Medical Benefits

News & Analysis as of

New Final Regulations and FAQs Provide Guidance on Preventive Services Coverage

Through new FAQs and final regulations, the U.S. Departments of Labor (“DOL”), Health and Human Services (“HHS”) and the Treasury (the “Departments”) have further clarified various issues related to the preventive care...more

Supreme Court Tightens Standards for Vesting of Retiree Medical Benefits

In January of this year, the U.S. Supreme Court, in M&G Polymers USA LLC v. Tackett, ruled against a group of retirees by vacating a Sixth Circuit decision holding that a collective bargaining agreement created a vested right...more

Physician Progress Report: Get one every doctor visit

Following every visit to your authorized treating doctor, be sure to ask the doctor or his assistant for a copy of the doctor’s physician progress report. There is a DIR-approved form that most doctors use, although some...more

Health Alert (Australia) - May 4, 2015

In This Issue: Judgments; Legislation; and Reports & Publications. Excerpt from Reports & Publications: Queensland. Office of the Health Ombudsman 24 April 2015 - Health Ombudsman releases third...more

Employers Must Prepare Now for Seattle’s New Minimum Wage Rate, Effective April 1

Employers with employees working within the city limits of Seattle must begin complying with Seattle’s Minimum Wage Ordinance on April 1. The new Seattle ordinance will increase the hourly minimum wage for covered employees...more

IRS Rules Captive Reinsurance Arrangement Involving Retiree Medical Benefits Qualifies as Insurance for Federal Tax Purposes

On May 18, 2014, the Internal Revenue Service (IRS) ruled that an employer’s wholly owned captive insurance subsidiary could reinsure the employer’s retiree medical benefit risks and still qualify as insurance for federal tax...more

ADA Accessibility Attestation Forms for FIDA (Medicare-Medicaid Advantage Duals) Plans

The Financial Alignment Initiative of the Centers for Medicare & Medicaid Services ("CMS") is a test program designed to better coordinate care for dual Medicare-Medicaid enrollees by aligning the financing of Medicare and...more

Seventh Circuit: Insurance Companies Are Proper Defendants In Suits For ERISA Benefits

The Seventh Circuit held that a health insurer that makes benefits determinations and pays benefit claims, rather than the health plan itself, is a proper defendant in an action for benefits under ERISA Section 502(a)(1)(B)....more

Staffing Industry Compliance with the Employer Shared Responsibility (aka “Pay-or-Play”) Provisions of the Affordable Care Act:...

Under the Patient Protection and Affordable Care Act (the “Act”), the federal government, state governments, insurers, employers, and individuals all share responsibility to make affordable health insurance coverage widely...more

Seventh Circuit Rules that Medical Necessity Trumps State-Imposed Cap on “Optional” Medicaid Coverage

In a class action lawsuit, the U.S. Court of Appeals for the 7th Circuit recently affirmed a lower court decision granting a preliminary injunction that prevented the state of Indiana from enforcing a $1,000 annual cap on...more

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