Practice Groups

Health and Welfare
Representative Engagements

We help our clients develop sound strategies for ensuring compliance with the complex state and federal laws that govern the health care industry and plan sponsors, and work with them to maximize tax-effective funding strategies for long-term liabilities such as retiree medical plans. We also have considerable experience with structuring, negotiating, and drafting documentation of managed care programs, and we design innovative new products for evolving areas in health care. In the past two years, we have:

•	Monitored HIPAA privacy, standard transaction, and security regulations.

•	Drafted comments to proposed HIPAA regulations on behalf of a large health insurance company and held conference calls with plan representatives nationwide to discuss issues.

•	Worked with large employer plans to “audit” HIPAA privacy, transactions, and security compliance, establish and document necessary HIPAA procedures, draft required notices and contract language, and conduct training programs for employees.

•	Drafted “wrap” plan documents for employers who would like to consolidate welfare benefit plans into a single document, including reviewing and updating insurance policies, trust documents, summary plan descriptions, and 5500s.

•	Designed and evaluated defined contribution health plans, including Health Savings Accounts and Health Reimbursement Accounts.

•	Reviewed contracts between health plans and third party administrators for self-funded claims processing as well as contracts between health plans and insurers for insured benefits.

•	Monitored Patients’ Bill of Rights legislation, drafted talking points, and proposed amendments to distribute to the Administration and Congress.

•	Performed welfare plan audits, including compliance with SPD and claims regulations, COBRA, HIPAA, cafeteria plan regulations, MSP rules, and ERISA plan asset requirements.

•	Reviewed claims procedures for employer plans and insurance companies to determine compliance with DOL claims procedure regulations, and helped plans to draft updated claims procedures and notices.

Innovative Approaches to Disease Management and Wellness Programs
A recent trend for welfare plans is to establish disease management programs to encourage healthier lifestyles and cut health care costs. We have worked with several large employers to determine innovative ways to share information and establish disease management or wellness programs. These programs range from a simple “stop smoking” classes to comprehensive incentive programs that pay participants—through cash or premium waivers—to lose weight, stop smoking, or lower their cholesterol. Some programs even incorporate a detailed health risk assessment that plans can use to identify “at-risk” participants and follow their progress individually.

Programs like these involve numerous regulatory issues which we have helped clients negotiate. The Department of Labor has issued detailed regulations specifying requirements for bona fide wellness programs. A plan must follow these regulations in order not to violate HIPAA nondiscrimination rules.

We have worked with plans to ensure that their disease management programs are structured to meet the requirements from the beginning. In addition, these programs typically use individually identifiable health information, which is protected by the HIPAA privacy and security rules. We have helped plans determine what information can be used, what authorization or notices must be provided, and what contractual provisions must be in place between the plan and any third parties assisting with the wellness program. We also have worked with plans to assess the tax implications of providing incentives, whether the wellness programs or the rewards can be paid out of plan assets, and how the ERISA SPD and claims regulations should apply to the program. And we have helped plans to draft the necessary documentation to describe their disease management programs, in compliance with ERISA, and have drafted opinion letters discussing how the program meets the requirements of ERISA, HIPAA, and the Internal Revenue Code.

Return to Health Care