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Health & Welfare Plans Newsletter

September 21, 2010

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No matter how benefits-savvy your employees may be, today's health care environment can confuse the most sophisticated consumer. That's why companies large and small use BeneCom for their benefits communication. We know benefits and we understand what employees need to know to make them work -- for themselves and for you. And while we're at it, we make your life a little easier, too.

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[Official Guidance]
EBSA Technical Release No. 2010-02: Grace Period for Complying with Interim Rules on Internal Claims and Appeals under the Patient Protection and Affordable Care Act
Excerpt: "This technical release sets forth an enforcement grace period until July 1, 2011 with respect to some of the additional standards set forth in the interim regulations in order to give plans and issuers more time to implement procedures and make changes to computer systems in order to comply fully."
(U.S. Employee Benefits Security Administration)

[Official Guidance]
EBSA Q&As: Questions regarding Affordable Care Act Implementation
Among the topics covered by the 16 questions-and-answers: Grandfathered Health Plans; Claims, Internal Appeals, and External Review; Dependent Coverage of Children; and Out-Of-Network Emergency Services.
(U.S. Employee Benefits Security Administration)

[Official Guidance]
Text of IRS Notice 2010-63 Soliciting Comments on Rules Prohibiting Insured Group Health Plans from Discriminating In Favor of Highly Compensated Individuals (PDF)
4 pages. Excerpt: "The final regulations under section 105(h) of the Code, prohibiting discrimination in favor of highly compensated individuals under self-insured medical expense reimbursement plans, were issued in 1981. The Department of the Treasury and the IRS are considering issuing guidance on the [upcoming statutory] extension . . . of the requirements of section 105(h)(2) to [non-grandfathered] insured group health plans. The Department of the Treasury and the IRS request comments on what additional guidance relating to the application of section 105(h) (2) would be helpful with respect to insured group health plans."
(Internal Revenue Service)

[Guidance Overview]
Bankrup.tcy Code Provides Enhanced Retiree Health Coverage Protection, Says Third Circuit
Excerpt: "One of the most contentious issues facing debtors with significant legacy obligations is the modification or termination of retiree benefits in bankrup.tcy. For debtors in the Third Circuit, such modification or termination just got harder."
(Pepper Hamilton LLP)

[Guidance Overview]
Guidance on Internal and External Claims Procedures
Excerpt: "These new internal claims and appeals procedures and external review procedures only apply to non-grandfathered group health plans and policies. Employers who are considering design changes to their existing plans that would result in the loss of grandfathered status should consider the administrative issues and costs involved with complying with these new procedures."
(Snell & Wilmer)

[Guidance Overview]
2010 and 2011 Group Health Plan Checklist (PDF)
Excerpt: "Below is a checklist of these major changes which require implementation in 2010 or 2011 as well as a listing of enrollment and annual notices that group health plan sponsors should consider during open enrollment."
(Bryan Cave)

[Guidance Overview]
COBRA Premium Subsidy: Employers May Want to Review Their Compliance One Last Time
Excerpt: "To be eligible for the subsidy, an individual must have lost coverage on account of an involuntary termination of employment between September 1, 2008 and May 31, 2010. However, changes in the law, time-specific notice requirements, and 'special election' rights may be leaving well-intentioned employers and administrators on the hook for inadvertent noncompliance."
(Deloitte via

[Guidance Overview]
What Notices Are Required By PPACA, for Plan Years Starting After Sept. 23?
Excerpt: "Many of the insurance market reform provisions of PPACA are effective for plan years starting after September 23, 2010 (which is this week!)."

[Guidance Overview]
IRS Posts Draft Small Employer Tax Credit Form, Information for Tax-Exempts
Excerpt: "Small employers -- those with 25 or fewer full-time employees and that pay annual average wages of less than $50,000 per worker -- may be eligible for tax credits to offer health insurance coverage for the first time or maintain coverage they already have."

[Guidance Overview]
DOL Fact Sheet Gives Tips for People Whose COBRA Subsidy Payments Are Ending
Excerpt: "The fact sheet gives individuals tips for maintaining coverage once the subsidy ends, and stresses the importance of continuing to pay COBRA premiums even without the subsidy to ensure guaranteed health insurance availability."

Few Insurers Provide Coverage for Weight Loss Treatment
Excerpt: "Only in recent years have a small number of insurers begun to include options for patients seeking to lose weight, as more treatments undergo scientific scrutiny."
(Kaiser Health News)

Major Health Insurers to Stop Offering New Child-Only Policies
Excerpt: "Some of the country's most prominent health insurance companies have decided to stop offering new child-only plans, rather than comply with rules in the new health-care law that will require such plans to start accepting children with preexisting medical conditions after Sept. 23."
(Washington Post; free registration required)

Medicare Doughnut Hole Relief Could Be Offset By Higher Prescription Drug Prices
Excerpt: "Beginning next year, at the expense of pharma.ceutical companies, millions of senior citizens in the Medicare coverage gap known as the 'doughnut hole' will receive 50 percent discounts off the price of brand-name prescription drugs. The government does not control the underlying prices; the law leaves that to the market."
(Washington Post; free registration required)

Catholic Group Opposes Coverage for Contraceptives
Excerpt: "The United States Conference of Catholic Bishops, in a letter sent Friday to the Department of Health and Human Services, said that preventing pregnancy is not preventing a disease."
(Business Insurance)

Heart Attack Risk Calculator May Be Flawed
Excerpt: "A new study finds that a widely used version of the ubiquitous heart attack risk calculator is flawed, misclassifying 15 percent of patients who would use it . . . [who would be ] inappropriately shifted into higher-risk groups that are more likely to be treated with medication."
(New York Times; free registration required)

CalPERS' Ailing Long-Term Care Plan
Excerpt: "California is the only state in the U.S. that has gone the self-funded route for its public employee long-term care benefit plan. And that makes some officials very nervous."

Better Information, Interventions Improves Medication Adherence
Excerpt: "According to the National Council on Patient Information and Education, more than half of Americans (54%) do not always take their prescribed medicine as directed. To make matters worse, the recession exacerbated the challenge of poor medication compliance."
(Employee Benefit News; free registration required)

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Benefits in General; Executive Compensation

[Guidance Overview]
Transition Relief for Correction of Certain Section 409A Document Failures Expires at the End of This Year
Excerpt: "Earlier this year, the IRS instituted a program that . . . that generally allows employers to correct certain technical problems without the imposition of Section 409A penalties, which are described below. This transition relief is only available for corrections that are made on or before December 31, 2010."
(Snell & Wilmer)

NH Retirement System Posts Pension Data Online - News Story - WMUR Manchester
Excerpt: "The New Hampshire Retirement System has released a list detailing individual annual pension amounts paid to more than 23,500 retirees or their beneficiaries. The list . . . includes each individual retiree's NHRS member classification (Employee, Teacher, Police, or Fire), as well as the type of benefit (i.e. service retirement, early retirement, job-related disability, non-job-related disability, etc.) and whether the recipient was employed by the state or a political subdivision. The list does not include the names of individual pension recipients."

Webcasts and Conferences

Form 5500 Refresher Course
in California on September 22, 2010
presented by

NY CLE Program: New Fiduciary Developments re: Plan Investments and Their Potential Impact on Plan Sponsors, Fiduciaries and Service Providers
in New York on October 21, 2010
presented by WEB (Worldwide Employee Benefits Network ), New York Chapter

Press Releases

Additional Health Care Reform Provisions Kick In
National Association of Insurance Commissioners (NAIC)

ERPA - New Federal Designation For TPA Practioners
Retirement Plan Specialists, Inc. (RPS)

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