Health plan admin - misc (BenefitsLink.com)Headlines re Health plan admin - misc, gathered by BenefitsLink.comCleaning Up the Company's Health Insurance Eligibility Rolls- (Found June 19, 2008 ) Excerpt: "A school district in Cleveland saved $3.5 million in two steps: First, it identified ineligible dependents and removed them from the district's health care rolls. Then, the district clamped down with a new policy that required spouses to use their own employer's health care coverage." (Workforce Management; free registration required)http://www.workforce.com/section/02/feature/25/41/03/index.html Guidance Overview Appellate Court Affirms State Insurance Department Cease & Desist Order Against TPA's ERISA Challenge- (Found June 19, 2008 ) Excerpt: "An Indiana appellate court held that the Indiana Department had jurisdiction over a claims administrator's activities where the practical function was the provision of insurance. This case presents analysis of the oft-cited defense to insurance department regulation, that of ERISA preemption." (Health Plan Law blog by Attorney Roy F. Harmon III)http://healthplanlaw.com/?p=577 Health Insurance Company Bosses Make Bigtime Bucks - Nonprofits Defend Executives' Pay- (Found June 19, 2008 ) Excerpt: "Bay State health insurance bosses are raking in multimillion-dollar pay packages - and politically wired powerbrokers get tens of thousands as part-time directors - even as the state and its taxpayers struggle to pay skyrocketing health care costs, a Herald review shows." (Boston Herald)http://www.bostonherald.com/news/regional/general/view.bg?articleid=1079694&srvc=rss Opinion What's the Size, Role & Future of TPAs' Marketplace- (Found June 19, 2008 ) Excerpt: "The estimates used in this report are intended for guidance to understand what is really going on in the marketplace...not to be used as 'gospel' or plugged into statistical formulas. Basic differences in vocabulary means every number has a built-in 1,000% potential distortion factor. For example, a family of parents and 10 children are variously described as 1, 2, 3, 4, or 12 'lives', so even simple counting of heads will be distorted." (Frederick D Hunt, Jr. via Society...http://users.erols.com/spba/p0000015.html Official Guidance The IRS Employer's Supplemental Tax Guide for Use in 2008 - Publication 15-A (PDF)- (Found June 19, 2008 ) 60 pages. Excerpt: "This publication supplements Publication 15 (Circular E), Employer's Tax Guide. It contains specialized and detailed employment tax information supplementing the basic information provided in Publication 15 (Circular E)." (Internal Revenue Service)http://www.irs.gov/pub/irs-pdf/p15a.pdf Guidance Overview ERISA Preempts State Withholding Law- (Found June 19, 2008 ) Excerpt: "Employers can thank the son of a Supreme Court Justice for obtaining needed guidance on an ERISA preemption issue that has been a traditional gray area of group health plan administration." (Infinisource)http://www.infinisource.net/Infinisource/News_Review_Articles/news_review20080311-3.aspx CEOs Have Their Own Ideas About Improving Health Insurance Coverage- (Found June 19, 2008 ) Excerpt: "Company CEOs are united in their hopes that there is some way to tame health care costs and insurance premium increases. But beyond that, they have their own ideas on how health plans could be improved to benefit their employees and their companies. . . . Many businesses have found ways, often through trial and error, to address the twin goals of providing health coverage to attract and keep employees while tweaking the coverage and instituting other efforts to keep a handle on...http://www.bizjournals.com/dallas/stories/2008/03/17/focus1.html?b=1205726400^1605439 Opinion A Closer Look at the Procedural Aspects of Delegation of Claims Review- (Found June 19, 2008 ) Excerpt: "As noted previously, the lack of the plan administrator's involvement in the benefits denial decision was cited as the reason for applying a de novo, as opposed to an abuse of discretion, standard of review. In the case discussed there, Shelby County Healthcare Corp. v. Majestic Star Casino, LLC, Slip Copy, 2008 WL 782642 (W.D.Tenn.) (March 20, 2008), the district court concluded that this lack of involvement distinguished this case from those in which deference must be accorded..http://healthplanlaw.com/?p=585 Guidance Overview Claim for Negligent Misrepresentation That Employee Had Health Coverage Was Not Preempted by ERISA- (Found June 19, 2008 ) Excerpt: "EBIA Comment: As this court noted, generalizations as to the scope of ERISA preemption can be problematic. Some state laws affect employee benefit plans in 'too tenuous, remote or peripheral' of a manner to warrant preemption by ERISA." (Employee Benefits Institute of America)http://www.ebia.com/weeklyguest/19341/20080421300d45f8140a7c76896d0cecb0967961/BNL080327 Guidance Overview Claims Administrator's Handling of Claim Satisfies Urgent Care Regulations- (Found June 19, 2008 ) Excerpt: "The facts of this sad case illustrate the tragic conflict that can arise when families trying to obtain medical care for loved ones confront the claims administration mechanisms that operate as cogs and wheels within the larger mechanical apparatus of the ERISA remedial system. One of the salient facts that undoubtedly frustrated the plaintiff was that the defendant refused to approve a drug that it had previously approved and had evidently proved efficacious. Nonetheless, in the.http://healthplanlaw.com/?p=613 |