Self-Insured Health Plans

News & Analysis as of

ERISA self-insured health plan not required to cover same sex spouses

In Roe v. Empire Blue Cross Blue Shield, No. 12–cv–04788 (NSR), 58 EBC 1077, 2014 WL 1760343 (S.D. N.Y. May 1, 2014), the United States District Court for the Southern District of New York held a self-insured health plan that...more

Self-Insured Health Plans May Be Required To Allow Health Care Providers Access To Their Claims And Appeals Process

In a precedent-setting case, a district court in the Northern District of Illinois recently ruled that in-network chiropractors were considered “beneficiaries” under the Employee Retirement Income Security Act of 1974 (ERISA)...more

Risk Taking in the Provider World: Is a Knox-Keene Plan a Good Strategic Move For You?

Reimbursement for health care services in California continues its shift toward capitation, resulting in health care providers increasingly forming their own health plans under the Knox Keene Health Care Service Plan Act (the...more

The Federal Court for the Southern District of New York Rules that Employers with Self-Insured Health Plans Need Not Offer Medical...

The issue of same-sex spousal rights is now largely resolved for qualified retirement plans. However, substantial questions about same-sex spouse health benefits remain unanswered. In Roe v. Empire Blue Cross Blue Shield,...more

The Affordable Care Act – What You Need to Know Checklist

In This Presentation: - Review Employer Information - Fees - Mandates - Additional Points - Communications - Excerpt from Review Employer Information. Employer’s Health Plans - 1. Identify the...more

Trustee Alert – Transitional Reinsurance Fee Update

Health care reform imposed on all health plans a Transitional Reinsurance Fee (TRF) for three years— 2014 through 2016. For 2015 and 2016, there is an exemption from the TRF program for self-insured plans that self-administer...more

More Multiemployer Plan Relief – Final Rule Exempts Self-Insured/Self-Administered Plans from Transitional Reinsurance Fee in 2015...

On March 5, 2014, the Department of Health and Human Services released a Final Rule addressing, among other things, transitional reinsurance fees payable in the 2014 through 2016 benefit years. By way of background,...more

ACA: Employers, Non-Discrimination Rules And The ‘Cadillac Tax’

For most employers, the substantive provisions of the Patient Protection and Affordable Care Act (the PPACA) have been implemented. Almost all plans cover an employee’s child until that child reaches the age of 26, fully...more

Equal Coverage Requirements of Affordable Care Act Delayed

Employers are continuing to feel the impact of and to respond to the federal Affordable Care Act. Just today, it was reported that Target Corporation will be no longer offer health insurance benefits to its part-time...more

Nondiscrimination Testing for Health and Welfare Plans

Some employee benefits enjoy a tax-favored status under the Tax Code, but such favorable tax treatment applies with respect to certain highly compensated individuals only if the plans satisfy applicable nondiscrimination...more

Affordable Care Act’s Special Rules for Grandfathered And Self-Insured Health Plans

The Affordable Care Act’s (“ACA”) mandates regarding health care plans, including the individual mandate, take effect with no change in schedule, despite the recent U.S. Treasury Department’s decision to postpone employer...more

First Payment Of Employer's PCORI Fees For Self-Insured Health Insurance Plans Due July 31

The first payment of the Patient-Centered Outcomes Research Institute (PCORI) fee imposed by the Affordable Care Act is due next week on July 31st. While the U.S. Treasury Department has delayed implementing certain health...more

The Employer’s Playbook for Affordable Care Act Compliance: Self-Insured Plans - Remember - July 31, 2013 Deadline for Paying...

Media coverage of the one year delay in certain Affordable Care Act provisions might mislead some employers into thinking they have no obligations. Many requirements still take effect this year and in 2014. Here is one of the...more

PCOR Trust Fund Fee Due Soon for Many Plans

Calendar-year plans should use updated IRS Form 720 and related instructions to file by July 31 deadline. Under the Affordable Care Act (ACA), for plan years ending on or after October 1, 2012, plan sponsors of...more

Final Affordable Care Act Regulations on the Exemption of Contraceptives Coverage by Religious Employers and Student Health...

The final regulations retain the definition of a religious employer, modify the accommodations provided for eligible organizations that object to contraception coverage on religious grounds, and describe how contraceptives...more

Supreme Court Finds DOMA to Be Unconstitutional -- Impact on Employers Explained

On June 26, 2013, a majority of the Supreme Court held in United States v. Windsor that Section 3 of the Defense of Marriage Act (DOMA), which defined marriage for purposes of federal law as the union of a man and a woman, is...more

The Employer’s Playbook for ACA Compliance: Ten Practical Strategies for 2014

The Affordable Care Act (a/k/a Health Care Reform, or the ACA) is complicated. While there is nothing in the ACA that requires any employer to provide group health care coverage to its employees, the failure to do so can come...more

Healthcare Reform White Paper: Countdown To 2014

Although the Patient Protection and Affordable Care Act (“PPACA” or the “Act”) is now over three years old, the Act’s core requirements will not take effect until 2014....more

PCORI Fee Deadline Looms For Self-Insured Health Plans

The Patient Centered Outcome Research Institute was created under the Affordable Care Act to "promote the use of evidence-based medicine by disseminating comparative clinical effectiveness research findings." The Institute is...more

Express Plan Terms Allow Self-Insured Plan to Recover Medical Benefits Paid to Employee Post-McCutchen

In Quest Diagnostics v. Bomani, et al., 11-CV-00951 (D. Conn., June 19, 2013), the court granted Quest Diagnostic’s (“Quest”) motion for summary judgment, ruling that Quest, as the fiduciary to its self-insured medical plan,...more

The Affordable Care Act’s Patient-Centered Outcomes Fee Deadline is Approaching - Many Employers with Self-Insured Plans Must...

As part of the Affordable Care Act, insurance companies offering certain health insurance policies and employers, including public agencies, that sponsor certain self-insured plans may be responsible for reporting and paying...more

Attention Employers With Self-Insured Health Plans: PCOR Fees Due July 31

Under the Affordable Care Act, certain insurers and self-insured health plans are responsible for paying fees to help fund the Patient-Centered Outcomes Research Institute. ...more

Health Care Reform Update: July 31 Fee Deadline for Most Self-Insured Plans

The IRS has released a revised version of Form 720 “Quarterly Federal Excise Tax Return” for sponsors of self-insured health plans to pay annual fees imposed under the Affordable Care Act. The fee for 2013 is $1 per covered...more

Revised IRS Form 720, Updated For Reporting Patient-Centered Outcomes Research Institute (PCORI) Fees, Now Available: Due By July...

The Affordable Care Act (the ACA) established the Patient-Centered Outcomes Research Institute (the Institute) in order to provide comparative clinical effectiveness research data so that patients, health care providers,...more

Guidance for Self-Insured Health Plans and Payment of PCORI Fees: IRS Revises Form 720

For plan sponsors and insurers wondering how to pay the fee for the Patient-Centered Outcomes Research Institute (which is due by July 31, 2013 for calendar year plans), the IRS has revised Form 720 to provide needed...more

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