Tag Archives: Health plans

Insurer’s Recovery Rights Were Rooted in ERISA Docs in Spite of Plan Administrator’s Contrary Words

An insurer won recovery of health expenses paid from a member’s $255,000 settlement after said member refused to reimburse the insurer for medical payments it made. It did so in spite of an affidavit from the company plan administrator saying…

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In Case You Missed It: Plan Administrator Must Give Providers ERISA Appeal Process

The ruling in Penn. Chiropractic Ass’n v. BCBSA threatens to make recoveries more difficult for all insurers and may complicate the claims administration of self-funded plans. It also may necessitate self-insured plan sponsors reviewing network contracts with providers. Here’s what happened:…

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FAQs Describe How Plans, Administrators Will Pay Reinsurance Contributions

On May 22, CMS issued guidance (registration required) describing how plans, third-party administrators and insurers will pay reinsurance contributions required under health care reform for the next three years. The guidance says a contributing entity can complete all required steps for the…

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CMS: Waiting Periods on Essential Benefits May Be Discrimination

Employer-sponsored health plans and insurers got a double dose of compliance advice on May 16 from the Centers of Medicare and Medicaid Services in the form of a set of Frequently Asked Questions. The first FAQ clarifies that insurers in the…

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Court Allows ERISA Plan to Deny Coverage to Same-Gender Spouse

A self-insured employer that explicitly excludes same-gender spouses from health plan coverage did not violate ERISA’s benefit interference or fiduciary breach provisions by having such exclusionary language, a federal district court in New York ruled. A same-gender couple had argued that, in…

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Employers and Health Plans: Panelists Don’t See ACA Exodus

The jury’s still out on the impact of health care reform on employment‐based health benefits, but predictions of mass instability are certainly not materializing, reform experts said May 15 at a policy forum sponsored by the Employee Benefits Research Institute…

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Penalties Await Plans That Ignore ACA’s High-litigation Risks

Employers have cited complying with the Affordable Care Act as their number one concern in surveys, and that wouldn’t be the case if there weren’t taxes and money penalties backing it up. This is true even though the government postponed…

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Organization Strategy Must Underlie Health Reform Decisions

How a company complies with health care reform should be determined by what kind of employer it is, how exclusive its workforce is, and how important its benefit package is seen as an aid to recruitment and retention. Only after…

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Notre Dame University Denied Contraception Injunction

The 7th Circuit in a 2-1 ruling refused to grant a preliminary injunction to Notre Dame University, which would have freed the university from participating in reform’s requirement to provide contraceptives at no cost to all women. In so doing the court criticized…

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AOL Debacle Highlights Need to Maintain HIPAA Privacy Practices

Although sponsors of group health plans have had their hands full sorting through the still-changing Affordable Care Act requirements, the recent uproar involving AOL CEO Tim Armstrong is a stark reminder of the need to stay vigilant on HIPAA privacy…

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