Adam V. Russo | October 29, 2010

By Stephen D. Rosenberg of Boston ERISA & Insurance Litigation Blog, www.bostonerisalaw.com

Well, here’s a story on an unpublished Ninth Circuit decision on the impact on the duty to defend of related claims provisions in claims made insurance policies. Although policies vary in the language and structure they use to accomplish it, these provisions essentially declare a claim made during a policy period to be linked to earlier events or an earlier claim if they all arise from related events, with there being no coverage if the earlier related events occurred before the policy period of the policy under which coverage is being sought. The operation of these provisions is of crucial importance for the operation of claims made insurance policies and for insurance programs built on them, in that a claims made policy is built around the idea that the policy will only provide coverage for claims – such as lawsuits – actually first made against the insured during the effective period of that policy, and that the policy won’t provide any coverage if the loss for which coverage is sought relates to a claim that began before the commencement of that policy period. Claims made policies are priced on only covering claims actually first arising during the policy period – and not on covering those that started before the policy period or were not made until after it ended. By precluding coverage when a particular claim actually stems from events or another claim that predated the policy, the related acts language is the mechanism for effectuating this intent. I will warn you up-front that this is a very simplistic introduction to a fairly complicated subject, but it captures the idea. (more…)

Category: 9th, Claims Review | No Comments »
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Adam V. Russo | October 29, 2010

By Andrew R. McIlvaine, Human Resource Executive, www.hreonline.com 

Healthcare reform may be a no-win situation for employers. The changes mean the cost of insuring employees will be significantly higher than if the new law had not passed, according to one organization. However, dropping coverage will also entail significant costs.

New research from the Corporate Leadership Council has found that healthcare reform will trigger much greater increases in the cost of healthcare benefits than if the reforms had not been enacted. (more…)

Category: Health Care Legislation, PPACA | No Comments »
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Adam V. Russo | October 29, 2010

By Adriel Bettelheim and Chris Thompson of the San Francisco Chronicle, www.sfgate.com

Oct. 25 (Bloomberg) — Employers may be allowed to switch their health insurers and still be shielded from costly coverage changes mandated in President Barack Obama’s health-care overhaul, a White House official said.

Under the law passed in March, once companies change plans they must provide added services, including preventative care. The U.S. is weighing whether to allow employers to avoid the requirements, even with a new insurer, as long as benefit levels stay the same, said a White House official who asked not to be identified because the talks are private. (more…)

Category: Health Care Legislation | No Comments »
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Adam V. Russo | October 25, 2010

MyHealthGuide, www.myhealthguide.com

Washington — The U.S. Department of Labor’s Employee Benefits Security Administration today announced a proposed rule to update the definition of “fiduciary” to more broadly define the term as a person who provides investment advice to plans for a fee or other compensation.

The department’s proposed rule would amend a 1975 regulation that defines when a person providing investment advice becomes a fiduciary under the Employee Retirement Income Security Act (ERISA). The proposed amendment would update that definition to take into account changes in the expectations of plan officials and participants who receive advice, as well as the practices of investment advice providers. (more…)

Category: ERISA, Fiduciary, Fiduciary Liability, Welfare Benefit Plans | No Comments »
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Adam V. Russo | October 25, 2010

MyHealthGuide, www.myhealthguide.com

Source: Todd Leeuwenburgh, Thompson Publishing

Mr. Leeuwenburgh’s preface: The case against Individual Mandate proceeds in Florida, but not in Michigan. The Florida court refused to kill the question of whether the individual mandate (to get health coverage or pay a penalty) might have exceeded Congress’ power to regulate trade under the Commerce Clause. But in Michigan, a federal judge ruling on the merits of the case, refused to block health reform’s individual mandate. Both courts heard government arguments that the Commerce Clause allows Congress to prohibit economic “non-activity” — that is, the failure to maintain health insurance, and to penalize those who fail to maintain such insurance. (more…)

Category: Florida, Health Care Legislation, Medicaid, Michigan | No Comments »
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Adam V. Russo | October 22, 2010

While researching various resource tools prevalent to the health care industry, I came across Healthcare Blue Book, a resource tool used to find the average pricing for medical services based on one’s geographical location. I found this site to be somewhat helpful when seeking the usual and customary pricing of a service and thought that my readers would too.

I am gathering feedback from our clients, partners and blog readers on what you may like or dislike about the Healthcare Blue Book.

If you don’t mind, please visit www.healthcarebluebook.com, choose a service from the main navigation, enter your zip code, and you will receive an estimate on the average pricing for a particular service in your area. Once you have played around on this site, we would appreciate if you would email your feedback of likes, dislikes, what you found helpful, what you found confusing, etc. to bhoffman@phiagroup.com.

Thank you so much!!

Category: News, Usual and Customary | No Comments »
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Adam V. Russo | October 21, 2010

Health care expenses rise with body mass

By Joanne Wojcik of Business Insurance Magazine, www.businessinsurance.com

A study that attempts to quantify the cost of obesity in the workplace should help health benefits professionals persuade upper management that weight management programs will yield a return on investment, health benefit experts say.

However, some health benefit experts say the study, which estimates obesity costs U.S. employers $73.1 billion annually in increased medical costs and lost productivity, may be underestimating the scope of the problem because it does not also take into account disability and workers compensation costs. (more…)

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Adam V. Russo | October 21, 2010

By Jerry Geisel of Business Insurance Magazine, www.businessinsurance.com

WASHINGTON—The latest batch of health care benefits guidance provided by federal regulators provides yet more answers for employers to comply with the new health care reform law.

Much of the guidance involves questions that have been raised—and not fully resolved by previous guidance—about the conditions health care plans have to meet to be “grandfathered” and thus exempt from some of the new law’s requirements. (more…)

Category: Health Care Legislation | No Comments »
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Adam V. Russo | October 18, 2010

By Jerry Geisel of Business Insurance, www.businessinsurance.com

WASHINGTON—Employers that make design changes that result in one of their health care plans losing grandfathered status will not relinquish that status for other plans they offer, federal regulators have clarified.

Under the health care reform law, health care plans will lose grandfathered status if they make certain design changes, such as boosting coinsurance requirements or increasing employees’ premium contributions by more than five percentage points. Grandfathered plans are exempt from certain reform law requirements, such as providing full coverage for preventive services. (more…)

Category: Health Care Legislation | No Comments »
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Adam V. Russo | October 18, 2010

Kaiser Health News, www.kaiserhealthnews.com

A number of candidates for federal and state office are sounding off on how they view health reform.

In the Connecticut race for Senate, The Middletown (Conn.) Press reports that state Attorney General Richard Blumenthal is touting the new law in his battle with wrestling entertainment head Linda McMahon. “‘I support the health care reform bill as a good start,’ he said. ‘My experience with many of these health care issues comes from my dealing with people who’ve been denied health care insurance.’ He said those cases have been his most satisfying. ‘The fact is, for me the most meaningful cases are the thousands that we’ve done when people come to my office and they’ve been denied health care insurance coverage for absolutely medically necessary treatment, and it can range from cancer medicine to stem cell transplant to baby formula to a variety of other sometimes life-saving medical procedures’” (Stannard, 10/18). (more…)

Category: Health Care Legislation | No Comments »
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Adam V. Russo | October 18, 2010

by Rosalind Helderman of The Washington Post, www.washingtonpost.com

A federal judge for the Eastern District of Virginia said Monday that he would rule on the constitutionality of the federal health care law by the end of the year, a key legal test for the sweeping legislation.

In a packed Richmond courtroom, U.S. District Court Judge Henry E. Hudson heard more than two hours of oral arguments by lawyers acting on behalf of Virginia Attorney General Ken Cuccinelli II (R) and the Obama administration. (more…)

Category: Health Care Legislation, Virginia | No Comments »
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Adam V. Russo | October 14, 2010

Earlier today I had the pleasure of speaking at the SIIA 30th Annual National Education Conference & Expo held in Chicago, IL.

Click here to see my presentation on ”The Future of Subrogation & Reimbursement as a Cost Containment Strategy for Self-Funded Benefit Plans”.

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Adam V. Russo | October 12, 2010

By Steve LeBlanc of The Boston Globe, www.boston.com

LOWELL, Mass. –At 6-feet, 6-inches tall, Charles Baker towered over the martial arts boxers who clambered into the Kun Khmer Federation gym on a side street of this former mill town during a recent campaign stop.

Baker was there to hear how the gym has become a focal point for the city’s Cambodian residents and to meet with owner Vannak Kann, who said that while he likes Democratic incumbent Gov. Deval Patrick, he’s voting for Baker, a Republican, on Nov. 2. (more…)

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Adam V. Russo | October 8, 2010

HCAA, www.hcaa.org

HHS Awards Grants to 48 States for Health Insurance Exchanges

The Department of Health and Human Services (HHS) awarded nearly $49 million to help 48 states and the District of Columbia plan for the establishment of health insurance exchanges. Starting in 2014, health insurance exchanges will put greater control and greater choice in the hands of individuals and small businesses. The state-based exchanges will make purchasing health insurance easier by providing eligible consumers and businesses with one place where they can compare and purchase health insurance coverage. These grants of up to $1 million each will give states the resources they need to conduct the research and planning needed to build a better health insurance marketplace and determine how their exchanges will be operated and governed. Alaska and Minnesota were the only two states to turn down the grants. (HHS Press Release 09/30) (Hill 09/30)

Category: Health Care Legislation | No Comments »
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Adam V. Russo | October 8, 2010

If you plan on attending SIIA’s 30th Annual National Education Conference & Expo next week, don’t forget to stop by on October 14th for my presentation on “The Future of Subrogation & Reimbursement as a Cost Containment Strategy for Self-Funded Benefit Plans”.

I will post my entire PowerPoint presentation following my speech.

Category: News, Subrogation | No Comments »
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