Archive for the ‘Welfare Benefit Plans’ Category

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 high-deductible plan with a health savings account (HSA), up 1 percentage point from the previous year. An additional 4.9 percent were eligible for an HSA but did not have such an account. Overall, 8.9 percent of adults with private insurance were either in a CDHP or were in a high-deductible plan that was eligible for an HSA, but had not opened an account. Read more

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. Read more

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, arguing that the employer had been obligated—as a condition of reimbursement under the stop-loss policy—to provide COBRA election notices to the employees within 30 days of their first day of leave. The employer argued that its health plan provided full coverage for the first 90 days of a leave of absence, so that no COBRA election notice was required until the end of the leave (assuming the employee terminated employment by not returning to work). Indeed, one of the employees involved in the case did not return at the end of the leave, and the employer did provide a COBRA election notice at that time. The employer sued the stop-loss insurer for reimbursement under the policy. Read more

EBRI Publications

“Social Security Reform: How Different Options Might Affect Future Funding.” Author: Craig Copeland. Read more

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 that the $70,000 reimbursement is considered equitable relief under the Employee Retirement Income Security Act (ERISA). The courts rejected Ralph W. Cutter’s argument that because the benefits were not paid directly to him and were not in his possession, the plan could not seek reimbursement from him. Read more

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? Read more

by Nancy L. Bolton, Employee Benefit News

Like many of our local government and corporate peers, Palm Beach County, Fla., made the switch to the self-funding of our group health plan in 2003, when health trends were hitting 30%, 40% and, in our case, 50% at renewal. After long deliberations and a tiny leap of faith, the county decided to keep those profit margins insurers were trying to capture through their outrageous renewal quotes. Read more

by Karen Pallarito of Business Insurance, www.businessinsurance.com  

The nation’s sour economy has added a new step to the tango of self-insured employers and third-party administrators handling their medical claims.

Employers still want a partner that provides first-rate claims administration and customer service, and many require TPAs to provide sophisticated data-mining tools and care management programs. Experts say employers’ efforts to stretch available dollars are keeping TPAs on their toes. Read more

Legal action is one option against Health Research Insights.

by Emily Berry, American Medical News, www.amednews.com

Medical societies in several states are talking about how to fight back against a Tennessee-based firm hired by self-insured companies to collect perceived overpayments to physicians.

Doctors in Georgia were the first to be contacted by Health Research Insights, and the Medical Assn. of Georgia is “exploring all legal remedies,” said Donald Palmisano Jr., MAG general counsel. Read more

Doctors protested self-insured Georgia-Pacific’s attempt to collect refunds of suspected claims upcoding.

by Emily Berry of American Medical News, www.amednews.com

Following an outcry from physicians and discussions with the Medical Assn. of Georgia, one of Atlanta’s largest employers has temporarily halted work by a company it hired to seek supposed overpayments from doctors. Read more

The 2008 Employee Benefits study by the U.S. Chamber of Commerce found that small businesses saw the cost of providing certain benefits rise from 2006 to 2007. Health insurance costs rose 15%, averaging $4,559 per employee in 2007 from $3,961 in 2006. The report showed that employers began scaling back on employee benefits as the economy slowed down in 2007. The average dollar amount of employee benefits fell 14% to $18,496 in 2007 from $21,527 the year before.

by Dave Lenckus of Business Insurance

While third-party administrators can deliver efficiencies for self-insured programs, risk managers should require protections and maintain vigilant oversight for instances when the claims process breaks down, risks managers say.

If “properly vetted,” a TPA can provide great service and “enhance metrics and decision making” said Wayne L. Salen, director of risk management for Labor Finders International Inc, In Palm Beach Gardens, Fla. Read more

by Ron E. Peck, Esq.

As you can imagine, some optional benefits are being eliminated and other benefits – once thought of as concrete – are being made voluntary.  That means beneficiaries must choose whether to go without a benefit, or pay for it themselves. Read more

While health care costs increases continue to far outpace inflation, costs are rising at a far more moderate pace than a few years ago, according to two surveys released last week.

The surveys-one by the Washington-based Kaiser Family Foundation and Chicago-based Health Research & Educational Trust, and the other by Stamford, Conn.-based benefit consultant Towers Perrin-also show that employers are turning more to consumer-driven health plans to help control costs. Read more

The Supreme Court held in MetLife vs. Glenn that conflicted interests require a higher standard of review whenever the claims adjudicator and the claims financier were the same.  Thus, any claim contested in court will confer a significant advantage to the arrangement where the claims are adjudicated by an independent third party and paid by an independent employer.  This means a disadvantage where the claims are both adjudicated and paid by the same two parties, such as employer’s self-administered and self-funded plan or fully insured plans. Read more