Adam V. Russo | February 12, 2010
The highest appellate courts of Maryland and Montana handed down decisions relating to the method by which insured group health plans and the personal insurance protection (PIP) benefits are to be coordinated. In both cases, a group plan refused to cover medical expenses for which PIP reimbursement is provided through auto liability policies. The courts [...]
Adam V. Russo | February 12, 2010
High courts of Maryland and Montana handed down contrasting decisions relating to coordination of insured group-health and personal insurance protection (PIP) benefits. in both cases, a group plan refused to cover medical expenses for which PIP reimbursement was provided through auto liability policies. In Maryland, a court gave precedence to a provision saying group plans [...]
Adam V. Russo | February 12, 2010
A problem that rarely came up before is arising now. Until recently, very few cases involved a person with both group and non-group (also known as individual or family) health coverage. Indeed modern courts rarely had a chance to consider the problem of how to coordinate such coverage.
Adam V. Russo | February 12, 2010
A problem that rarely came up before is arising now. Until recently, few cases involved coordinating health benefits for people who have both group and non-group coverage. However, because health reform will almost certainly result in more people being covered by non-group policies, plan sponsors should get a better understanding of the issue. The same [...]
Adam V. Russo | February 9, 2010
In the waning days of 2007, with the cost of health care continually escalating and with more and more of the costs being borne by the United States Government, Congress passed and President Bush signed into law the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). With the stroke of his pen, the President [...]
Adam V. Russo | January 5, 2010
Jerry Geisel
WASHINGTON—Eleventh-hour congressional action extending a COBRA premium subsidy law assures continuation of the subsidy for millions of laid-off workers and their families, but also more work for employers.
Ending weeks of uncertainty, Congress gave final approval and President Obama signed into law late last month a Department of Defense spending bill that includes provisions extending [...]
Adam V. Russo | December 15, 2009
Joanne Wojcik
For many benefit managers, the economic downturn resulted in a domino effect of events this year.
Perhaps the single biggest benefits event came early, when Congress enacted the American Recovery and Reinvestment Act of 2009, which provided a 65% subsidy to laid-off workers who purchased COBRA coverage from their employers.
Adam V. Russo | November 25, 2009
Employer cuts costs by allowing workers to ‘earn’ lower rates
Joanne Wojcik
PHOENIX—Safeway Inc. has reduced its health care cost increases by more than $150 million since 2005 using an approach that closely resembles how auto insurers rate drivers.
Adam V. Russo | May 13, 2009
Starting April 1, group health plans must offer a special enrollment right and coordinate coverage for individuals who are either entering or exiting state health coverage programs. Under the law reauthorizing the State Children’s Health Insurance program (SCHIP), plans and insurers must allow an employee or dependent to enroll under the terms of the plan [...]
Adam V. Russo | November 11, 2008
Motor vehicle insurance policies usually include personal injury protection (PIP) coverage that will reimburse the insured and/or a family member for a limited amount of medical expenses regardless of who was at fault. Many current motor vehicle policies limit the PIP coverage to relatively small amounts if the injured person has other health coverage. The [...]
Adam V. Russo | June 9, 2008
Cooper v. Premera Blue Cross, Slip Copy, 2008 WL 2180148 (W.D.Wash.) (May 23, 2008) addresses a risk often overlooked by plan participants when debating over their benefit plan’s right of reimbursement from other liable insurance carriers.
Cooper suffered multiple injuries while he was a passenger involved in an ATV accident and applied for benefits through his [...]
Adam V. Russo | June 6, 2008
Magellan Services v. Highmark Life Insurance Company, – N.W.2d –, 2008 WL 2221979 (Iowa) (May 30, 2008) brought forward a dispute about coordination of benefits against an ERISA preemption of state regulation of a self-funded health plan based upon the presence of stop loss coverage.
Adam V. Russo | April 22, 2008
Under a new MSP reporting requirement, plans working through an insurer, third party administrator (TPA) or plan administrator will have to disclose information on situations in which the group health plan was primary in relation to Medicare.
The requirement is at Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007, passed by both [...]
Adam V. Russo | July 18, 2007
Recently, the Eastern District Court of Michigan held in Citizens Insurance Company of America v. Pitney Bowes Software Systems Employee Medical & Health Care Service Corp., 2007 WL 713144 (E.D. Mich 2007) that where the Plan document excluded claims covered by automotive insurance in its claim exclusions section, and asserted a right to coordinate benefits [...]
Adam V. Russo | July 18, 2007
In Cheryl Street v. Ingalls Memorial Hospital, (2007 U.S. Dist. Lexis 18643), the Northern District Court of Illinois held on March 15, 2007 that just as a Plan must identify funds prior to seeking equitable relief in Federal Court, so too must relief sought by participants be specifically identifiable. In one case, decided by the [...]
