Tag Archives: Health plans

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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The ACA After Five Years: Disasters Did Not Materialize, But More Change Is Needed

Five years ago, in March 2010, the Affordable Care Act was signed into law by President Obama to resolve problems in the U.S. health system, including: the high number of uninsured Americans; Americans unable to get coverage due to pre-existing…

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Connecting Members and Data Promises to Reduce Costs

Tremendous cost-cutting and patient care improvements await insurers and plans that can leverage the recent gains of computing to improve patient self-management of care. The challenge is how to tap the big pools of data, and get “actionable” personalized results…

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Sixth Circuit Overturns $2.8M ERISA Award for Unjust Enrichment

Simply paying an aggrieved plan participant for unpaid benefits due was enough to make him whole under ERISA, so no further money damages were warranted as a form of equitable relief, a federal appeals court has ruled. With this conclusion,…

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High Court Sees Problems in King Petitioners’ Arguments

Petitioners in King v. Burwell could run up against the same logic that brought down Medicaid expansion under health care reform: it could be unconstitutional for the federal government to use draconian coercion to force states to set up exchanges. Justice Anthony…

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