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Final rules: essential health benefits, cost-sharing, and actuarial value

Hodgson Russ LLP
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USA
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May 31 2013

Beginning in 2014, non-grandfathered individual health insurance policies and policies issued to small employers must provide "essential health

Notice 2012-59 90 day waiting period limitation

Hodgson Russ LLP
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USA
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September 28 2012

For plan years beginning on or after January 1, 2014, a group health plan or health insurance issuer may not use a waiting period that exceeds 90 days

Medical plan preauthorization language violates SPD standards

Hodgson Russ LLP
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USA
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August 29 2012

In Koehler v. AETNA Health Inc., the U.S. Court of Appeals for the Fifth Circuit held that Aetna’s benefits decision was not, as a matter of law, entitled to deference where the same document, Aetna’s certificate of coverage, served as both the plan document and summary plan description (SPD

Agencies issue new FAQs regarding summary of benefits and coverage

Hodgson Russ LLP
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USA
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April 27 2012

The U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury have issued a set of frequently asked questions (FAQs) regarding the implementation of the Patient Protection and Affordable Care Act

Supreme Court considers constitutionality of individual mandate

Hodgson Russ LLP
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USA
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April 27 2012

At the end of March, the U.S. Supreme Court heard arguments on the constitutionality of a provision in the Patient Protection and Affordable Care Act (ACA) that requires most U.S. residents to maintain health care coverage for themselves and their dependents

District Court holds that insurer breached fiduciary duty when crediting below market interest to retained asset accounts

Hodgson Russ LLP
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USA
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April 27 2012

Unum Life Insurance Company of America issued group life insurance policies to two employers

Supplemental life insurance benefit denied because evidence of insurability condition not met

Hodgson Russ LLP
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USA
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March 28 2012

The U.S. Court of Appeals for the Second Circuit, reversing a district court decision, ruled in favor of a life insurance company in denying supplemental life insurance benefits to a designated beneficiary

Summary of benefits and coverage: final rules issued

Hodgson Russ LLP
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USA
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February 28 2012

Group health plans and health insurance issuers offering group health insurance coverage are required to provide a written summary of benefits and coverage (SBC) for each benefit package that is offered

Final rules issued regarding reasonable health insurance premium increases

Hodgson Russ LLP
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USA
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July 29 2011

Under the Affordable Care Act (health care reform), any proposed rate increase at or above 10 percent by an individual or small group market insurer must be scrutinized by independent experts to ensure justifiability