Tag Archives: Health plans

Fiduciary Duties Are Myriad, So Safeguards Matter

Monitoring the performance of service providers, making required disclosures to participants and beneficiaries, keeping good records and filing reports with the government are just a few of the important functions a fiduciary must ensure are properly executed, an enforcement official…

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Court: Employers Can Condition Health Benefit on Wellness Participation

An employer may require its workers to participate in a wellness program in order to receive health insurance benefits, a federal district court has ruled, dismissing a lawsuit brought by the U.S. Equal Employment Opportunity Commission. Granting summary judgment for…

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IRS Extends ACA Employer Reporting Due Dates

Employers will have 60 more days to send notices to participants and beneficiaries, and about 90 more days to send notices to the IRS about health coverage offered and employees’ health coverage status, the IRS announced Dec. 28. IRS Notice…

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Recover Health Plan Costs Even With a Worst-case SCOTUS Ruling

By Roy Harmon III Several outcomes in an upcoming Supreme Court decision on the extent of health plan subrogation and reimbursement rights could make life more difficult for plans. One outcome in Montanile v. Bd. of Trs. National Elevator Industry…

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Technology and ICD-10 Give Plans New Recovery Powers

Health plans are unlocking the power of ICD-10 codes and using modern technologies to identify and track the progress of cases to maximize recoveries when plan members have been reimbursed twice for injuries caused by liable third parties, Elizabeth Longo,…

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Puerto Rico Health Insurer Will Pay Record $3.5M HIPAA Settlement

A Puerto Rico health insurer agreed to pay $3.5 million in a HIPAA settlement after the U.S. Department of Health and Human Services, investigating multiple breach reports from the company, found what it called “widespread noncompliance” throughout the organization. Triple-S…

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ACA Proposal Addresses Balance Billing and Narrow Networks

Employers that purchase small group coverage that is federally regulated under the Affordable Care Act will have additional assurances that their plan members will not be balance billed in certain situations, under proposed rules issued in pre-publication form on Nov….

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Health Plans Should Learn New Rules to Prevent Balance Billing

Thanks to cost pressures exacerbated by the Affordable Care Act, narrow-network plans have increased in popularity because of their lower premiums, but plans using such networks need to think about associated potential problems with poor provider access, balance billing and…

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Grandfathered Plan and Patient Protection Guidance Finalized

How much a health plan may change before losing grandfathered plan status was addressed in a final Affordable Care Act rule issued on Nov. 13 by the three U.S. departments that administer ACA reform. The rule (which takes effect on Jan. 1, 2017) finalizes…

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Obama Signs Bill Eliminating ACA’s Auto-enrollment Requirement

Large employers with 200 and more employees will not have to automatically enroll their workforces into health plans, under budget legislation signed by President Obama. This Affordable Care Act provision was repealed because it was a low government priority and because…

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