Self-Funded Health Plans

News & Analysis as of

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

10 Results
|
View per page
Page: of 1