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Health & Welfare Plans Newsletter

September 3, 2010

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[Guidance Overview]
Guidance and Model Notices Issued on Reviews of Health Benefit Claims (PDF)
2 pages. Employer actions are suggested.

[Guidance Overview]
More Guidance on Claims and Appeals Requirements for 2011
Excerpt: "In general, . . . self-funded plans should know: Self-insured group health plans have been granted an interim enforcement safe harbor until further notice. In order to avoid penalty during the enforcement safe harbor, a self-insured group health plan must either (a) comply with the standard and expedited external review procedures detailed in the guidance (which are based on the new state minimum procedures), or (b) voluntarily comply with a state process (assuming that the state is willing to allow access to its external review process). The agencies intend to issue additional guidance in the future with model language for the plan's SPD, describing the plan's new internal claims and appeals and external review procedures."
(Holland & Hart LLP)

[Guidance Overview]
ERISA Plan's Reimbursement Claim Enforced Against Disbursed UIM Benefits
Excerpt: "This is a very significant opinion addressing ERISA health plan subrogation. . . . U.S. Airways v. James McCutchen et al presents a set of facts typical of an ERISA health plan subrogation case."
(Roy Harmon via Health Plan Law)

Health Law Myths: Outside the Realm of Reality
Excerpt: "[Many of the] more outlandish claims have at least some basis in truth. Here are some of the more popular myths about the law and the fact that gave rise to them."
(Morning Edition via National Public Radio)

Workers Absorbed Increases in Health Insurance Costs, According to Survey
Excerpt: "Workers' share of the cost of a family policy jumped an average of 14 percent, an increase of about $500 a year. The cost of a policy rose just 3 percent, to an average of $13,770."
(The New York Times; free registration required)

2010 New York State Legislative Update Relevant to New York Employers
The New York State Legislature enacted and the Governor signed a number of laws: the Domestic Workers Bill of Rights, Funeral Leave Benefits for Same-S.ex Couples, and Health Benefits for Volunteer Firefighters and Ambulance Workers.
(Jackson Lewis LLP)

Maintaining Grandfathered Status for Health Care Plans Appears to Be Exercise in Frustration, Says Expert
Excerpt: "The list of triggers that negate a health-care plan's 'grandfathered' status is long and easy to trip over, including such actions as switching insurance carriers and tinkering with employees' share of healthcare costs in any substantive way."

Health Benefits In 2010: Premiums Rise Modestly, Workers Pay More Toward Coverage
Excerpt: "Workers paid more toward premiums in 2010, and more workers are in consumer-directed plans and plans with high deductibles than in 2009. Thirty percent of firms reported that they reduced the scope of benefits or increased cost sharing because of the recession."
(Health Affairs)

Employers Shifting the Health Cost Burden to Employees, According to Survey
Excerpt: "The bad news for workers is that their share of the premiums soared by 14 percent, reaching almost $4,000, while the amount employers contributed did not increase. In other words, employers shifted virtually all of the increased premium costs to their hapless workers, who were in a weak position to resist in an economy where there were few other jobs to jump to."
(The New York Times; free registration required)

The Boston Health Law Reporter, Summer 2010 (PDF)
30 pages. The articles in this edition present a health law analysis.
(Boston Bar Association)

Retirees Younger Than 65 Will Get Short-Term Help with Health Costs Under Health Reform
Excerpt: "Planning accordingly means setting aside lots of money now to pay for what could be a hefty increase in health-care expenses in 2012 and 2013."
(MarketWatch, Inc.)

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

[Guidance Overview]
A $327 Million Stock Option Mistake
Excerpt: "A case decide[d] this week by the U.S. Court of Appeals . . . demonstrates the high sta[k]es of stock plan miscommunications. In Bell v. Pfizer Inc. . . ., a 2-1 majority of the Court held that Pfizer did not breach its fiduciary duties under [ERISA] by making potentially misleading statements, albeit unintentional, to an employee about her ability to exercise millions of dollars in stock options."
(Michael Melbinger via Winston & Strawn LLP)

Court Rules Terminated Employee to Receive $3M in Benefits After Company Refused Him Severance
Excerpt: "[The former employee] will get benefits he should have received since 2005, like early retirement, which includes a pension and lifelong health benefits. That's over $3 million in damages, including attorney's fees."
(New Jersey On-Line LLC)

Webcasts and Conferences

Dodd-Frank Act: Impact on Executive Compensation and What To Do Now
Nationwide on September 30, 2010
presented by ABA Joint Committee on Employee Benefits

Health Care Reform and Other Legal Developments for Employer-Sponsored Health Plans Webinar
Nationwide on September 14, 2010
presented by Ballard Spahr LLP

Retirement Plan Service Provider Disclosures to Plan Fiduciaries: A Guide to the Interim Final Rules
in New York on September 21, 2010
presented by New York Metropolitan Area Chapter - ISCEBS

Press Releases

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Newly Posted Employee Benefits Jobs

Retirement Benefits Administration
for General Atomics
in CA

Employee Benefits Manager
for Susquehanna International Group
in PA

VP, Marketing Management
for Prudential
in CT

Benefits Manager (SF)(Job ID: 21686)
for Morrison & Foerster LLP
in CA

Benefits Analyst (Health & Welfare) (Job ID: 21773)
for Morrison & Foerster LLP
in CA

Executive Compensation and Benefits Associate/Consultant
for Bostonian Group - a Marsh & McLennan Agency Company
in MA

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