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How a company complies with health care reform should be determined by what kind of employer it is, how exclusive its workforce is, and how important its benefit package is seen as an aid to recruitment and retention. Only after that analysis should an employer look at whether gains can be made by, say, reducing […]
The 7th Circuit in a 2-1 ruling refused to grant a preliminary injunction to Notre Dame University, which would have freed the university from participating in reform’s requirement to provide contraceptives at no cost to all women. In so doing the court criticized the university’s argument that signing an EBSA Form 700 — expressing objections to the contraceptive […]
Although sponsors of group health plans have had their hands full sorting through the still-changing Affordable Care Act requirements, the recent uproar involving AOL CEO Tim Armstrong is a stark reminder of the need to stay vigilant on HIPAA privacy — even as companies wrestle publicly with health care costs. As has been widely reported, […]
Companies with 50-99 employees that do not offer health insurance to their workers will not be subject to fines for failing to provide coverage until 2016. This gives such mid-sized firms an additional year to prepare health coverage for workers, and that delay adds to the one-year delay in enforcement of the Affordable Care Act’s […]
The claims administrator of an employer-sponsored health plan abused its discretion when it rejected a health benefits claim because it: (1) denied it without an explanation or plausible support; (2) had a structural conflict of interest because it was also the insurer; and (3) violated ERISA regulations by merely reciting its policy without refuting the […]
By Paul Hamburger, Esq. A recent U.S. Supreme Court decision held that a plan’s contractual limitations provision is enforceable. It just has to be of reasonable length and not conflict with a “controlling” statute. The case is Heimeshoff v. Hartford Life & Accident Insurance Co. et al., No. 12-729 (S. Ct. Dec. 16, 2013). A number of […]
Employee assistance programs and certain “limited wraparound coverage” would be added to the set of “limited excepted benefits” exempt from most of the requirements of the Affordable Care Act, under proposed rules in the Dec. 24 Federal Register (78 Fed. Reg. 77632). The proposal also would make it easier for dental and vision benefits to […]
A third-party claims administrator may not be sued for violating the Mental Health Parity and Addiction Equity Act because the law by its terms applies only to group health plans and their insurers, a federal district court ruled. Related ERISA claims against the TPA were also dismissed because the company was not the “plan administrator” […]
Employers — particularly those that sponsor self-funded plans — have important health care reform mandates to comply with in January 2014, many of which are unaffected by the Obama administration’s stay in enforcement of the pay-or-play rules. There is still time for employers to get their health care reform fixes right. The job is more […]
Final mental health parity rules issued Nov. 8 make several changes to the prior, interim version. The exemption for “clinically appropriate standards of care” was eliminated because regulators decided it was confusing and subject to abuse, and the rules’ application to “intermediate” coverage levels was clarified in response to uncertainty about how the interim rules’ […]