Tag Archives: Health plans

What Federal Contractors Need to Know about Self Insurance

By Nicole Mitchell Contractors often disclose the cost savings of self-insured plans with excitement, but buyer beware. Most contractors are surprised when I don’t immediately commend them on cost savings and instead ask them,“Did you know there are ’special‘ compliance…

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Rules for QHP Transparency Soon Will Apply to Employers

Insurers and plan sponsors soon will have to report to the government (and list on a web page) their policies on: out-of-network liability and balance billing; enrollee claim submission; claims and denials; recoupment of overpayments; medical necessity; prior authorization; drug…

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Supreme Court Will Rule on Preemption of Vermont Health Reporting Law

The U.S. Supreme Court will decide whether ERISA preemption shields a self-funded health plan from state requirements to report health claims data. The court agreed June 29 to hear Gobeille v. Liberty Mutual Ins. Co. (2015 WL 2473478). The state of…

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Supreme Court Upholds Exchange Subsidies

The U.S. Supreme Court in a 6-3 vote affirmed that subsidies may go to individuals in states with exchanges established by the federal government, and the statute did not restrict subsidies to only states that themselves ran exchanges. Such a…

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Reform FAQs Solidify Rules on OOP Maximums, Provider Nondiscrimination

Non-grandfathered employer-sponsored group health plans must abide by out-of-pocket maximums for every individual covered, whether they are enrolled in “self-only” or in “other than self-only” (family) coverage. And the government stayed enforcement of the Affordable Care Act’s provider nondiscrimination rules,…

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IRS Further Explains Large-employer ACA Reporting

Large employers learned more details in new IRS guidance about how to both report about their coverage and fill out and file IRS forms designed to determine whether they are meeting the Affordable Care Act’s coverage requirements for employers. Under the…

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DOL: Plans Must Cover All Contraceptives, Not Some

Plans and insurers must cover all 18 contraception methods approved by the U.S. Food and Drug Administration, according to a new set of questions and answers on the Affordable Care Act’s preventive care coverage requirements. “Reasonable medical management” still may…

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Insurance Contract Overrules More Specific SPD, 9th Circuit Rules

The 9th U.S. Circuit Court of Appeals decided that an insurance certificate was an official plan document that overrode the plan’s summary plan description. It shows that plans are vulnerable when they attempt to set out plan terms in the…

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Reform Reinsurance Fund Refund Requests Due Soon

The Centers for Medicare and Medicaid Services announced an April 30 deadline for claiming certain overpayments of the transitional reinsurance fee. The announcement covers overpayments due to miscalculating enrollment counts on which the fee is based. Such miscalculations occur for…

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Supreme Court Will Resolve Split over ERISA Reimbursement

The U.S. Supreme Court decided to hear a case to resolve whether an ERISA health plan can recover money it spent on a plan participant’s care from his or her personal injury settlement, even if the participant has already spent…

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