Doctors Sue Anthem over ER Coverage

The Medical Association of Georgia (MAG) and the American College of Emergency Physicians have sued Blue Cross Blue shield of Georgia (BCBSGA) over Anthem's policy of denying payment for emergency department visits that are later deemed non-emergent. The plaintiffs allege that the policy violates the ACA, which requires insurers to cover emergency care based on a [...]

By |2018-08-01T09:44:11-04:00August 1st, 2018|2018 News, News|

Cyber Liability Insurance for Employee Benefit Plans

"Many [plan sponsors] are purchasing cyber liability insurance coverage to supplement their data security measures.... [M]any policies vest the decision to retain legal counsel in the insurer, rather than the policyholder.... Plan sponsors should also identify the plan's service providers who have access to PII and PHI and ensure that the plan's cyber liability policy [...]

By |2018-07-02T15:49:46-04:00July 1st, 2018|2018 News, News|

States May Sue Trump Administration Over New Association Health Plan Rules

"At least two states (Massachusetts and New York) are threatening to sue the Trump administration over this new rule.... In several states, group health insurance laws will need to be revised to permit individuals and small groups to participate in AHPs if they are not otherwise members of pre-existing tax-qualified bona fide associations.... [M]any states [...]

By |2018-07-02T15:48:44-04:00July 1st, 2018|2018 News, News|

DOL Issues Final Association Health Plan Rules

"On June 19, 2018, the Department of Labor (DOL) released a final rule that offers new options for associations to sponsor health plans for their members.  These new options allow more small businesses to come together to create large employer plans free from many of the Affordable Care Act (ACA) mandates applicable to individual and small [...]

By |2018-07-02T15:47:29-04:00July 1st, 2018|2018 News, News|

“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. Inventory all plans, including qualified, nonqualified, health and welfare, and severance plans that are subject to ERISA. 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 |2018-06-01T10:48:53-04:00June 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 |2018-05-07T10:57:33-04:00May 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 |2018-05-07T10:47:18-04:00May 1st, 2018|2018 News, News|
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