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Rather than merely finding that an individual was entitled to benefits due, a federal appeals court ordered an insurer to pay a large monetary award under ERISA based on the equitable theories of unjust enrichment and disgorgement of ill-gotten profits. The 6th U.S. Circuit Court of Appeals held that the insurer used money it should […]
Legislation designed to make it more difficult for smaller employers to self-insure by restricting their ability to obtain stop-loss insurance with very low attachment points was signed into law on Oct. 1 by California Gov. Jerry Brown. S.B. 161, which takes effect Jan. 1, 2014, will prohibit stop-loss insurers in California from issuing policies with specific […]
An increasing number of employers are examining providing a low-benefits health plan that covers only preventive health services but not high-price major medical claims. Offering this type of low cost or “skinny” plan is allowed under the health reform law. The question is: Will skinny plans trigger a large-employer exodus to de minimis coverage, and if so, […]
Health reform fees that health insurers and self-funded plans must pay in order to fund the Patient-Centered Outcomes Research Institute are “ordinary and necessary business expenses,” and therefore qualify as deductible from federal taxes, a recent IRS memo states. Insurers and health plans will pay the $1 (soon to become $2) per covered life fee […]
Fast-moving events have advanced state-level proposals aimed at regulating stop-loss, which would make it more expensive for small employers to self-insure health benefits, and put power over self-funding in the hands of state insurance commissioners. Utah law now requires stop-loss insurers to cover incurred and unpaid claims if a small employer plan terminates — an unprecedented requirement. […]
On April 22, the Colorado House of Representatives passed legislation regulating stop-loss through minimum attachment points, and requiring stop-loss insurers to give the commissioner information about their self-insuring clients with 100 and fewer full-time equivalents. The bill also would give the insurance commissioner authority to unilaterally raise minimum stop-loss attachment points based on medical price […]
Employers might pay less than $63 per covered life per year under health reform’s transitional reinsurance fee rules, but that would require a surplus in the fund, a U.S. Department of Labor official told an employer plan industry group on April 18 in Washington, D.C. Even though possible, such a reduction would be contingent on: […]
If small companies self-insure their health plans and in doing so can get stop-loss coverage with very low attachment points, they could siphon healthy lives away from the new insurance market designed by health reform to insure millions of new lives, the Urban Institute warned in a April 2013 report. The Institute explained that low […]
The health reform law provides that entities called “Navigators” will assist consumers and small businesses in researching health insurance exchanges — but stop-loss insurers for self-funded health plans won’t be one of them. Those insurers, as well as individuals and other entities with too close a financial relationship to such insurers, would be excluded from […]
Companies that self-fund health benefits are larger than companies that fully insure health benefits and their solvency is just as good as companies that fully insure, a government report required by the health reform law indicates. The reform law requires reports on the prevalence, solvency and quality of self-funded plans, with the stated goal of […]