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Health & Welfare Plans Newsletter

July 29, 2010

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No matter how benefits-savvy your employees may be, today’s health care environment can confuse the most sophisticated consumer. That’s why companies large and small use BeneCom for their benefits communication. We know benefits and we understand what employees need to know to make them work – for themselves and for you. And while we’re at it, we make your life a little easier, too.

For more information visit our site or call (860) 674-2626, Ext. 2001

[Guidance Overview]
Interim Final Regulations Could Mean Trouble for Grandfathered Health Plans
Excerpt: "Employers with grandfathered plans must analyze whether the benefit of being grandfathered is justified by the cost and administrative burden of maintaining grandfathered status. To do this, an employer must know which provisions of PPACA do and do not apply to grandfathered plans and which of those provisions are relevant to its own plan."
(Perkins Coie LLP)

[Guidance Overview]
Guidance on PPACA Internal Claims and Appeals and External Review Processes
Excerpt: "HHS will establish standards for the federal external review process that will be similar to the process in the NAIC Model Act."
(Miller & Chevalier Chartered)

[Guidance Overview]
Interim Final Rule on Appeal Process Changes from Health Care Reform (PDF)
6 pages. Excerpt: "The Rule also provides that where a plan or issuer does not 'strictly adhere' to these requirements, the claimant will be deemed to have exhausted the internal claims and appeals process and may immediately initiate an external review or pursue any available remedies, such as judicial review."
(Groom Law Group)

[Guidance Overview]
New Rules Cover Claim Appeals, External Reviews for Nongrandfathered Health Plans
The target page provides links to the 'Full Alert' on the new rules; Full text of PPACA rules on claims, appeals and external review; Full text of proposed excise tax rules from the IRS; Full text of news release on new rules from HHS; Full text of fact sheet on new rules posted on; and, Full text of NAIC model external review standards.
(Mercer LLC)

[Guidance Overview]
New Mental Health 'Safe Harbor' Gives Health Plans Some Breathing Room
Excerpt: "Until final rules are issued, the enforcement safe harbor will allow health plans to split their outpatient classifications (in-network and out-of-network) into two subclassifications: office visits and all other outpatient items and services."

More Employers Peg Workers' Insurance Premiums to Health Status
Excerpt: "As companies put the final touches on their health care plans for 2011, more of them say they are planning to penalize workers who decline to participate in disease management or lifestyle behavior programs, who smoke, or who do not take part in voluntary health screenings offered by an employer."
(MarketWatch, Inc.)

Americans Cut Back on Visits to Doctor
Excerpt: "The drop in usage is showing up as health-care companies report financial results. Insurers, lab-testing companies, hospitals and doctor-billing concerns say that patient visits, drug prescriptions and procedures were down in the second quarter from year-ago levels."
(The Wall Street Journal)

Health Research Group Promotes Employer Self Insurance
Excerpt: "Employers should consider taking advantage of the additional claims data available and potential for additional employee wellness programs and self-insure their health care plans, a research group says."

Health Care Reform Law Will Increase Demand for Preventive Services, Say Experts
Excerpt: "Despite the benefits of the preventive care provisions in the health reform bill, they have raised some concerns. For example, insurance plans might shift costs to compensate for the mandated coverage of preventive services, resulting in higher insurance premiums."
(American Academy of Family Physicians)

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Benefits in General; Executive Compensation

[Guidance Overview]
Dodd-Frank and Executive Compensation: What Should a Public Company and Its Compensation Committee Do?
Excerpt: "Key Compliance Issues and Tips [on] Executive Compensation Disclosure: Forward-Looking Statements - Beware of 'forward-looking statements' with respect to pay vs. performance. (Multi-year bonus programs should be reviewed carefully.)"
(Fox Rothschild LLP)

New Executive Pay and Corporate Governance Mandates Have Become Law
Excerpt: "Companies now must submit executive pay and golden parachutes to shareholder votes, comply with new disclosure rules and compensation committee and adviser independence standards, and adopt clawback policies."
(Mercer LLC)

Feds Could Lose Talent Without Same-S.ex Leave, Benefits, Report Says
Excerpt: "Almost two-thirds of Fortune 1000 companies and 83 percent of Fortune 100 companies offer leave and other benefits to such employees, while the federal government is hamstrung by the Defense of Marriage Act, prohibiting recognition of same-s.ex marriage and proscribing benefits to such couples, according to CRS."
(Thompson Publishing Group Inc.)

Webcasts and Conferences

"Answering Your Controlled Group Questions" Web Seminar
Nationwide on August 24, 2010
presented by SunGard Relius

"The New Service Provider Regs: The Wait Is Over" Web Seminar
Nationwide on August 10, 2010
presented by SunGard Relius

2010-2011 Basic IRA Seminar
in Iowa on September 21, 2010
presented by Collin W. Fritz & Associates, Ltd.

Employers Forum Workshop
in New York on September 7, 2010
presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

Press Releases

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Newly Posted Employee Benefits Jobs

Senior Retirement Advisor
for Freedom One Financial Group
in MI

Client Relationship Manager - Texas or Atlanta, GA
for Transamerica Retirement Services
in GA, TX

Director of Sales
for Dedicated Defined Benefit Services
in CA

Compliance Reviewer/Analyst
for Retirement Plan Services, LLC
in MO

Operations Manager
for Pension Corporation of America
in OH

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