Health Insurance

News & Analysis as of

Federal Court Allows Hospital’s Antitrust Claims to Proceed on Narrow Market Definition

Winning an antitrust lawsuit hinges on defining the “relevant market,” and this case may prove the point. Methodist Health Services Corporation notched the first win in its battle against Saint Francis Medical Center as a...more

Obama Administration Finalizes Health Insurance Wraparound Coverage Rule

The Departments of Labor, Health and Human Services, and Treasury published a final rule on March 18, 2015 that amends the definition of excepted benefits to allow group health plan sponsors, in limited circumstances, to...more

The ACA Five Years Later: A Good Investment or Risky Business? We Dare Not Opine!

The enactment of the Patient Protection and Affordable Care Act (ACA), signed into law on March 23, 2010, represents a significant legislative milestone in healthcare reform and a continuing communications challenge for...more

BEST IN LAW: Employers need to heed Obamacare Reporting Rules

Compliance with reporting obligations is always important for any employer, but the employer reporting requirements under the Affordable Care Act pack a significant penalty that makes compliance particularly...more

Health Update - March 2015

Supporting Informed Decision Making in the Health Insurance Marketplace: A Progress Report - Editor’s note: As Affordable Care Act (ACA) implementation moves forward and the marketplace continues to evolve, there is a...more

Can Retirees Use HSAs?

Yes – and no. A Health Savings Account (HSA) is like an IRA but for the payment of medical expenses instead of retirement income. HSA contributions are not taxed, and like IRA accounts, they belong to the employee. ...more

Washington Healthcare Update

This Week: Bipartisan, Bicameral Permanent SGR Fix Introduced... House Budget Committee Advances FY2016 Budget Proposal... National Coverage Determinations Proposed for Removal... HHS Releases Proposed Rules on EHR Incentive...more

"Surprise Medical Bills" Law

Consider the following scenario. You are a patient who had a colonoscopy performed by a physician who participates in your health insurance plan. A week later, you receive two “surprise” medical bills from an anesthesiologist...more

Health Alert (Australia) - March 23, 2015

In This Issue: Judgments; Legislation; and Reports. Excerpt from Reports: New South Wales (NSW). Ministry of Health - Media Releases - 18 March 2015 - NSW says protect against mosquitoes after huge...more

Week in Review - March 2015 #3

Friday marked the first committee deadline and thus a flurry of activity at the Capitol to act favorably on bills in their respective policy committees. MNsure - When Governor Mark Dayton’s supplemental budget...more

To Understand King v. Burwell Look To Yates v. US

On March 4, 2015, the U.S. Supreme Court heard argument in King v. Burwell, the most publicized case to reach the high court in some time. The issue is whether certain tax subsidies essential to the proper fiscal management...more

California Court Rejects Insurer’s Right to Rescind Policy

In DuBeck v. California Physicians’ Service, 2015 Cal. App. LEXIS 203 (March 5, 2015, opinion filed), the California Court of Appeal examined whether a health insurer’s conduct constituted a waiver of the right to rescind its...more

More Risk for All and “Free” Care?

While the Supreme Court continues to debate the outcome of King v. Burwell in their chambers, stakeholders must be prepared for the potential fallout the nine justices’ ruling may have. Two weeks ago, we summarized the...more

Michigan Congressmen Introduce Bill Permitting Healthcare Providers to Negotiate Collectively with Health Insurers

On January 6, two Michigan Congressmen – Representative John Conyers (D-Mich.) and Representative Dan Benishek (R-Mich.) – introduced the “Quality Health Care Coalition Act of 2015.” The bill (H.R. 105) would permit...more

Health Coverage for Staffing Firm Employees – Who is Responsible?

The Issue: Whether the recipient employer or the staffing firm from which the employer hires workers is responsible for offering health coverage to those workers under the Affordable Care Act’s employer mandate....more

Health Sector Under ACCC Spotlight In 2015

ACCC ENFORCEMENT PRIORITIES - The Australian Competition and Consumer Commission (ACCC) has released its enforcement priorities for 2015, with the Chairman of the ACCC giving a speech on the topic last week. Each year,...more

The Managed Mediation of a Payor-Provider Health Care Dispute

In the health care industry, payors and providers often have claims for both underpayment and overpayment arising from ongoing contracts or other health care services rendered. When claims arise between a payor and a...more

Premera Blue Cross Targeted by Hackers – 11 Million Individuals Compromised

Premera Blue Cross (“Premera”) announced this week that it has been the target of a sophisticated cybersecurity attack in which the information of approximately 11 million individuals has been compromised. This announcement...more

Fifth Circuit: Hospital Enjoys Standing to Seek ERISA Benefits

The Fifth Circuit ruled that an out-of-network medical provider that was assigned a patient’s rights to health insurance benefits has standing to sue a health plan that underpays its portion of the benefits due even if the...more

State Legislatures React To Latest Health Data Breaches By Updating State Data Breach Notification Laws And Encryption...

Recent, large-scale breaches of health information have served to highlight the fact that federal agencies have only rarely assessed penalties against companies as a result of these breaches, while many states do not have...more

Manatt on Health Reform: Weekly Highlights - March 2015 #3

FEDERAL NEWS: More than 8 in 10 Federal Marketplace Enrollees Receive Tax Credits - According to data released by CMS, 7.7 million consumers, or 87 percent of those on the Federally-facilitated Marketplace with...more

New HHS Regulations “Clarify” that Health Plans Covering Families Must Have “Embedded” Individual Cost-Sharing Limits

On February 27, 2015, the Department of Health and Human Services (HHS) released its final HHS Notice of Benefit and Payment Parameters for 2016. The lengthy regulation covers a wide range of topics affecting group health...more

Health Care Update - March 2015 #3

In This Issue: - Permanent Medicare Doc-Fix Could be a Reality, CHIP Reauthorization May Be Lynchpin - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives -...more

Short-Term Relief for Small Employers Reimbursing Employee Premiums - But Significant Penalties Loom if You Don’t Stop Soon!

For nearly two years now, the IRS has been explaining that employers are no longer permitted to reimburse employees for premiums the employees paid for individual health insurance coverage....more

ACA Deadlines Do Apply to American Indians, But There are Many Exemptions

Under the Affordable Care Act, most Americans are now required to either maintain minimum health insurance coverage, get an exemption, or pay a tax penalty. ...more

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