cmonfils | January 8, 2012
As a general rule, state insurance laws apply to employer-sponsored insured group health plans but not self-insured group health plans. The Employee Retirement Income Security Act of 1974, as amended (ERISA) generally exempts group health plans sponsored by private sector employers from state insurance laws. However, because insurers must comply with state insurance laws, a group health plan that purchases insurance to provide benefits will be indirectly subject to the state laws applicable to the insurer. Thus, if your company sponsors a group health plan that includes any kind of insurance contract or policy, you should make sure that you keep up-to-date on state law changes and their impact on your plan, and that you properly notify your participants (and, in certain cases, eligible individuals) of any changes to their plan benefits.
Category: California, Connecticut, Health Insurance, Illinois, New York, Rhode Island, Texas, Wisconsin |
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cmonfils | December 26, 2011
Covered lives assessments under the New York Health Care Reform Act (HCRA) that are determined by county of residence will be higher in 2012 than in 2011 for both individuals and families in all eight State regions. The percentage increases range from just under 1 percent to more than 8 percent. However, the set percentage surcharge for indigent care will remain the same in 2012 as in 2011.
Category: Health Care Legislation, New York |
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cmonfils | December 16, 2011
from Spencer’s Benefits Reports: For the last few years, states have been leading the way toward more comprehensive health care coverage to ensure that more people have or can obtain health insurance. With the passage of federal health care reform, states will have increasing responsibilities in regard to employer-provided health insurance benefits. Spencer’s Benefits Reports continues to provide regular updates about state health care reform.
Category: California, Health Care Legislation, Indiana, Louisiana, Minnesota, New York |
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cmonfils | November 18, 2011
ALBANY, N.Y.—Eleven health insurers have been ordered to refund $114.5 million to policyholders in New York under minimum medical spending requirements similar to those being enacted nationwide under health care reform beginning this year.
Category: Health Insurance, New York |
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cmonfils | November 18, 2011
ALBANY, N.Y. — New York soon will require insurers to cover screening, diagnosis and treatment for autism spectrum disorders, which will increase premiums for all individuals and businesses.
Supporters say the new law will include routine toddler screenings, behavioral health treatments, speech therapy, occupational therapy and physical therapy. That should bolster early and effective treatment and save families as much as $50,000 a year in out-of-pocket cost for 30,000 autistic New York children.
Category: Health Insurance, New York |
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cmonfils | November 16, 2011
New York insurance companies that were not covering the screening, diagnosis and treatment for autism spectrum disorders will now be mandated to do so effective Nov. 1, 2012.
New York is the 29th state to pass some version of Ryan’s Law, a bill that started in South Carolina in 2005 after Lorri Unumb, who was at the time a law professor at the Charleston School of Law and a mother of a two-year-old autistic son, decided to write a bill that would mandate insurance companies provide up to $50,000 in behavioral therapy annually for children up to age 16. The New York bill puts an annual cap of $45,000 on coverage.
Category: Health Insurance, New York |
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cmonfils | October 12, 2011
www.modernhealthcare.com
By Modern Healthcare Posted: October 3, 2011 – 12:01 am ET
Raising the Medicare eligibility age to 67 will be among a host of topics American Hospital Association members will discuss with lawmakers this week during the group’s advocacy meeting in Washington. “This is an idea that has been put forward by House Democrats, an idea put forth by the president,” said Tom Nickels, AHA’s senior vice president of federal relations. “So this is not an idea that doesn’t have a wide spectrum of individuals who are willing to consider it—not endorse it, but consider it.”
(more…)
Category: California, Delaware, Maryland, Medicare, New York |
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cmonfils | September 19, 2011
Coordination of Benefits
Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
Legal Brief
Contrary to two recent decisions, a health plan in New York failed in its effort to intervene in a plan participant’s lawsuit against a third party, which would have let the plan in on settlement negotiations or made it a party to the court’s allocation of the settlement proceeds. A recent decision, Robles v. Bruhns, 2011 WL 1564649 (N.Y. Sup. Ct., Suffolk Cty., April 26, 2011), refused to allow such an intervention. (more…)
Category: Legal, New York |
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cmonfils | August 25, 2011
www.subrogation.org
Federal Employee Health Benefit Plan Recoveries Under Attack
Recently, four putative class action lawsuits, challenging a Federal Employee Health Benefits plans’ right to recover or subrogate, have been filed. The suits, one filed in New York and the others filed in Missouri, allege that the Federal Employee Health Benefit Act (FEHBA) does not preempt state anti-subrogation laws and that the health plans’ recoveries, on behalf of Federal Employee Health Benefit (FEHB) plans, are not allowed. The suits also seek the refund of past FEHB plan subrogation recoveries. (more…)
Category: Health Insurance, Missouri, New York, Subrogation |
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cmonfils | August 25, 2011
Braintree, Massachusetts 08/23/11 – A class action lawsuit was recently filed in the State of New York (Rebecca Meek-Horton v. Trover Solutions, Inc. et.al, State of New York, Supreme Court, New York County, Case No. 108804-2011), which alleges that Medicare Advantage Plans violate a New York State law when they impose liens on participants who receive personal injury settlements, arising from injuries for which said Advantage Plan has already advanced payment. (more…)
Category: Collateral Source Rule, Medicare, New York, Reimbursement |
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cmonfils | August 22, 2011
Coordination of Benefits Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
Legal Brief
Contrary to two recent decisions, a health plan in New York failed in its effort to intervene in a plan participant’s lawsuit against a third party, which would have let the plan in on settlement negotiations or made it a party to the court’s allocation of the settlement proceeds. A recent decision, Robles v. Bruhns, 2011 WL 1564649 (N.Y. Sup. Ct., Suffolk Cty., April 26, 2011), refused to allow such an intervention. (more…)
Category: New York |
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cmonfils | August 10, 2011
Rebecca Meek-Horton v. Trover Solutions Inc. et al (State of New York, Supreme Court, New York County, Case No. 108804-2011)
A lawsuit naming 50 insurers as defendants has been filed in New York Supreme Court, New York County. The complaint relates to Medicare Advantage plans and accuses the insurers of violating a 2009 state law by imposing liens on patients who receive personal injury settlements. (more…)
Category: Medicare, New York |
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cmonfils | August 8, 2011
www.subrogation.org
Over the past several weeks, two lawsuits seeking class certification have been filed and both suits could potentially affect the way carriers pursue and handle their subrogation rights. (more…)
Category: Illinois, Medicare, New York, Subrogation |
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cmonfils | July 11, 2011
The Subrogator Spring/Summer 2011
Amidst the deluge of healthcare reform, anti-subrogation legislation was passed in the State of New York on November 12, 2009, which purported to eliminate the right of fully insured carriers and self-funded benefit plans, coming within the purview of state law, to pursue subrogation and reimbursement. Accordingly, benefit plans in New York which are not private, self-funded plans, no longer have an enforceable right to subrogation and/or reimbursement. The Phia Group has never accepted anti-subrogation legislation without a fight. When the Phia Group received word of the statutory shift, its attorneys immediately began to seek out ways to enforce plan rights. (more…)
Category: Collateral Source Rule, New York, Subrogation |
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cmonfils | July 4, 2011
www.pnhp.org By Douglas Turner The Buffalo News, June 20, 2011
WASHINGTON — Conservative House Republicans, flush from their 2010 victory over the perceived overreach of the Obama health care law, flooded the Capitol with heroic-sounding legislation last winter. (more…)
Category: Health Care Legislation, New York |
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