Adam V. Russo | December 13, 2010
By Joanne Wojcik of Business Insurance Magazine, www.businessinsurance.com
A health care reform rule that caps how much insurers can spend on administrative costs is likely to cause headaches for employers that offer fully insured health plans to their workers. (more…)
Adam V. Russo | December 1, 2010
Companies that eliminate co-payments report better medication adherence – and lower health-care costs.
By Kimberly Blanton, www.CFO.com
To control health-care costs, more companies are resorting to a strategy that doesn’t seem to make sense: They are spending more.
Employers are rejecting unpopular benefit cuts and instead eliminating co-payments on prescription drugs to encourage employees with severe health problems to take their medications and stay healthy. The theory is that the financial incentive will stave off emergency-room visits, hospital stays, and disability claims over the longer term. (more…)
Adam V. Russo | November 18, 2010
MyHealthGuide, www.myhealthguide.com
Federal Court Chastises Stop Loss Carrier Over Efforts to Achieve Piecemeal Adjudication of Multiple Claims
MyHealthGuide Source: Tom Croft, Esq., King & Croft LLP, 11/10/2010 www.StopLossLaw.com
Case: Bekaert Corp. v. Standard Security Life Insurance Company of New York, Inc., No.5:09 CV 2903, in the United States District Court for the Northern District of Ohio, October 8, 2010) Court’s Opinion. (more…)
Adam V. Russo | November 18, 2010
MyHealthGuide, www.myhealthguide.com
MyHealthGuide Source: Fred Hunt, President, Society of Professional Benefit Administrators (SPBA), 11/10/2010, www.SPBATPA.org
Preface by Mr. Hunt: For 30 years, I have been providing these very candid insights & prognosis. They are provided to all SPBA members as well as available for the outside world to read. To my own surprise, the accuracy rate of the forecasts has been extremely high. This time, I think the forecast will again be accurate, but the outcome more circuitous, with so many specific issues in flux right now. Flux will remain for about 4 years. (more…)
Adam V. Russo | November 1, 2010
MyHealthGuide, www.myhealthguide.com
MyHealthGuide Source: Matthew Brodsky, Senior Editor/Web Editor, Risk & Insurance® Article
Employers weigh the difficulties of grandfathering their employee-health plans under new federal guidelines versus the opportunities of self-insurance. The self-funded marketplace could win.
After fearing and lobbying against federal health reform, the industry that caters to self-funding employers might actually experience new, profitable opportunities, thanks to the Patient Protection and Affordable Care Act. (more…)
Adam V. Russo | October 25, 2010
MyHealthGuide, www.myhealthguide.com
Washington — The U.S. Department of Labor’s Employee Benefits Security Administration today announced a proposed rule to update the definition of “fiduciary” to more broadly define the term as a person who provides investment advice to plans for a fee or other compensation.
The department’s proposed rule would amend a 1975 regulation that defines when a person providing investment advice becomes a fiduciary under the Employee Retirement Income Security Act (ERISA). The proposed amendment would update that definition to take into account changes in the expectations of plan officials and participants who receive advice, as well as the practices of investment advice providers. (more…)
Adam V. Russo | October 6, 2010
By Rebecca Moore of PlanSponsor, www.plansponsor.com
October 1, 2010 (PLANSPONSOR.com) – Senator Jay Rockefeller (D-West Virginia) has opened a probe into the limited benefit “mini-med” plans that McDonald’s Corp. offers to employees.
Bloomberg reports that Rockefeller asked Scott Beacham, CEO of BCS Financial Corp., whether the company’s health offerings amount to a good deal for many of McDonald’s low-wage and hourly employees. BCS Financial offers limited-benefit plans that cover 30,000 employees of McDonald’s. (more…)
Adam V. Russo | September 21, 2010
By Michelle Andrews of National Public Radio, www.npr.org
With health insurance costs climbing and open enrollment season almost upon us, you might expect that the boss will do everything to wriggle out of new requirements coming down with the federal health overhaul.
But that may not be the case. And in a way you might not expect, those decisions could put you on the hook for higher deductibles, copayments and out-of-pocket costs. (more…)
Adam V. Russo | September 8, 2010
By Joanne Wojcik of Business Insurance Magazine, www.businessinsurance.com
DALLAS—A pilot project that launched this week will help nine employer members of the Dallas-Fort Worth Business Group on Health more effectively tailor their benefits to better address worker health and productivity while also lowering overall health care costs. (more…)
Adam V. Russo | September 8, 2010
By Joanne Wojcik of Business Insurance Magazine, www.businessinsurance.com
Health care reform not expected to halt years-long trend
Average annual premiums for employer-sponsored health insurance grew just 3% this year for family coverage, but employees’ share of those costs surged 14%, according to a survey released last week.
The 12th annual Kaiser Family Foundation/Health Research & Educational Trust “Employer Health Benefits” survey found that employee contributions for single coverage grew 15% compared with the 5% increase in annual employer premiums. (more…)
Adam V. Russo | September 7, 2010
Summary
State appeals court in Missouri affirms trial court ruling — Scroggins was injured in a trip-and-fall at a R.Lobster. Her employer’s (St. John’s Hospital, a subsidiary of Sisters of Mercy) self-funded plan covered her health expenses. Also, she sued the restaurant and extracted a settlement. The plan had subro clause up to the full amount it paid in expenses. The trial court refused to enforce the lien (it was a veiled partial assignment of her personal injury claim, and contrary to Missouri public policy). The plan was not subject to ERISA, because of its religious non-profit affiliation made it a church plan. Accordingly, the appeals court upholds state public policy, noting (a) that tort settlement is for pain and suffering, which is not to be a marketable commodity; (2) the plan had no separate claim against the tortfeasor; cases where liens were allowed in personal injury claims involved payers that claims against tortfeasor.
Click here to see the entire case
Adam V. Russo | September 7, 2010
By Fran Matso Lysiak of Insurance News Net, www.insurancenewsnet.com
Health insurers and their employer customers may be battling more lawsuits and paying out costly, big-ticket claims they may have previously denied as a result of the U.S. health care reform law.
The law requires new plans, and non-grandfathered existing plans, and policies in the individual market, to meet the new claim and appeal rules — including an external review requirement — for plan years starting after Sept. 23, 2010, said Edward C. Fensholt, senior vice president, director of compliance services, Lockton Benefit Group. (more…)
Adam V. Russo | September 7, 2010
MyHealthGuide, www.myhealthguide.com
By Tom Croft, Esq. of King & Croft LLP, www.StopLossLaw.com
Nationwide Life Ins. Co. v. City of Canton, Ohio, et al., No. 09AP-939, CPC No. 07CVH-08-11779 in The Court of Appeals of Ohio, Tenth District, 8/31/2010). Court’s Opinion
Mr. Croft’s comment: The myth that a stop loss carrier cannot win a disclosure dispute in court implodes yet again. This case involved a classic disclosure-issue fact pattern concerning a participant’s esophageal cancer, and a failure to make required disclosure on the part of the insured and one of its two TPAs. Relatively large dollars were involved. The Court of Appeals determined that the trial court had been correct in entering judgment for the stop loss carrier and its MGU. (more…)
Adam V. Russo | September 2, 2010
By Jim Hoitt of R.E. Moulton, a OneAmerica Company
Adam V. Russo | August 27, 2010
Employer’s Guide to Self-Insuring Health Benefits, Thompson Publishing Group
Employers and other plan administrators are due greater deference in their benefits plan decisions than some lower courts have allowed, the U.S. Supreme Court ruled. The Court’s 5-3 opinion in Conkright v. Frommert allows ERISA plan administrators to retain deferential review even after an erroneous interpretation of the plan. The plan was acting in good faith, its miscalculations were honest, the errors were isolated and a “one-strike-you’re-out” approach was unreasonable, Chief Justice John Roberts stated in the majority opinion. Deference should be upheld where possible, because if not, litigation becomes more labyrinthine and frequent, and plan administration becomes more complicated, the Court concluded. However, he noted, patterns of wrong plan interpretations — even in good faith — are still grounds for forfeiting deference.
