cmonfils | July 28, 2011
www.eric.org Jul 25, 2011
ERIC News Release For Immediate Release: July 25, 2011Washington, D.C. — The ERISA Industry Committee (ERIC) today submitted comments on the amendment to the interim final regulations implementing the internal claims and appeals and external review processes under the Patient Protection and Affordable Care Act (ACA). (more…)
cmonfils | July 28, 2011
www.ebn.benefitnews.com By Michelle M. Stimson July 29, 2011
Due to the economic recession and the potential for increased health insurance costs brought about by health care reform, many employers are beginning to view self-funded health care plans as a more attractive option than fully insured plans. These employers recognize the advantages of self-funding, which include cost savings, increased cash flow and more flexibility in benefit decisions, administration and funding. Self-funded plans will be favored under health care reform because, while many provisions of health care reform apply both to fully insured and self-funded plans, there are many provisions of health care reform from which only self-funded plans are exempt. For example, self-funded plans will not have to comply with the new marketing, internet portal, enrollment and provider network and quality accreditation rules. This will mean direct cost savings to the plan, which will pass through to the employer. There are also many state mandates from which self-funded plans are still exempt. (more…)
cmonfils | July 28, 2011
www.nixonpeobody.com 7/21/2011
Texas health care entities must comply with a new health care privacy law that requires an update to policies and procedures, Notice of Privacy Practices, and employee training by September 2012.
Texas House Bill 300 (HB 300), recently signed into law by Governor Rick Perry, mandates new patient privacy protections and harsher penalties for privacy violations related to electronic health records (EHR). The requirements of the Texas law are more stringent than those of its federal counterpart, the Health Insurance Portability and Accountability Act (“HIPAA”). (more…)
cmonfils | July 28, 2011
www.mintz.com By Alden J. Bianchi and Patricia A. Moran July 19‚ 2011
The “insurance market reform” provisions of the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 (together, the Act) generally require health insurance issuers in the individual and group markets, and employer-sponsored group health plans, to comply with a series of rules regarding internal claims and appeals and external review processes (collectively, the “claims procedure rules”). The claims procedure rules build on similar requirements enacted more than 30 years ago under the Employee Retirement Income Security Act of 1974 (ERISA), which were designed to ensure that participants in employee benefit plans had access to a full and fair review of disputed claims. They are set out in a new provision of the Public Health Service Act (PHSA) that is carried over into both ERISA and the Internal Revenue Code (the Code). (more…)
cmonfils | July 28, 2011
www.employeebenefitsupdate.com Thursday, July 21, 2011
Last week the U.S. Department of Health and Human Services (“HHS”) released proposed regulations designed to implement the provisions of the Affordable Care Act calling for the establishment of State-based affordable insurance exchanges (“Exchanges”). As explained by HHS in the preamble to the proposed regulations, “Exchanges will offer Americans competition, choice, and clout. Insurance companies will compete for business on a level playing field, driving down costs. Consumers will have a choice of health plans to fit their needs. And Exchanges will give individuals and small businesses the same purchasing clout as big businesses.” Whether those lofty goals can be met through the establishment of Exchanges remains to be seen. But the new proposed regulations certainly present a much clearer picture of what the Exchanges will look like and how they will operate. (more…)
cmonfils | July 28, 2011
www.cfo.com David McCann July 21, 2011
There’s no time like the present for employers to start thinking about whether to offer health-care insurance after 2014.
Now that most companies have implemented the initial effective provisions of the Patient Protection and Affordable Care Act, it may soon be time to start thinking about a key element of the health-care reform law that’s not slated to take effect until 2014. (more…)
cmonfils | July 28, 2011
www.thehill.com By Julian Pecquet – 07/21/11
A major provision of the healthcare reform law designed to prevent businesses from dropping coverage for their workers could inadvertently leave families without access to subsidized health insurance.
The problem is a huge headache for the Obama administration and congressional Democrats, because it could leave families unable to buy affordable health insurance when the healthcare law requires that everyone be insured starting in 2014. (more…)
cmonfils | July 27, 2011
Facts:
Participant of an ERISA covered Plan had an accident and filed an action in Wisconsin wherein he named the Plan as a defendant and disputed Plan’s rights under the Made Whole Rule. Plan then filed a cross claim against defendant parties and a counter claim against member asserting made whole inapplicable due to plan language. Plan participant settled with defendant party including a surgery he consistently related to the accident and never advised plan of settlement negotiations. Subsequent to that settlement, he claimed there was an IME showing the surgery was not related to the accident. (more…)
cmonfils | July 25, 2011
By Joe Forward, Legal Writer, State Bar of Wisconsin
July 12, 2011 – Under an Employee Retirement Income Security Act (ERISA) benefits plan, an insurer was entitled to reimbursement amounts it paid to cover a beneficiary’s medical expenses, even though the beneficiary was not made whole through settlement, the Wisconsin Supreme Court recently concluded. (more…)
cmonfils | July 25, 2011
www.myhealthguide.com
MyHealthGuide Source: Self-Insurance Institute of America, Inc. (SIIA), 7/19/2011, www.SIIA.org
The Self-Insurance Institute of America, Inc. (SIIA) announced that it has partnered with the Self-Insurance Educational Foundation, Inc. (SIEF) to produce a series of events designed to educate congressional staff members about self-insurance and alternative risk transfer. All of the events will be held on Capitol Hill in Washington, DC. (more…)
cmonfils | July 25, 2011
www.myheat;hguide.com
MyHealthGuide Source: Thomas Croft, Esq., King & Croft LLP, 7/20/2011, www.StopLossLaw.com
Case: Woodruff & Sons, Inc. v. The Covenant Services Group, Inc., No. 8:11-cv-1096, in the United States District Court for the Middle District of Florida, July 12, 2011). Court’s Opinion
Mr. Croft’s Comment: This state law based case was filed against a TPA for allegedly failing to meet a stop loss policy deadline for the filing of an aggregate claim, with the result that the claim was denied. The defendant TPA moved to dismiss the Complaint against it, arguing that ERISA pre-empted the group’s state law claims. (more…)
cmonfils | July 25, 2011
www.myhealthguide.com
MyHealthGuide Source: RAND Corporation, Study sponsored by the U.S. Department of Labor, RAND Study: Employer Self-Insurance Decisions and the Implications of the Patient Protection and Affordable Care Act as Modified by the Health Care and Education Reconciliation Act of 2010 (ACA)
(more…)
cmonfils | July 21, 2011
www.cfo.com Jeff Mamorsky July 19, 2011
Court challenges to the health-care reform law, especially its provision requiring everyone to buy health insurance, make for an uncertain future.
The Patient Protection and Affordable Care Act (the “Act”) — known as health-care reform or ObamaCare by many proponents and opponents, respectively — is being challenged in the courts. A major issue concerns the constitutionality of the federal mandate that all individuals maintain adequate health-insurance coverage or pay a penalty to the Internal Revenue Service. (more…)
cmonfils | July 21, 2011
www.healthcare-legislation.blogspot.com July 15, 2011
Two new regulations proposed by the Department of Health and Human Services (HHS) set basic standards for health benefits exchanges established under the Patient Protection and Affordable Care Act. Basically, these rules do the following: (more…)
cmonfils | July 21, 2011
www.dwt.com By Dipa N. Sudra and Jeff Belfiglio 07.14.11
Health care reform requires nongrandfathered group health plans, both insured and self-insured, to change their internal claims procedures and external review procedures. Even as plans work to implement these rules, the Internal Revenue Service, the Department of Labor, and the Department of Health and Human Services have jointly released amended interim final regulations in response to comments on the interim final regulations issued last July (discussed in a previous advisory). The agencies also issued technical guidance1 and revised model notices.2 (more…)
