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A third-party administrator faces California health privacy and unfair business practices charges for allegedly handing over a plan participant’s case management information to an employer, which then terminated her to avoid paying for her impending liver transplant. The TPA’s arguments for ERISA preemption failed because the plan participant’s state-law action could have been brought in […]
By Nicole Mitchell Contractors often disclose the cost savings of self-insured plans with excitement, but buyer beware. Most contractors are surprised when I don’t immediately commend them on cost savings and instead ask them,“Did you know there are ’special‘ compliance requirements for self-insurance plans and failure to meet the compliance requirements makes the cost unallowable?” Most […]
New IRS guidance spells out more issues the agency plans to address in imposing the excise tax on high-cost employer-sponsored health coverage (commonly known as the Cadillac tax). These include: (1) identifying taxpayers who may be liable for the excise tax; (2) aggregating several employers under one plan sponsor’s payment; (3) allocating the tax among […]
The U.S. Supreme Court will decide whether ERISA preemption shields a self-funded health plan from state requirements to report health claims data. The court agreed June 29 to hear Gobeille v. Liberty Mutual Ins. Co. (2015 WL 2473478). The state of Vermont is appealing the 2nd U.S. Circuit Court of Appeals’ ruling in Liberty Mutual v. […]
The U.S. Supreme Court in a 6-3 vote affirmed that subsidies may go to individuals in states with exchanges established by the federal government, and the statute did not restrict subsidies to only states that themselves ran exchanges. Such a reading of the statute was not in line with the intent of the Affordable Care […]
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 […]
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 […]
Implants — spinal fusion; as well as hip, knee and shoulder replacements — have emerged as major price problems today. Costs are up and so is utilization, which explains the cost surge health plans are undergoing for these procedures, according to three attorneys from The Phia Group in Braintree, Mass., who spoke in a Jan. […]
State laws barring stop-loss policies with low attachment points are not preempted by ERISA, the U.S. Department of Labor said in Technical Release 2014-01. Ten states have passed such laws, many of them since the advent of the Affordable Care Act. When small groups self-insure, they are subject to proportionately larger impacts from particular expensive claims, have […]
The next three months are crunch time. Employers have to get moving on several deadlines, most of them required under health care reform. Some reform rules should have taken effect in 2014, but were subject to the year-long delay instituted by the Obama administration. Health Plan Identifiers Nov. 5, 2014 is the deadline for large group […]