Self-Funded Health Plans

News & Analysis as of

Alert: Health Plan Update on Out-of-Pocket Limitations

The Affordable Care Act (the “ACA”) established limitations on the annual out-of-pocket costs that a health plan may impose on a participant. The U.S. Department of Health and Human Services, Department of Labor and the...more

The ACA’s Toyota tax

For several years now, employers have spent a great deal of time focusing on the Affordable Care Act’s (ACA) play-or-pay mandate. Numerous articles have been written and numerous educational seminars have been given...more

Iowa Supreme Court Affirms Ruling for Health Insurer in Antitrust Dispute

In late February, the Iowa Supreme Court affirmed a lower court ruling in Mueller v. Wellmark, ending a seven year battle over whether the health insurer’s agreement with employers operating “self-funded” insurance plans to...more

Insurance Antitrust Legal News: Volume 4, Number 3

Auto Insurers Again Seek Dismissal of In Re Auto Body Shop Antitrust Litigation - In early March, the auto insurer defendants in the In re Auto Body Shop Antitrust Litigation renewed their motions seeking the dismissal...more

Federal Judge Rules BCBSM’s “Value of Blue” Report Did Not Disclose Hidden Fees

A federal judge in the case of Alma Products v. BCBSM recently agreed with arguments presented by Varnum that Blue Cross Blue Shield of Michigan's "Value of Blue" report did not reveal that it was charging hidden fees (often...more

Timing of termination creates question of fact in association discrimination case

In employment law, including association discrimination cases, timing is everything. When Terry Booker was fired from his job of 22 years at Delfasco, a manufacturing facility in Greene County, Tennessee, in March 2012,...more

Recent Federal Court Ruling on Application of Texas Prompt Pay Laws to Self-Funded, Medicaid and Out-of-State Plans and Their...

What's new? A Dallas federal district court recently ruled that the Texas Prompt Pay Law does not apply to employer-funded health plans, Medicaid plans, or out of state patients that use Texas providers, or to a Third Party...more

Beware of Stop-Loss Coverage Gaps When Choosing a Self-Funded Major Medical Plan

The Affordable Care Act requires applicable large employers to make broad-based offers of group health insurance coverage to substantially all their full-time employees or face potential tax penalties. (The term “applicable...more

Honored in the Breach: Employer Action Items for an Insurer Data Breach

This morning, Anthem Blue Cross and Blue Shield, one of the largest health insurers in the country, notified its policyholders, members, and business partners that it was recently the target of an external cyber attack that...more

View From McDermott: A New Type of ERISA-Based Hold-Up—The Rise of Out-of-Network Provider Suits Against Self-Funded Health Care...

Over the past decade, there has been a significant increase in the number of physicians who have dropped out of Preferred Provider Organization (‘‘PPO’’) and Health Maintenance Organization (‘‘HMO’’) networks and attempted to...more

Sixth Circuit Addresses Plan Assets and Limitations Issues in Holding Service Provider’s Fee Assessments Constituted Self-Dealing

The Sixth Circuit held in Hi-Lex Controls, Inc. v. Blue Cross and Blue Shield of Michigan that a service provider was liable as a fiduciary under ERISA for unauthorized fees it assessed against a self-funded health plan. In...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 38: Congress Eliminates Separate Cap on Deductibles

In a rare display of bipartisanship, Congress voted to eliminate the Affordable Care Act’s separate cap on deductibles that applies to individual and small group insurance products. (These limits never applied to large...more

Health Plan Class Action Lawsuit Filed in Northern California

Approximately 300 employers and other organizations, many of which are in Northern California, were named as co-defendants in an ERISA class action lawsuit filed on November 22, 2013, in the U.S. District Court for the...more

In Pipefitters, Sixth Circuit Holds Service Provider Is Fiduciary in Assessing Fee

Speed Read - The Sixth Circuit, in a unanimous decision, affirmed a lower court ruling in Pipefitters Local 636 Insurance Fund v. Blue Cross and Blue Shield of Michigan, holding that an entity providing services to a...more

Have You Audited Your Self-Funded Health Insurance Plan?

Michigan Court awards over $5 million in damages to employer who was the victim of fraud by its third party administrator. A federal district court in Michigan has just ruled that the sponsor of a self-funded health...more

Deadline Approaching For Self-Funded Medical Plan Sponsors

Insurers and plan sponsors of self-funded plans, must soon start paying a fee to support the Patient-Centered Outcomes Research Trust. This was established by the Patient Protection and Affordable Care Act; the trust finances...more

Varnum Wins $5.1 Million Judgment Against Blue Cross Blue Shield Of Michigan For Hidden Fees

BCBSM Charges Self-funded Customers Hidden Fees starting in 1994 - Prior to 1994, BCBSM charged its self-funded customers various surcharges and subsidies to prop up its insured lines of business, but those surcharges...more

A Self-Funded Employer’s Worst Nightmare

Employers who sponsor health plans for their employees can purchase insurance contracts to fund those plans. Alternatively, employers can self-fund or self-insure those benefits, agreeing to pay the claims themselves....more

Certain Plan Designs Will Cost More Under The Patient-Centered Outcomes Research Institute Fees

The Affordable Care Act establishes a Patient-Centered Outcomes Research Institute as a private nonprofit corporation to assist patients, clinicians, purchasers and policy makers in making informed health decisions using...more

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