cmonfils | February 3, 2012
INDIANAPOLIS–(BUSINESS WIRE)–Medical and pharmacy benefits managed by WellPoint’s affiliated health plans are linked to lower medical costs of $8 to $16 per employee monthly compared to those without an integrated pharmacy program, according to an independently verified analysis of members in WellPoint’s health plans.
The analysis shows that the integration and coordination of medical and pharmacy benefits, as well as other factors, are generally associated with lower medical costs compared to employers who do not have WellPoint affiliated health plans’ integrated pharmacy programs
Category: Coordination of Benefits, Health Insurance |
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cmonfils | March 1, 2011
Thompson Publishing January 2011 Volume. 19, No. 1
By Jack B. Helitzer, Esq.
Until recently, group health plans usually covered dependent children only up to the child’s 19th birthday — or until the child’s 23rd birthday if the child was a full-time student in college or graduate school — unless the child married, entered military service or became employed on a full-time basis. But since the passage of health reform, non-grandfathered plans must cover dependent children until their 26th birthday regardless of whether the child lives with the parents, is financially dependent on them, is married or in school or is employed or not. This is sure to create new situations of duplicate coverage, while at the same time eliminating many OBD options. Clarity about the starting date of employee coverage and the date the child entered the plan can help you order benefits. (more…)
Category: Coordination of Benefits, Health Care Legislation |
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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 came up with different results. (more…)
Category: Coordination of Benefits, Maryland, Montana |
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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 can coordinate with any entity that paid health expenses. Montana’s insurance commissioner threw out Blue Cross’ (BCBS) group-plan enrollment forms, which reserved the right to not pay for an injured member who received or benefits from liability insurers. The court rebuffed BCBS’ challenge, ruling that the Blue would be entitled to subrogation only after it paid benefits to its insured.
Category: Coordination of Benefits, Maryland, Montana |
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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. (more…)
Category: Coordination of Benefits, Health Care Legislation |
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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 issue is getting attention from state regulators. Nine of 10 states that use the 2005 NAIC model COB rule allow group and non-group policies to coordinate their benefits. Only one state – Idaho – mandates that non-group policies be always secondary; the other 49 states have no description on how group and non-group coverage are to be coordinated.
Category: Coordination of Benefits, Health Care Legislation |
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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 created a responsibility for self insured organizations, liability insurers, group health plans and non-group health plans that pay bodily injury claims to insure that the Medicare system is protected from bearing the costs of current and future medical expenses if those expenses are the primary responsibility of an entity other than Medicare. Entities making such payments are known as RREs. (more…)
Category: Coordination of Benefits, Medicare, Subrogation |
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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 COBRA premium subsidies. (more…)
Category: Coordination of Benefits, Health Care Legislation |
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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. (more…)
Category: Coordination of Benefits, Health Care Legislation, Mental Health Parity |
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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. (more…)
Category: Arizona, Coordination of Benefits, Health Care Legislation |
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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 if: (1) he or she loses SCHIP (or Medicaid) eligibility and asks to be covered under the group plan within 60 days; or (2) he or she becomes eligible for premium assistance under SCHIP or Medicaid to buy group health coverage and asks to be covered within 60 days of that eligibility determination. Plans must meet minimum creditable standards to enable individuals to receive premium support. (more…)
Category: Coordination of Benefits, Summary Plan Description |
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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 general idea of that approach is to provide greater PIP coverage, but to permit the auto insurer to have secondary liability if the injured person has other coverage. (more…)
Category: Coordination of Benefits, Massachusetts |
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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 own auto carrier, Allied Insurance, because the driver’s vehicle was uninsured. Cooper received $64,200 for medical expenses and lost wages through his PIP and UM coverage. (more…)
Category: 9th, Coordination of Benefits, Plan Language, Subrogation |
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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. (more…)
Category: Coordination of Benefits, Iowa, Preemption |
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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 chambers of Congress and signed into law on Dec.29. (P. Law No. 110-173) Its effective date will be Jan. 1, 2009. (more…)
Category: Coordination of Benefits, Medicaid, Medicare |
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