The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors
Key Takeaways - The Delaware Department of Insurance (Department) is conducting targeted market conduct exams of Third Party Administrators (TPAs) for compliance with state insurance laws and regulations....more
I was very lucky that when I started as an ERISA attorney in 1998, I worked as a staff attorney for a third-party administrator (TPA). It gave me insight and experience that I could never have gotten as an attorney working...more
At work and at home, one of the worst things I ever did was make a mistake and not accept responsibility for it. Instead of owning up, I would make excuses, turning the fight over the mistake into a bigger issue than the...more
Our “health plan hygiene” series has focused on steps that fiduciaries of employer-sponsored group health plans can take to ensure they meet their fiduciary responsibilities. This issue has been brought to the forefront...more
A health plan’s fiduciaries are responsible for administering the health plan. Because most employers are not in the business of administering health benefits, they outsource the day-to-day health plan administration to a...more
A U.S. District Court in Connecticut recently issued an order that highlights the importance of understanding exactly what the term “medically necessary” means in an ERISA health plan....more
In De Dios v. Indemnity Insurance Company of North America, the Iowa Supreme Court set out to answer a certified question of law: Can third-party administrators be liable for bad faith failure to pay workers’ compensation...more
Recently, two state insurance departments took action against third party administrators in their respective states based on their failure to be properly licensed. These regulatory actions demonstrate the importance for TPAs...more
One of the most annoying phrases out there is: “if it ain’t broken, don’t fix it”. I have disliked it for more than 20 years after seeing a student government political candidates use it back at Stony Brook. Through...more
In This Issue: - Nevada Begins Audits of TPAs - Insurers Challenge Requirement to Use Social Security Death Master File - ACLI Files Lawsuit Regarding Prohibition on Offshoring - Tennessee Modifies...more