cmonfils | January 22, 2012
Today, the Department of Health and Human Services announced that, “Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.”
cmonfils | January 22, 2012
WASHINGTON — The U.S. Department of Labor today announced a $2 million National Emergency Grant supplemental award, in the form of a National Emergency Grant, to provide an estimated 1,175 additional jobless workers in North Carolina with partial premium payments for health insurance coverage. The state qualified for funds available under the American Recovery and Reinvestment Act.
cmonfils | January 22, 2012
Health insurance premium increases in five states have been deemed “unreasonable” by the U.S. Department of Health and Human Services, HHS Secretary Kathleen Sebelius announced today.
After independent expert review, HHS determined that Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.
cmonfils | January 20, 2012
Excela Health entered the Great Recession as the largest mental health provider for the Pennsylvania county that’s home to its three hospitals.
A year and a half later, as the recession drew to a close, Excela began to refer and transfer outpatient mental health patients to primary-care doctors and community clinics to stem losses.
cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
As illustrated here, ERISA did not preempt the Washington Mental Health Parity Act.
Even though it correctly applied an insured ERISA plan’s coverage restrictions on neurodevelopmental therapy for children over six years old, the administrator’s refusal to pay a 10-year-old dependent’s mental health treatment violated a state law that bound insurers and HMOs. (more…)
cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
A claims administrator lost an attempt to dismiss negligence and breach of contract charges relating to its failure to process and pay a large claim before the final day of a stop-loss policy’s run-out period.
The self-insured Hebrew Home health plan sued administrator CoreSource and stop-loss insurer Sun Life for negligence and breach of contract under state law, alleging that the administrator dragged its feet paying the claim and ended up missing a March 31 deadline that would have enabled the plan to collect $180,000 in stop-loss reimbursement. (more…)
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 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
In a surprising decision, the 3rd U.S. Circuit Court of Appeals used the concept of “appropriate equitable relief” to restrict an employer-sponsored health plan’s recovery from a third-party settlement. Full reimbursement of what the plan paid out would have been “inappropriate and inequitable,” even though the plan had asserted recovery rights over any monies collected from a third party. Full recovery would have been unfair because: (1) the plan participant’s recovery ended up being less than what the plan paid after attorney’s fees were deducted; and (2) the plan never intervened in the third-party recovery. The outcome diverges from many recent cases, which upheld plans’ claims on total proceeds, regardless of whether the plan participant was “made whole” or had money to pay attorney’s fees. (more…)
cmonfils | January 17, 2012
The beginning of 2012 ushered in seven new requirements for health insurance coverage provided by employers to Connecticut residents that proponents say will save lives and money in the long run.
“An ounce of prevention is worth a pound of cure,” said state Sen. Joseph Crisco Jr., D-Woodbridge, co-chairman of the state legislature’s Insurance and Real Estate Committee, referring to the new requirements for breast MRIs, colonoscopies and prostate cancer screening and treatment.
cmonfils | January 17, 2012
H-E-B is sharing with the public what it’s learned about its own employees’ wellness and on Friday will launch “Healthy at H-E-B” at the store at 2950 Southmost Blvd.
The company describes the effort as a “comprehensive commitment to improve the health of Texans.” As part of the initiative, H-E-B will showcase chef-inspired recipes at in-store cooking demonstrations designed to show customers how to make healthy, inexpensive meals
cmonfils | January 15, 2012
MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 1/12/2012, www.Thompson.com
Case: Pacific Shores Hosp. v. United Behavioral Health, 2011 WL 6402435 (C.D. Calif., Dec. 19, 2011)
A benefit administrator’s adverse benefit determination was imperfect but sufficient to comply with claims procedure rules, the U.S. District Court for the Central California district concluded in the above case. 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. (more…)
cmonfils | January 13, 2012
FRANKFORT, Ky.—Kentucky licensed 18 new captive insurance companies in 2011, bringing the total number of active captives in the state to 137 at year’s end.
http://www.businessinsurance.com/article/20120113/NEWS06/120119936?tags=58|73|60
cmonfils | January 12, 2012
Reporting from Sacramento— Fewer California companies offered their workers health insurance last year, and the ones that did charged employees more for their coverage.
That’s among the findings of an annual California Employer Health Benefits Survey released Wednesday by the California HealthCare Foundation, a research and grant-making nonprofit organization.
http://www.latimes.com/health/healthcare/la-fi-california-health-care-costs-20120105,0,3760812.story
cmonfils | January 12, 2012
An Oregon labor relations board has sided with the state regarding a controversial state workers wellness program, ruling that the measure is not subject to union negotiations.
The Employment Relations Board decided on a 2 to 1 vote that the state did not have to negotiate with the Association of Oregon Corrections Employees over the implementation of the Health Engagement Model as part of this year’s health plan for state workers.
cmonfils | January 11, 2012
Though it was not unexpected, state officials don’t yet have a complete plan to deal with a high court ruling that roughly 30,000 legal immigrants were unfairly excluded from a state health care program.
“Over the time of this deliberation we’ve understood that there might be a need to adjust the way that things go,” Health and Human Services Secretary JudyAnn Bigby said Friday.
