August 2011  |  Volume 2, Number 8

Contract, Compliance and Research Updates
Interim Final Rules and Model Notices on Internal Claims and Appeals and External Review Process
Correction Released
Effective July 22, 2011, The U.S. Department of Labor, Department of Treasury and Department of Health and Human Services released a correction of the amendment to interim final rules with request for comments. (updated 7/26/2011) The U.S. Employee Benefit Security Administration (EBSA) and Department of Health and Human Services (HHS) issued amendments to the Interim Final Rules implementing the requirements regarding internal claims and appeals and external review processes for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act (PPACA). These rules are intended to respond to feedback from stakeholders on the interim final regulations and to assist plans and issuers in coming into full compliance with the law through an orderly implementation process. The amendments focus primarily on six issues:
  1. Expedited notification of benefit determinations involving urgent care
  2. Additional notice requirements with respect to notice of adverse benefit determinations or final internal adverse benefit determination
  3. Deemed exhaustion of internal claims and appeals processes
  4. Providing notices in a culturally and linguistically appropriate manner
  5. Duration of transition period for State external review processes
  6. Scope of the Federal External Review Process

The agencies also released additional guidance and revised model notices related to the amended interim final rules, linked below.

In This Issue
Contract, Compliance and Research Updates
Wisconsin Updates
HR360 Wins Top Tier Awards


More information regarding Health Care Reform and other benefit resources is available on the HR360 website, available to BSG clients under the "Resources" menu of their HR Express website. HR360 includes new features including step-by-step interactive guides which make the processes of hiring, termination, COBRA and FMLA so much easier in addition to the new online tools such as job description builder and salary benchmarking tool.

BSG subscribes to this service for your benefit. If you would like more information regarding this resource please contact your account management team at BSG. 
Wisconsin Updates
Wisconsin Budget Act Amends Dependent Coverage Law, But Not Tax Implications

On June 26, 2011, Governor Scott Walker signed into law the biennial Budget Bill. The Wisconsin Budget Bill modified a provision in the Wisconsin Statutes that required employers with insured group health plans (and self-funded public sector health plans) that offer dependent health insurance coverage to their employees to include coverage for certain adult dependent children up to the day before the child's 27th birthday. Specifically, Wisconsin law now appears to follow the requirements of the federal health care reform law (the Patient Protection and Affordable Care Act (PPACA)), which requires that employers provide coverage to adult children of employees up to the day before the child's 26th birthday.


Effective Date

  • Generally effective January 1, 2012
  • Effective on a later date when the terms of a collective bargaining agreement cover the subject employees/plan.
  • Wisconsin employers sponsoring plans that were affected by the prior Wisconsin dependent coverage law are still required to provide coverage to dependents up to their 27th birthday through at least the end of 2011.

Tax Implication

  • The Wisconsin Budget Bill did not change the disparity between the Wisconsin and federal tax laws.
  • Wisconsin employers that provide dependent health coverage (insured or self-funded) to their employees must, for Wisconsin income tax purposes, impute as income the fair market value of health insurance coverage provided to employees for their children who are not tax dependents.
  • All employers who have not previously taken steps to ensure its payroll practices properly account for the imputed income issues should take immediate steps to do so.

Click here to read the full "Client Alert" from Charles P. Stevens, Kelli Toronyi Newman and Kirk A. Pelikan of Michael Best & Friedrich LLP.


Partnership for Prevention: IOM Releases New Report on Clinical Preventive Services for Women 

The Partnership for Prevention recently posted information from the Institute of Medicine (IOM) recommendations about preventive services for women.


"Last week the IOM panel released its report Clinical Preventive Services for Women: Closing the Gaps detailing the findings. It concluded that eight additional preventive services should be added to the services that health plans will cover with no co-pays or deductibles under the Women's Health Amendment in the ACA. Eliminating financial barriers would increase the number of women getting these services. These services include improved screening and counseling for cervical cancer and sexually transmitted infections, including HIV and HPV; annual well-woman preventive care visits; gestational diabetes screening for pregnant women; lactation counseling and equipment for breast-feeding mothers; and additional screening and counseling to detect and prevent domestic violence. The report also recommends that insurers cover "the full range" of FDA-approved contraceptive methods, as well as sterilization and reproductive counseling at no cost to the patients, to prevent unintended pregnancy."


John L. Barlament, Partner at Quarles & Brady LLP commented relative to the adoption of the rules relating to birth control coverage (among other things) for health plans, "For many plans this may not be controversial (although it may add to the cost). For religious organizations this may be a big deal. There is a possible exemption for 'religious employers' but the exemption seems rather weak, at least at first glance." 


To learn more:

HR360 Wins Top Tier Awards

HR360 has won a number of major awards for industry leadership and content excellence. The entire HR360 team is deeply gratified by the positive and enthusiastic response has received and, as always, everyone involved is dedicated to producing the best possible online HR library and newsletter. Look for some exciting new features in the coming months.


HR360 Awards & Recognition:

  • Hermes Creative Award: Gold Award for content writing and Web copy
    Hermes Creative Awards is an international competition for creative professionals involved in the concept, writing and design of traditional materials and programs, and emerging technologies. Winners included Aetna, American Express, American Cancer Society, ICF International.
  • Communicator Awards: Award of Distinction for law and legal services on
    The Communicator Awards are judged and overseen by the International Academy of the Visual Arts (IAVA), a 550+ member organization of leading professionals from various disciplines of the visual arts dedicated to embracing progress and the evolving nature of traditional and interactive media. Winners included NBC Universal, TMPG, Novo Nordisk, United Healthcare, T. Rowe Price.
  • Magnum Opus Awards: Gold Award for Best Editorial - New Publication, Silver Award for Best Overall Editorial and Honorable Mention for Best How-to-Article: Termination Meetings

    The ContentWise Magnum Opus Awards are the leading custom media awards program recognizing excellence in editorial, design and strategy for organizations using print and online publications as well as social media in their content marketing efforts. Winners included Aetna, State Farm Insurance, Proctor & Gamble, MetLife, and Bank of America.

  • American Business Awards: (the Stevies) Finalist in the content writing, legal and new service categories.
    Honoring organizations of all types and sizes and the people behind them, the Stevies recognize outstanding performances in the workplace worldwide. Winners included: Apple, Inc., Cisco, General Electric, Groupon, and CIGNA Government Services.
Enlighten is published by The Benefit Services Group, Inc., (BSG®) and is provided free of charge to select BSG client representatives and associates.

By providing links to other sites, BSG does not guarantee, approve or endorse the information or products available at these sites, nor does a link indicate any association with or endorsement by the linked site to BSG.

The preceding is not intended to be and is not offered as legal advice. We are prohibited from the practice of law. Compliance is the responsibility of the employer or Plan sponsor and affected employees who should seek their own legal counsel regarding questions about information presented in this newsletter.

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