for the election of directors."
(Sutherland Asbill & Brennan LLP)

Special Report on Employee Relocation
Excerpt: "The recession forced a drastic shift in relocation philosophies in the last two years, as companies struggled to find the right people for a position, move them where they're needed and keep them there in an economically feasible way."
(Workforce Management; free registration required)

Fish v. Greatbanc Trust Corp. Amicus Brief, in Support of Plaintiffs' Opposition to Defendants' Joint Motion for Summary Judgment
Excerpt: "Section 413 of [ERISA], generally gives plaintiffs six years from the date of a fiduciary breach to file an action to redress the breach. In cases where 'the plaintiff' had 'actual knowledge' of the breach, however, the statute shortens the period to three years beginning on 'the earliest date on which the plaintiff had actual knowledge of the breach or violation.'"
(U.S. Department of Labor)

Supplemental Pay in the Healthcare Industry: Overtime Pay, Bonuses, and Shift Differentials
Excerpt: "The use of supplemental pay in the healthcare industry differs from other service-providing industries primarily in that shift differentials play a greater role, while bonuses appear to play a lesser role. The relative importance of shift differentials in the healthcare industry is probably related to the 'round-the-clock' nature of healthcare services in general."
(U.S. Bureau of Labor Statistics)

State Judges Can Rule on QDRO Cases
Excerpt: "A federal appellate court has ruled that state courts can decide whether domestic relations orders . . . meet the requirements for being considered qualified domestic relations orders . . . under federal benefits law."
(PLANSPONSOR.com)

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