HIPAA nondiscrimination provisions prohibit group health plans and health insurance issuers from discriminating against individual participants and beneficiaries in eligibility, benefits, or premiums based on a health factor. Wellness programs offered in conjunction with group health plans must also be nondiscriminatory. Final regulations issued on June 3, 2013, describe nondiscriminatory... Read More
The 2010 Affordable Care Act (ACA) includes a number of new taxes and fees to be assessed to pay for many of the new federal health care mandates. One of such fees is called the Patient- Centered Outcomes Research Trust Fund Fee (“PCORI fee”), which is to be remitted to... Read More
As many of our readers know, on Tuesday, May 14, 2013, Minnesota became the twelfth state to recognize same sex marriages. The effective date of the change is August 1, 2013, which gives employers some time to react to the change and analyze its effect on their employment policies and... Read More
On April 16, 2013, the U.S. Supreme Court issued its opinion in U.S. Airways, Inc. v. McCutchen http://www.supremecourt.gov/opinions/12pdf/11-1285_i4dk.pdf finding in favor of U.S. Airways in its quest to recover $66,866 in medical expenses incurred by its employee as a result of a traffic accident. McCutchen was a participant in the... Read More
ERISA requires that plans contain a reasonable claims procedure. Courts have generally required claimants to exhaust that claims procedure before filing a lawsuit. In addition, if the plan gives the plan administrator discretion to interpret the plan and decide claims, a court will often give deference to the plan administrator’s... Read More
Many employers know that one benefit to an ERISA plan is the standard of review available when the participant brings a lawsuit for benefits under the plan. If the plan documents give the plan administrator discretion to decide claims, then the court will review the exercise of the plan administrator’s... Read More
Pactiv Corporation sponsored a severance plan subject to ERISA. The plan required an employee to sign a separation agreement and release in a “form acceptable to the company” in order for the employee to be entitled to a payment under the plan. The severance plan itself did not contain a... Read More
I recently blogged about an employer who continued health insurance coverage for an employee on short term disability in contravention of the health plan document. The employer lost its stop-loss coverage for health claims incurred by the disabled employee because the health plan document did not specifically allow for continued... Read More
Last Thursday, June 28, in a 5-4 decision, the U.S. Supreme Court found that the Patient Protection and Affordable Care Act of 2010 (the “Affordable Care Act” or “Act”) is constitutional paving the way for final implementation of its provisions. http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf While the Administration argued that the Act was... Read More
There has been much discussion and blogging about different possible outcomes from the U.S. Supreme Court’s review of the Affordable Care Act (ACA). However, it is only recently that we are starting to see articles analyzing the effect that a complete repeal might have. If the Supreme Court strikes... Read More
