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These executive summaries were compiled from EMPLOYEE BENEFITS INFOSOURCE database, a source for information on employee benefits and human resources.
Child's Play.
Patton, Carol; Human Resource Executive; v26 no1 pp 30, 32 Jan-Feb 2012; journal article
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Abstract :
With a large percentage of health plan participants being employees' children, some companies are actively promoting kids' wellness. Baptist Health South Florida in Miami started a program targeting childhood obesity with a whole family, multigenerational approach. Involving parents and grandparents led to improvements in cholesterol, blood pressure and/or body weight. Minitab Inc. offers camp programs for kids from five to 13 years of age, focusing on physical activity, good food choices and safe play, including parents at a daily nutritional lunch, and it sponsors a weekly kids' circuit along with parents at the onsite gym. Employers that do not have such resources can get involved in wellness programs at local schools, offer sports activities on Take Your Child to Work Day and make sure that employees' kids get biometric screenings and counseling as needed through health care providers.
[0161731]
The Impact of PPACA on Employment-Based Health Coverage of Adult Children to Age 26.
Fronstin, Paul; EBRI Notes; v33 no1 pp 2-6 Jan 2012; journal article
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Abstract :
Under the Patient Protection and Affordable Care Act (PPACA), health plans are required to cover adult children up to age 26, effective September 23, 2010. Data from three surveys show the positive effect of the mandate on health care coverage for this group. The Census Bureau's Current Population Survey found employment-based coverage for dependent adults aged 19 through 25 years rose from 24.7 percent in 2009 to 27.7 percent in 2010. The Survey of Income and Program Participation showed a rise from 26.9 percent in the first nine months of 2010 to 27.1 percent in October and November of that year. The National Health Interview Survey by the Centers for Disease Control revealed coverage growth from 51 percent to 55.8 percent in the first half of 2011, while the rate of uninsured ages 19-25 fell from 33.9 percent to 28.8 percent.
[0161551]
Benefit Denial: Appeals Court Affirms Plan's Discretion to Deny Benefits as Not Medically Necessary.
Mendoza-Ben-Yosef, Agnes; BNA's Pension & Benefits Reporter; v38 p 2144 Nov 22, 2011; journal article
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Abstract :
The Tenth Circuit Appeals Court upheld the district court's decision on a plan administrator's denial of benefits in Eugene S. v. Horizon Blue Cross Blue Shield of New Jersey. The plaintiff sought approval for coverage in a residential treatment program, which the treating physician recommended but the plan's consulting doctors stated were unnecessary. The courts ruled the plan administrator was not required to give greater weight to the treating physician's opinion and that the administrator's decision was reasonable. Further, the plan specifically gave the administrator discretionary authority to determine benefits eligibility, leading correctly to the courts' ruling under an arbitrary and capricious standard of review.
[0161321]
Tracking Health Insurance Coverage by Month: Trends in Employment-Based Coverage Among Workers, and Access to Coverage Among Insured Workers, 1995-2010.
Fronstin, Paul; EBRI Notes; v32 no10 pp 14-19 Oct 2011; journal article
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Abstract :
A month-by-month analysis of health insurance coverage between 1995 and 2010 reveals that the percentage of workers offered health benefits and percentage taking the coverage have changed little. Among wage and salary workers from age 18 to 64, the rate of those with job-based benefits in their own name or as a dependent changed little between 1995 and 2007. The percentage of coverage in one's own name hovered from just under 60 percent in 1996 up to 61.8 percent in 2002, dipping to 56.8 percent in May 2008 and further to 55.9 percent in August 2009, after which a slight recovery appears to have started. Coverage for dependents rose from 17.4 percent in 1995 to nearly 20 percent in 1999 and hit a low of 16 to 17 percent from 2003 to 2007, rebounding to 17.5 percent in July 2010. The rate of uninsured mirrors the strength of the economy and employment rate, typically in the 13 to 15 percent range but hovering around 18 percent between 2008 and 2010.
[0161145]
Remedies: Court Finds No Equitable Relief Claim for $1.6M Spent to Treat Participant's Child.
Mendoza-Ben-Yosef, Agnes; BNA's Pension & Benefits Reporter; v38 p 1672 Sep 13, 2011; journal article
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Abstract :
The Seventh Circuit Court of Appeals found no equitable relief claim for a self-funded employee health plan for benefits paid to health care providers for treatment of a plan participant's child in Kolbe & Kolbe Health & Welfare Benefit Plan v. The Medical College of Wisconsin Inc. The plan determined that the child had not been enrolled and was therefore not a covered person, but paid the medical providers despite the determination. The plan then attempted to recover the payments under an overpayment provision that gave the plan the right to recover overpayments made on behalf of covered persons. The case was remanded back to district court with a recommendation to dismiss, but the district court's dismissal of a state law claim was reversed on the grounds that the law was not an alternate ERISA enforcement mechanism.
[0160954]