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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

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

Legal challenges to health care reform continue to work through the courts

Hodgson Russ LLP
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USA
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April 15 2011

In late January, a district court in Florida ruled that the Patient Protection and Affordable Care Act (PPACA) is unconstitutional

MEWA held to be not fully insured under ERISA

Hodgson Russ LLP
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USA
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April 15 2011

When unrelated employers join together in an association or other group to purchase or arrange for health insurance, the association is defined as a "multiple employer welfare arrangement" or "MEWA" under the law

Same-sex domestic partner policy does not discriminate against opposite-sex couples

Hodgson Russ LLP
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USA
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April 15 2011

Reversing a decision by the Westchester County Human Rights Commission, a New York appeals court recently held that a policy adopted by a local Board of Cooperative Educational Services (BOCES) to offer health care to same-sex domestic partners did not unlawfully discriminate against opposite-sex domestic partners

Insurer not a fiduciary when negotiating rates

Hodgson Russ LLP
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USA
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February 11 2011

The Court of Appeals for the Sixth Circuit ruled that an insurer was not acting as a fiduciary when it negotiated rates with hospitals that favored its health maintenance organization clients over its self-funded plan clients