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Health & Welfare Plans Newsletter

August 19, 2010

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[Guidance Overview]
Can Preexisting Condition Insurance Plans Help Employers Control Health Care Costs?
Excerpt: "An employer could be subject to sanctions if it offers financial incentives to enrolled individuals who end up in the [Preexisting Condition Insurance Plan]. Would the comparisons of eligibility periods and coverage costs be sufficient to constitute 'disincentives'? The PCIP rules do not appear to preclude the employer from steering new employees to the program. Any reasons why it should not?"
(Tax Management Inc.)

[Guidance Overview]
Regulations Regarding Internal Claims and Appeals and External Review Processes
Excerpt: "The new claims and appeals requirements under health care reform will impose more time-consuming and expensive rules on plan administrators. Plan sponsors considering the benefits of retaining grandfathered status will want to carefully consider these costs. These additional costs may encourage employers to retain grandfathered status. However, in many cases, if an employer has multiple benefit options, only some of which may be grandfathered, it may make more sense to apply all of the new claims procedures to all applicable group health plans in order to make the process consistent for everyone."
(Sherman & Howard)

Healthy Employees Shave $14M from Trihealth Costs
Excerpt: "'It's more than just about the medical claims cost -- we look at absence costs, productivity savings, short-term and long-term cost savings, clinical indicators,' . . . ."
(Cincinnati Business Courier)

Fact Checking San Diego on Retiree Health Care Reform
Excerpt: "Of the 10 fiscal reforms on the city of San Diego's November sales tax ballot proposition, reducing retiree health care costs is city's the biggest opportunity for savings."

Faced with Rising Health Costs, Large Employers Plan to Shift Burden to Workers
Excerpt: "Seventy percent of large employers said they will eliminate lifetime dollar caps on overall benefits, according to the latest annual survey conducted by the National Business Group on Health (NBGH), while 63 percent plan to increase premium rates in 2011, up from 57 percent this year."
(Capitol Hill Publishing Corp.)

ObamaCare's Loss Ratio Rules Are Out of Balance, Critics Say
Excerpt: "Supporters say these new 'medical loss ratio' regulations could provide better value for consumers. Critics argue that they could decrease innovation and competition."
(Investor's Business Daily)

New York State Requires Discussion on Options Before Breast Removal Surgery
Excerpt: "[A] state law signed on Sunday by Gov. David A. Paterson will require New York hospitals and doctors to discuss the options for breast reconstruction with their patients before performing cancer surgery, to give them information about insurance coverage and to refer them to another hospital, if necessary, for the reconstructive surgery."
(The New York Times; free registration required)

Plan to Cut Vacation Time for Shelby County, Tennessee, Employees
Excerpt: "While the measure would save the county thousands of dollars, it would also lump workers' vacation, sick, bonus and bereavement time into one category; reducing the total time off in some cases from 61 days to 35."
(Newport Television LLC)

National Association of Insurance Commissioners Defers the Worst Insurance Industry Demands for Weakening the Implementation of Health Care Reform
Excerpt: "'Today the NAIC took a step toward ending the health insurance companies' stranglehold on our health care. The top state insurance regulators from across the nation voted to put patient care above insurance company profits.'"
(Consumer Watchdog)

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Benefits in General; Executive Compensation

[Guidance Overview]
Dodd-Frank's Mandatory Executive Compensation Clawback: A Practical Review and Assessment
Excerpt: "While the concept of 'clawing back' executive compensation is not new, the Act goes well beyond what has been required before."
(Pepper Hamilton LLP)

California Proposition 8 Barring Same-S.ex Marriage Ruled Unconstitutional: What the Ruling Means for Employers
Excerpt: "The court's ruling is likely to have limited effect on employers so long as federal law does not recognize same-s.ex marriage. California law already extends the same rights and obligations to registered domestic partners as to spouses, including, for example, the right to take family leave due to the serious illness of a domestic partner."
(Littler Mendelson P.C.)

Federal Compensation Critics Keep the Debate Alive
Excerpt: "[A Cato Institute budget analyst], responding to [the Office of Personnel Management Director's] comments to The Washington Post, says his colleagues and other critics are citing data from the Bureau of Economic Analysis instead of the Bureau of Labor Statistics because the BEA provides a comprehensive analysis of the financial impact of a worker's benefits package."
(The Washington Post; free registration required)

Dodd-Frank Adds New Subsection to Exchange Act, 'Disclosure of Hedging by Employees and Directors'
Excerpt: "The obvious aim of this provision is to encourage companies to adopt policies that prohibit hedging transactions. Section 955 does not require any company to adopt such a policy, but we expect that most will do so."
(Michael Melbinger via Winston & Strawn LLP)

Webcasts and Conferences

CDHC Solutions Forum
in Georgia on September 9, 2010
presented by FieldMedia, LLC

NY CLE Program: Healthcare Reform - Are You Ready? Top 10 Immediate Action Items
in New York on September 16, 2010
presented by WEB (Worldwide Employee Benefits Network ), New York Chapter

Press Releases

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