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Employer preparation for preparing for health care reform’s pay-or-play provisions, especially data reporting (under Sections 6055 and 6056) to the IRS, can be complicated by: (1) changes in workers’ employment status (from part-time to full-time); (2) an organization’s switching from one measurement method to another; and (3) the structure of controlled groups and subsidiaries, speakers […]
In a decision sharply at odds with a recent Illinois ruling, a federal district court in Arizona held that health care providers cannot be characterized as plan beneficiaries who can sue to compel payment of ERISA benefits. The court rejected the view that a direct payment for services is an ERISA benefit that give providers […]
A former employee left with more than $13,000 in unpaid medical bills after his employer retroactively terminated his employment and health benefits can sue for state-law claims, a federal district court ruled. The individual alleged that while he was hospitalized, the employer said his expenses would be covered. Thus, he did not elect COBRA coverage. […]
An insurer won recovery of health expenses paid from a member’s $255,000 settlement after said member refused to reimburse the insurer for medical payments it made. It did so in spite of an affidavit from the company plan administrator saying the insurer was not authorized to collect the funds from the member’s settlement proceeds. It […]
The ruling in Penn. Chiropractic Ass’n v. BCBSA threatens to make recoveries more difficult for all insurers and may complicate the claims administration of self-funded plans. It also may necessitate self-insured plan sponsors reviewing network contracts with providers. Here’s what happened: a federal district court gave providers ERISA beneficiary status instead of following the language in […]
On May 22, CMS issued guidance (registration required) describing how plans, third-party administrators and insurers will pay reinsurance contributions required under health care reform for the next three years. The guidance says a contributing entity can complete all required steps for the reinsurance contributions process on Pay.gov, including registration, submission of the annual enrollment count and remittance of […]
Employer-sponsored health plans and insurers got a double dose of compliance advice on May 16 from the Centers of Medicare and Medicaid Services in the form of a set of Frequently Asked Questions. The first FAQ clarifies that insurers in the individual and small group market may not impose waiting periods on specific essential health benefits. […]
A self-insured employer that explicitly excludes same-gender spouses from health plan coverage did not violate ERISA’s benefit interference or fiduciary breach provisions by having such exclusionary language, a federal district court in New York ruled. A same-gender couple had argued that, in light of U.S. v. Windsor, because the plan declined to cover the spouse, the employer interfered […]
The jury’s still out on the impact of health care reform on employment‐based health benefits, but predictions of mass instability are certainly not materializing, reform experts said May 15 at a policy forum sponsored by the Employee Benefits Research Institute in Washington, D.C. The Affordable Care Act will not trigger a rapid exodus from employer-sponsored […]
Employers have cited complying with the Affordable Care Act as their number one concern in surveys, and that wouldn’t be the case if there weren’t taxes and money penalties backing it up. This is true even though the government postponed until 2015 penalties for failure to comply with the ACA’s play-or-pay mandates, temporarily reducing the […]