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Health & Welfare Plans Newsletter

July 28, 2010

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These one-day regional seminars will provide a quick and cost-effective way for jointly-managed plans to know what they need to do now in response to unfolding reform regulations. Included is an afternoon workshop addressing the early retiree subsidy application process. Two additional workshop options are also offered -- Multiemployer Perspectives and Public/Governmental Plan Perspectives.

[Guidance Overview]
Health Reform Rules for Internal Claims and Appeals and External Review Processes
3 pages. Excerpt: "The rules provide that the denial, reduction, termination, or failure to make payments (in whole or part) for a benefit is an adverse benefit determination that must be eligible for an internal claims and appeals process."
(PricewaterhouseCoopers LLP)

[Guidance Overview]
Proposed Modifications to HIPAA Privacy and Security Rules to Implement HITECH Act (PDF)
19 pages. Excerpt: "This White Paper addresses the following notable provisions of the Proposed Rule: Part 1: New privacy and security standards imposed on business associates and their subcontractors; Part 2: Restrictions on marketing involving protected health information; Part 3: Restrictions on the sale of PHI; Part 4: Revisions to the requirements for use and disclosure of PHI for research purposes; Part 5: Other significant revisions to the Privacy Rule; Part 6: Revisions to the Enforcement Rule."
(McDermott Will & Emery)

[Guidance Overview]
Internal Appeals and External Review Processes under the Affordable Care Act
Excerpt: "Although group health plans subject to ERISA must already comply with uniform standards for handling claims and appeals for benefits, the Rules provide additional requirements that must be incorporated into these internal claims procedures."
(Kilpatrick Stockton LLP)

[Guidance Overview]
Agencies Outline Preventive Care Coverage Requirements under PPACA (PDF)
6 pages. Excerpt: "The Regulations clarify that a network-based plan is not required to provide coverage for recommended preventive services delivered by an out-of-network provider and may impose cost-sharing requirements for any such out-of-network services that are offered."
(Alston & Bird LLP)

[Guidance Overview]
How to Keep Grandfathered Status Under Health Care Reform Rules
Excerpt: "This Update summarizes a recently issued interim final rule that explains which insured and self-insured health plans have grandfathered status, what can eliminate that exemption, and how grandfathered status affects compliance."
(Mercer LLC)

A First Year's Report Card for the COBRA Premium Assistance Program
Excerpt: "Based upon a literature scan, key informant interviews, and available data, this brief addresses key questions: To what extent did subsidy increase take-up of COBRA coverage? Did subsidy reduce 'adverse selection' of older, sicker people into COBRA coverage? Are yet higher subsidies or other measures needed to move closer to full enrollment? What are the implications for COBRA policy under health reform and for the implementation of health reform itself?"
(Urban Institute)

Removing Ineligible Dependents Could Save Companies Between 4% to 6% of Their Annual Health Care Costs.
Excerpt: "To offset [expected] higher expenses, companies will raise premiums on plans and systematically weed out ineligible individuals . . . ."

Census Data Reveal Broad Differences Among States in Rates of Uninsured
Excerpt: "The statistics are for 2007 and show health insurance coverage by state and for each of the country's roughly 3,140 counties. The numbers do not include the impact on millions of people who lost their jobs and health insurance after the recession began in December 2007."
(The Washington Post; free registration required)

An employer writes:

"I have to tell you that of all the job boards I've ever used, this one has the best quality of candidates. I don't get flooded with tons of resumes, and even the candidates who aren't fit for the jobs we have don't miss the mark by much."

Benefits in General; Executive Compensation

Public Employees Get More Benefits Than Private-Sector Counterparts
Excerpt: "As of March, 88% of state and local government workers had access to employer-sponsored medical plans, compared with 71% of private-sector workers, according to a Labor Department report released Tuesday."
(The Wall Street Journal)

After Tighter Pay Standards Established, 17 Banks Paid Out $1.6 Billion in Bonuses, Golden Parachutes, Retention Awards and the Like
Excerpt: "President Obama's effort to curb executive pay at bailed-out financial institutions was hobbled from the start. [The White House pay czar] was allowed to veto compensation packages for top bankers at institutions that had received taxpayer funds, but only until the banks repaid them."
(The New York Times; free registration required)

Webcasts and Conferences

"403(b) Plan Design Workshop" - Boston
in Massachusetts on August 27, 2010
presented by SunGard Relius

"Cross-Tested/Safe Harbor 401(k) Plan Design Workshop" - Boston
in Massachusetts on August 26, 2010
presented by SunGard Relius

"Cross-Tested/Safe Harbor 401(k) Plan Design Workshop" - Charlotte
in North Carolina on August 25, 2010
presented by SunGard Relius

Voluntary Fiduciary Correction Program Workshop
in California on August 31, 2010
presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

Press Releases

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Newly Posted Employee Benefits Jobs

Compliance Manager
for Associated Pension Consultants
in CA

Payroll Coordinator
for The Glenmede Trust Company
in PA

Retirement Plan Consultant
for Retirement Alliance, Inc.
in AZ, CA, CO, NM, NV, OK, TX, UT

Institutional Sales & Investment Advisor
for City National Bank
in CA

Account Manager
for The Standard

Benefit and Planning Counselor
for Principal Financial Group
in NY

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