Adam V. Russo | December 14, 2010

By Stephen D. Rosenberg , www.bostonerisalaw.com

I have been keeping my eye out for an article on the CIGNA Corp. v. Amara case before the Supreme Court – argued a little over a week ago – that focuses more on the practical realities of the case for plan sponsors and participants, rather than on the “inside baseball” analysis of the lawyers and their arguments, which were all the rage in the immediate aftermath of the argument before the high court. I think I finally found it here, in this piece from CFO.com. (more…)

Category: Summary Plan Description, Supreme Court | No Comments »
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Adam V. Russo | December 14, 2010

By Fred Schneyer, www.plansponsor.com

December 13, 2010 (PLANSPONSOR.com) – A federal judge in Virginia has ruled that the mandate in the health care reform law requiring most Americans to get health coverage or pay a penalty is unconstitutional.

U.S. District Judge Henry Hudson of the U.S. District Court for the Eastern District of Virginia agreed with the Commonwealth of Virginia, which filed the legal challenge, that federal lawmakers overstepped their constitutional powers under the Commerce Clause to include the coverage mandate in the new law. The mandate is not scheduled to kick in until 2014. (more…)

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

www.jonesday.com

On December 8, 2010, the U.S. Court of Appeals For the Sixth Circuit ruled in favor of Jones Day’s client Blue Cross Blue Shield of Michigan in an important case involving the scope of ERISA’s fiduciary conduct rules (DeLuca v. Blue Cross Blue Shield of Michigan). The case involved the question of whether Blue Cross acts as a fiduciary and is subject to ERISA’s stringent fiduciary conduct rules when it negotiates hospital reimbursement rates that apply to its self-insured book of business. (more…)

Category: 6th, ERISA, Michigan | No Comments »
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Adam V. Russo | December 14, 2010

By Tom Lawrence, www.healthsubrogationblog.com

A recurring issue for health plan subrogators is whether a state law — or federal common law — common fund doctrine requires a health plan to reduce it’s subrogation amount by one-third. In Electric Energy, Inc. v. Lambert, in the United States District Court for the Western District of Tennessee, No. 10-2629-STA-tmp (December 2, 2010), the Court held that the Illinois common fund doctrine was preempted by ERISA and plan language rejecting the common fund doctrine was sufficient to preclude application of a federal common law common fund doctrine. (more…)

Category: 6th, Plan Language | No Comments »
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Adam V. Russo | December 14, 2010

By Larry O’Dell,  www.boston.com

RICHMOND, Va.—A federal judge declared the foundation of President Barack Obama’s health care law unconstitutional Monday, ruling that the government cannot require Americans to purchase insurance. The case is expected to end up at the Supreme (more…)

Category: Health Care Legislation, Virginia | No Comments »
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Adam V. Russo | December 13, 2010

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

A health care reform rule that caps how much insurers can spend on administrative costs is likely to cause headaches for employers that offer fully insured health plans to their workers. (more…)

Category: Health Care Legislation, PPACA, Welfare Benefit Plans | No Comments »
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Adam V. Russo | December 13, 2010

By Janet Adamy of The Wall Street Journal, www.online.wsj.com

WASHINGTON—A congressional committee is widening its investigation of bare-bones health-insurance policies to encompass potentially hundreds of plans offered by low-wage employers.

What started as a probe into McDonald’s Corp.’s insurance plan for store workers is expanding into broad scrutiny of “mini-med” policies that could ensnare large mini-med carriers including Aetna Inc. and Cigna Corp. (more…)

Category: Health Care Legislation, News | No Comments »
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Adam V. Russo | December 7, 2010

By Anna Wilde Mathews of The Wall Street Journal, www.wsj.com

Spurred by incentives in the federal health-overhaul law, hospitals and doctors around the country are beginning to create new entities that aim to provide more efficient health care.

But these efforts are already raising questions about whether they can truly save money, or if they might actually drive costs higher. (more…)

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Adam V. Russo | December 7, 2010

by Alan L. Quiles and Kelly H. Kolb of Employee Benefit News, www.employeebenefits.com

The Patient Protection and Affordable Care Act and Reconciliation Act includes a provision that amends the Fair Labor Standards Act to require employers to provide nonexempt nursing mothers unpaid breaks to express breast milk in a private place other than a restroom for up to one year after the child’s birth. (more…)

Category: Arkansas, PPACA | No Comments »
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Adam V. Russo | December 1, 2010

Companies that eliminate co-payments report better medication adherence – and lower health-care costs.

By Kimberly Blanton, www.CFO.com  

To control health-care costs, more companies are resorting to a strategy that doesn’t seem to make sense: They are spending more.

Employers are rejecting unpopular benefit cuts and instead eliminating co-payments on prescription drugs to encourage employees with severe health problems to take their medications and stay healthy. The theory is that the financial incentive will stave off emergency-room visits, hospital stays, and disability claims over the longer term. (more…)

Category: News, Welfare Benefit Plans | No Comments »
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Adam V. Russo | December 1, 2010

MyHealthGuide, www.myhealthguide.com

SIIA, www.siia.org

As reported by SIIA’s Government Relations Staff, Federal agencies will be continually issuing regulations and notices of guidance pertaining to how provisions of the newly enacted Patient Protection and Affordable Care Act will be implemented. SIIA staff will develop summaries of these and distribute along with the full documents as soon as they are released. (more…)

Category: Health Care Legislation, PPACA | No Comments »
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Adam V. Russo | December 1, 2010

From The Texas Department of Insurance

Mental Health Parity: A proposed rule amending 28 TAC Sections 21.2401 – 21.2407, relating to requirements for parity between mental health or substance use disorder benefits and medical/surgical benefits, has been filed with the Office of the Secretary of State on November 18, 2010 for publication in the Texas Register on December 3, 2010. A copy of this proposed rule may be accessed through a website maintained by the Secretary of State at

http://www.sos.state.tx.us/texreg/index.shtml (more…)

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