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Health & Welfare Plans Newsletter

July 30, 2010

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[Official Guidance]
Text of Interim Final HHS Regs on Pre-Existing Condition Insurance Plan Program (PDF)
21 pages. Excerpt: "An individual is eligible to enroll in a [Pre-existing Condition Insurance Program, or 'PCIP'] if he or she: . . . has not been covered under creditable coverage for a continuous 6-month period of time prior to the date on which such individual is applying for PCIP . . . ."
(U.S. Department of Health & Human Services)

[Guidance Overview]
Health Care Reform: Guidance on Claims and Appeals Rules
Excerpt: "Group health plans and insurers subject to the new requirements should review their current internal claims and appeals procedures, and revise them as necessary to avoid potential liability and loss of deference upon judicial review."
(McDermott Will & Emery)

[Guidance Overview]
Guidance on Preventive Services and Claims Processes Impacts Next Plan Year's Design and Grandfathered Plan Decisions
Excerpt: "The most recent guidance covers several requirements of the Act that are effective for plan years beginning on or after September 23, 2010 (January 1, 2011, for calendar year plans): coverage of preventive services, and new internal claims review and external appeals procedures for group health plans."
(Holland & Hart LLP)

[Guidance Overview]
'Grandfathering' Rules Effect on Consumers
Excerpt: "This issue brief explains which reforms and consumer protections apply to grandfathered plans, what changes in a health insurance plan trigger a loss of grandfathered status, and the expected impact of grandfathering on consumers."
(Center on Budget and Policy Priorities)

[Guidance Overview]
Key Notification and Communication Requirements in Health Care Reform
Excerpt: "The final regulations detailing the exact disclosure requirements for all regulations are not yet out. But here are seven items that should be on your radar for your benefits communication strategy."
(Employee Benefit News; free registration required)

[Guidance Overview]
Court Blocks Arizona Domestic Partner Benefits Limit
Excerpt: "The disputed law modified the state employee health and accident insurance plan to apply only to the workers and their spouses, children under 19 and children under 23 who are full-time students."

Employer Wellness Initiatives Grow, but Effectiveness Varies Widely
Excerpt: "While employer wellness programs have spread rapidly in recent years, few employers implement programs likely to make a meaningful difference in employees' health -- customized, integrated, comprehensive, diversified programs strongly linked to a firm's business strategy and strongly championed by senior leadership and managers throughout the company."
(National Institute for Health Care Reform)

Hearing on Implementation of the Health Information Technology for Economic and Clinical Health Act
Held July 27, 2010. The target page provides links to witness testimonies.
(U.S. House Committee on Energy and Commerce, Subcommittee on Health)

Health Care Reform Impact on Claim and Appeal Procedures
Excerpt: "The regulations raise a number of issues/concerns for sponsors/plan administrators: 1. How will the strict adherence standard apply (e.g. will a minor failure to include some relatively immaterial matter in a denial letter result in loss of deference)? 2. When will deference apply in general? 3. . . . ."
(BNA Pension & Benefits Blog)

Democrats Under Fire Over Health-Law Reporting Mandate
Excerpt: "Starting in 2012, businesses will be required to file a 1099 to the Internal Revenue Service for each supplier or service provider to which payments exceed $600 in a single year. They are already required by law to report payments to non-corporate service providers, but the health-care law broadened that to include corporate vendors and purchases of goods."
(The Wall Street Journal)

Smaller Firms Fear Health Care Reform Cost Hikes, According to Survey
Excerpt: "Most respondents agreed that health care coverage remains an important tool to attract and retain employees. More than eight out of ten employers (85%) said that health care benefits will either continue to be just as important, or more important, in the future."

Updated Chart Shows Complexity of Health Care Reform, According to Republicans
Excerpt: "In addition to capturing the massive expansion of government and the overwhelming complexity of new regulations and taxes, the chart portrays: $569 billion in higher taxes; $529 billion in cuts to Medicare; swelling of the ranks of Medicaid by 16 million; 17 major insurance mandates; and the creation of two new bureaucracies with powers to impose future rationing: the Patient-Centered Outcomes Research Institute and the Independent Payments Advisory Board."
(Joint Economic Committee / Republicans)

Gazing Into CBO's Budget and Health Care Crystal Ball
Excerpt: "Last month, the Congressional Budget Office issued its own set of updated [budget] projections, but the frame of reference was the long-term, and not just the next 10 years. Unfortunately, the farther out one looks, the worse the picture gets."
(Henry J. Kaiser Family Foundation)

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Benefits in General; Executive Compensation

If Bush Tax Cuts Expire, Will Employers Accelerate Compensation Payouts in 2010?
Excerpt: "With the Bush tax cuts set to expire -- and no clear decision on what Congress will decide to do about it -- some employees are wondering if their organizations will consider paying some bonuses and other comp in 2010 instead of next year under higher tax rates."
(Human Resource Executive Online)

Employee Ownership Update for July 29, 2010
NCEO Executive Director Corey Rosen discusses the following: Research shows it's a myth that employees don't stay with employers as long as they used to. An examiner for a bankrup.tcy court found the solvency opinion in the Tribune ESOP transaction may have involved fraud. It is uncertain whether the new executive compensation rules will really change things. The NCEO is seeking 'Don't Do That' stories in the equity compensation field.
(National Center for Employee Ownership)

Disclosure of Pay Versus Performance Under Dodd-Frank
Excerpt: "The Act allows, but does not require, this disclosure to include a graphic representation of the information required to be disclosed. Presumably, this would be an enhancement to the Performance Graph."
(Michael Melbinger via Winston & Strawn LLP)

Webcasts and Conferences

Pension, Profit-Sharing, Welfare, and Other Compensation Plans
in District of Columbia on October 7, 2010
presented by ALI-ABA (American Law Institute-American Bar Association)

Retirement, Deferred Compensation, and Welfare Plans of Tax-Exempt and Governmental Employers
in District of Columbia on September 13, 2010
presented by ALI-ABA (American Law Institute-American Bar Association)

Voluntary Fiduciary Correction Program Workshop
in New York on September 1, 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 Account Director
for ClearPoint Financial
in WA

Client Relationship Manager
for Goldleaf Partners
in MN

Benefits Compliance Specialist
for SPX Corporation
in NC

Nurse Case Manager
for The Standard
in NY

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