cmonfils | December 26, 2011
Scott Golding, executive director of the Presbyterian Medical Care Mission, knows the clinic’s policy of paying female employees six weeks of maternity leave is “pretty rare” these days.
“But it’s just important for us to let them have that time,” Golding said. “We take the philosophy this is an important job, but it is a job — and family comes first. And if we can help people keep their family happy and together as much as possible, then they make much better employees.”
Category: FMLA, Texas |
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cmonfils | December 22, 2011
December 12, 2011 (PLANSPONSOR.com) – The Texas Employees Retirement System expects to save about $20 million next year by shifting most of its retirees to a Medicare Advantage health-insurance plan.
Category: Health Insurance, Medicare, Texas |
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cmonfils | December 22, 2011
December 22, 2011 — The Self-Insurance Institute of America, Inc. (SIIA) today announced that it has filed a complaint in Federal Court requesting a declaration that Michigan’s recently passed Health Insurance Claims Assessment Act is preempted by the Employee Retirement Income Security Act (ERISA). SIIA also seeks an injunction against implementation and enforcement of the Act involving self-insured group health plans that are subject to ERISA or their business partners. (more…)
Category: ERISA, Michigan, Third Party Administrators |
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cmonfils | December 16, 2011
The Self-Insurer November 2011 Issue & Volume 37
From the Bench By Thomas Croft, Esq.
(Goyen v. Vail Corp., No. 10-cv-02392, in the United States District Court for the District of Colorado, September 26, 2011).
If it weren’t for the recent brouhaha spawned by the NAIC’s criticisms of stop loss insurance, this case would be somewhat akin to an announcement that no tsunami occurred today—greatly reassuring, but somehow not so newsworthy.
The plaintiff plan participant sued her employer and its TPA in state court for benefits denied under the Plan, relying on state law causes of action. The defendants removed the case to federal court and then moved to dismiss on the grounds of ERISA pre-emption. The Court converted the motion to a motion for summary judgment. Plaintiff argued that the Plan’s purchase of what the court termed “stop-gap insurance” rendered it no longer self-funded, such that ERISA’s “deemer clause” did not operate to insulate the Plan from state law based claims under the Supreme Court’s ruling in FMC Corp. v. Holiday, 498 U.S. 52 (1990). (more…)
Category: Colorado, Self-Funding, Stop Loss |
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cmonfils | December 16, 2011
San Francisco’s Health Care Security Ordinance has been amended to require more of certain employers with workers in the City and County of San Francisco. The amendments will take effect January 1, 2012.
The Ordinance requires many employers to spend a specified minimum amount toward certain health care expenses for their employees working in the City and County of San Francisco. (For more information on the Ordinance, see our article, San Francisco Health Care Law Survives ERISA Preemption.)
Category: California, Health Care Legislation |
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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 | December 15, 2011
On July 1, 2011 the Texas Supreme Court finally settled the long-standing issue of whether an injured plaintiff may recover the amount of medical expenses charged by doctors or the amount actually paid or incurred. Trial lawyers have long argued that plaintiffs should be entitled to recover the amount charged to them by doctors and hospitals, which is usually significantly more than the discounted amounts paid by subrogated insurers or compensation carriers. Defendants have, of course, argued just the opposite. This new standard for proving medical expenses is having the effect of bringing plaintiffs’ counsel and subrogated carriers together, because we have something the trial lawyers want and need. (more…)
Category: Subrogation, Texas |
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cmonfils | December 2, 2011
In 1989 and 1990, federal courts ordered two hospitals in Rockford, Ill., to stop merger talks after concluding that the combined organization would threaten competition and gain too much clout at the bargaining table with insureres.
Twenty-two years later, FTC lawyers are making the same arguments, specifically citing the 1989 and 1990 federal court opinions as direct evidence in their decision to challenge another proposed hospital merger in Rockford—the third legal challenge to a hospital acquisition the agency has filed this year.
http://www.modernhealthcare.com/article/20111128/MAGAZINE/311289947
Category: Health Care Legislation, Illinois, Legal |
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cmonfils | December 2, 2011
Now that the deficit-reduction supercommittee has failed to reach agreement, healthcare providers are dealing with the reality that things could get worse before they get worse.
A series of congressional hearings, intense lobbying efforts and countless closed-door meetings were not enough to help the 12-member Joint Select Committee on Deficit Reduction complete its task last week of delivering a proposal to Congress that identified ways to reduce the federal deficit by at least $1.2 trillion over the next 10 years. This summer’s Budget Control Act required that unless Congress could identify such savings, “sequestration” would kick in starting in January 2013, when $1.2 trillion in automatic, across-the-board cuts over 10 years will be split between defense and nondefense programs. The law limits the amount of healthcare savings by capping reductions to Medicare payments at 2%.
http://www.modernhealthcare.com/article/20111128/MAGAZINE/311289960/cloudy-outlook
Category: Arizona, Health Care Legislation, Medicaid, Medicare, Pennsylvania, South Carolina |
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cmonfils | December 2, 2011
A class-action lawsuit was filed against Sutter Health in connection with the theft of a desk top computer that held personally identifiable data of nearly 4.3 million patients (
see related story).
The suit asks a California court to require Sutter to encrypt its data at rest and seeks $1,000 a person in damages for each member of the class of nearly 1 million people whose records were on the stolen office computer. The 10-page complaint filed in Sacramento Superior court names Karen Pardieck as the lead plaintiff and Sutter Health, Sutter Medical Foundation and Sutter Physician Services as defendants.
http://www.modernhealthcare.com/article/20111128/MAGAZINE/311289955/
Category: California, HIPAA, News |
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cmonfils | November 29, 2011
Wisconsin Senate Bill 217: A bill which will affect the amount of time a driver’s license suspended for negligent operation of a motor vehicle has passed both the Wisconsin House and Senate and is currently on the Governor’s desk. SB 217 would limit the aforementioned suspension period to five years from the date of entry of a judgment against the negligent driver. This is a significant departure from current law, which allows the suspension to remain in place until the judgment is satisfied or discharged.
Thanks to Ken Wilber of Wilber & Associates in Bloomington, Illinois for bringing this bill to NASP’s attention.
Category: Wisconsin |
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cmonfils | November 29, 2011
Kansas Senate Bill 136: Kansas recently enacted a bill that would prohibit a driver from recovering noneconomic losses if they fail to maintain the mandatory personal injury protection coverage required in the state. The bill applies to personal injury lawsuits and wrongful death causes of action and bars recovery of noneconomic losses when someone is driving an automobile without the mandatory PIP benefits required by Kansas automobile injury reparations act, article 31 of chapter 40 of the Kansas Statutes Annotated. Two exceptions are noted: (more…)
Category: Kansas |
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cmonfils | November 27, 2011
A seemingly obscure regulatory battle in Florida could upend efforts to implement health-care reform nationwide.
At issue is a regulation requiring insurance companies to spend at least 80 percent of premiums on medical costs. Florida, a swing state with voters skeptical of the health-reform law, is pushing back. The state wants the Obama administration to waive the spending requirement for Florida insurers, a move that critics say would roll back a crucial consumer protection in the health-reform law.
Category: Florida, Health Care Legislation, Health Insurance |
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cmonfils | November 20, 2011
Employer’s Guide to Self-Insuring Health Benefits
Thompson Publishing November 2011 Vol. 19, No. 2
A plan participant cannot pick definitions from various state or federal statutes and impose them on the plan where the plan left terms undefined, if the plan applies a common and ordinary meaning to those terms when asked to justify a claims denial.
Applying this rule, a Michigan appeals court affirmed a lower state court’s ruling upholding a plan’s benefits denial for a surrogate mother’s delivery of triplets. (Spectrum Health v. Lehr, No. 298688, (Mich. App., Sept. 8, 2011).) (more…)
Category: Claims Procedures, ERISA, Health Insurance, Michigan |
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