Adam V. Russo | October 29, 2008
Latest Article From AM News Staff
By Amy Lynn Sorrel
The decision could lay the groundwork for a U.S. Supreme Court fight over “pay or play” laws requiring companies to pitch in for health coverage.
A recent federal appeals court ruling may open the door for states looking to experiment with employer mandates as part of health system reform.
A panel of the 9th U.S. Circuit Court of Appeals unanimously upheld San Francisco’s initiative requiring businesses to spend a minimum level of money on workers’ health care, rejecting arguments that the federal Employee Retirement Income Security Act preempted the city ordinance. (more…)
Category: 9th |
No Comments »
Tags:
Adam V. Russo | October 29, 2008
The Latest Article From Associated Press Writer
By Mark Niesse
Hawaii is dropping the only state universal child health care program in the country just seven months after it launched.
Gov. Linda Lingle’s administration cited budget shortfalls and other available health care options for eliminating funding for the program. A state official said families were dropping private coverage so their children would be eligible for the subsidized plan. (more…)
Category: Hawaii |
No Comments »
Tags:
Adam V. Russo | October 29, 2008
Thanks to the Self-Insurance Institute of America, Inc. (SIIA) for bringing this news to our attention. It seems that a “model law” has been drafted by the National Conference of Insurance Legislators, with the purpose of ratification by member States in mind.
The law addresses concerns over PPO rental networks; situations where PPO networks negotiate discounts with non-payer, third party entities (such as third party administrators). (more…)
Category: ERISA, Preemption, Third Party Administrators |
No Comments »
Tags:
Adam V. Russo | October 29, 2008
As of October, 2008, health plans will have to re-evaluate how they cover full time student dependants. Proposed legislation (H.R.2851) recently signed into law by President Bush, will make it mandatory that health plans which cover full time student dependants allow those dependants to remain covered for up to a year out of school, if they are on sick leave with a physician certified illness. This, after numerous youths have had to choose between coverage, and taking time off to care for their serious ailments. (more…)
Category: New Hampshire |
No Comments »
Tags:
Adam V. Russo | October 28, 2008
You may have heard of the case Benefit Recovery, Inc. v. Donelon, et al., 521 F.3d 326 (5th Cir. 2008); F.3d 2008 WL 642972 (5th Cir. La.), 43 Employee Benefits Cas. 1417. It was likely brought to your attention by someone claiming there is a made whole rule in Louisiana that binds even self-funded employee benefit plans, coming within the purview of ERISA. This is simply not the case. (more…)
Category: ERISA, Louisiana, Made Whole Rule, Preemption |
No Comments »
Tags:
Adam V. Russo | October 17, 2008
Latest Article From Central New York Business Journal Business Journal
The number of major U.S. employers offering incentives to promote employer-sponsored health and wellness programs rose nearly 10 percent from 2007 to 2008, according to a recent national report.
The report finds the number of companies offering workers wellness incentives increased from 62 percent last year to 71 percent this year, says Katherine Herring Capps, one of the study’s lead authors and president of Health2 Resources, a Vienna, Va.-based health-care consulting firm. (more…)
Category: News |
No Comments »
Tags:
Adam V. Russo | October 17, 2008
Even as a majority of employers roll out next year’s health care plans, consultants and benefits managers say the weakening economy is causing concern that health care costs will be greater than projected.
Some employers, worried that costs will exceed their budgets, began chang¬ing plan designs to keep their budgets on an even keel as they headed into a new year filled with economic challenges. (more…)
Category: News |
No Comments »
Tags:
Adam V. Russo | October 16, 2008
A self-insured employer may seek reimbursement from a guaranty association for an insolvent insurer’s apportioned share of a worker’s compensation claim, according to a recent decision of the Connecticut Supreme Court. A worker sought comp benefits from his employer which was either self-insured for workers’ comp or was covered under policies issued by various carriers. Since one of these carriers had declared bankruptcy, any workers’ compensation claims made against it were being administered by the Connecticut Insurance Guaranty Association (CIGA). The employer asserted an apportionment claim against CIGA which contended that a self-insured employer may not obtain reimbursement for an insolvent carrier’s share of workers’ compensation benefits. The high court rejected this argument and held that a self-insured employer is entitled to seek reimbursement in accordance with Supreme Court precedent establishing that self-insured entities may assert claims against CIGA. (more…)
Category: Connecticut |
No Comments »
Tags:
Adam V. Russo | October 16, 2008
The legislature has passed a health package that would allow insurers to offer “no-frills” coverage to the state’s 3.8 million uninsured residents. Under the plan, residents ages 19 to 64 could purchase limited health coverage for as little as $150 per month. Insurers offering such coverage would be exempt from mandates. Policies can cover preventive care and office visits but not care from specialists or long-term hospitalizations. The package also would allocate $1.5 million to establish an entity to help businesses with fewer than 50 employees negotiate health insurance rates, as well as handle premiums and claims. (more…)
Category: Florida, News |
No Comments »
Tags:
Adam V. Russo | October 16, 2008
Under the Massachusetts health care reform initiative, which became law in April 2006, 439,000 residents of the Commonwealth have become newly insured. Slated to become effective in 2009 are provisions which will impose new minimum standards on the health insurance that Massachusetts residents are required to carry under financial penalty. The Commonwealth seeks to further expand the reform by widening the group of employers potentially subject to a “fair share contribution” to the state fund. (more…)
Category: Massachusetts |
No Comments »
Tags:
Adam V. Russo | October 16, 2008
October 13, 2008 Newsweek Article
By Jane Bryant Quinn
If you think that “The Market” – whatever market – always works for the best, you’ll love John McCain’s version of health insurance reform. It uses the tax code to shove you toward individual policies (more “choice!”) and away from comprehensive, employer supported plans. The nonpartisan Tax Policy Center puts the cost of his proposed subsidies at $1.3 trillion over 10 years. (more…)
Category: News |
No Comments »
Tags:
Adam V. Russo | October 6, 2008
Business groups won a partial victory when Gov. Deval Patrick’s administration decided to exempt companies with 50 or fewer full-time employees from a new health care coverage requirement. The Patrick administration unveiled the change, which would collectively cost businesses in the state about $30 million a year under the state’s “Employer Fair Share” rules. (more…)
Category: Massachusetts, News |
Comments Off
Tags:
Adam V. Russo | October 6, 2008
The Ninth Circuit has a decision of first impression concerning issue exhaustion and ERISA in the denial of benefits context. In Vaught v. Scottsdale Healthcare (9th Cir 09/29/2008), the Ninth Circuit declined to impose an “issue exhaustion” requirement under ERISA.
Vaught sued his healthcare plan under ERISA asserting a claim challenging the plan’s decision denying his claim for benefits. The trial court granted summary judgment in favor of the plan. The 9th Circuit reversed as to that claim. (more…)
Category: 9th |
No Comments »
Tags:
Adam V. Russo | October 6, 2008
Elizabeth Edwards, the wife of former Democratic presidential candidate and former Sen. John Edwards linked the current economic downturn with problems in the U.S. health care system, the AP/Kansas City Star reports. Elizabeth Edwards, who has incurable cancer, has made several recent public appearances in support of efforts to expand health insurance to all residents. (more…)
Category: News |
No Comments »
Tags:
Adam V. Russo | October 6, 2008
When negotiations concerning a possible settlement of plaintiff’s subrogation claim failed, Ms. DeBoer demanded her share of the settlement, and the attorney defendants paid over to her the amounts they had recovered, less their counsel fees and expenses. In doing so, they carefully notified Ms. DeBoer of her obligation to repay the plaintiff’s subrogation claim, and obtained from Ms. DeBoer an agreement to indemnify them against any claims which might ensue because they had paid over the proceeds to her. The present lawsuit followed. (more…)
Category: 3rd, 6th, Pennsylvania, Provider Reimbursement, Tennessee |
No Comments »
Tags:
