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Rejecting a plan participant’s claims that plan documents should specifically list in-network providers, the 7th U.S. Circuit Court of Appeals held that a plan clearly providing information on how to check for provider status was sufficient to escape benefits-denial and fiduciary-breach claims. In affirming a lower court decision, the court also rejected an argument that […]
A set of safe harbors related to the enforcement of summaries of benefits and coverage (SBCs), which insurers and plan sponsors must distribute as part of health care reform, was issued May 11 by the U.S. Department of Labor and the Employee Benefits Security Administration. The DOL/EBSA guidance creates regulatory exceptions for situations where insurers […]
The federal government seems to be fishing around for evidence showing that self-insured health health plans will siphon off healthy lives from state-run insurance exchanges (a cornerstone of reform). On April 26, the U.S. Departments of Labor (DOL), Health and Human Services (HHS) and IRS/Treasury issued a set of questions about the use of stop-loss […]
Beginning in 2014, employers that sponsor health plans will have to watch closely if any employees qualify for a premium tax credit, triggered whenever the employer-sponsored coverage is unaffordable, or does not provide minimum value. On April 26, the IRS requested comments on how to determine whether a health plan provides “minimum value.” It did […]
Employers with high-deductible health plans (HDHPs) that make it possible for employees to open health savings accounts (HSAs) have plenty of lead time to prepare for 2013. The IRS on April 27 issued Revenue Procedure (Rev. Proc.) 2012-26, which contains the HSA and HDHP limits for calendar year 2013. The HSA annual limits and the […]
About a year from now, employers and plan administrators will be preparing to pay a fee to fund the Patient Centered Outcomes Research Institute (PCORI). The IRS on April 17 (77 Fed. Reg. 22691) issued proposed regulations on the fee. The Patient Protection and Affordable Care Act (PPACA) created the PCORI fee to promote research […]
As the U.S. Supreme Court decides the fate of health reform, America is getting the chance to try the law on for size while waiting for the people in the robes to say how much of it will remain in effect. Some employers are probably soft-pedaling implementation – they don’t like the law much anyway, […]
It may seem paradoxical that the U.S. Department of Labor (DOL) should begin auditing health plans for compliance with the health reform law’s mandates, given that the U.S. Supreme Court could very well strike down the Affordable Care Act (ACA) for being unconstitutional in early summer. But it’s better that plans be ready to demonstrate […]
A standard health plan identifier proposed by the U.S. Department of Health and Human Services (HHS) could cost health plans a total of up to $1.3 billion to implement. The proposed rules, released April 9, would establish a unique health plan identifier (HPID) for HIPAA-covered health plans (both group health plans and insurers), and an […]
The outcome in this case should remind employers that even with stop-loss (S-L) in place, a self-insured health plan is risky business. Trouble for the Claire’s Stores health plan started in the form of a premature birth, which generated about $1 million in charges. Under the terms of its S-L contract, the plan had to […]