cmonfils | April 25, 2012
Employer’s Guide to Self-Insuring Health Benefits April 2012 | Vol.19, No.7
An ERISA health plan fairly applied its unproven treatment exclusion to a patient’s long-term intravenous (IV) antibiotic treatment, and overcame her allegations that the payment cut-offs were improper. (more…)
cmonfils | March 4, 2012
Employers Guide to Self-Insuring Health Benefits February 2012 | Vol. 19, No. 5
A health plan’s claim denial was imperfect but sufficient to comply with claims procedure rules, the U.S. District Court for Central California concluded in a case brought by a hospital against a plan’s mental health benefit administrator. Discrepancies by reviewing physicians and adjustments made in discharge criteria were not enough to support allegations of claims procedure violations and overturn the denial, it held. The hospital in its lawsuit also argued that the benefit administrator lacked discretionary authority under the plan, because language in the plan and the summary plan description did not directly grant such authority. The court, however, found that plan language properly delegated authority — in a tortuous but clear way — to the administrator. (more…)
cmonfils | February 8, 2012
Two important cases provide good reminders to plan fiduciaries about (1) the importance of documentation of fiduciary processes, and (2) accurate communication of plan design changes to participants and beneficiaries.
cmonfils | December 13, 2011
PepsiCo Inc. employees across the country can get free travel to Johns Hopkins Hospital for surgeries under a new benefit the soda giant is now offering.
http://www.bizjournals.com/baltimore/news/2011/12/08/pepsi-offers-workers-benefit-of.html
cmonfils | September 9, 2011
A GPA Customer Announcement
We are pleased to announce that we have extended our partnership with The Phia Group, a leading healthcare cost containment and consulting firm, to support our Plan Document services. GPA has had the pleasure of working with The Phia Group for more than 10 years of subrogation and claims recovery services. (more…)
cmonfils | August 31, 2011
August 19, 2011 Peter Wand, David Manch
The Department of Labor recently announced plans to substantially increase the number of ERISA compliance audits it conducts each year. This is the first in a series of Client Alerts that Lewis and Roca LLP will publish over the coming months to help our clients evaluate their compliance with ERISA and related federal mandates, including COBRA, HIPAA and the Patient Protection and Affordable Care Act of 2010. (more…)
