“Tie Goes to the Plan Administrator: Sixth Circuit Clarifies Importance of Firestone Language for ERISA Plan Interpretation

[P]lan sponsors should take the following steps as a result of this litigation.

  1. Inventory all plans, including qualified, nonqualified, health and welfare, and severance plans that are subject to ERISA.
  2. Review these plans to make sure that they have language that provides the plan administrator with authority to interpret the plans and resolve ambiguities, consistent […]
By | 2018-06-01T10:48:53+00:00 June 1st, 2018|2018 News, News|

How Fear of Catastrophic Health Care Expenses May Cause Retirees to Inefficiently Self-Insure

“[M]edian cumulative out-of-pocket medical expenses [from age 70 until death] for the long-lived elderly is quite modest at $27,000. At the same time, it is true that some long-lived elderly report very high cumulative out-of-pocket medical expenses: 10 percent of this older cohort say they racked up more than $172,000 in out-of-pocket medical expenses, and […]

By | 2018-05-07T10:57:33+00:00 May 1st, 2018|2018 News, News|

Denial of Supplemental Life Benefit Overturned Due to Poor Claims Administration

“This is a case study in how not to administer benefits — a vague SPD, inconsistent explanations, cryptic claim records filled with acronyms and jargon, and poor coordination among the plan sponsor, TPA, and insurer resulted not only in an award of benefits but potential liability for the wife’s attorney fees. Also, the maximum ERISA […]

By | 2018-05-07T10:47:18+00:00 May 1st, 2018|2018 News, News|

Patients Overpay for Prescriptions 23% of the Time

“The practice of charging a copay that is higher than the full cost of a drug is called a ‘clawback’ … After taking your insurance card, your pharmacist says you owe a $10 copay, which you pay, assuming that the drug costs more than $10 and your insurance is covering the rest. But unbeknownst to […]

By | 2018-04-02T07:21:45+00:00 April 1st, 2018|2018 News, News|

A Health Plan ‘Down Payment’ Is One Way States Try Retooling Individual Mandate

“As President Donald Trump and congressional Republicans tirelessly try to dismantle the Affordable Care Act, a number of states are scrambling to enact laws that safeguard its central provisions….Maryland is on the cutting edge with legislation moving through both chambers of the Statehouse…. Proposals have been discussed or advanced in at least nine states, including California, […]

By | 2018-04-02T07:20:34+00:00 April 1st, 2018|2018 News, News|

Thanks for Noticing: Disability Claims Procedure Regulations Change Notice Requirement Next Month, Impose Strict Compliance Standard

“The DOL’s revised ERISA disability claims procedures regulations will be taking effect [this] month, and plan sponsors should take a hard look at plan processes over the next few weeks to ensure compliance. The new requirements apply to disability benefit claims filed after April 1, 2018, after a 90-day delay postponed the effective date from […]

By | 2018-04-02T07:19:25+00:00 April 1st, 2018|2018 News, News|