Adam V. Russo | 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 Most Bang for Your Benefits Buck” advises employers how implementing plan designs that appeal to their specific employee populations will encourage them to be smarter health care consumers, seek out preventive care and adopt healthy lifestyles that ultimately will reduce overall health care spending. (more…)
Category: Welfare Benefit Plans |
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Adam V. Russo | 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 page 11 of this Newsletter, the objectives of ERISA sometimes conflict with the objectives of state laws. (more…)
Category: ERISA, New Jersey, Preemption, Subrogation, Supreme Court, Welfare Benefit Plans |
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Adam V. Russo | 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 external review processes. Both sets of interim final regulations are effective for plan years beginning on or after September 23, 2010. Neither requirement applies to grandfathered group health plans. (more…)
Category: Claims Procedures, Claims Review, PPACA, Welfare Benefit Plans |
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Adam V. Russo | 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 been doing it for years — a growing number of smaller companies are self-insuring to cut co sts. According to data collected by PricewaterhouseCoopers, the percentage of employers with fewer than 1,000 people in their health-care programs that self-insure has almost doubled, from 29% in 2008 to 48% in 2010. (more…)
Category: Stop Loss, Welfare Benefit Plans |
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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 for some employers. (more…)
Category: Welfare Benefit Plans |
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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.
Category: Health Care Legislation, Welfare Benefit Plans |
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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 released. (more…)
Category: Health Care Legislation, Welfare Benefit Plans |
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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 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. (more…)
Category: Welfare Benefit Plans |
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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. (more…)
Category: Exclusion, HIPAA, Medicare, Summary Plan Description, Welfare Benefit Plans |
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Adam V. Russo | September 24, 2009
EBRI Publications
“Social Security Reform: How Different Options Might Affect Future Funding.” Author: Craig Copeland. (more…)
Category: Welfare Benefit Plans |
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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 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. (more…)
Category: 9th, Welfare Benefit Plans |
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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? (more…)
Category: Claims Review, Provider Reimbursement, Rhode Island, Welfare Benefit Plans |
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Adam V. Russo | July 2, 2009
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. (more…)
Category: ERISA, Welfare Benefit Plans |
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Adam V. Russo | May 29, 2009
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. (more…)
Category: Third Party Administrators, Welfare Benefit Plans |
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Adam V. Russo | May 27, 2009
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. (more…)
Category: ERISA, Provider Reimbursement, Welfare Benefit Plans |
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