News 2017-08-20T09:17:05+00:00

ERISAPros News

Mercer’s Mike Sinkledam Reminds Calendar Year Plans to Implement New SBC Requirements During This Year’s Open Enrollment

“While ‘not a lot has changed from last year, from a compliance standpoint, when it comes to open enrollment, the new Summary of Benefits and Coverage (SBC) template and uniform glossary need to be implemented during this year’s open enrollment for calendar year plans,’ according to Mike Sinkeldam, a principal […]

By | November 20th, 2017|

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 […]

By | November 13th, 2017|

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 […]

By | October 17th, 2017|

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 | October 9th, 2017|

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 […]

By | October 2nd, 2017|

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 […]

By | September 19th, 2017|

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 […]

By | September 2nd, 2017|
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