cmonfils | January 25, 2012
DOVER — “If you do something to encourage a healthy lifestyle, it will make folks happier, they’ll have more energy and be more productive,” says Pat Sliva at the Tuscarawas County Board of Developmental Disabilities.
Sliva is human resources coordinator at the Board and credits these positive outcomes to the organization’s five-year involvement with Union Hospital’s Workplace Wellness program.
cmonfils | January 24, 2012
A new state law allows Franklin County to reactivate its wellness programs in hopes of lowering health-care costs paid by taxpayers.
Legislation signed by Gov. John Kasich in late December clears up what some county prosecutors said was cloudy language regarding whether counties can create programs to combat obesity, high blood pressure, diabetes and heart disease. The law takes effect 90 days after signing.
cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
Most self-insured governmental plans adopt ERISA principles in governing trusts, and use ERISA-style plan documents and summary plan descriptions (SPDs). However, just because they look to ERISA for guidance when crafting programs, they would be mistaken to assume they have ERISA-style rights.
In Daugherty v. Wayne County Bd., 2011 WL 5028365 (Ohio App. 9 Dist., Oct. 24, 2011), a self-insured county health plan argued that because it reserved itself discretionary authority in the SPD, that its disputed denials should be entitled to a more favorable review in court. (more…)
cmonfils | January 5, 2012
CHIP –AL, AK, CA, ID, IL, OA, KS, LA, MI, NJ, NM, OH, OR, WA, WI
Dec. 28 (Bloomberg) — Twenty-three states will share $296.5 million in U.S. payments for encouraging low-income families to enroll their children in public health programs.
Bonuses announced today reward states that streamline eligibility for Medicaid, the federal-state health program for the poor, or the Children’s Health Insurance Program. The effort is aimed at children younger than 19 from households with annual incomes of as much as $45,000 for a family of four, though some states have more generous criteria.
cmonfils | November 18, 2011
It won’t be the body blow to President Barack Obama’s health-care law that some might have hoped, but Ohio voters yesterday overwhelmingly approved a state constitutional amendment voicing their displeasure with a federal law requiring most Americans to buy health insurance by 2014 or face fines.
cmonfils | October 26, 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.
cmonfils | September 19, 2011
HEALTHCARE REFORM – CT, ID – IL – KS – OH
www.hr.cch.com
CCH® BENEFITS — 08/26/11
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.
cmonfils | June 15, 2011
www.modernhealthcare.com By Andis Robeznieks June 13, 2011
The system noted that the 177-bed hospital has seen a 10% decrease in discharges since 2003, a 16% decline in surgical procedures since then, and—on some days—had as few as 47 patients. The closing would correspond with the planned Oct. 3 opening of the $25 million Huron Community Health Center on the hospital’s campus. (more…)
cmonfils | April 1, 2011
3/28/11
from Spencer’s Benefits Reports: A two-month stay at a residential treatment facility for cocaine addition did not qualify for plan coverage because an acute level of care was not needed after two days, the Sixth Circuit Court of Appeals ruled in upholding the plan’s denial of benefits (Meredith Solomon v. Medical Mutual of Ohio, No. 09-4152). (more…)
Adam V. Russo | November 18, 2010
MyHealthGuide, www.myhealthguide.com
Federal Court Chastises Stop Loss Carrier Over Efforts to Achieve Piecemeal Adjudication of Multiple Claims
MyHealthGuide Source: Tom Croft, Esq., King & Croft LLP, 11/10/2010 www.StopLossLaw.com
Case: Bekaert Corp. v. Standard Security Life Insurance Company of New York, Inc., No.5:09 CV 2903, in the United States District Court for the Northern District of Ohio, October 8, 2010) Court’s Opinion. (more…)
Adam V. Russo | September 16, 2010
NASP, www.subrogation.org
NASP was invited to speak to the Ohio State Bar Association (OSBA) Subrogation Committee Meeting on September 14, 2010. NASP President Elect, Ken Levine, was in attendance and NASP Amicus Committee Chair, Daran Kiefer, represented NASP at this meeting, presenting written testimony that you can read on the NASP website at www.subrogation.org. (more…)
Adam V. Russo | September 7, 2010
MyHealthGuide, www.myhealthguide.com
By Tom Croft, Esq. of King & Croft LLP, www.StopLossLaw.com
Nationwide Life Ins. Co. v. City of Canton, Ohio, et al., No. 09AP-939, CPC No. 07CVH-08-11779 in The Court of Appeals of Ohio, Tenth District, 8/31/2010). Court’s Opinion
Mr. Croft’s comment: The myth that a stop loss carrier cannot win a disclosure dispute in court implodes yet again. This case involved a classic disclosure-issue fact pattern concerning a participant’s esophageal cancer, and a failure to make required disclosure on the part of the insured and one of its two TPAs. Relatively large dollars were involved. The Court of Appeals determined that the trial court had been correct in entering judgment for the stop loss carrier and its MGU. (more…)
Adam V. Russo | August 25, 2010
Coordination of Benefits
The common-law collateral source rule is intended to ensure that a person who suffers a financial loss as a result of other person’s wrongdoing does not achieve reimbursement of more than 100 percent of the loss from all sources. In Ohio, the modern collateral source rule is governed by a statute that permits the alleged wrongdoer to “introduce evidence of any amount payable as a benefit to the [injured party] as a result of the damages that result from an injury, death or loss to person or property that is the subject of a claim upon which the action is based, except of the source of collateral benefits has… a contractual right of subrogation.” The Supreme Court of Ohio recently considered the application of the statute in determining how much the injured party received in benefits from his health insurer. The case is Jacques v. Manton, 2010 WL 1816324 (S. Ct. Ohio, May 4, 2010). (more…)
Adam V. Russo | August 12, 2010
CCH® BENEFITS, www.hr.cch.com
California
The California Public Employee’s Retirement System (CalPERS) has approved an average increase of more than 9% in health premiums next year for state and local government workers. CalPERS blamed the rate increase on rising costs for hospital care, doctor visits, and prescriptions. The increase will mean higher premiums for public agencies and their 1.3 million employees, dependents, and retirees. For more information, visit http://www.calpers.ca.gov/. (more…)
Adam V. Russo | May 17, 2010
Case: Galion Community Hospital v. Hartford Life & Accident Ins. Co,, No. 1:08-cv-1635, in the United States District Court for the Northern District of Ohio, Eastern Division, May 7, 2010).
Mr. Croft’s Comment: This case involves two arguably conflicting provisions in an advance funding endorsement concerning the timing of submission of requests for advance funding:
To be eligible for advance reimbursement with respect to an Agreement year, Your request must be received by Us no later than the 10th calendar day following the end of that Agreement Year, provided the agreement is in force on the date we receive the request. (more…)
