cmonfils | October 26, 2011
Employers make push for wellness as costs go up, packages go out.
Employers across Georgia are tucking a strong message into benefit enrollment packages going out to employees this fall: They want their workers to do more to get healthy.
cmonfils | September 19, 2011
CCH® BENEFITS — 09/01/11
from Spencer’s Benefits Reports: According to the Kaiser Family Foundation’s State Health Facts, 23 states have established American Health Benefit Exchanges under the Patient Protection and Affordable Care Act (ACA), have enacted legislation with the intent to establish an Exchange, or have Exchange legislation pending.
Massachusetts and Vermont have established Exchanges, while California, Colorado, Connecticut, Hawaii, Maryland, Nevada, Oregon, Vermont, Washington, and West Virginia have enacted legislation to establish an Exchange. Hawaii’s Exchange will be a nonprofit, Vermont Exchange will be operated by the state. The rest of the Exchanges will be quasi-governmental.
The Exchange will be a clearinghouse and contract with all qualified health plans in Colorado and Hawaii. In California, Connecticut, Oregon, and Vermont, the Exchange will be an active purchaser contracting with selected health plans and/or negotiating premium prices with health plans. The other states have not yet decided the type of Exchange they will operate.
In Illinois, Indiana (by executive order of the governor), North Dakota, and Virginia, legislation has established the intent to set up an Exchange, while Alabama (by executive order of the governor), Georgia (by executive order of the governor), Mississippi, and Wyoming will study the feasilibility of an Exchange.
The District of Columbia, New Jersey, North Carolina, and Pennsylvania have Exchange legislation pending.
For more information, visit http://statehealthfacts.kff.org/comparemaptable.jsp?ind=962&cat=17.
Rate Review Programs
The federal government will either conduct or assist health insurance rate reviews in nine states, according to the most recent fact sheet from the Center for Consumer Information and Insurance Oversight (CCIIO), which discusses the rate review requirements included in the ACA.
According to the CCIIO, as of Aug. 15, 2011, state rate review procedures were as follows:
43 states, the District of Columbia, and one U.S. territory have effective rate review in at least one insurance market;
41 states, the District of Columbia, and the U.S. Virgin Islands have effective review for all insurance markets and issuers.
In two states (Virginia, Pennsylvania), the federal government will partner with the state to conduct reviews; and
The federal government will conduct reviews in seven states (Wyoming, Montana, Missouri, Louisiana, Idaho, Arizona, and Alabama) and four U.S. territories (American Samoa, Guam, Northern Marianas Islands, and Puerto Rico) until those areas are able to strengthen their review processes and authorities.
Starting Sept. 1, 2011, insurers seeking rate increases of 10% or more for non-grandfathered plans in the individual and small group markets are required to publicly disclose the proposed increases and the justification for them.
For more information, visit http://cciio.cms.gov/resources/factsheets/rate_review_fact_sheet.html.
cmonfils | August 22, 2011
By MICHAEL COOPER August 12, 2011
The provision in President Obama’s health care law requiring Americans to buy health insurance or face tax penalties was ruled unconstitutional on Friday by the United States Court of Appeals for the 11th Circuit, in Atlanta.
It was the first appellate review to find the provision unconstitutional — a previous federal appeals court upheld the law — and some lawyers said that the decision made it more likely that the fate of the health care law would ultimately be decided by the Supreme Court. (more…)
cmonfils | May 3, 2011
Coordination of Benefits April 2011 | Vol. 19, No. 2
As we know, self-funded health plans subject to ERISA usually provide that their right to reimbursement is not subject to the make-whole rule. Federal courts have ruled that in the absence of a plan provision to the contrary, federal common law will impose the makewhole rule when the plan seeks reimbursement. For that reason, virtually all ERISA health plans today specifically provide that they are entitled to reimbursement of benefits paid even if the plan participant is not made whole. (more…)
Adam V. Russo | August 25, 2010
Coordination of Benefits Handbook
Although federal case law is well settled on the principle that an ERISA health plan is entitled to reimbursement of benefits paid from tort settlement proceeds that are clearly identified as such, it appears that attorneys for plan participants still come up with several arguments seeking to avoid such liability. Those arguments often rely on state statutes, but they often raise other issues. A recent decision by a U.S. District Court in Georgia in favor of the plan’s right to reimbursement indicates how modern federal courts dispose of those arguments. The case is Brown & Williamson Tobacco Corp. v. Collier, 2010 WL 1487772 (M.D. Ga., April 13, 2010). (more…)
Adam V. Russo | May 4, 2010
Colliers are in possession of the $ 70,000 and the fund is specifically identifiable and satisfying standard for relief under § 502(a)(3). The Court agreed that the Plan must be reimbursed.
Since the plan is a self-funded ERISA plan, federal law preempts Georgia’s anti-subrogation statute. In addition, the Plan had rejected the made whole doctrine in the plan document and the Court correctly stated that while the made whole doctrine is the default rule in the Eleventh Circuit, the Colliers fail to acknowledge that the doctrine can be expressly excluded.
Adam V. Russo | February 23, 2010
Georgia. Georgia Health Commissioner Rhonda Medows has urged state lawmakers to adopt a tax hike on hospitals and health care plans to help with the state’s Medicaid deficit problem. Beginning on July 1, the state will face a $506 million shortfall in Medicaid funds. The recession has caused enrollment in Medicaid to soar:from Une 2009 to 2010 enrollment has increased 7.7% to more than 1 million people. For more information, visit http://health.state.ga.us/.
Adam V. Russo | July 23, 2008
Diamond Crystal Brands, Inc. v. Wallace, 531 F.Supp.2d 1366 (N.D. Ga.2008)
After the negligent medical care and consequential death of Deborah Hayes, the Estate and her daughter Tamara Hayes pursued a wrongful death claim against the hospital. In Georgia State Court plaintiffs settled for $900,000, of which $837,000 went to Tamara Hayes and $63,000 to the Estate of Deborah Hayes.
Prior to Deborah Hayes’s death, her employer, Diamond Crystal provided $261,863.58 in medical benefits related to the medical malpractice. After the settlement, Diamond Crystal sought reimbursement of claims paid. (more…)
