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Health & Welfare Plans Newsletter

September 29, 2010

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[Official Guidance]
Brief for Secretary of Labor as Amicus Curiae Supporting Defendant-Appellee, Metropolitan Life Insurance Company
Excerpt: "The question presented in this case concerns whether, in light of the decision in Kennedy v. DuPont, 129 S. Ct. 865 (2009), holding that plan administrators must distribute benefits to beneficiaries in accordance with plan documents, ERISA allows a plan administrator to disregard a validly-executed beneficiary designation because the plan lacks a formal procedure through which a designated beneficiary can refuse benefits."
(U.S. Department of Labor)

[Guidance Overview]
Early Retirement Reimbursement Program Reimbursement Process
Excerpt: "The Department of Health and Human Services . . . announced on September 17, 2010 procedures for employers whose applications have been accepted to prepare for receiving reimbursement under the Early Retirement Reinsurance Program . . . ."
(Hewitt Associates)

[Guidance Overview]
New Health Care Subrogation Decision Holds That Cooperation Clause Relieves Plan of Payment Obligations Where Participant Fails to Provide Information
Excerpt: "This case is a reminder to health plan counsel not to forget about cooperation provisions. These provisions can be powerful tools when a plan participant (or his or her attorney) refuses to cooperate with a plan."
(Health Subrogation Blog)

[Guidance Overview]
Changes on Over-the-Counter Drug Coverage Required Under Health Care Reform in 2011
Excerpt: "Over-the-counter medicines or drugs purchased without a prescription on or after January 1, 2011 (other than insulin) may no longer be paid for or reimbursed under [health flexible spending arrangements, health reimbursement arrangements, health savings accounts or Archer Medical Savings Accounts]."
(Proskauer Rose LLP)

[Guidance Overview]
No Penalties for Failure to Provide SPD Without Specific Written Request
Excerpt: "EBIA Comment: A plan sponsor may be charged $110 per day if it does not provide an SPD within 30 days after an individual's written request. But as this case illustrates, there are no specific penalties in ERISA for failure to prepare or furnish an SPD, absent a written request. Having said that, providing SPDs is a good practice that keeps employees informed and might help avoid costly litigation."
(Employee Benefits Institute of America)

[Guidance Overview]
HHS's Interim Guidance on Federal External Review Procedures for Insurers
Excerpt: "EBIA Comment: The HHS guidance gives a significant new role to OPM, which is now responsible for administering the external review process as to insurers -- at least for those states that do not have an external review law. As noted, however, the guidance is interim and does not necessarily reflect the final process that will be developed by HHS for insurers following the transition period."
(Employee Benefits Institute of America)

[Guidance Overview]
Labor Department's Practical Guidance on New PPACA Rules
Excerpt: "The FAQs recognize that a self-insured plan may not be contracting directly with an independent review organization (IRO), but rather the plan's third-party administrator may be doing so. The Department advises that such arrangements may satisfy the requirements, but notes that the plan fiduciaries would, nonetheless[,] have a duty under ERISA to monitor the IRO and the other plan service providers."
(Deloitte via

[Guidance Overview]
IRS Asking How Non-Discrimination Rules Should Apply to Insured Group Health Plans
Excerpt: "Effective for plan years beginning on or after September 23, 2010, non-grandfathered insured group health plans are prohibited from discriminating in favor of highly compensated individuals in substantially the same way as are self-insured group health plans. Before issuing guidance, the IRS is requesting public comment on how these rules should be applied to insured plans."
(Deloitte via

[Guidance Overview]
Labor Department's Enforcement Grace Period for New Claims Procedures
Excerpt: "After the interim regulations were issued, group health plans and issuers responded that some of the changes were unexpected and more time would be needed to comply. In turn, the Department of Labor announced . . . that, until July 1, 2011, it would not take enforcement action against a group health plan that is working in good faith to comply (but is not yet compliant with) the new requirements . . . .'
(Deloitte via

Draft: Regulation for Uniform Definitions and Standardized Rebate Calculation Methodology for Plan Years 2011, 2012 and 2013 Per Section 2718 (b) of the Public Health Service Act (PDF)
32 pages. The NAIC is soliciting comments on the draft by October 4, 2010.
(National Association of Insurance Commissioners)

Group Health Costs Projected to Rise 8.8 Percent in 2011, According to Hewitt Analysis
Excerpt: "The average group health plan cost per employee is projected to rise to $9,821 next year, according to an analysis released Monday, September 27 . . . . Costs include employer and employee premium contributions, but not employee out-of-pocket expenses, such as co-payments and co-insurance."
(Workforce Management; free registration required)

Electronic Health Record Standards: Federal Government Takes Steps to Ensure Electronic Systems Are Strong, Secure, and Able to Communicate with Each Other
Excerpt: "On July 28, 2010, the US Department of Health and Human Services (HHS) issued its first set of these standards, which are designed to ensure that the systems are secure and reliable. Another key goal is to make certain that data collected by one system is compatible with data collected by another. That way, if a patient approves, health care providers can exchange the information, which will help them operate more efficiently and improve patient care."
(Health Affairs)

Douglas County, Colorado, Works to Become Nation's Healthiest School District
Excerpt: "To reach this goal, the team made not only employee but also student wellness a top priority, and as such, benefits is no longer something that is considered for a few months of the year during negotiations, open enrollment, or when an employee gets sick. Beginning in 2009, benefits decisions now are determined by answering this question: 'Will this change bring us closer to becoming the healthiest school district in the United States by 2015?'"
(Employee Benefit News; free registration required)

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Benefits in General; Executive Compensation

National Compensation Survey: Employee Benefits in the United States, March 2010
Employee benefits data tables: United States, for March 2010, include Retirement benefits; Health care benefits; Life, short-term disability, and long-term disability insurance benefits; Holiday, vacation, sick, and other leave benefits; Other benefits; and, Benefit combinations.
(U.S. Bureau of Labor Statistics)

The Right Wing Myth on Public Employee Pay
Excerpt: "[F]indings broadly confirm existing research indicating that when relevant workforce factors like education and experience are taken into account, public workers earn lower pay and benefits than those working in the private sector."
(The Huffington Post)

Statement on 'Wake Up, Washington!' Month by Susan Scanlan, Chair of the National Council of Women's Organizations
Excerpt: "Unlike the bankers and financiers of Wall Street who brought us to the brink of economic calamity, your average woman on the street has not received a bailout. We're still working at low wage jobs, more than half of which offer no paid vacation, retirement, or sick leave let alone childcare or transportation assistance. Right now, the nurses, teachers, secretaries, grocery store clerks, data processors, hair stylists, and waitresses whom I represent are grateful to have a job, even if they receive only 77-cents for every dollar their male counterparts earn."
(Retirement USA)

Webcasts and Conferences

"ERISA Workshop" - Atlanta
in Georgia on October 29, 2010
presented by SunGard Relius

"ERISA Workshop" - Bloomington
in Illinois on October 27, 2010
presented by SunGard Relius

"ERISA Workshop" - Charlotte
in North Carolina on October 28, 2010
presented by SunGard Relius

"ERISA Workshop" - Des Moines
in Iowa on October 29, 2010
presented by SunGard Relius

"ERISA Workshop" - Detroit
in Michigan on October 27, 2010
presented by SunGard Relius

"ERISA Workshop" - Knoxville
in Tennessee on October 27, 2010
presented by SunGard Relius

"ERISA Workshop" - Minneapolis
in Minnesota on October 28, 2010
presented by SunGard Relius

"ERISA Workshop" - St. Louis
in Missouri on October 28, 2010
presented by SunGard Relius

"ERSIA Workshop" - Houston
in Texas on October 29, 2010
presented by SunGard Relius

401(k) EP Phone Forum
Nationwide on October 15, 2010
presented by Internal Revenue Service (IRS)

Health Care Reform: Updates and Recent Guidance
Nationwide on October 21, 2010
presented by ABA Joint Committee on Employee Benefits

Press Releases

Newly Posted Employee Benefits Jobs

Regional Mgr Client Service
for The Standard
in CA

Transition Manager
for AUL/OneAmerica Financial Partners, Inc.
in IN

Pension Administrator
for Prestigious mid-Long Island New York firm
in NY

Product Manager
for Morgan Stanley Smith Barney
in NY

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