January 29, 2003 - 7,947 subscribers

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Critical Design Elements of Consumer-Directed Health Plans
Excerpt: "Last June's IRS ruling placed significant decision-making power in the hands of employers in determining plan design. As increasing numbers of employers offer [consumer-directed health] plans to their employees, designs will evolve to address unique issues." (Inside Consumer-Directed Care via AISHealth.com)

Higher Health Insurance Premiums Mean Higher Sales Commissions
Excerpt: "One little-noticed side effect of health insurers' double-digit premium increases is the correspondingly higher commissions insurers pay to the brokers who sell their products. Commission payments constitute an increasingly large portion of insurers' administrative expenses-- and while few payers have plans to overhaul commission structures to cut costs, some have revised payment structures to trim expenses or emphasize some products over others." (Managed Care Week via AISHealth.com)

Roots of Employer-Provided Health Insurance Coverage Are Shallow
Excerpt: "[H]ow did health care benefits come to be considered a right in the first place? The story is one of mutual interests and, in hindsight, a cautionary tale." (Newhouse News Service via The [New Orleans] Times-Picayune)

Another Federal Court Approves Constructive Trust Remedy to Enforce Subrogation/Reimbursement Rights
Forsling v. J.J. Keller & Assocs. (E.D. Wis. 2003). Excerpt: "[Here] the court found that a constructive trust remedy was available under the principles of Knudson, provided that the funds at issue 'are identifiable, have not been dissipated, are still in the control of a defendant, and in good conscience belong to [the plan] pursuant to [its] subrogation provisions.'" (EBIA Weekly)

Wisconsin State Court Enforces Plan's 'Subrogation' Claim Under State Law
Palmerton v. Associates' Health and Welfare Plan (Wis. Ct. App. 2003). Excerpt: "Yet another subrogation and reimbursement case appeared on the radar this week, adding to the flurry of cases we have covered since the U.S. Supreme Court's Knudson decision in January 2002.... [The plaintiff argued that Knudson] limited the plan to equitable remedies, so that equitable defenses (like the make-whole rule and the common-fund doctrine) could be asserted. The state court rejected this argument ..." (EBIA Weekly)

Plan's Exclusion of Coverage For "Surgical Impregnation Procedures" Did Not Violate Title VII or PDA
Saks v. Franklin Covey Co. (2d Cir. 2003). Excerpt: "The employee in this case sued for reimbursement of infertility treatment expenses from her employer's self-insured health plan. The plan specifically excluded coverage for 'surgical impregnation procedures,' including artificial insemination and in vitro fertilization--procedures that the employee had undergone several times." (EBIA Weekly)

Firm Properly Denied Coverage of Gender Reassignment Surgery As Not Medically Necessary
The Second Circuit U.S. Court of Appeals has ruled that an employer properly denied coverage of an employee's gender reassignment surgeries as not being 'medically necessary.' The ruling came in Mario v. P&C Food Markets, Inc. (No. 01-9220). (SpencerNet)

Supreme Court Holds That Untimely Assignment Under 1992 Coal Act Is Valid
In a 6-3 decision in two consolidated cases, the U.S. Supreme Court has held that the untimely assignment of health care benefit liability under the Coal Industry Retiree Health Benefit Act of 1992 is still valid. The cases are Barnhart v. Peabody Coal Company, et al. (Docket No. 01-705) and Holland, et al. v. Bellaire Corporation, et al. (Docket No. 01-715). (SpencerNet)

Take Close Look at Fine Print Before Signing On to Section 529 Savings Plan
Excerpt: "So if you're an employer, what's not to like about 529 plans? Is there even a downside to offering your employees yet another benefit, especially one that-- isn't it precious?-- helps your staffers save for their children's education? On the surface, 529 plans appear to be a terrific benefit. But dig a little deeper, and you might conclude that offering them may not yet be worth your while." (Inc.com)

Wall Street Journal Profiles Patient Advocacy Group Created by Former Aetna Employees
Excerpt: "The Wall Street Journal on Jan. 28 profiles a company established by several former Aetna executives who now work as advocates helping patients 'maneuver through the denials, disappointments and dread caused by health insurers.' The company, called Health Advocate, contracts with employers for less than $3 per person per month ..." (KaiserNetwork.org)

Bush Seeks Medicare, Malpractice Reforms
Excerpt: "Calling Medicare a 'binding commitment of a caring society,' President Bush asked Congress to spend $400 billion over the next 10 years to establish a prescription drug benefit for the elderly as part of a broad Medicare overhaul that would turn more toward private insurers." (AP via New York Times; one-time registration required)

What Price Pain and Suffering?
Excerpt: "One patient's perspective in the rising debate over malpractice reform and award caps." (The Hartford Courant)

Specialists Wary of Medicare Overhaul
Excerpt: "But attempts over the past six years to shift elderly Americans into private HMOs caused turmoil for the 6 million seniors who tried it out, said health specialists, increasing out-of-pocket costs and shrinking benefits for most." (The Boston Globe)

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Links to Items on Executive Comp, Benefits in General

Commentary: Filings Show CEOs Got Raises as Returns Fell
Excerpt: "Faced with dismal 2002 returns, as well as the foul smell that soaring executive pay left in the noses of shareholders last year, you would think chief executive officers would have cleaned up their compensation acts. A review I did of 2001-2002 pay changes for 31 CEOs filing early proxy statements with the U.S. Securities and Exchange Commission shows otherwise." (Graef Crystal on Bloomberg.com)

Cutbacks in Stock Options Might Favor Executives
Excerpt: "Fewer options should mean fewer reasons to manipulate earnings for personal gain, or so the logic goes. Trouble is, compensation consultants say all that's really happening is that fewer options are being given to average workers. Executives are largely unaffected, which creates a disproportion that not only does little to remove temptation at the top but can be bad for business in general." (AP via New York Times; one-time registration required)

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Newly Posted or Renewed Job Openings


Pension Administrators
for Polycomp Administrative Services, Inc.
in CA

401(k) Enrollers/Independent Contractors
for Diversified Investment Advisors
in ALL STATES

401k Pension Administrator
for Penservco, Inc.
in FL

Defined Benefit Implementation Analysts
for Constantin Control Associates
in NJ

Enrolled Actuary
for Invesmart
in MA

ERISA Counsel
for American Express
in MN

Sales Associate - Health and Welfare Administration
for National Employee Benefits Outsourcing Vendor
in CA, GA, MO, OH

Bi-lingual Contract Enroller
for Professional Benefit Services
in IN

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Newly Posted Webcasts
( Post Yours! )

IRS/ASPA Washington Update
on March 27, 2003
presented by ASPA & IRS

Changes Ahead: The Private Insurance Market and Employer-Provided Coverage
on January 24, 2003
presented by Families USA

Bill Clinton's Perspective on Healthcare
on January 23, 2003
presented by Families USA

2003: The Year Ahead in Health on the Hill
on January 28, 2003
presented by KaiserNetwork.org

The Imperative of Universal Health Coverage
on January 23, 2003
presented by Families USA

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Newly Posted Conferences
( Post Yours! )

The U.S. Employers Summit on Reducing Healthcare Costs
in DC
March 26, 2003
IBF Conferences, Inc.

Form 5500 Update Program (1/2 day only)
in CO, MS, TN
March 20, 2003
SunGard Corbel

Form 5500 Update Program (1/2 day only)
in AZ, CA, LA
March 27, 2003
SunGard Corbel

7th Annual Compensation & Benefits Forum
in
April 12, 2003
Institute for International Research

Form 5500 Update Program (1/2 day only)
in CA, WA
April 3, 2003
SunGard Corbel

Form 5500 Update Program (1/2 day only)
in DC, GA, MO, OH
April 24, 2003
SunGard Corbel

Form 5500 Update Program (1/2 day only)
in PA
April 30, 2003
SunGard Corbel

Form 5500 Update Program (1/2 day only)
in MA, NE, TX
May 1, 2003
SunGard Corbel

Form 5500 Update Program (1/2 day only)
in IA, NY
May 7, 2003
SunGard Corbel

Form 5500 Update Program (1/2 day only)
in MO, TX, WI
May 8, 2003
SunGard Corbel

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