News & Analysis as of

Self-Insured Health Plans

A Seemingly Important Win for Wisconsin Worker’s Compensation Insurance Carriers and Employers

by Ruder Ware on

On its face the decision of the Wisconsin Supreme Court in Flug v. LIRC, 2017 WI 72 (decided on June 30, 2017), is a clear, important win for the employer side in common injuries that involve pre-existing degenerative...more

Self Insured Groups Save 50% More On Healthcare Coverage with this One - Two Punch: Triage and Customized Quota Share (Rebate)...

by Slim Ventures LLC on

Medium and large employers have found that they can save an average of 30% self insuring the health care of their employees. And while policymakers and pundits lament the need for healthcare reform, self insured groups...more

Update #8: American Health Care Act Passed by House May Revive Annual and Lifetime Limits in Self-Insured Employer Plans

by Davis Wright Tremaine LLP on

On May 4, the House Republicans narrowly passed the American Health Care Act (AHCA). Except for effective dates, the provisions impacting employers were generally unchanged. One major change to the original bill is that...more

House Passes Bill Blocking Federal Regulation of Stop-Loss Insurance

by Clark Hill PLC on

The U.S. House of Representatives passed the Self-Insurance Protection Act (H.R. 1304), on April 5, 2017, in an effort to preclude federal regulation of stop-loss insurance. This Act would not alter regulation of the current...more

Employment and Benefits Advisory: 2017 Reminders and Developments

by Sullivan & Worcester on

New Relief for Small Employer Health Reimbursement Arrangements - As mentioned in prior advisories, the Departments of Labor, Health and Human Services and Treasury have taken the position that employers cannot reimburse...more

Q&A with Paula Williams: Guidelines allow voluntary employer wellness programs

by GableGotwals on

Guidelines allow voluntary employer wellness programs - Q: A federal court recently heard a case involving a corporate wellness program. What was the basis for the Equal Employment Opportunity Commission (EEOC) lawsuit...more

2016 End of Year Plan Sponsor “To Do” List: Health & Welfare

by Snell & Wilmer on

As 2016 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

Reminder: November 15 Transitional Reinsurance Program Filing Deadline is Fast Approaching

by Bass, Berry & Sims PLC on

To help stabilize the individual insurance market, Section 1341 of the Affordable Care Act introduced the Transitional Reinsurance Program (TRP), which includes the collection of a TRP fee from “contributing entities” for...more

HIPAA Compliance – Not Just an Issue for Health Care Providers

by Dechert LLP on

Many people believe that compliance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) is solely an issue for health care providers and their affiliates. However, nothing could be further from the...more

Just What The Doctor Ordered: Court Denies The EEOC’s Motion For Summary Judgment In ADA Suit Regarding Employer’s Wellness...

by Seyfarth Shaw LLP on

Seyfarth Synopsis: After the EEOC brought an action under the Americans With Disabilities Act against an employer who implemented a wellness program requiring employees to take a health assessment to participate, the Court...more

Michigan Health Insurance Claims Assessment Act is Not Preempted by ERISA

by McDermott Will & Emery on

The Sixth Circuit, has decided, on remand from the Supreme Court, that the Michigan Health Insurance Claims Assessment Act (Act) is not preempted by ERISA. The Act imposes a 1 percent tax on all paid claims by insurers or...more

Affordable Care Act Compliance: IRS Releases Draft 2016 Employer Reporting Forms and Instructions

by McDermott Will & Emery on

The Internal Revenue Service recently issued revised draft Forms 1094-C and 1095-C and related instructions for use for the 2016 reporting year. ...more

Deadline Reminder for Employers and Providers: Electronically File Information Returns with IRS by June 30

by Bryan Cave on

Self-insured employers, applicable large employers and health coverage providers are reminded that the June 30 deadline to electronically file information returns with the IRS is approaching. The deadline to provide...more

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

by McGuireWoods LLP on

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

by Bryan Cave on

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

by Shipman & Goodwin LLP on

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

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

by Alston & Bird on

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

by Snell & Wilmer on

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

by Locke Lord LLP on

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

by Sherman & Howard L.L.C. on

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

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