Premiums

News & Analysis as of

CMS Now Requiring Qualified Health Plans To Accept Premium Payments From Certain Third Parties

As previously reported on November 13, 2013 and February 20, 2014, the Centers for Medicare and Medicaid Services ("CMS") has attempted to provide guidance as to when it is appropriate for issuers of "qualified health plans"...more

The Elevator Speech Overview

The House and Senate were both on recess this week. On Tuesday, the U.S. suspended the operations of Syria’s U.S. embassy and consulates as the Syrian civil war enters its fourth year. Also Tuesday, details of an NSA...more

Affordable Care Act Redux

Another delay in implementation of the Affordable Care Act (“ACA” or “Obamacare”) has prompted PK Law to update our material on the Act. Here are some points to bear in mind as March 31 approaches...more

Flood Insurance Reform Bill with Escrow Amendments Awaits President’s Signature

The U.S. House of Representatives and Senate recently passed, and the President is expected to sign into law, amendments to the Biggert-Waters Flood Insurance Reform Act of 2012 (the Act). The legislation seeks to address...more

Recent Legal Decisions Prove That Your Experience Modification Rate Matters More Than Ever

Some contractors no doubt experienced sticker shock when their most recent workers’ compensation audit came back with a higher-than-expected Experience Modification Rate, or EMR, that raised their insurance premium despite...more

Imputed Income and Health Insurance in Divorce Settlements, Part 2

With most Massachusetts health insurance plans, provided he/she has not yet remarried, an employee with at least one dependent child can add a former spouse to the coverage for no additional cost, so there is no additional...more

Feds’ Argument in Favor of Premium Tax Credit Gains Momentum, Still Under Attack in Federal Courts

A second federal district court judge has ruled in favor of the government on one of the most serious challenges to the Patient Protection and Affordable Care Act of 2010 (ACA). The court dismissed a challenge to the...more

Update on PBGC Premiums

This year, we have both bad and good news for PBGC premiums – while the premium amounts have increased for 2014, the PBGC has also taken action to streamline the payment rules for large plans. Since it’s a rare occasion when...more

District Court Upholds Validity of IRS Rule Authorizing Premium Tax Credits to Individuals Who Enroll in Health-Care Coverage...

A district court in the District of Columbia recently held that the Internal Revenue Service’s (“IRS”) rule authorizing premium tax credits to individuals who enroll in health-care coverage through federal exchanges was...more

Recent Guidance on Wellness Programs Clarifies Premium Surcharges for Tobacco Use

As previously reported, the federal agencies responsible for drafting the rules implementing the Affordable Care Act (ACA) (the U.S. Labor Department, the U.S. Department of Health and Human Services and the U.S. Treasury...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 50: Wellness Programs, Affordability, and Premium Tax Credits

The Affordable Care Act imposes a series of interrelated requirements on individuals, employers and providers. Individuals must maintain coverage or face the prospect of a tax penalty; carriers must offer and renew coverage....more

Lawsuits Over Health Exchange Premium Subsidies Challenge Heart of Reform Law

Royal Oakes was quoted in a Jan. 5th, 2014, Business Insurance article, Lawsuits Over Health Exchange Premium Subsidies Challenge Heart of Reform Law, by discussing a pair of lawsuits aimed at limiting availability of premium...more

The PBGC Changes Flat-Rate Premium Due Date for Large Plans

The PBGC finalized a proposed rule that changes the flat-rate premium due date for large plans to the same as their variable-rate due date, which is 9.5 calendar months after the beginning of the premium payment year (October...more

Supermarket To The World – The ADM FCPA Enforcement Action

Last week, it was announced by the Department of Justice (DOJ) and Securities and Exchange Commission (SEC) that it had settled an enforcement action with Archer-Daniels-Midland Company (ADM). The DOJ resolved a criminal...more

What The Hail Is Going On In Texas?

Every lawyer knows that most state court lawsuits fall into a few general categories: slip and falls, auto accidents, employment disputes and collection actions. Year after year after year, the majority of state court...more

Health Care Reform Implementation Update - December 19, 2013

The deadline to enroll in coverage for January 1 was officially extended by a week, but the new December 23 deadline is fast approaching, and premium payments are required to be paid by the last day of 2013 for January 2014...more

Legal Alert: Cost of Insurance Litigation – Insurers Retain Discretion to Set COI Rates in Two Key Victories

In the first federal appellate decisions addressing cost of insurance (COI) charges in life insurance policies, the Seventh Circuit Court of Appeals handed two victories to insurers in opinions issued December 13, 2013. In...more

Insuring Your Business - December 2013: Insurance Coverage for Food Claims: Communicating with Your Insurance Company

One of the most frustrating aspects of dealing with a food insurance claim can be communicating with your insurance company adjuster. Knowing your insurance company’s obligations to you can help reduce the frustration....more

Connecticut Law Requires Employers to Adopt Cafeteria Plans

In 2007 Connecticut adopted a law requiring employers to adopt cafeteria plans if their employees are required to pay a portion of the health insurance premium for employer-sponsored health insurance through payroll...more

IRS Adopts Final Regulations On Reporting Mortgage Insurance Premium Payments

The Internal Revenue Service (“IRS”) has issued final regulations requiring financial institutions and other persons who receive mortgage insurance premiums aggregating $600 or more during calendar year 2013 to report such...more

Queensland Premier announces initiative to drive down insurance costs in North Queensland

Premier Newman announced the Queensland Government and Federal Government will work together to directly tackle the cost of insurance in North Queensland. ...more

CFPB Settles with Mortgage Insurance Company for Violations of RESPA

The CFPB announced it had entered into a consent order with a mortgage insurance company following the CFPB’s filing of a complaint in the United States District Court for the Southern District of Florida against the company...more

Health Insurance Premium Regulation Bid Draws Criticism

Barger & Wolen partners Richard De La Mora and Richard Hopkins were both quoted in a Nov. 14, 2013, Daily Journal article, Hospital insurance premium regulations bid draws criticism, about a proposed ballot initiative...more

May Providers Pay Health Insurance Premiums for HealthCare.gov Plan Enrollees?

Following last week's declaration that Qualified Health Plans (QHPs) on HealthCare.gov are not "Federal health care programs," and thus are not subject to the federal Anti-Kickback Statute, CMS released additional guidance...more

Ninth Circuit Upholds Rescission of Life Insurance Policy and Rejects Novel Theories

This week the Ninth Circuit affirmed a grant of summary judgment in favor of USAA Life Insurance Company, holding that the insurer was entitled to rescind the policy under California law when it discovered that its insured...more

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