“[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 […]
“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 […]
“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 […]
“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, […]
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 […]
“Plans should have ERISA fidelity bond coverage from an approved provider as of the beginning of the plan reporting period with a coverage amount in accordance with the regulations…. Who needs to be covered? … What type of coverage do I need? … Which coverage is required to be disclosed on the Plan’s annual Form […]
Are Your Qualified and Nonqualified Employee Benefit Plans in Compliance With the New ERISA Disability Claims Regulations?
“[W]here a plan does not provide for its own fiduciaries to make a determination of disability — but instead defers to the determination made by the administrator of another plan (like the employer’s long-term disability plan) — then only the terms of the other plan need to be amended. Examples include health plans that extend […]
Association Health Plans: Proposed DOL Rules Create Potential Opportunity for Associations and Small Employers
“On Jan. 5, 2018, the Department of Labor (DOL) issued a proposed rule that would make it easier for small businesses to join together to purchase health insurance.
This is not a […]
The DOL recently issued a final rule that increases civil monetary penalties for violations of ERISA and other federal laws such as the Fair Labor Standards Act (FLSA), Family Medical Leave Act (FMLA) and Occupational Safety and Health Act […]
“The new venture will focus on the collective buying power of employers who purchase healthcare for the 1.15 million employees in their organizations. Their approach features five strategies widely used by large self-insured employers to contain their employee health costs. This one is expected to leverage technology […]