Compliance September 1, 2005

Judge: Oral COBRA Notice Legally Sufficient

September 1, 2005 (PLANSPONSOR.com) - A Michigan man suing his former employer over his health coverage won a mixed legal victory when a federal judge cleared the engineering firm of wrongdoing on one issue but paved the way for more proceedings on another.
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US District Judge Robert Holmes Bell of the US District Court for the Western District of Michigan ruled that Dreisenga & Associates had satisfied the notice requirements of the Consolidated Omnibus Budget Reconciliation Act (COBRA).

Even though President Daniel Dreisenga did not specifically refer to COBRA in his conversation with plaintiff Thomas Joiner, the interaction with Joiner allowed him to make an informed decision about his ability to continue coverage after he retired, Bell said.

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According to Bell, Joiner and Dreisenga discussed continuation of coverage and agreed Joiner would be responsible for the premium. This notification allowed Joiner to make an informed decision, the court said.

While Dreisenga “may not have specifically referred to [Joiner’s] continuation coverage as a benefit conferred under COBRA, the notice given adequately informed him of his ability to continue coverage. Thus, [Joiner] was able to elect to continue coverage that would otherwise terminate due to his retirement. In short, through [Dreisenga’s] notification and continuation of [Joiner’s] coverage, the purpose of COBRA was served,” Bell wrote in his opinion.

However, Bell refused to dismiss the remainder of Joiner’s case alleging that Dreisenga violated the Health Insurance Portability and Accountability Act (HIPAA) by terminating his coverage after learning he had prostate cancer. Bell said because there was conflicting testimony about how long Joiner was supposed to be covered and whether the employer was informed of the cancer before or after it terminated insurance coverage, Joiner had the right to keep that part of the case alive.

The company alleged that Joiner was entitled to coverage only until age 65 and that it notified Joiner it was terminating his coverage before he informed them he had cancer. Joiner asserted that the agreement on continued coverage did not have a specific termination date and that he notified the company of his cancer before the termination of coverage.

The case is Joiner v. Dreisenga & Associates Inc., W.D. Mich., No. 1:04-CV-437, 8/29/05.

Benefits August 31, 2005

Lost Productivity Annual Price Tag: $260 billion

August 31, 2005 (PLANSPONSOR.com) - A New York City-based health care advocacy group has put an enormous annual price tag on the nation's lost productivity due to health problems among working-age Americans - $260 billion.
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A Commonwealth Fund study, Health and Productivity Among U.S. Workers, by Fund staff Karen Davis, Sara Collins, Michelle Doty, Alice Ho, and Alyssa Holmgren, based on data from a 2003 Fund report, revealed that 18 million adults ages 19 to 64 were not working and had a disability or chronic disease, or were not working because of health reasons.

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“A healthy workforce is one of our most important economic assets as a nation,” Fund researchers wrote. “While ensuring that all Americans have health insurance coverage and receive effective medical services would certainly help protect this vital asset, the cost of doing so has thus far deterred the nation’s policymakers.”

The study found that nearly two-thirds (64%) of workers reported missing days because of their own illness or that of a family member. Analysis of the survey data finds that an estimated 69 million workers took sick days in 2003, amounting to 407 million lost days of work. Valuing this missed time at workers’ actual wage rates, an estimated $48 billion of economic output was not generated due to time off while sick.

Half of workers reported a time when they were unable to concentrate at work because of their own illness or that of a family member, accounting for 478 million days. Some 20% reported six days or more in this condition. The difference between sicker and healthier workers reporting six or more days at work of reduced productivity was even greater (31% vs. 16%).

The Commonwealth Fund authors asserted that providing workers with the means to maintain their health and the health of family members, including affordable and comprehensive health insurance coverage and paid sick leave, could yield economic payoffs for working families and the overall economy.

“ When people are unable to work or drop out of the workforce because of serious health problems or disability, they do not generate economic output, pay taxes on earnings, or help raise the nation’s economic standard of living,” the researchers pointed out. “Investing in the health of workers and the prevention of disability and serious illness could have an economic payoff. The US labor force would expand, with the potential for a significant increase in the nation’s standard of living and economic output.”

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