ERISAPros News

Concern over surprise medical bills—those from out-of-network physicians that patients had no role in choosing—has grown tremendously in recent years.  Some states have taken steps to mitigate this problem. However, these measures do not apply to the roughly half of Americans enrolled in self-insured health plans because ERISA precludes states from […]

The term telehealth encompasses clinical diagnosis, education, management, and the monitoring of health via technology. It is not a specific service, but rather an umbrella term for a variety of strategies to enhance medical care delivery.

The greatest advantage of telehealth is ease of access. Patients can quickly and easily speak with doctors […]

The IRS answers FAQs regarding The Affordable Care Act’s employer shared responsibility provisions related to:

• Basics of the Employer Shared Responsibility Provisions
• Employers Subject to the Employer Shared Responsibility Provisions
• Identification of Full-Time Employees
• Offers of Coverage
• Affordability and Minimum Value
• Liability for the Employer Shared Responsibility Payment
• Calculation […]
  

Last year the EEOC sued cosmetics and fragrance giant Estée Lauder, claiming its parental leave policies discriminated against men. Estée Lauder provided eligible new mothers with six weeks of paid parental leave for child bonding (in addition to leave for recovery for childbirth), but it only offered new fathers two […]

Promises from drug makers to control persistent increases in drug costs seem to last only as long as it is politically expedient to make them. To counteract this behavior, the Trump administration has floated proposals such as promoting competition from generic drugs and changing Medicare drug-purchase policies. Some experts are […]

The number of patients with claims in self-funded plans from $1 million to $1.5 million rose from 104 in 2014 to 194 in 2017 according to a new Sun Life Financial report. Over the four year period, high claims totaled $6.9 billion. Cancer represented $798.7 million, followed by metabolic disorder and hemophiliac […]

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 […]

“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 […]

“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 […]

“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 […]