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Health & Welfare Plans Newsletter

August 24, 2010

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[Official Guidance]
Text of Model Notice of Adverse Benefit Determination
2 pages.
(U.S. Employee Benefits Security Administration)

[Official Guidance]
Text of Model Notice of Final Internal Adverse Benefit Determination
2 pages.
(U.S. Employee Benefits Security Administration)

[Official Guidance]
Text of Model Notice of Final External Review Decision
2 pages.
(U.S. Employee Benefits Security Administration)

[Guidance Overview]
The Ohio Military Family Leave Act Is in Effect as of July 2, 2010
Excerpt: "This Act applies to both public and private employers with 50 or more employees and allows eligible employees to take up to 10 days or 80 hours, whichever is less, of unpaid leave when a family member who is a member of the uniformed services is called to active duty or is injured, wounded or hospitalized while serving on active duty."
(Littler Mendelson P.C.)

[Guidance Overview]
New Internal and External Review Requirements for Claims and Appeals Procedures under Reform
Excerpt: "Effectively, these new requirements mean that group health plans must review appeals immediately upon receipt to allow for potential interim 'mini appeals' prior to the deadline for responding to the appeal. In addition, plans that currently allow for two levels of appeal might consider reducing that to one to maximize the time allowed for the above process to take place."
(Jones Day)

[Guidance Overview]
Guidance on Claims and Appeals Procedures for Group Health Plans Under Health Reform
Excerpt: "Under the regulations, group health plans must provide notices of an adverse benefit determination and of available internal claims and appeals procedures and external review processes in a culturally and linguistically appropriate manner, including in a non-English language if 25 percent of all participants are literate in the same non-English language (for plans with 100 or more participants, if the lesser of 500 participants or 10 percent of all participants are literate in the same non-English language)."
(Davis Wright Tremaine LLP)

HHS Website Is One-Stop Shop for Details about New Preventive Services Mandate
Excerpt: "The U.S. Department of Health and Human Services has established a Web site - - that includes a comprehensive, detailed list of all the mandated preventive services along with other information about the health reform law."
(Deloitte via

Minnesota Department of Revenue Comments on State Tax Nonconformity with Federal Code
Excerpt: "There are two specific provisions at issue. The first involves the tax treatment of health benefits provided to employees' children who are less than 26 years old but may not be the employee's 'dependent' for tax purposes. The second is the exemption for employer provided adoption assistance."
(Deloitte via

South Carolina Will Spend $2.4 Million on Bariatric Surgeries for State Workers
Excerpt: "After monitoring the participants for a year and a half, the pilot program will check for complications and see if the surgeries lead to health-care savings."

Health Law Requires Continued Insurance Coverage for Patients in Clinical Trials
Excerpt: "The law requires health plans to pay the routine care costs of patients who participate in clinical trials for the prevention, detection and treatment of cancer and other life-threatening conditions."
(Henry J. Kaiser Family Foundation)

Health Care Reform Could Cost Health Insurers Far More Than Expected
Excerpt: "'As long as their investment incomes hold up, most large insurers should be able to handle the increased medical expenses expected under the new health care reform,' commented Martin D. Weiss, president of Weiss Ratings. 'If investment income declines significantly, however, few insurers will be able to comply without debilitating impacts to their bottom line, and ultimately, their financial stability as well.'"
(Wolters Kluwer)

Federal Agencies Offer Safe Harbor on External Review Processes under PPACA
Excerpt: "Federal agencies have announced the availability of EBSA Technical Release No. 2010-01, which provides an interim enforcement safe harbor for non-grandfathered self-insured group health plans not subject to a State external review process, and therefore subject to the Federal external review process."

The nation's workforce and health care system are constantly evolving and so are the legal issues. Law Journal Press helps you handle any benefits law question with up-to-date, authoritative books on all aspects of the field. Get legal and practical advice from leading experts on everything from COBRA to ERISA, "contingent" employees to family and medical leave, and more. Browse our product listings for detailed information and special offers.
Sponsored by ALM

Benefits in General; Executive Compensation

Potential Overhaul of Proxy System Has Executive Pay Implications
Excerpt: "An SEC concept release seeks input by Oct. 20 on potential proxy system reforms, some of which have implications for executive pay. The release covers three major topics: the accuracy, transparency and efficiency of the voting process; shareholder communications and participation; and the relationship between voting power and economic interest."
(Mercer LLC)

Principal 10 Best Stand Firm on Employee Benefit Commitment
Excerpt: "This is the ninth consecutive year the Principal has sponsored the program that honors growing companies (five - 1,000 employees) for their commitment to employees' financial security through outstanding employee benefit offerings."

Webcasts and Conferences

"A 401(k) Practitioner's Guide to 457(b) Plans" Web Seminar
Nationwide on September 14, 2010
presented by SunGard Relius

Health Care Reform: Technical Aspects and Practical Considerations for Employers!
Nationwide on September 16, 2010
presented by ABA Joint Committee on Employee Benefits

Press Releases

Sentinel Benefits Opens North Carolina Sales Office
Sentinel Benefits & Financial Group

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Newly Posted Employee Benefits Jobs

Experienced Retirement Plan Administrator
for Valley Forge Pension Management
in PA

Financial Services Specialist
for Nationwide
in OH

Experienced DB administrator
for Summit Benefit & Actuarial Services, Inc.

New Business Manager
for Qualified Plan Consultants, LLC
in IA

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