Self-Insured Health Plans

News & Analysis as of

Employee Health Plans: Good News / Bad News – State Claims Reporting Laws Do Not Apply, but Recovery of Overpayments Made More...

Employee health plans recently received good and bad news from the Supreme Court. On the upside, the Court invalidated a State law that required self-insured employee health plans (and their third-party administrators) to...more

ERISA Prevents Vermont from Requiring Self-Insured Health Plans to Provide Data Relating to Healthcare

Vermont and a few other states have adopted so-called “All-Payer Claims Databases” (“APCD”) in an effort to collect financial and other information relating to healthcare for purposes of controlling costs and generally...more

Manatt on Health Reform: Weekly Highlights - March 2016

HHS approves waiver extending Medicaid coverage to Flint residents impacted by the water crisis; SCOTUS rules that states cannot require self-insured health plans to provide claims data; and seven insurers sign on to...more

Supreme Court Update: Lockhart V. United States (14-8358), Gobeille V. Liberty Mutual Insurance Co. (14-181)

Who could have imagined a month ago that our summary of Justice Scalia's dissent in Montgomery v. Alabama (14-280) would be our last opportunity to analyze an opinion from the Justice who, alongside Jackson and Holmes, will...more

Supreme Court: ERISA Pre-empts Vermont’s Health Data Collection Law as Applied to Self-Insured Health Plans

In Gobeille v. Liberty Mut. Ins. Co., No. 14-181, 2016 U.S. LEXIS 1612 (Mar. 1, 2016), the U.S. Supreme Court held that ERISA pre-empts Vermont’s “all-payer database” law – to the extent it is applied to self-insured health...more

The Demise of ERISA Preemption has been Exaggerated

Many states have recently enacted laws requiring insurers, and self-funded health plans, to report detailed medical information to state databases, including eligibility and medical claims data. The purpose of collecting this...more

Health Coverage Providers: Deadlines for Health Coverage Providers to Report Minimum Essential Coverage are Approaching

Who Must Report? If you are a health insurance issuer, self-insured employer, or other entity that providedminimum essential coverage (MEC) during calendar year 2015, including a state government providing Medicaid or...more

APCDs: One Solution to Obtaining Meaningful Performance Data

The American health care system is under immense pressure to control costs and improve quality. As a result, there is a corresponding need for access to health care data and the development of new methods to obtain value...more

Can States Require Access to Health Care Data?

Last month, the United States Supreme Court appeared skeptical that states have the authority to require self-insured plans to supply large quantities of data regarding how much they pay for their medical claims. The case,...more

Manatt on Health Reform: Weekly Highlights - December 2015 #4

HealthCare.gov enrolls 8.2 million; Manatt and RWJF release an open access dataset on Marketplace plans nationwide; Montana names administrator for its Medicaid expansion; and Michigan gets the green light in the nick of time...more

Employee Benefits & Executive Compensation Advisory: Staying on the Compliance Track: The 2015 Health Benefits Year in Review

In a year-end flurry of activity, Congress adopted major tax and spending legislation, which was signed into law on Friday, December 18 by President Obama. The legislation, called the Consolidated Appropriations Act, 2016...more

2015 End of Year Plan Sponsor “To Do” List Health & Welfare

As 2015 comes to an end, we are pleased to present you with our traditional End of Year Plan Sponsor “To Do” Lists. Like last year, we are presenting our “To Do” Lists in three separate Employee Benefits Updates. Part 1 of...more

New Texas Medical Stop-Loss Rules Drafted by Texas Department of Insurance

Within an environment of increased federal and state regulatory emphasis on health insurance related issues arising due to the passage by the U.S. Congress of the Patient Protection and Affordable Care Act of 2010, the Texas...more

End of Year Issues Impacting Employer Health Plans

With the end of 2015 fast approaching, employers should be aware of certain issues under the Patient Protection and Affordable Care Act (“ACA”), the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and...more

IRS Adjusted ACA Fee Amounts for the 2015/2016 Policy or Plan Years and Additional Payment Options

The Patient-Centered Outcomes Research Institute (PCORI) fee was established under the Affordable Care Act (ACA) to advance comparative clinical effectiveness research. The PCORI fee is assessed on issuers of health insurance...more

PCORI Fee Inflation Adjustment

In Notice 2015-60 (October 9, 2015), the IRS announced that the PCORI fee will rise to $2.17 per covered life for plan years ending on or after October 1, 2015 and before October 1, 2016. For plan years ending on or after...more

Same-Sex Marriage is Legal – Are Your Employee Benefit Plans Up to Date?

What is the Supreme Court’s holding in Obergefell v. Hodges? LB: The U.S. Supreme Court ruled that all states must license a marriage between two people of the same sex and all states must recognize a lawful same-sex...more

Final 2015 Forms 1094-B, 1095-B, 1094-C, 1095-C and Instructions

On September 16, 2015, the IRS finalized these ACA coverage reporting Forms and Instructions... We report here, with minimal analysis, changes that we recognized on first comparison to the 2015 Draft Forms and Instructions....more

Third Circuit Rules Failure to Disclose Deadline to File Suit in Denial Letter Warrants Setting Aside Limitations of Suit...

The Third Circuit ruled on August 26, 2015, that if a claim administrator fails to disclose in its final denial letter any plan-imposed deadline to challenge the denial in court, then that deadline will be set aside in favor...more

The “Cadillac Tax” is Rollin’ In!

When healthcare reform was rolled out in 2010, there was a provision included in the law imposing a tax on healthcare benefits provided to employees that exceed a threshold cost. This tax has been referred to as the...more

Impact of the Same-Sex Marriage Decision on Employee Benefit Plans

In Obergefell v. Hodges, the Supreme Court held that states may not deny same-sex couples the right to marry, finding that doing so violates the Fourteenth Amendment. Writing for the five-justice majority, Justice Kennedy...more

Is Your Health Plan HIPAA Compliant?

Data breaches with respect to medical information are on the rise, given that such information is generally more valuable on the black market than stolen credit card data. The 2015 breach of healthcare company Anthem, Inc.,...more

July and August 2015 Filing and Notice Deadlines for Qualified Retirement and Health and Welfare Plans

Employers and plan sponsors must comply with numerous filing and notice deadlines for their retirement and health and welfare plans. Failure to comply with these deadlines can result in costly penalties. To avoid such...more

ERISA Preemption Trumps State Insurance Law Yet Again: Ninth Circuit Declines to Apply California’s Insurance Notice-Prejudice...

In a recent decision, the Ninth Circuit Court of Appeals rejected a Plan participant’s attempt to extend California insurance law’s notice-prejudice rule to self-insured ERISA plans. Zagon v. Am. Airlines, Inc., 2015 BL...more

June and July 2015 Filing and Notice Deadlines for Qualified Retirement and Health and Welfare Plans

Employers and plan sponsors must comply with numerous filing and notice deadlines for their retirement and health and welfare plans. Failure to comply with these deadlines can result in costly penalties. To avoid such...more

64 Results
|
View per page
Page: of 3
JD Supra Readers' Choice 2016 Awards

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:

Sign up to create your digest using LinkedIn*

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.

Already signed up? Log in here

*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.
×