Phia Group Russo & Minchoff

A statement by U.S. Department of Health and Human Services Secretary Kathleen Sebelius

cmonfils | February 3, 2012

In August 2011, the Department of Health and Human Services issued an interim final rule that will require most health insurance plans to cover preventive services for women including recommended contraceptive services without charging a co-pay, co-insurance or a deductible.  The rule allows certain non-profit religious employers that offer insurance to their employees the choice of whether or not to cover contraceptive services. Today the department is announcing that the final rule on preventive health services will ensure that women with health insurance coverage will have access to the full range of the Institute of Medicine’s recommended preventive services, including all FDA -approved forms of contraception.  Women will not have to forego these services because of expensive co-pays or deductibles, or because an insurance plan doesn’t include contraceptive services. This rule is consistent with the laws in a majority of states which already require contraception coverage in health plans, and includes the exemption in the interim final rule allowing certain religious organizations not to provide contraception coverage. Beginning August 1, 2012, most new and renewed health plans will be required to cover these services without cost sharing for women across the country. 

http://www.hhs.gov/news/press/2012pres/01/20120120a.html

Adam’s Letter to the Wall Street Journal

cmonfils | February 3, 2012

On January 7, 2012, Leslie Scism wrote an article for the Wall-Street Journal, titled “When Insurance Fails: Cheaper Policies Bought in the Workplace Can Have Drawbacks.”  As an attorney as well as a regular reader of the Wall-Street Journal, I was shocked to see such misinformation.    At the outset, the author mentions premium increases health insurance has been imposing upon us.  These premium increases apply solely to what is called “fully funded insurance policies;” whereby an insured pays premiums to an insurance carrier, and the carrier bears the risk of loss.  (more…)

Gender Reassignment Surgery Officially Dubbed A Deductible Medical Expense

cmonfils | January 18, 2012

Employer’s Guide to Self-Insuring Health Benefits    January 2012 | Vol. 19, No. 4

Expenses incurred for gender reassignment surgery and hormone therapy are now deductible medical expenses under Code Section 213.

 The IRS announced in Action on Decision (AOD) 2011-03 that it has acquiesced to a 2010 Tax Court ruling that these expenses are deductible. The AOD appeared in the Nov. 21 Internal Revenue Bulletin. See: http://www.irs.gov/pub/irs-aod/aod201103.pdf(more…)

Should Doctors Be ‘Parsimonious’ About Health Care?

cmonfils | January 11, 2012

A major medical group issued ethical guidelines on Monday that take the provocative position of urging doctors to consider cost-effectiveness when deciding how to treat their patients.

The American College of Physicians, the second-largest U.S. doctors’ group after the American Medical Association, included the recommendation in the latest version of its ethics manual, which provides guidance for some 132,000 internists nationwide.

http://www.npr.org/blogs/health/2011/12/30/144485098/should-doctors-be-parsimonious-about-health-care?ps=sh_sthdl

GAO Releases New Report on Risk Retention Groups

cmonfils | January 11, 2012

www.siia.org

January 10, 2012 – The United States Government Accountability Office (GAO) today released a new report on risk retention groups (RRGs) entitled Clarifications Could Facilitate States’ Implementation of the Liability Risk Retention Act.

Congress requested that this report be prepared in order to better determine whether the Liability Risk Retention Act (LRRA) should be amended. SIIA along with other industry groups currently support the passage of the Risk Retention Modernization Act (HR 2126). (more…)

Top 12 Healthcare Buzzwords for 2012

cmonfils | January 8, 2012

This year’s crop of healthcare buzzwords and catchphrases includes a handful of terms that are really oxymorons. By oxymoron, of course, we mean one of the words or phrases in the expression contradicts the rest. But if you think about it, that’s the very theme of health reform today.

Texas Supreme Court Requests that Baylor Health Care System in Response to SIIA’s Amicus Brief Petition in Case of GPA Holding, Inc. v. Baylor Health Care System

cmonfils | January 5, 2012

www.myhealthguide.com

MyHealthGuide Source: The Phia Group, 12/31/2011

Editor’s Note: Last week (and again below), this Newsletter reported that The Self-Insurance Institute of American (SIIA) filed an Amicus Brief on behalf of GPA Holding, Inc. in the case, GPA Holding, Inc. v. Baylor Health Care System.  The Texas Supreme Court has now responded.
The Texas Supreme Court has requested an answer from Baylor in response to the  Amicus Brief  filed by SIIA.  This indicates a greatly improved likelihood that the Court will hear the appeal. Evidently, the issues raised in SIIA’s brief, as well as briefs filed by the petitioner and other organizations, worried the Court enough to examine the lower court’s decision.

“This is a positive development in that Court has taken our briefs very seriously and is now forcing Baylor to respond before making a decision whether or not to take the case,” says Mike Ferguson, SIIA’s Chief Operating Officer.

At issue is whether third party administrators (TPAs) can be held financially liable for health care services incurred by self-insured group health plan participants. The lower courts (trial and appeal) declared that such financial liability is lawful, relying solely upon a one-sided interpretation of the applicable PPO agreement’s terms.

SIIA’s brief, drafted by attorneys Adam Russo and Ron Peck of The Phia Group, LLC, argues that such legal interpretation requires that TPAs be deemed plan fiduciaries (as only fiduciaries may be responsible for usage of plan assets), which clearly conflicts with the Employee Retirement Income Security Act (ERISA).

More broadly, SIIA contends that the Appeals Court decision threatens the existence of TPAs in Texas and elsewhere, and in turn, would greatly compromise the viability of self-insured group health plans for most employers eliminating one of the most cost efficient, and effective methods for providing robust health benefits to Americans.

Swiss Re backs management buyout of Irish health insurer

cmonfils | December 29, 2011

DUBLIN (Reuters)—Ireland’s Quinn Healthcare has been sold to management in a deal that will see its 500,000 policies underwritten by reinsurer Swiss Re Ltd.

Quinn Healthcare, Ireland’s second-largest health insurer after state-owned VHI, was under the control of the state-owned Irish Bank Resolution Corporation following the collapse of the business empire of its former owner, Sean Quinn. 

Primer & Update on these special tax Advantaged, closely held small business insurance companies

cmonfils | December 21, 2011

Self-Insurer   December 2011         Issue and Volume 38

831 (b) Captives Lead    New Captive Formations

By Tom Cifelli, Managing Director, Captive Experts

831 (b) captives are known as small insurance companies under the US internal revenue code. This special U.S. tax on operating income and taxes only investment income.

831 (b) captives account for a high percentage of total new captives being formed in recent years because they offer smaller successful companies and their owners significant operating, asset protection, wealth transfer and other advantages. Read more on this below. (more…)

Special Communication

cmonfils | December 21, 2011

www.siia.org

December 15, 2011 – The Self-Insurance Institute of America, Inc. (SIIA) today filed an “initial” amicus brief with the Texas State Supreme Court in the case of GPA Holdings, Inc. v. Baylor Health Care Systems. This initial brief supports GPA’s request that the Supreme Court consider arguments to reverse an adverse judgment issued by the Fifth District Court of Appeals. Should the Court agree to hear arguments, SIIA will file a secondary, more comprehensive brief. (more…)

What the …? Walmart cuts health benefits, but seeks to launch primary health services

cmonfils | December 12, 2011

I find Walmart to be a wholly disconcerting place. I just find it very strange that it sells tires, toothpaste, turkeys, tinsel and t-shirts all under the same gigantic roof — and markets this as a good thing. One-stop shopping is one thing, but sheesh.

Anyway, Walmart has confused me once more, with two recent developments. Last month, the nation’s largest retailer and private employer announced it would stop providing health benefits to its part-time workforce. Then, just days later, the retail giant quietly issued an RFI (acquired by Kaiser Health News) seeking a partner to provide more health clinics in its stores — offering medical services that wouldn’t be covered for its part-time employees.

Sutter Sued Over Theft of Computer With Patient Data

cmonfils | December 2, 2011

A class-action lawsuit was filed against Sutter Health in connection with the theft of a desk top computer that held personally identifiable data of nearly 4.3 million patients (see related story).

The suit asks a California court to require Sutter to encrypt its data at rest and seeks $1,000 a person in damages for each member of the class of nearly 1 million people whose records were on the stolen office computer. The 10-page complaint filed in Sacramento Superior court names Karen Pardieck as the lead plaintiff and Sutter Health, Sutter Medical Foundation and Sutter Physician Services as defendants.

http://www.modernhealthcare.com/article/20111128/MAGAZINE/311289955/

Care Clarification

cmonfils | November 20, 2011

Wal-Mart is up to something, something to do with primary care. The only thing that Wal-Mart itself is saying is that it’s not doing what it told potential partners it wants to do.

The commotion started with the retail giant’s circulation of a 14-page request for information document from Wal-Mart’s Health & Wellness division seeking “mutually beneficial proposals that will aggressively drive down costs within the healthcare system.” 

Small, But Mighty

cmonfils | November 20, 2011

With consolidation in the big-plan consulting market over the past few years garnering all the headlines – Towers Perrin merging with Watson Wyatt in 2009 to form Towers Watson and Aon joining forces with Hewitt last year to create Aon Hewitt – it’s easy to forget there are a slew of smaller consulting firms out there providing consistently high levels of service to thousands of small- to mid-sized organizations.

http://ebn.benefitnews.com/news/consulting-firms-small-ed-bray-laurie-miller-robert-arnoff-2719009-1.html

Institute of Medicine Report Ties Essential Health Benefits To Budget

cmonfils | October 17, 2011

www.hcaa.org

Regulatory Alert  

There are a number of articles in the news today on the Institute of Medicine’s (IOM’s) recommendations to HHS about what constitutes “essential health benefits.”   The definition is important because there cannot be lifetime or annual dollar limits on essential health benefits, but no one knows what that term means.  It could also impact whether an employer’s plan provides enough benefits for pay or play purposes in 2014.

Read the Alert and join the conversation on what the rules should be!

The full IOM Report can be viewed here