Practical HR Tips, News & Advice. Updated Daily.
Plans and insurers must cover all 18 contraception methods approved by the U.S. Food and Drug Administration, according to a new set of questions and answers on the Affordable Care Act’s preventive care coverage requirements. “Reasonable medical management” still may be used to steer members to specific products within those methods of contraception. A plan […]
The 9th U.S. Circuit Court of Appeals decided that an insurance certificate was an official plan document that overrode the plan’s summary plan description. It shows that plans are vulnerable when they attempt to set out plan terms in the SPD only without corresponding language in the official plan document. For stronger plan design, the […]
The Centers for Medicare and Medicaid Services announced an April 30 deadline for claiming certain overpayments of the transitional reinsurance fee. The announcement covers overpayments due to miscalculating enrollment counts on which the fee is based. Such miscalculations occur for two reasons, CMS said: misapplication of a permitted method for determining the annual enrollment count; […]
The U.S. Supreme Court decided to hear a case to resolve whether an ERISA health plan can recover money it spent on a plan participant’s care from his or her personal injury settlement, even if the participant has already spent those particular funds. To settle this question, the Court granted certiorari March 30 in Montanile v. Bd. of Trustees […]
Five years ago, in March 2010, the Affordable Care Act was signed into law by President Obama to resolve problems in the U.S. health system, including: the high number of uninsured Americans; Americans unable to get coverage due to pre-existing conditions; the high cost of care; and suboptimal care as a result of poor incentives […]
Tremendous cost-cutting and patient care improvements await insurers and plans that can leverage the recent gains of computing to improve patient self-management of care. The challenge is how to tap the big pools of data, and get “actionable” personalized results out to plan members so they can choose better, cheaper care and manage this care […]
Simply paying an aggrieved plan participant for unpaid benefits due was enough to make him whole under ERISA, so no further money damages were warranted as a form of equitable relief, a federal appeals court has ruled. With this conclusion, a majority of the full en banc 6th U.S. Circuit Court of Appeals overturned an earlier ruling […]
Petitioners in King v. Burwell could run up against the same logic that brought down Medicaid expansion under health care reform: it could be unconstitutional for the federal government to use draconian coercion to force states to set up exchanges. Justice Anthony Kennedy emerged as a potential swing vote when he raised that Constitutional balance-of-powers question, which […]
New IRS regulations define the way health insurers will pay fees under Section 9010 of the Affordable Care Act. In the rules, the IRS applies Notice 2014-47 and provides further guidance on how covered entities will pay the fees for 2015 and subsequent fee years. It also tells how covered entities will report and pay on behalf of […]
On Feb. 23, the Centers for Medicare and Medicaid Services put on public display final rules that require employer health plans to cover physician and hospital services in order to meet health care reform’s minimum value requirement. The rules also set the contribution self-insured health plans and insurers must make to a premium-stabilization fund for the individual […]