Understanding Employee Benefits

What You Say in Your SPD About Claims Processing Makes a Difference

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Employers who self fund their medical plans often have contracts with their third party administrators about claims processing. Some of those contracts provide that the claims processor has discretion to decide claims; others provide that the claims processor is simply acting in a ministerial fashion so that the employer ultimately... Read More

Topics: ERISA and Other Benefits Litigation, Health Plan

Time to Review Plan Subrogation Procedures

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Most self-funded ERISA medical plans provide that participants who have been injured by other people (think car accidents) must reimburse the plan if the participant recovers from the other person for those injuries. In order to obtain that reimbursement, a plan document must contain appropriate reimbursement/subrogation language and the plan... Read More

Topics: ERISA and Other Benefits Litigation, Health Plan, Welfare Plans

EEOC Loses Another Wellness Case, Part 1

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The EEOC has been bringing lawsuits against employers challenging wellness programs. A recent case involved a company that had previously provided a credit to employees enrolled in the health plan who participated in a health risk assessment (HRA) and biometric screenings. The company had eliminated the credit and instead conditioned... Read More

Topics: Health Care Reform, Health Plan