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Agencies issue new FAQS regarding implementation of ACA

Proskauer Rose LLP
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USA
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April 30 2013

The US Departments of Labor, Health and Human Services (HHS), and the Treasury (the "Agencies") jointly issued yesterday a document entitled "FAQs

IRS releases final regulations on comparative effectiveness research fee to fund PCORI; guidance on transitional reinsurance fee

Proskauer Rose LLP
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USA
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December 10 2012

On December 5, 2012, the Internal Revenue Service ("IRS") released final regulations regarding the payment of fees by insurers and plan sponsors of group health plans to fund the Patient-Centered Outcomes Research Institute (the "Institute" or "PCORI"

The Affordable Care Act and its coverage mandates for employers: a potent recipe for ERISA class actions

Proskauer Rose LLP
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USA
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August 20 2012

Although the Patient Protection and Affordable Care Act (ACA) has engendered much controversy (pro and con) in the business community, one area that has received less discussion is whether ACA may increase employers’ exposure to high-stakes class action litigation

Supreme Court upholds the Affordable Care Act’s individual mandate: what it means for employers and plan sponsors

Proskauer Rose LLP
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USA
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June 28 2012

The Supreme Court of the United States (the "Court") ruled today, in a 5-to-4 landmark decision, that the individual mandate under the Patient Protection and Affordable Care Act ("the Act") is constitutional, although it also held that certain Medicaid expansion provisions are unconstitutional

Third Circuit limits relief available to ERISA welfare plans seeking reimbursement of medical expenses

Proskauer Rose LLP
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USA
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November 17 2011

In a case of significant importance for plan sponsors and fiduciaries, the U.S. Court of Appeals for the Third Circuit held in US Airways, Inc. v. McCutchen, No. 10-3836 (3d Cir. Nov. 16, 2011), that an employee benefit plan was not entitled to full reimbursement of medical expenses it paid to a participant even though the plan provided that the participant was required to reimburse the plan for all amounts paid "out of any monies recovered from a third party."

Exhaustion of benefit claims

Proskauer Rose LLP
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USA
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November 7 2011

In Laird v. Norton Healthcare, Inc., No. 10-5205, 2011 WL 4597539 (6th Cir. Oct. 6, 2011), the Sixth Circuit held that claims for short-term disability ("STD") benefits and long-term disability ("LTD") benefits were properly denied for failure to timely exhaust the respective plans' administrative remedies

Disability benefit offsets

Proskauer Rose LLP
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USA
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November 7 2011

In Riley v. Sun Life & Health Insurance Co., --- F.3d ----, No. 10-2850, 2011 WL 4634218 (8th Cir. Oct. 7, 2011), the Eighth Circuit held that a long-term disability plan administrator could not offset from plaintiff’s monthly disability benefits the amount of Department of Veterans Affairs benefits the plaintiff also received for the same condition

Preemption

Proskauer Rose LLP
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USA
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November 7 2011

In Fossen v. Blue Cross and Blue Shield of Montana, Inc., ---F.3d---, 2011 WL 4926006 (9th Cir. Oct. 18, 2011), the court held that ERISA and HIPAA preempted plaintiffs’ state law claims seeking restitution of health care coverage premiums they allegedly overpaid

The constitutionality of the individual mandate under the Affordable Care Act an issue now ripe for Supreme Court review

Proskauer Rose LLP
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USA
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November 7 2011

Section 1501 of the Affordable Care Act requires all individuals (with limited exception) to buy health insurance or pay a penalty to the federal government, starting in 2014

Implementing a high deductible health planhealth savings account re-design and planning for open enrollment

Proskauer Rose LLP
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USA
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November 7 2011

In light of health care reform and health plan re-design issues, a lot of employers are looking at high deductible health plans and health savings accounts to give people additional options

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