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Health & Welfare Plans Newsletter

August 26, 2010

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[Official Guidance]
Federal Agencies Announce Availability of Model Forms for Health Plan Claims, Appeals and External Review; Interim Enforcement Rule Prescribed (PDF)
3 pages. Excerpt: "[New] EBSA Technical Release No. 2010-01 . . . 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. (In the case of health insurance coverage offered in connection with a group health plan, the issuer has primary responsibility to comply with the interim final regulations.) This interim enforcement safe harbor applies for plan years beginning on or after September 23, 2010 and until superseded by future guidance . . . ."
(U.S. Department of Health & Human Services; U.S. Department of Labor; U.S. Department of the Treasury)

[Guidance Overview]
Internal Claims and Appeals and External Review Process under Health Care Reform (PDF)
4 pages.
(Reinhart Boerner Van Deuren s.c.)

[Guidance Overview]
ERISA Long Term Disability Appeal Won Against Hartford
Excerpt: "The Hartford determined that she was disabled as of February of 2008 and began paying her benefits in July of 2008. In November of 2009, Hartford terminated her benefits claiming she was no longer disabled."
(Attorneys Dell & Schaefer)

[Guidance Overview]
Required Cafeteria Plan Amendments
Excerpt: "Internal Revenue Code Section 125 requires that a cafeteria plan be in writing and be adopted on or before the first day of the first plan year to which it relates. This applies to amendments to the plan as well. In proposed regulations issued in 2007, the IRS stated that if a cafeteria plan does not comply with applicable requirements regarding content and timing of adoption, then the plan is not a cafeteria plan and all employees' elections of non-taxable benefits are not effective."
(Fisher & Phillips LLP)

[Guidance Overview]
Model Notices for PPACA's Claims and Appeals Regulation and Interim Guidance on the Federal External Review Process (PDF)
6 pages. Excerpt: "On August 23, 2010, [DOL, HHS, and Treasury] jointly released model notices that non-grandfathered plans and health insurance issuers may use to satisfy new requirements under [PPACA] regarding adverse benefit determinations and appeals of adverse benefit determinations."
(Groom Law Group)

[Guidance Overview]
ERISA Plan Wins Recovery from Settlement; Auto Insurer Must Reimburse Member
Excerpt: "This is the first time we've seen a case where a federal district court ruled that a Michigan no-fault auto insurer now has to pay more than its maximum plan liability when a health plan subject to ERISA recovered a substantial portion of the tort settlement proceeds it paid."
(Passion for Subro)

Employers Packaging Next Year's Benefits Plans Confront Health Insurance Overhaul
Excerpt: "While not every employer blames the new law, one executive said the carriers she's dealing with say the rate hikes are attributable to new requirements such as coverage of preventive services, and extending benefits to adult children . . . ."
(Henry J. Kaiser Family Foundation)

Medical Errors in 2008 Cost the U.S. Almost $20 Billion
Excerpt: "These are just the quantifiable costs, including higher medical costs attributable to the errors, and costs associated with higher mortality rate and costs resulting from lost productivity . . . ."
(Wolters Kluwer)

Health Reform Presents Big Opportunity for Benefits Outsourcing
Excerpt: "The International Data Corporation (IDC) forecasts that U.S. employee benefits outsourcing services spending in 2010 will grow 3.8% over 2009."
(PLANSPONSOR.com)

Employers Plan to Increase Health Coverage Cost Sharing Next Year, According to Survey
Excerpt: "An Aon news release said the poll also found that 57% of companies will ask employees to contribute more for the overall cost of health care in 2011."
(PLANSPONSOR.com)

[Opinion]
'Putting the Brakes on ObamaCare'
Excerpt: "The real wallop of ObamaCare will come in 2014, when most of the spending begins and businesses and individuals are hit with intrusive and expensive mandates. The main job of Republicans, should they capture Congress, will be to slow down implementation of the law and explain to the American people the damage it will do -- and already is doing -- to our economy. . . . Published in The Wall Street Journal, August 25, 2010."
(The Wall Street Journal via Galen Institute)




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Webcasts and Conferences

Grandfathered Plan Status: Weighing the Costs and Benefits
Nationwide on August 24, 2010
presented by EBIA / Thomson Reuters


Press Releases


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