Tag: Health plans

Self-Funded Health Plan Can’t Shake Down Providers for Benefits Paid for Non-Enrollee

The sponsor of a self-funded health plan cannot escape its responsibility to ensure that only fully eligible people are enrolled. Illustrating this maxim is a self-funded plan’s sad quest to recover gigantic sums from health providers for services it paid on behalf of a non-beneficiary. The plan paid more than $1 million in claims for a […]

DOL Clarifies End of COBRA Premium Subsidy Period

Keep in mind that some individuals may be eligible for COBRA premium subsidies beyond Aug. 31, 2011, the U.S. Department of Labor (DOL) noted today in updated material on its website. The updated frequently-asked-question on the end of the subsidy period follows: Q1: I’ve heard that the COBRA Premium Reduction (Subsidy) ends on August 31, 2011, […]

Vermont Drops Immediate Demand for Liberty Mutual Data

A quick update on the case involving the state of Vermont’s demand for claims data from Liberty Mutual’s group health plan — the state agreed to drop its immediate demand for this information, pending the ultimate outcome of the lawsuit. The state’s health and insurance agency had issued a subpoena for this data, and Liberty […]

Employer Sues to Block State’s Demand for Health Plan Data

An insurance company recently sued the state of Vermont to block its attempt to get details on the employees and family members enrolled in the company’s group health plan, and the actual claims they’ve submitted. Vermont health care regulators want this information for a database designed to measure and improve the quality of health care […]

Resuscitate COBRA Premium Subsidies to Help Unemployed, Commonwealth Fund Says

In the waning days of the COBRA premium subsidy, The Commonwealth Fund is calling for the program to be resuscitated as a way to help unemployed and uninsured workers until health care reform is fully implemented. In an Aug. 24 issue brief,  the Fund noted that “the worst economic downturn since the Great Depression has […]

Verizon Strike Raises COBRA Coverage Issues

I often feel like raising a picket sign when I look at my phone bill, but that’s another story — right now, I just want to use the news of the Verizon strike to remind you of its COBRA continuation coverage implications. As has been widely reported, approximately 45,000 unionized Verizon workers went on strike […]

Fed Agencies Packing in More PPACA Health Reform Rules

When it comes to implementing health reform, the federal government agencies definitely are not taking a summer vacation. Just this week, new rules on communicating health plan information to consumers, health insurance exchanges and premium tax credits have been issued. Here’s a quick list: 1. Communicating health plan information. The U.S. Departments of Labor, Health […]

Beware the Undead: ERISA Equitable Relief Ruling Brings Cases Back from the Grave

A landmark Supreme Court ruling on relief available under ERISA in employee benefit cases is bringing cases back to life that we thought were dead and gone. In CIGNA v. Amara, the U.S. Supreme Court on May 16 ruled that ERISA’s enforcement provision allowing for “appropriate equitable relief” — ERISA Section 1132(a)(3) — aka Section […]

Rose-colored Glasses: Self-funding Is Looking Better for Smaller Firms

If you run a smaller firm and pay an insurance company to cover your workers’ health, one of your top concerns is probably how to control spiraling health insurance expenses. Just two or three major health expenditures can cause your insurer to radically increase your premiums. And if you’re located in a part of the […]

Health Coverage Premium Subsidies: One Step Closer to Extension?

At least in the Senate, a consensus is being reached on trade adjustment assistance that could lead to an extension of premium subsidies under the Health Coverage Tax Credit (HCTC) program. Here are two snippets from a joint statement issued Wednesday: [Senate Majority Leader Harry Reid (D-Nev.)]: “My staff and Senator McConnell’s staff have been […]