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So far ERISAPros has created 125 blog entries.

What to Do When You Receive an Out-of-Network Shakedown Letter

“A physician-owned, out-of-network health care service provider – such as an ambulatory surgery center or a sleep center – sends a demand letter to the plan administrator. The letter asserts an appeal of a denied benefits claim by one of the plan’s participants; requests copies of a lengthy list of plan-related documents; and alleges that […]

By | 2017-11-14T08:18:13+00:00 November 13th, 2017|2017 News, News|

IRS Draws Line in the Sand, Won’t Accept Individual Tax Returns Without ACA Information

“For the first time, an individual must complete line 61 (as shown in previous iterations) of the Form 1040 when filing his/her tax return…. It is reasonable to assume that an employee is more likely to inquire as to the whereabouts of the ACA information necessary to complete his/her 2017 tax return. Therefore, the possibility […]

By | 2017-10-30T06:59:55+00:00 November 6th, 2017|2017 News, News|

Telemedicine Expanding Rapidly

“According to one recent survey, telemedicine services (i.e., remote delivery of healthcare services using telecommunications technology) among large employers (500 or more employees) grew from 18% in 2014 to 59% in 2016. Common selling points touted by telemedicine vendors include reduced health care costs and employee convenience. However, state licensure laws imposing restrictions on telemedicine […]

By | 2017-10-30T06:54:15+00:00 October 17th, 2017|2017 News, News|

DOL Opposes UnitedHealth’s Cross-Plan Offsetting Practice

“The Labor Department opposes a health insurance practice called ‘cross-plan offsetting,’ in which insurers like UnitedHealth reduce payments owed to medical providers for services rendered to specific patients. The reductions are meant to offset overpayments the providers previously received on account of different patients who participate in other plans insured by the same company. This […]

By | 2017-10-30T06:49:01+00:00 October 9th, 2017|2017 News, News|

Pregnancy is Not a Pre-existing Condition for Disability Insurance

The U.S. Court of Appeals for the Eleventh Circuit, in Bradshaw v. Reliance Standard Life Insurance Co., has rejected a disability insurer’s decision to deny disability benefits to an insured who suffered a stroke days after giving birth on the basis that her pregnancy was a pre-existing condition.

…While the Affordable Care Act has eliminated health […]

By | 2017-10-30T06:45:46+00:00 October 2nd, 2017|2017 News, News|

Well Drafted Plan Document Saves Self-Insured Medical Plan Over $350,000

“A self-insured medical plan included an anti-assignment provision that prohibited a health care provider from suing on behalf of a participant. The court found the anti-assignment clause to be valid and enforceable. This case highlights the value of a well drafted plan document. Employers sponsoring self-insured plans are encouraged to review their plan documents to […]

By | 2017-08-31T12:11:10+00:00 September 19th, 2017|2017 News, News|

How Qualified and Nonqualified Plan Sponsors Should Respond to the Latest Guidance on ERISA Disability Claims Procedures

“While the fiduciary rule has received most of the attention in the world of ERISA as of late, a lesser known regulation that was finalized late last year also may require action by plan sponsors. This regulation, issued by the Department of Labor (DOL) in December 2016, requires applicable plans to satisfy additional procedural and […]

By | 2017-08-31T12:09:10+00:00 September 12th, 2017|2017 News, News|

COBRA and Severance Agreements: A Gift or a Curse?

COBRA“If the individual is left enrolled as an active employee, fully-insured employers may risk violating the medical plan eligibility requirements in their insurance contract. Similarly, self-funded employers may violate the coverage provisions of their stop-loss agreement. Consequently, failure to offer COBRA can expose an employer to significant […]

By | 2017-08-31T12:01:36+00:00 September 2nd, 2017|2017 News, News|

Updated SBC Templates Apply for 2018 Open Enrollment

“Given the current House and Senate ‘repeal and replace’ ACA legislation, many employers are wondering if they need to take the time to revise their SBCs to comply with the new template and requirements. The short answer is use of the new SBC templates is still required. Both the House-passed legislation and the current legislation […]

By | 2017-08-14T07:08:10+00:00 August 14th, 2017|2017 News, News|