Health Plan Law contains information about group health plans, claims administration and related ERISA fiduciary issues. Roy F. Harmon, author of this website, is a principal in Harmon & Major, P.A., a law firm located in Greenville, South Carolina and has over twenty years experience in ERISA matters, from plan design and drafting to case controversies and litigation.
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More on this later, but Judge Henry Hudson has ruled that the PPACA individual mandate is unconstitutional: Judge Henry E. Hudson ruled Monday for the state’s claim that the requirement for people to purchase health care exceeds the power of Congress under the Constitution’s Commerce...
Thus, in a nutshell, Blue Cross lowered rates for its own subsidiary by effectively raising them for Flagstar and other self-insured plans. The letter agreements between Blue Cross and the hospitals spell out these facts in black and white. But that does not mean that Flagstar knew about the deals....
The Courts of Appeals disagree as to whether Varity prohibits a plaintiff from simultaneously pursuing equitable relief pursuant to Section 502(a)(3) and benefits due under the terms of the plan pursuant to Section 502(a)(1)(B). The Third Circuit has not ruled on the issue, and district judges...
The federal agencies regulating under the PPACA have determined that changing issuers should not result in a loss of a plan’s grandfathered status. The new guidance was anticipated inasmuch as a change in insurers is frequently necessary and the distinction between self-funded plans (that...
It appears that the individual mandate under the PPACA may be headed for rough sailing. Here is an excerpt from an opinion today in which the Obama administration’s motion to dismiss was denied. The government has never required people to buy any good or service as a condition of lawful...
The Employee Benefit Security Administration has published several “frequently asked questions” installments. These FAQ’s supplement the several interim rules providing guidance on some of the many vague standards set forth in the PPACA. The regulatory effect of a FAQ is perhaps an untested legal...
Here, US Airways seeks the restoration of particular funds, the lawsuit settlement and UIM benefits, as distinct from McCutchen’s general assets, traceable to the Plan and subject to an equitable lien for the benefit of the Plan. Therefore, even if the monies paid to McCutcheon are not specifically...
There are a number of federal criminal, civil and administrative enforcement provisions set forth in the Medicare statutes which are aimed at preventing fraudulent conduct, including hospice fraud, and which help maintain program integrity and compliance. Some of the more prominent enforcement...
“ERISA provides certain minimal procedural requirements upon an administrator’s denial of a benefits claim.” Wade v. Hewlett-Packard Dev. Co. LP Short Term Disability Plan, 493 F.3d 533, 539 (5th Cir. 2007). The plan administrator must “provide adequate notice in writing to...
We have never considered whether § 502(a)(3) authorizes equitable reformation of an ERISA plan due to a scrivener’s error, but our case law addressing the related problem of ambiguous plan language suggests that such relief may be appropriate. Young v. Verizon’s Bell Atl. Cash Balance...