cmonfils | January 31, 2012
Coordination Of Benefits January 2012 Vol. 20 No. 1
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 to less than what the plan paid out in health benefits. In US Airways, Inc. v. McCutchen, the appeals court held that full reimbursement of expenses to the employer-sponsored health plan would be “inappropriate and inequitable relief.” Full recovery would constitute unjust enrichment for the plan because: (1) the plan participant’s recovery ended 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 appeals court held these facts overruled the fact that the plan had subrogation reimbursement provisions asserting recovery rights over any monies collected from a third party, and it overturned a lower court’s decision requiring the participant to pay the plan the whole amount. (more…)
Category: 3rd, ERISA, Self-Funding, Supreme Court |
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cmonfils | January 25, 2012
January 17, 2011 (PLANSPONSOR.com) – California Attorney General Kamala D. Harris has filed a friend-of-the-court brief in the U.S. Supreme Court supporting the constitutionality of federal health care reform and urging the high court to uphold the law.
Harris, joined by 12 other attorneys general, argued in the brief that the Constitution gives Congress broad powers to regulate interstate commerce, including individual conduct that substantially affects interstate commerce.
Category: Health Care Legislation, PPACA, Supreme Court |
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cmonfils | January 24, 2012
More than 480 state lawmakers plan to file a brief Thursday urging the Supreme Court to uphold President Obama’s healthcare law.
The group includes at least one lawmaker from every state, including the 26 states whose attorneys general are suing to overturn the healthcare law’s individual insurance mandate. The Supreme Court is scheduled to hear oral arguments in March and will likely rule on the law this summer.
Category: Health Care Legislation, Supreme Court |
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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…)
Category: ERISA, Health Care Legislation, Mental Health Parity, PPACA, Preemption, Supreme Court, Washington |
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cmonfils | January 15, 2012
A small-business group fighting President Barack Obama’s health-care law asked the Supreme Court on Wednesday to add two plaintiffs to its lawsuit after possible problems arose with an initial plaintiff.
Category: Health Care Legislation, Supreme Court |
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cmonfils | January 15, 2012
Industry files brief on issue of severability; Insurance market reforms and coverage requirement cannot be separated
AHIP and BCBSA today filed an amicus brief in the U.S. Supreme Court stating that certain insurance market reforms in the Affordable Care Act (ACA) are inextricably linked to the law’s personal coverage requirement and have to be severed from the ACA if the Court finds the coverage requirement unconstitutional.
Category: Health Care Legislation, Health Insurance, Supreme Court |
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cmonfils | January 8, 2012
www.myhealthguide.com
MyHealthGuide Source: Fred Hunt, Active Past President, SPBA, 12/2012, www.SPBATPA.org
The state of TPAs and the forecast for the future is the brightest it has been for many years (not to say that it is not an extremely tight marketplace).
Background and Mood
TThis article is useful for perspective in shaping corporate strategy, but also serves as a candid analysis for outsiders such as investors, researchers and others who want to understand the TPA world today and into the future. As a result of hearing often from SPBA members, we have an unmatched repository of real-world hands-on totally-candid insight. (more…)
Category: Health Insurance, Plan Sponsor, PPACA, State Law, Stop Loss, Supreme Court, Third Party Administrators |
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cmonfils | January 3, 2012
Employer’s Guide to Self-Insuring Health Benefits December 2011 | Vol. 19, No.3
The U.S. Supreme Court definitively announced on Nov. 14 it will decide the question of whether Congress exceeded its powers to regulate commerce when it decided to require people to buy health insurance (that is, whether the individual mandate is allowed under the U.S. Constitution). The court will hear National Federation of Independent Business v. Sebelius; and Florida v. HHS. The High Court will hear oral arguments in February and March 2012; it said it will issue a ruling in June 2012. It will also cover the question of “severability;” that is, the issue of whether the entire law must fall in the event that the individual mandate is stricken. The National Federation of Independent Business expressed hope that the Court would overturn the law, saying that it was putting a damper on business growth and job creation. (more…)
Category: 11th, 4th, Health Care Legislation, HHS, PPACA, Supreme Court, Washington D.C. |
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cmonfils | January 1, 2012
WASHINGTON — Chief Justice John Roberts said Saturday that he has “complete confidence” in his colleagues’ ability to step away from cases where their personal interests are at stake, and noted that judges should not be swayed by “partisan demands.”
The comment, included in Roberts’ year-end report, comes after lawmakers demanded that two Justices recuse themselves from the high court’s review of President Barack Obama’s health care law aimed at extending coverage to more than 30 million people. Republicans want Justice Elena Kagan off the case because of her work in the Obama administration as solicitor general, whereas Democrats say Justice Clarence Thomas should back away because of his wife’s work with groups that opposed changes to the law.
http://www.localwireless.com/wap/news/text.jsp?sid=254&nid=792177481&cid=10009&scid=-1&ith=3&title=National+News&headtitle=National+News%22
Category: Health Care Legislation, Supreme Court |
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cmonfils | December 27, 2011
The Supreme Court announced on Monday that it would devote three days in late March to hearing arguments in challenges to the 2010 health care overhaul law. A decision in the case is expected by the end of June.
The court agreed to hear the case on Nov. 14, saying it would put aside five and half hours for arguments and specifying how much time it would devote to each of four issues. Monday’s announcement assigned those issues to particular days, giving a sense of the logical sequence in which the justices will approach them.
Category: Health Care Legislation, Supreme Court |
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cmonfils | December 12, 2011
The insurance industry is terrified that the Supreme Court will strike down the individual mandate to buy insurance next year while leaving the rest of the healthcare reform law intact.
For insurers, the death of the mandate alone — one of many plausible outcomes in the blockbuster case — is the nightmare scenario, one Republican healthcare lobbyist told The Hill.
Category: Health Care Legislation, Supreme Court |
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cmonfils | December 12, 2011
Should the arguments heard by the high court regarding the health law be televised on C-SPAN? And should certain justices step away from the case? These are among the key questions that continue to buzz around the health law’s day in court.
The New York Times: Supreme Court TV? Nice Idea, But Still Not Likely
A couple of weeks ago, the Supreme Court agreed to hear a constitutional challenge to President Obama’s health care law. The case is a once-in-a-generation blockbuster, and the court underscored its importance by scheduling five and a half hours of oral arguments, the most in any case since 1966. The day after the announcement, Brian P. Lamb, the chairman of C-Span, wrote to Chief Justice John G. Roberts Jr. with a modest request. “We believe the public interest is best served by live television coverage of this particular oral argument,” Mr. Lamb said. The request is, of course, doomed. Yet it is hard to say why (Liptak, 11/28).
http://www.kaiserhealthnews.org/Daily-Reports/2011/November/29/supreme-court-and-health-law.aspx
Category: Health Care Legislation, Supreme Court |
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cmonfils | December 12, 2011
Just a little more than an hour after some House Democrats recently demanded an inquiry into Supreme Court Justice Clarence Thomas’s ethics, Senate Republicans stepped up the pressure on Justice Elena Kagan to take herself out of the court’s decision on the health-care reform act.
Category: Health Care Legislation, PPACA, Supreme Court |
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cmonfils | December 12, 2011
The insurance industry is terrified that the Supreme Court will strike down the individual mandate to buy insurance next year while leaving the rest of the healthcare reform law intact.
For insurers, the death of the mandate alone — one of many plausible outcomes in the blockbuster case — is the nightmare scenario, one Republican healthcare lobbyist told The Hill.
Category: Health Care Legislation, Health Insurance, Supreme Court |
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cmonfils | November 30, 2011
WASHINGTON — The Supreme Court on Friday made two prominent Washington lawyers very happy and very busy, appointing them to argue on behalf of positions that neither side in the challenges to the 2010 health care law has chosen to embrace.
Category: Health Care Legislation, Supreme Court |
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