The Health Insurance Blog of Attorney Adam V. Russo
Welcome to Passion for Subro! The purpose of this site is to share my passion for the health insurance industry with the rest of you fanatics. I hope this site will be your destination for the latest in health care as well as self insured news across the country. While I envision that this site will serve as a great educational resource, it will also keep you entertained with the funny, difficult, confusing and just plain weird world of self insurance.
Thanks for visiting!
Posted By cmonfils on September 8, 2011
MyHealthGuide Source: Jerry Geisel, 8/30/2011, Business Insurance Article
WASHINGTON–House Republican leaders on Monday, August 29, said several House committees will develop legislation to repeal the health care reform law’s grandfather plan rules. (more…)
Posted By cmonfils on September 8, 2011
MyHealthGuide Source: GAO, 7/29/2011,
Editor’s Note: Brokers are more inclined to direct groups toward self-funding because MLR is not monitored and generally exceeds PPACA threshold guidelines. Medical Loss Ratio (MLR) is a commonly used indicator, measuring the proportion of premium dollars an insurer used for medical claims, as opposed to other functions, such as marketing, actuarial activities, or profit. PPACA established federally required minimum MLRs for insurers operating in the individual and group insurance markets. (more…)
Posted By cmonfils on September 8, 2011
Complimentary Web Seminar
September 29, 2011 | 2pm ET/11am PT
Whether you are newly self-funding your benefit plan, have self-funded for quite some time, or are simply considering self-funding as an option for your health program, you will not want to miss this presentation. (more…)
Posted By cmonfils on September 8, 2011
As national healthcare reform continues to be a hot topic throughout the country, key congressional staffers received a timely lesson on self-insured group health plans today from the Self-Insurance Educational Foundation, Inc. (SIEF) during a luncheon briefing event held in the House Rayburn Office Building on Capitol Hill. (more…)
Posted By cmonfils on September 8, 2011
www.ncpa.org September 8, 2011
It seems like forever that Consumer Reports has been telling people to haggle over the price of a microwave or a car. Now the folks behind the magazine want you to haggle with your doctor — or at least let her know that you can’t afford that bypass, says National Public Radio (NPR). (more…)
Posted By cmonfils on September 1, 2011
www.mwl-law.com August 2011
During the tort reform flurry of 2003 in Texas, CPRC § 41.0105 was amended to limit a plaintiff’s recovery of medical expenses to those that are paid or incurred, rather than the full medical bill charged to the patient. One of the lingering questions was whether the full, non-discounted bills could be presented to a jury. The Texas Supreme Court addressed this issue on July 1, 2011, holding only paid or incurred medical expenses can be presented to a jury. (more…)
Posted By cmonfils on September 1, 2011
August 31, 2011 – The Self-Insurance Institute of America, Inc. (SIIA) today submitted a letter to Michigan Governor Rick Snyder formally requesting him to veto legislation that would impose a one percent tax on medical claims paid by health plans, including self-insured group health plans. (more…)
Posted By cmonfils on August 31, 2011
By Geoffrey C. Beckwith Aug 28, 2011
On July 12, dozens of lawmakers, municipal leaders, community groups and union officials stood together and watched as Massachusetts Gov. Deval Patrick signed a new law reforming the way that cities and towns design health insurance plans for their employees. (more…)
Posted By cmonfils on August 31, 2011
August 24, 2011 By Stanley D. Baum
In Kough v. Teamsters’ Local 301 Pension Plan, No. 10-2128 (7th Cir. 2011) (Nonprecedential Opinion), the plaintiff had suffered a disability, and then returned to work in 2005. He soon (in that year) suffered a heart attack and abandoned his attempt to work. He filed a claim for disability benefits under a union pension plan subject to ERISA (the “Plan”), but the claim was denied by the Plan. The plaintiff then filed this suit. (more…)
Posted By cmonfils on August 31, 2011
www.hreonline.com By Tom Starner
The healthcare reform law is placing added pressures on employers, as it adds direct and indirect costs to providing healthcare benefits to workers. “Employers need to look for creative solutions, because rising costs are not going to go away … . If you want to continue providing healthcare benefits, you need to think outside the traditional box,” an expert says. (more…)
Posted By cmonfils on August 31, 2011
From the August 18, 2011 EBIA Weekly
[State of Florida ex rel. Atty. Gen. v. HHS, 2011 WL 3519178 (11th Cir. 2011)]
Available at http://www.uscourts.gov/uscourts/courts/ca11/201111021.pdf
The 11th Circuit Court of Appeals has held that Congress exceeded its power to regulate interstate commerce when it enacted health care reform’s individual mandate, which beginning in 2014 will require individuals to maintain health coverage or pay a penalty. Conceding that the individual mandate cannot be neatly classified as either economic or noneconomic activity, the 11th Circuit examined the unprecedented nature and far-reaching implications of the mandate, as well as numerous limits on Congress’s commerce authority, and concluded that the federal government cannot mandate that individuals purchase and maintain health insurance from a private company. (more…)
Posted By cmonfils on August 31, 2011
www.dorsey.com August 23, 2011
The Patient Protection and Affordable Care Act (“health care reform” or “PPACA”) changed the annual coordinated election period for Medicare Part D (prescription drug coverage). The annual election period for Medicare Part D is now October 15 through December 7. (Prior to PPACA’s enactment, the election period was November 15 to December 31). An updated model notice of creditable coverage is available on CMS’s website. (more…)
Posted By cmonfils on August 31, 2011
August 22, 2011
Proposed health care reform regulations issued on August 17, 2011, by the Departments of Labor, Health and Human Services, and Treasury (the “Departments”) impose new rules on group health plans and individual and group health insurers that are intended to enable consumers to more easily understand the health coverage they have, and make apples-to-apples comparisons of available options. These rules are intended to carry out certain provisions of last year’s health care reform that required the Departments to develop standards for plans and insurers to compile and provide an accurate summary of benefits and coverage. These rules apply to both grandfathered and non-grandfathered health plans. Failure to comply may result in significant monetary penalties. (more…)
Posted By cmonfils on August 31, 2011
August 19, 2011 Peter Wand, David Manch
The Department of Labor recently announced plans to substantially increase the number of ERISA compliance audits it conducts each year. This is the first in a series of Client Alerts that Lewis and Roca LLP will publish over the coming months to help our clients evaluate their compliance with ERISA and related federal mandates, including COBRA, HIPAA and the Patient Protection and Affordable Care Act of 2010. (more…)
Posted By cmonfils on August 31, 2011
www.healthcare-legislation.blogspot.com Friday, August 19, 2011
Most health care organizations expect health care reform to boost costs significantly, while increasing access to care and improving quality through a renewed focus on organizational effectiveness, according to a new survey of more than 200 health care professionals. (more…)
