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November 21, 2011 Get Retirement News  |  Advertise  |  Unsubscribe  |  Past Issues  |  Search

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[Guidance Overview]
Third Circuit Limits Relief Available to ERISA Welfare Plans Seeking Reimbursement of Medical Expenses
"The Third Circuit's ruling appears to depart from existing case law in two significant respects. First, the Court applied equitable considerations in circumstances where the plan provisions specifically addressed the reimbursement issue and were not found to be ambiguous. Second, using its equitable authority, the Court reformed the plan without finding that the conditions for reformation identified in Amara had been satisfied." (Proskauer Rose LLP)

American Health Care Congress and Exhibition   [Advert.]

Sponsored by World Congress

Bringing together the health care community to discuss strategies aimed at more efficient and effective operation of our health system post-reform. December 5-6, 2011, Anaheim, CA.

[Guidance Overview]
Delay in Application of New Summary of Benefits and Coverage Requirements and New Guidance on Mental Health/Substance Abuse Parity Requirements
"In a set of Answers to Frequently Asked Questions, the U.S. Departments of Treasury, Labor, and Health and Human Services have intimated that the looming ACA deadline for the production and distribution of summaries of benefits and coverage will be extended. The FAQs also provide guidance on the qualitative requirements under MHPAEA." (Ballard Spahr LLP)

[Guidance Overview]
DOL FAQs on Health Care Reform and the Mental Health Parity Requirements
"[R]egarding the FAQs addressing the MHPAEA, it should be noted that an exception to the nonquantitative treatment limits might permit some differences in practices, including preauthorization standards, based on recognized clinically appropriate standards of care." (Practical Law Company)

[Guidance Overview]
Guidance on Connecticut Paid Sick Leave Law Now Available
"The law goes into effect on January 1, 2012." (Jackson Lewis LLP)

[Guidance Overview]
HHS Announces Immediate Start to HIPAA Audit Program (PDF)
"The audit program will be run through the HHS's Office of Civil Rights . . . and will examine a wide range of covered entities, including group health plans." (Kelly, Hannaford & Battles P.A.)

The Potential of Value-Based Insurance Design
"It seems that even . . . relatively slight improvements in adherence through the use of VBID resulted in gains in health outcomes. It is well known that adherence to drugs, such as statins, drops off over time in patients with asymptomatic disorders. The outcome of this study suggests that factors other than cost need to be considered for VBID to reach its full potential." (HCPLive)

Sick-Time Payouts Spike as Minnesota State Employee Retirements Rise
"Although paying out unused sick time is extremely rare in the private sector, it's common at all levels of government around the country. It's been the standard policy in Minnesota for at least 40 years, before state workers were unionized." (Pioneer Press)

Supreme Court Names Two Lawyers to Argue Points in Health Care Law
"The Supreme Court on Friday made two prominent Washington lawyers very happy and very busy, appointing them to argue on behalf of positions that neither side in the challenges to the 2010 health care law has chosen to embrace." (The New York Times; free registration required)

Wellness Project Seeks to Serve and Protect Those Who Serve and Protect
"[Oregon] Health & Science University medical researchers have launched a unique health promotion and intervention program study that could help police improve their well-being so that compensable injuries are less likely and disability durations are shorter." (Business Insurance)

Wellness Program Uses Rewards to Boost Patients' Health Literacy
"MedEncentive L.L.C.'s so-called 'information therapy' program uses financial incentives to promote patient health literacy, empowerment and adherence, with the goal of improving outcomes and ultimately lowering health care costs." (Business Insurance)

Medical Stop-Loss Insurers Warming Up to Wellness Programs
"Many stop-loss underwriters providing excess coverage will consider effective wellness and disease management programs in calculating premiums for specific stop-loss coverage, which pays claims of an individual plan member that pierce a certain deductible threshold, or aggregate stop-loss coverage, which pays when total actual claims exceed 125% of total expected claims." (Business Insurance)

Wellness Awards Shrink Health Care Costs
"In 'Energizing Workplace Wellness Programs: The Role of Incentives, Rewards & Recognition,' the IRF examines whether workplace wellness programs can play a significant role in reducing the largely preventable conditions brought on by the poor health choices that escalate U.S. health care costs, threatening to consume as much as 25 percent of GDP by 2025." (Incentive Research Foundation)

Democrats Urge Obama to Protect Contraceptive Coverage in Health Plans
"[A]fter protests by Roman Catholic bishops, charities, schools and universities, the White House is considering a change that would grant a broad exemption to health plans sponsored by employers who object to such coverage for moral and religious reasons." (The New York Times; free registration required)

Legal Questions and Answers That Will Decide the Health Law's Fate
"The challenge to the Affordable Care Act that the U.S. Supreme Court will consider this March involves a series of complex and inter-related legal questions. How the court views each one -- including the constitutionality of the law's individual mandate and Medicaid expansion, as well as the application of the Anti-Injunction Act and the question of severability -- will trigger a cascade of related decisions." (The Henry J. Kaiser Family Foundation)

Americans Are Fat, and Expected to Get Much Fatter
"If Americans stay on this path, 83 percent of men will be overweight or obese by 2020. Women are right behind them, with 72 percent projected to be overweight or obese by then." (NPR)

Small Businesses Have New Tools in Choosing Health Insurance
"In addition to featuring information about new benefits in the law, also has a health insurance finder tool, which displays information about insurance plans with estimated base rates, doctor choices, number of applications that were denied, and other details that allow consumers to compare options. And as of today, this insurance tool includes private coverage options for small businesses:" (

Group Health Care Costs Climb 6.1 Percent as Cost per Employee Tops $10K
"This year's increase is slightly less than in 2010, when costs jumped an average of 6.9 percent, but is in line with cost increases in recent years." (Workplace Management: free registration required)

Architect of Obama's Health Care Plan Fears a 'Political' Decision by the Supreme Court
"Jonathan Gruber, an M.I.T. professor and a key intellectual architect of President Obama's overhaul of the American health care system, said, 'You know, I think basically, what they've constructed, the Affordable Health Act, is the best possible private-sector solution to our problem of the uninsured that we have available, you know, short of single-payer.'" (Capital New York Media Group, Inc. via Physicians for a National Health Program)

Fifth Consecutive Month of Health Cost Increases in September
"Data released [November 17, 2011] by S&P Indices for the S&P Healthcare Economic Composite Index indicate that the average per capita cost of healthcare services covered by commercial insurance and Medicare programs increased by 5.75% over the 12-months ending September 2011." (Healthcare Town Hall)

The 2012 Presidential Candidates and the U.S. Health Care System: A 'Plank' Summary
"[This] summary provides a current snapshot of the candidates and their various blueprints for reform. Our intent is to be thorough and accurate in compiling what they have said or indicated they will do. As plans take shape, CAHI will explain what the proposals really mean for our health care system and, most importantly, for Americans' access to affordable health insurance coverage. And we'll eliminate the 'spin' so you don't have to." (Council for Affordable Health Insurance)

Leveraging Health Care Exchanges
"Unless the U.S. Supreme Court rejects the entirety of the healthcare-reform law, healthcare exchanges will become effective in 2014. And while some are fearful of the change, the shift could be a very good thing for employers and employees alike." (Human Resource Executive Online)

Letter to the Editor: Cutting Health Costs by Reducing the Bureaucracy
"Peer-reviewed studies in The New England Journal of Medicine by two colleagues and me document that administrative costs account for 31 percent of health spending in the United States versus 17 percent in (Can.ada)." (The New York Times; free registration required)

The Conservative Case for Health Care Reform's Individual Mandate
"In fact, the only individuals who may actually be forced to do something they would not do voluntarily are those who can afford insurance but choose not to buy it. It is these individuals and families whose supposed rights to not have insurance are being defended by critics of the new law." (Los Angeles Times)

Making Sense of Multiple Health Delivery System Reform Efforts
"The list of delivery system reform efforts that are currently being designed, planned, and implemented, in both public and private sectors, is impressive. We have patient-centered medical homes, health homes, accountable care organizations, initiatives to reduce avoidable rehospitalizations, programs to improve transitions to and from nursing homes, and health information exchanges, to name just a few." (The Commonwealth Fund)

Health Care Costs and Unhealthy Politics
"The whole debt problem is growing medical costs. Yes, pretty much the WHOLE problem. The cost of health care is going up faster than inflation." (The Washington Post; free registration required)

Benefits in General; Executive Compensation

[Guidance Overview]
ISS 2012 Policy Updates (PDF)
"On November 17, ISS issued updates to its U.S., Canadian, European and other international voting policies for the 2012 proxy season that will apply to all publicly traded companies with shareholder meetings on or after February 1, 2012." (Frederic W. Cook & Co., Inc.)

[Guidance Overview]
IRS Clarifies Application of All Events Test to an Employer's Bonus Pool Liability
"The IRS issued Rev. Rul. 2011-29 last week, which clarifies the IRS position regarding a taxpayer's ability to accrue in the year before payment its liability for bonuses under a program creating a bonus pool and resulting in a liability to a group of employees." (Miller & Chevalier Chartered)

[Guidance Overview]
Upcoming Benefit Deadlines
Listed are deadlines from December 1, 2011, to January 31, 2012. (The Law Firm of Baker & Daniels LLP)

Press Releases

Financial Mindset of Retirees Improving Though Fewer Considering How Long Assets Will Last

Employees Want Health Plans That Are Simple, Personalized And Support Their Own Health Improvement
(Aon Hewitt)

New Handbook Offers Guidance on Complexities of Multiemployer Benefit Plans
(International Foundation of Employee Benefit Plans)

Unprecedented online tool developed by HHS for small businesses to find and compare health insurance plans
(U.S. Department of Health & Human Services)

Building financial literacy through benefits research and education

Record percentage of younger workers indicate increasing concern about personal job security – Mercer Workplace Survey™

Optum Institute Launches; Will Provide Analysis and Insight on Rapidly Changing Health Care Landscape
(OptumHealth Inc.)

Lockton Expands International Benefits Services Practice

Sprint Employees Respond to the Challenge for Health and Wellness

PFCD Briefing Spotlights Health Information Technology in Managing Chronic Diseases, Cutting Health Care Costs
(Partnership to Fight Chronic Disease (PFCD))

Healthy Transformations to use VitalHealth EHR for Employee Health and Wellness
(VitalHealth Software), Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
Phone (407) 644-4146
Fax (407) 644-2151

Jeanette Hull, News Editor
David Rhett Baker, J.D., Editor and Publisher
Lois Baker, J.D., President
Holly Horton, Business Manager

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