Health care reform regulations that took effect for the 2011 plan year require non-grandfathered self-insured and insured group health plans to make changes to their internal appeal procedures and offer external reviews of denied claims. As a result, all plans, whether subject to or exempt from ERISA, will have to follow the same general claim-handling rules.
Under one administration suggestion, TPAs could fund the coverage through rebates they receive from drug manufacturers that the TPA is not contractually liable to forward to the affiliates.Read More
Under the ERRP, early retiree health care sponsors are reimbursed for 80 percent of claims—up to $90,000—after a participant incurs $15,000 in expenses.Read More
Large employers at the annual National Business Group on Health conference held last week grappled with uncertainty around health care, but one thing was clear: Employees will be asked to do more to keep costs down by staying healthy and becoming savvier consumers. Read More
Not only are obese workers comp claimants likely to miss more work days than healthy-weight co-workers with similar injuries, obese workers are likely to have higher medical costs and are more likely to become permanently disabled, research has shown.Read More
The Supreme Court is expected to rule by June on whether the individual mandate is constitutional. And if not, can it be severed from the rest of the Patient Protection and Affordable Care Act?Read More