Self-Funded Health Plans

News & Analysis as of

“A Trap for the Unwary” – Does Your Self-Funded Health Plan Provide Transgender Benefits? It Might Need to Soon.

Assistant Secretary of Labor Phyllis Borzi recently offered informal guidance on the broad scope of nondiscrimination regulations proposed under Section 1557 of the Affordable Care Act. During her remarks at the ABA Labor...more

Collecting Another Supreme Win for ERISA Preemption - Court in Gobeille Invalidates Vermont Data Collection Law

The U.S. Supreme Court decided the case of Gobeille v. Liberty Mutual Insurance Co. last week, in which the Court invalidated a Vermont health care data collection law as being preempted by the Employee Retirement Income...more

Supreme Court Concludes That ERISA Preempts State Reporting Requirements

In a closely observed federalism battle over the scope of ERISA preemption, the Supreme Court came down on the side of Federal power. Specifically, in Gobeille v. Liberty Mutual Insurance Company, the Court, in a 6-2 ruling,...more

ERISA Preemption Made Easy? Supreme Court Sends Vermont All-Payer Database Back to the Drawing Board

On the first day of decisions since the unexpected passing of Justice Scalia, the Supreme Court of the United States ventured into the thorny area of preemption under the Employee Retirement Income Security Act (ERISA) and...more

Quirky Question #270: A Win for Wellness Plans

Question: Our company offers employees a self-funded and self-insured health plan. We’d now like to implement a wellness program. Can we require employees to complete a health risk assessment which requests personal medical...more

Supreme Court requires fast action for ERISA subrogation recovery

A nearly unanimous Supreme Court recently found that a health plan cannot recover amounts subject to subrogation if the recipient has already spent the settlement funds....more

Self-Funded Plan Discrimination Against Mental Health Treatment: Is Yours Doing This?

On January 22, 2016, the court in Joseph and Gail F. v. Sinclair Services Company, D. Utah No. 2:14-cv-00505, held that a self-funded plan violated the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction...more

SURPRISE!!! The NJ Out-of-Network Consumer Protection, Transparency, Cost Containment, and Accountability Act Goes Forward and...

On November 17, 2015, New Jersey lawmakers forged ahead with the controversial legislation that addresses, among other things, “surprise” medical bills from out of network providers. According to its sponsors, the purpose of...more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 15 of 24): Coding Form 1095-C, Part II for...

As we noted in a previous post, the recently issued final 2015 Instructions for Forms 1094-C and 1095-C changed certain of the rules relating to the reporting for offers of COBRA coverage where the COBRA qualifying event...more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 10 of 24): IRS Issues Final Form 2015...

The IRS recently issued final instructions for Forms 1094-B and 1095-B and Forms 1094-C and 1095-C . The 2015 Instructions for Forms 1094-B and 1095-B implement a suggestion we made in a previous post relating to the...more

Hospitals Accused of Violating the False Claims Act Through Ownership of the PPO For Their Self-Funded Employee Health Plans

On August 27, 2015, following notification by the government that it had decided not to intervene, the United States District Court for the Middle District of North Carolina, ordered that a qui tam complaint charging...more

New Draft Instructions Released for ACA Information Reporting

As explained in my previous blog, Code Sections 6055 and 6056, added by the Affordable Care Act (“ACA”), require all employers (even small employers) sponsoring self-funded health plans and large employers to file information...more

More Cadillac Plan Tax Guidance from IRS

Code § 4980I (a/k/a/ the “Cadillac Plan tax”) was added by the ACA so that taxpayers with average group health plans would not subsidize, by tax preference, rich plans benefitting chiefly the rich. Section 4980I imposes a...more

ACA Information Reporting Penalties Have Been Increased

Code Sections 6055 and 6056 require large employers and all employers (even small employers) sponsoring self-funded health plans to file information returns with the IRS and furnish statements to applicable employees...more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 2 of 24): Yikes! The Costs of Failing to Comply...

The Affordable Care Act (ACA) imposes information reporting rules on providers of minimum essential coverage, e.g., insurance carriers and self-funded plans, and on applicable large employers, i.e., those employers that are...more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 1 of 24)

Alden Bianchi, Chair of the our Employee Benefits & Executive Compensation Practice, will provide a weekly installment on the complex reporting obligations outlined by the Affordable Care Act for health insurance carriers and...more

New ruling limits out-of-pocket expenses at individual level in 2016

Most health plan and health insurance policies include strategies that require persons covered under them to share in the costs that are paid. This strategy, often referred to as cost-sharing, serves two purposes. First, it...more

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

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