Medical Stop Loss Insurance Is Not a Commodity
bhoffman | September 2, 2010
By Jim Hoitt of R.E. Moulton, a OneAmerica Company
http://www.hiu-digital.com/hiu/201009#pg22
11th Circuit Explains Why It Upheld Plan’s Reimbursement Provision
bhoffman | August 25, 2010
Coordination of Benefits Handbook
Victims of accidents in subrogation/reimbursement cases have emotional appeal when they argue that tort settlements are reduced without some consideration of the fact that they were not “made whole” or had their recoveries diminished by not requiring a recovering plan to share the legal fees they incurred in making the settlement. There [...]
A Lesson in Self-Reliance
bhoffman | July 19, 2010
More and more small and midsize companies are looking to get off the insurance grid and cover their own employee health-care claims.
By Alix Stuart, www.CFO.com
Want to save money on health-care insurance? Try this strategy: stop buying it.
While self-insurance is nothing new to large companies — some 90% of those with more than 5,000 employees have [...]
R. E. Moulton’s Unlimited Specific Coverage Reimbursement Option for American United Life Insurance Company
bhoffman | July 14, 2010
R. E. Moulton, Inc. is pleased to announce the availability of an unlimited specific coverage reimbursement option for American United Life Insurance Company® (AUL) stop loss insurance policyholders, effective immediately. Additionally, for AUL policyholders requiring a maximum specific benefit, R.E Moulton will continue providing annual maximums with options of up to $10 million in coverage.
Federal Court Defines Issued and Paid for Stop Loss Claims
Adam V. Russo | June 21, 2010
Court Enters Judgment for Stop Loss Carrier Based On Pleadings Alone
MyHealthGuide Source: Tom Croft, Esq., King & Croft LLP, 6/15/2010, www.StopLossLaw.com
Case: Federal Warehouse Co. v. Nationwide Life Ins. Co, No. 2:08-cv-275, in the United States District Court for the Southern District of Ohio, Eastern Division (5/24/2010) Court’s Opinion
Sometimes these stop loss cases are just plain [...]
Texas Supreme Court Denies Review of Stop-Loss Case
Adam V. Russo | June 7, 2010
MyHealthGuide Source: StreetInsider.com, 6/2/2010,
AUSTIN, TX — The Texas Supreme Court has declined to review a case involving the amount some hospitals marked up workers’ compensation-related bills under rules in effect until 2008.
“Texas employers realized a great victory today,” Mary Barrow Nichols, general counsel and senior vice president for Texas Mutual, said. “A small number of [...]
Court Grants Summary Judgment to Stop Loss Carrier and MGU in Disclosure Case
Adam V. Russo | May 24, 2010
MyHealthGuide Source: Tom Croft, Esq., King & Croft LLP, 5/20/2010, www.StopLossLaw.com
Case: Evangelical Presbyterian Church v. American Fidelity Assurance Company, et al., No. 08-116317, in the Circuit Court of Wayne County, Michigan, 5/14/2010). Court Opinion
Mr. Croft’s Comments: A Michigan trial court entered a 15 page Order granting summary judgment for a stop loss carrier and an [...]
Ohio Federal Court Rules on Advance Funding Endorsement
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 [...]
Stable Condition: Medical stop-loss rate increases ease
Adam V. Russo | March 31, 2010
Cost trend ranges widely depending on employers’ exposure — Louise Kertesz
The medical stop-loss market for self-insured employers has ample capacity, but prices range from slight reductions to 60% increases for those with high exposures and a poor claims history, experts say.
“The (medical stop-loss) market is very similar to a couple of years ago,” said John [...]
Missouri Federal Court Reaffirms Fundamental Principle: Employer’s Purchase of Stop Loss Insurance Does Not Alter Self-Funded Character of Plan
Adam V. Russo | January 29, 2010
The Boeing Company v. Thurmon, No. 4:09-cv-1456, in the United States District Court for the Eastern District of Missouri, December 7, 2009. This is a subrogation case, significant for its fresh and express reiteration of the bedrock proposition that purchase of stop loss insurance by the sponsor of a self-insured employee benefit plan does not [...]
Standard Stop-Loss Employer Disclosure Form Endorsed
Adam V. Russo | January 25, 2010
Self-Insurance Institute of America ( www.SIIA.org) and Society of Professional Benefit Administrators ( www.SPBATPA.org) have endorsed a standardized stop-loss disclosure form, which also includes ICD-9 codes. The documents are intended to help facilitate the sharing of health data information between self-insured entities/TPAs and stop-loss insurers/MGUs for the purpose of medical stop-loss underwriting.
Subrogation Rights Not Affected By Stop-Loss Insurance Payment
Adam V. Russo | November 18, 2009
The fact that a stop-loss insurer reimbursed a plan for some of the benefits the plan does not affect the plan’s ability to seek recovery from the participant’s tort settlement with a third-party tortfeasor. A federal court in Idaho upheld that outcome, allowing the plan to assert an equitable lien. The plan was covered by [...]
Employer That Did Not Comply With Health Plan’s COBRA Notice Requirements Is Not Entitled to Stop-Loss Reimbursement
Adam V. Russo | October 28, 2009
EBIA Weekly, www.EBIA.com
Majestic Star Casino v. Trustmark, 2009 WL 3260561 (N.D. Ill. 2009)
This case involved employees who incurred large health care expenses while on approved 90-day leaves of absence. The employer sought reimbursement for the excess expenses under the stop-loss policy issued in connection with its self-funded health plan. But the stop-loss insurer denied payment, [...]
Another Issue Involving Stop Loss and Prompt Payment Statutes
Adam V. Russo | June 26, 2009
An inquiry by a TPA to the New York Insurance Department asked whether stop-loss insurers are subject to the prompt-pay rules of Insurance Law § 3224-a. In April 1982, the Insurance Department issued Circular Letter 7, which provides that stop-loss insurance is not reinsurance, but rather a form of accident and health insurance that may [...]
Court of Appeals Finds Sun Life Acted Arbitrarily and Capriciously
Adam V. Russo | June 25, 2009
by John Wood of ERISA and Disability Benefits Law Blog, www.erisaontheweb.com
Sherry DeLisle continued working after her car crashes in 1998 and 2000. She suffered spinal and closed head injuries. Her employer, Krandall & Sons, fired her on April 17, 2002, stating that “she was not doing her job.” Eight months later, DeLisle filed for long-term [...]
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