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 | No Comments »
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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.

Category: Alabama, Alaska, California, CHIP, Idaho, Illinois, Iowa, Kansas, Louisiana, Michigan, New Jersey, New Mexico, Ohio, Oregon, Washington, Wisconsin | No Comments »
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cmonfils | January 3, 2012

Employer’s Guide to Self-Insuring Health Benefits   December 2011 | Vol. 19, No.3 

The lack of cost transparency stands in the way of health cost control because it makes plan members unable to see prices before services are actually rendered, and harms their ability to budget health spending. Problems include: (1) multiple providers; (2) multiple network-provider contracts; (3) providers that often don’t know how extensive a patient’s treatment needs are until they start treatment; (4) insurers say contractual obligations with providers prohibit the sharing of negotiated rates; and (5) providers afraid of sharing negotiated rates due to their proprietary nature. Leah Binder, CEO of the Leapfrog Group, suggested that most employers can bring more efficient purchasing to their health plan in two ways: (1) change plan documents to reward members for using high-performance providers (for example, by waiving deductibles); and (2) computerize drug ordering and management systems, which would have quality as well as cost and efficiency advantages. (more…)

Category: California, CMS, Florida, Massachusetts, Medicaid, Medicare, New Hampshire, Transparency, Wisconsin | No Comments »
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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 | No Comments »
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cmonfils | November 8, 2011

Although health care reform legislation excluded the value of employer-provided health benefits provided to any employee’s child under the age of 27 at the end of the taxable year (not just tax dependents) effective March 30, 2010, several states did not incorporate that change into state law. As a result, there has been some confusion as to whether the value of employer-provided health benefits provided to non-tax dependent children would be subject to state taxes in those states. However, earlier this year, several states, including California and Minnesota, enacted legislation to conform state tax treatment of such coverage with federal tax treatment.

Category: Health Care Legislation, Health Insurance, Wisconsin | No Comments »
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cmonfils | November 7, 2011

The state’s insurance regulator wants to exempt health insurance companies from the new federal requirement that they spend 80% of premiums on medical care. The Office of the Commissioner of Insurance has asked the federal government for approval to phase in the new regulation over three years for health plans sold to people who buy health insurance on their own.

http://www.jsonline.com/business/state-wants-to-exempt-health-insurers-from-80-rule-132669603.html

Category: Health Care Legislation, Health Insurance, Wisconsin | No Comments »
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cmonfils | July 27, 2011

Facts: 

Participant of an ERISA covered Plan had an accident and filed an action in Wisconsin wherein he named the Plan as a defendant and disputed Plan’s rights under the Made Whole Rule.  Plan then filed a cross claim against defendant parties and a counter claim against member asserting made whole inapplicable due to plan language.  Plan participant settled with defendant party including a surgery he consistently related to the accident and never advised plan of settlement negotiations.  Subsequent to that settlement, he claimed there was an IME showing the surgery was not related to the accident. (more…)

Category: 7th, Made Whole Rule, Wisconsin | No Comments »
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cmonfils | July 25, 2011

By Joe Forward, Legal Writer, State Bar of Wisconsin

 July 12, 2011 – Under an Employee Retirement Income Security Act (ERISA) benefits plan, an insurer was entitled to reimbursement amounts it paid to cover a beneficiary’s medical expenses, even though the beneficiary was not made whole through settlement, the Wisconsin Supreme Court recently concluded. (more…)

Category: ERISA, Reimbursement, Wisconsin | No Comments »
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cmonfils | June 15, 2011

www.modernhealthcare.com       By Maureen McKinney     June 13, 2011

Category: Accountable Care Organizations, Medicaid, Medicare, Oregon, Wisconsin | No Comments »
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cmonfils | June 1, 2011

www.modernhealthcare.com          Melanie Evans   May 30, 2011 

Accountable care organizations, one provision to overhaul health financing under the Patient Protection and Affordable Care Act, would offer possible bonuses or penalties to providers based on quality and health spending targets, under proposed rules.  (more…)

Category: Accountable Care Organizations, Iowa, Medicare, Wisconsin | No Comments »
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cmonfils | May 31, 2011

www.hr.cch.com 

CCH® BENEFITS — 05/25/11

Category: Health Care Legislation, Wisconsin | No Comments »
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cmonfils | April 8, 2011

www.hr.cch.com      CCH® BENEFITS — 04/04/11

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. (more…)

Category: California, Colorado, Health Care Legislation, Illinois, Iowa, Kansas, Maryland, Vermont, Wisconsin, Wyoming | No Comments »
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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…)

Category: California, Connecticut, Health Care Legislation, Kansas, Louisiana, Maine, Massachusetts, New York, Ohio, Utah, Washington D.C., Wisconsin | No Comments »
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Adam V. Russo | June 21, 2010

www.plansponsor.com

June 8, 2010 (PLANSPONSOR.com) – The U.S. District Court for the Western District of Wisconsin has found that an employer did not breach its fiduciary duties by failing to inform a former employee and his wife about all of their benefit options. (more…)

Category: 7th, Federal Circuits, Summary Plan Description, Wisconsin | No Comments »
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Adam V. Russo | January 25, 2010

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. Because of the potential impact of this ongoing activity on employer-provided health insurance benefits, Spencer’s Benefits Reports provides regular updates about state health care reform.

Wisconsin. The state is anticipating cutting more than $600 million from its Medicaid program. The areas targeted for cuts include delaying payments into the budget next year, increasing generic drug usage, reducing rural hospital reimbursement payments, and rebidding contracts for state health care programs. Even with those reductions, high demand from the poor for health insurance benefits could result in up to a $150 million shortfall. For more information, visit http://dhs.wisconsin.gov/MEDICAID/.

Category: Health Care Legislation, Medicaid, Wisconsin | No Comments »
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