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Health Care Benefits

Will New Claims and Appeals Procedures Change Case Law?

March 20, 2012
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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.
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White House Suggestions on Funding Contraception Coverage Called 'Unworkable'

March 20, 2012
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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.
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Early Retiree Health Care Plan Sponsors Have to Dec. 31, 2014, to Use ERRP Funds

March 19, 2012
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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.
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The Hot List: 2012 Health Insurers

March 14, 2012
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Consumerism Coming to Companies' Health Care Plans

March 13, 2012
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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.
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Obesity Problems Weigh on Workers' Comp

March 8, 2012
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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.
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Lines Drawn as Individual Mandate Heads to High Court

March 8, 2012
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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?
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