Adam V. Russo | September 30, 2008
While health care costs increases continue to far outpace inflation, costs are rising at a far more moderate pace than a few years ago, according to two surveys released last week.
The surveys-one by the Washington-based Kaiser Family Foundation and Chicago-based Health Research & Educational Trust, and the other by Stamford, Conn.-based benefit consultant Towers Perrin-also show that employers are turning more to consumer-driven health plans to help control costs. (more…)
Category: News, Welfare Benefit Plans |
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Adam V. Russo | September 30, 2008
In line with trends in the private sector, health insurance premiums will increase an average of 7% next year in the health insurance program covering federal employees and retirees, the Federal Office of Personal Management said last week.
The 7% increase for the Federal Employee Health Benefits Program-which is the nation’s largest group plan, covering about 8 million people, is similar to rate increase industry experts expect private-sector employers to be hit with next year. (more…)
Category: News |
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Adam V. Russo | September 26, 2008
On September 22, 2008 the Fifth Circuit issued its decision in Young v. Wal-Mart Stores, Inc., et. al.
The case involved an ERISA claim for accidental death and dismemberment (AD&D) benefits in the amount of $25,000. The decedent suffered from a history of severe hypertension. He stopped taking his medication, became very ill and began vomiting profusely and choked to death. The policy provided an exclusion for losses related “in whole or in part from…sickness.” (more…)
Category: 5th, News |
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Adam V. Russo | September 25, 2008
Cost increases still remain much lower than those of a few years ago. In 2008, group health care costs increased by an average of 6.0%, to $8,331 per employee, and are projected to rise next year by 6.4%, according to Hewitt Associates, Inc. The analysis is based on information from more than 400 employers.
This year’s 6.0% average increase is up from a 5.3% increase in 2007 but is substantially lower than 2006′s average increase of 7.9% and the 9.2% hike in 2005. (more…)
Category: News |
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Adam V. Russo | September 23, 2008
by Ron E. Peck, Esq.
Offset: Denying future claims to reimburse the Plan for claims it has paid prior to third party settlement. It is a form of lien reimbursement.
Denial of Future Medical Claims: Denying future claims because they were caused by, and are the responsibility of a third party with whom the insured has settled or will settle, and thus for which the insured has removed liability from the third party and shifted responsibility onto him or herself.
Confusion regarding how a benefit plan and its administrator handle future claims resulting from an incident for which another party is or may become responsible is widespread. The greatest mistakes administrators make is confusing “offset” with “future credits” and other future claims, as well as confusing subrogation with exclusions. (more…)
Category: Claims Procedures, Claims Review, Offset |
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Adam V. Russo | September 9, 2008
On Monday September 15, 2008, Adam V. Russo, Esq. will be presenting his seminar on how the election affects upcoming legislation at the iWorks Summit 2008 Conference at the Coronado Island Marriot Resort in San Diego, CA.
See entire presentation before the conference
Category: ERISA |
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Adam V. Russo | September 5, 2008
The Supreme Court held in MetLife vs. Glenn that conflicted interests require a higher standard of review whenever the claims adjudicator and the claims financier were the same. Thus, any claim contested in court will confer a significant advantage to the arrangement where the claims are adjudicated by an independent third party and paid by an independent employer. This means a disadvantage where the claims are both adjudicated and paid by the same two parties, such as employer’s self-administered and self-funded plan or fully insured plans. (more…)
Category: 6th, ERISA, MetLife v. Glenn, Welfare Benefit Plans |
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