Health plan admin - misc (BenefitsLink.com)Headlines re Health plan admin - misc, gathered by BenefitsLink.comGuidance Overview Alaska Supreme Court - An Opinion on ERISA Preemption- (Found June 19, 2008 ) Excerpt: "The Supreme Court held: 1) ERISA 514 does not pre-empt a common law claim for negligent misrepresentation by non-participants. 2) Emotional distress damages were justified, even in the absence of physical injury . . . . 3) The allocation of 75 % fault to the Fund and 25 % fault to the employer was justified. The Court seemed to approve Judge Suddock's analogy of the employer to a 'lay consumer' and the Trust to an insurance company." (Alaska Employment Law)http://www.akemplaw.com/wiki/2008/03/07/alaska-supreme-court-two-labor-opinions/ Opinion Law Professor Amicus Brief Filed in Glenn ERISA Case- (Found June 19, 2008 ) Excerpt: "Donald Bogan (Oklahoma) sent us a copy of an amicus brief he and a few others at the University of Oklahoma College of Law filed last week in the U.S. Supreme Court ERISA standard of review case, MetLife v. Glenn, which is set for oral agreement on April 23, 2008." (Workplace Prof Blog)http://lawprofessors.typepad.com/laborprof_blog/2008/04/law-professor-a.html Guidance Overview On the Standard of Review - A New Checklist- (Found June 19, 2008 ) Excerpt: "The proper standard of review to be applied in judicial review of a plan administrator's decision varies depending on venue. Nor are the Courts all persuaded that the issues have been well decided." (Health Plan Law blog by Attorney Roy F. Harmon III)http://healthplanlaw.com/?p=595 More than Half of $2.2 Trillon U.S. Health Tab Called Wasteful- (Found June 19, 2008 ) Excerpt: "A new PricewaterhouseCoopers' Health Research Institute study found the top three areas of wasted spending are defensive medicine ($210 billion annually), inefficient claims processing (up to $210 billion annually), and care spent on preventable conditions related to obesity ($200 billion annually). The study report said the $1.2 trillion in waste, defined in the research as costs that could have been avoided without hurting service quality, has to be dealt with at a macro level..http://www.plansponsor.com/pi_type10/?RECORD_ID=41078 The Price of Excess - Identifying Waste in Health Care Spending (PDF)- (Found June 19, 2008 ) 22 pages. Excerpt: "To appropriately address waste in health spending, health industry leaders, policymakers and consumers must work together on system-wide goals and incentives to address the waste that imperils the health of us all. In this paper, we view waste as costs that could have been avoided without a negative impact on quality." (PricewaterhouseCoopers; lengthy free registration is required)http://pwchealth.com/cgi-local/hregister.cgi?link=reg/waste.pdf Guidance Overview CRS Report for Congress: Summary of the Employee Retirement Income Security Act (ERISA) (PDF)- (Found June 19, 2008 ) 76 pages; April 10, 2008. Excerpt: "The Employee Retirement Income Security Act of 1974 (ERISA) provides a comprehensive federal scheme for the regulation of employee pension and welfare benefit plans offered by employers. ERISA contains various provisions intended to protect the rights of plan participants and beneficiaries in employee benefit plans. These protections include requirements relating to reporting and disclosure, participation, vesting, and benefit accrual, as well as plan...http://benefitslink.com/articles/guests/RL34443.pdf Guidance Overview ERISA Plan's Prior Authorization and Plan Limits Requirements Preempt State Medicaid Demands for Payment If Procedures Not Followed- (Found June 19, 2008 ) Excerpt: "Employer health plans that require prior authorization or impose plan limits on certain types of care need not repay State Medicaid plans when those state plans pay for Medicaid recipients' treatments that the employer plan would not have paid unless the plan participant had received prior authorization under the employer plan. But this rule applies only if the plan participant first files the claim with the employer health plan and receives the employer plan's denial of payment,.http://benefitslink.com/articles/guests/washbull080414.html Opinion Tax Bill Provision Meant to Hinder Tax Evasion Could Boost HSA Administration Costs- (Found June 19, 2008 ) Excerpt: "HSAs are a tax scheme in which we taxpayers subsidize the health care of individuals with incomes high enough to qualify for the tax relief. It would be inappropriate if these taxpayer-subsidized funds were used to purchase entertainment centers or expensive vacation trips. Unfortunately, the only way to ensure that these funds are used for health care is to establish an administrative process to clear each payment made out of the accounts." (Physicians for a National Health.http://www.pnhp.org/news/2008/april/tax_evasion_through_.php Guidance Overview Stop Loss Carrier Averts ERISA Preemption in Dispute Over 'Fronted' Claims Reimbursement- (Found June 19, 2008 ) Excerpt: "With a sentence of Faulknerian length, the Fourth Circuit framed the question of possible ERISA preemption of a claims administrator against a plan sponsor. The case forms a interesting addition to the growing body of law to the effect that contractual disputes between plan sponsors and claims administrators are subject to state, not federal, law." (Health Plan Law blog by Attorney Roy F. Harmon III)http://healthplanlaw.com/?p=600 Bank of America Consolidates a Dozen Bennies Vendors, Hoping to Stabilize Costs- (Found June 19, 2008 ) Excerpt: "Bank of America's overhaul of its employee benefits program may in many ways be the first of its kind among corporations with jumbo-sized work forces. But benefits experts say the banking behemoth is unlikely to be the last large employer to consolidate almost all of its health-care and related vendors onto a single platform, because scores of companies are battling to stabilize -- and streamline -- their health-care operations and expenses." (Financial Week; free...http://www.financialweek.com/apps/pbcs.dll/article?AID=/20080421/REG/136129618/-1/FWIssueA... |