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
High Court Reverses Lower Courts, Restores ERISA Plan’s Discretion
bhoffman | 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 [...]
White Paper Examines Benefits Plans
bhoffman | August 27, 2010
Business Insurance Magazine, www.businessinsurance.com
Employers that want to get the most out of their investments in employee benefit programs will want to consider how and where their dollars are being spent and the effect on worker health and productivity, according to a new white paper published by Business Insurance.
“Maximizing Health Care ROI: How to Get the [...]
Self-Insured N.J. Government Entity Can’t Access Tort Judgment Proceeds
bhoffman | August 25, 2010
Coordination of Benefits Handbook
We are familiar with cases where ERISA and state laws conflict. As we know, self-insured health plans that are subject to ERISA may avoid the application of state laws because of ERISA preemption. As we have seen in our analysis of the case Bash v. State Farm Mutual Automobile Insurance Co. on [...]
Regulations Issued Under Health Care Reform on Preventive Services and Internal Claims and Appeals, and External Review Procedures
bhoffman | August 5, 2010
Bryan Cave LLP, www.bryancave.com
The Departments of Treasury, Labor and Health & Human Services (the “Departments”) recently issued two more batches of interim final regulations under the Patient Protection and Affordable Care Act, as amended (the “Act”). This new guidance addresses (i) the preventive services coverage mandate, and (ii) the new internal claims and appeals and [...]
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 [...]
How to Determine Whether a Fully Funded or a Self-Funded Insurance Plan is the Best Choice for Your Business
Adam V. Russo | July 9, 2010
By Matt McClellan, Smart Business Detroit
There are two predominant options for health plan funding in the marketplace: the traditional, fully funded option, and the self-funded model.
While most people think of the fully funded option when they think of insurance, Don Whitford, vice president of sales at Priority Health, says self-funding may be a better option [...]
Legal Impacts of Health Reform on Plans, Containing Claim Costs and Protecting Plan Assets
Adam V. Russo | July 8, 2010
Yesterday I spoke about the legal impacts of health reform on plans, containing costs and protecting plan assets at HealthFirst’s client conference in Tyler, TX. Click here to see my entire PowerPoint presentation.
PPACA Regulatory Update – 06/22/10
Adam V. Russo | June 23, 2010
SIIA, www.siia.org
As reported by SIIA’s Government Relations Staff, Federal agencies will be continually issuing regulations and notices of guidance pertaining to how provisions of the newly enacted Patient Protection and Affordable Care Act will be implemented. SIIA staff will develop summaries of these and distribute along with the full documents as soon as they are [...]
Consumer-Driven Health Plans
Adam V. Russo | November 5, 2009
Enrollment in Consumer-Driven Health Plans: The share of the adult population with private health insurance enrolled in account-based health plans (so-called “consumer-driven” health plans, or CDHPs) remains small but continues to grow. In 2009, 4 percent of the adult population with private health insurance was enrolled in a health reimbursement arrangement (HRA) or had a [...]
When Updating Your Plan Documents, Don’t Forget The Following:
Adam V. Russo | October 28, 2009
Reporting to Medicare
The purpose of these reporting requirements is to enable the Centers for Medicare & Medicaid Services (CMS) to determine whether those covered by Medicare are also covered by other insurance that, by law, must pay primary to Medicare.
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, [...]
Retirement Benefits
Adam V. Russo | September 24, 2009
EBRI Publications
“Social Security Reform: How Different Options Might Affect Future Funding.” Author: Craig Copeland.
9th Circuit Affirms Reimbursement of Benefits for Fraudulent Bene
Adam V. Russo | August 11, 2009
www.plansponsor.com
The 9th U.S. Circuit Court of Appeals has affirmed a lower court’s decision that that a health plan administrator should be reimbursed for benefits it paid for a woman who was falsely represented as a participant’s legal spouse.
EBIA reports that the appellate court agreed with the U.S. District Court for the Western District of Washington [...]
Marijuana Reimbursement Claims Highlight How Pot Could Be Gold for Employers
Adam V. Russo | August 11, 2009
by Jeremy Smerd – Workforce Management, www.workforce.com
A medical billing company may be blowing smoke, but could reimbursing patients for medical marijuana lower drug costs for employers?
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