Text of Revised Model Notice of Adverse Benefit Determination, from EBSA
Microsoft Word document; 2 pages. Excerpt: "[Q11:] The Departments' regulations make changes to shorten the times for making initial determinations with respect to urgent care claims, but did not make any changes to the times for making internal appeals decisions. The Departments' model notice of adverse benefit determination issued on August 23, 2010, was unclear as to which times have been shortened. What is the rule? [A:] Only the times for making the initial benefit determination were changed. The Departments have revised the model notice to eliminate confusion. The revised notice includes a header that reads, 'Revised as of September 20, 2010.'" (Source: http://www.dol.gov/ebsa/faqs/faq-aca.html)
(U.S. Employee Benefits Security Administration)
Labor Department Guidance Clarifies Provisions in Healthcare Reform
Excerpt: "New health care reform law guidance eases previous rules on how health care plans handle disputed claims and clears up uncertainty on coverage provided to employees' adult children. . . . Some employers . . . voluntarily extend coverage to employees' grandchildren, nieces and nephews if certain conditions, such as financial support and residency, are met. The Labor Department said such eligibility restrictions can continue to be imposed on employees' relatives who are not sons, daughters, stepchildren, adopted children or foster children."
HHS Releases Additional Guidance on the ERRP Reimbursement Process (PDF)
2 pages. Excerpt: "On September 17, HHS posted additional ERRP guidance on its website. The guidance provides those plan sponsors with approved applications with details on registering with the ERRP secure website, compiling early retiree lists, and submitting claims cost data to HHS."
Bishops Urge HHS Not to Mandate Contraception, Sterilization Coverage
Excerpt: "Two officials of the U.S. bishops' Office of General Counsel have told the U.S. Department of Health and Human Services that it should not mandate that group and individual health plans include coverage of contraception or sterilization as part of what the federal agency considers preventive care for women."
(The Georgia Bulletin)
Medical Tourism: Deal-Seekers Flock to Mexico for Medical Care
Excerpt: "As the tenacious recession leaves more Americans without jobs -- or working for employers who can no longer afford to provide insurance -- adding a medical procedure to the vacation itinerary looks increasingly attractive."
(San Francisco Chronicle)
New Health Law's Protections For Adult Children Start September 23
Excerpt: "Starting tomorrow, adult children will no longer be left to fend for themselves in their search for health insurance. The new federal health law requires that insurers give parents the option of keeping their adult children covered until they're 26 years old. It becomes effective for the health policy at the beginning of the plan year."
Medical Tourism: Have Insurance Card, Will Travel
Excerpt: "[W]hen patients pay a significant percent of their health care costs, or benefit financially from choosing certain providers, they have a strong incentive to go where prices are lower. Thus, medical tourists go abroad for treatments that can cost up to 80 percent less than at home."
(National Center for Policy Analysis)
Sources of Health Insurance And Characteristics of The Uninsured
Excerpt: "Employment-based health benefits remain the most common form of health coverage in the United States. In 2009, 59 percent of the nonelderly population had employment-based health benefits, down from 68.4 percent in 2000. "
(Employee Benefit Research Institute)
Obesity, Overweight Carry Heavy Financial Burden
Excerpt: "While the study focuses on the cost to the individual obese and overweight person, such as the value of lost life, lost wages, gasoline costs, and life insurance, it also notes that some of the costs are borne by employers and the government, including direct medical costs, short-term disability, disability pension insurance, absenteeism, and productivity losses."
Private Insurers Stealing from HSA Accounts
Excerpt: "Some health insurers in Southeast Michigan are beginning to charge higher premiums to employers who offer high-deductible employee health plans and then 'wrap' the plans by buying gap insurance or giving workers subsidies to cover the deductibles."
(Physicians for a National Health Program)
The Affordable Care Act: Six Months Later
Excerpt: "The Affordable Care Act puts Americans, not the health insurance companies, back in charge of their health care. The Patient's Bill of Rights in the Affordable Care Act will stop the worst insurance company abuses."
(U.S. House of Representatives, Committee on Education and Labor)
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.
Benefits in General; Executive Compensation
Federal Pay Called Into Question -- Again
Excerpt: "A panel of policy analysts on Tuesday delved into the pay debate, arguing that federal employees earn more than private sector workers, which could have a negative effect on the economic recovery and public perception of government."
Webcasts and Conferences
Newly Posted Employee Benefits Jobs
Subscribe to the BenefitsLink Retirement Plans Newsletter, Too!
Sign-up form is at https://benefitslink.com/newsletter (free).
This email has been published by:
1298 Minnesota Avenue, Suite H
Winter Park FL 32789
Fax: (407) 644-2151
Jeanette Hull, News Editor
David Rhett Baker, J.D., Editor and Publisher
Copyright 2010 BenefitsLink.com, Inc.; except that you can
forward this email in full (including this boilerplate part) or
otherwise reprint this email in full (including this boilerplate
part) without obtaining our permission.
Anyone can receive these emails; just have them sign up
at this web page: https://benefitslink.com/newsletter/
Other useful links: