Health plan admin - misc (BenefitsLink.com)Headlines re Health plan admin - misc, gathered by BenefitsLink.comGuidance Overview Eleventh Circuit Joins Tenth on Production of 'Appeal-Level' Medical Reviews- (Found June 19, 2008 ) Excerpt: "In this recent decision, the Eleventh Circuit added its weight to that of the Tenth on an important aspect of the standard of 'full and fair review'. The Eleventh Circuit held that an ERISA plan administrator was not required to furnish a plan participant the report of physician who conducted independent peer review of participant's medical records during review of the initial denial of participant's benefit claim. The court accepted the plan administrator's argument that it had..http://healthplanlaw.com/?p=607 Postscript to Metlife v. Glenn- (Found June 19, 2008 ) Excerpt: "In my opinion, the notion of internal firewalls and protections hinted at by Justice Kennedy shows a failure to understand the practical realities of insurance company claims administration. Moreover, Justice Roberts conflates insurance company administration and employer self-funded claims administration in his comments. I doubt anything definitive will come of this case and that we will have at least one footnote (probably by Justice Roberts) that will spawn endless...http://healthplanlaw.com/?p=609 IRS Updates 2007-2008 Priority Guidance Plan- (Found June 19, 2008 ) Excerpt: "The updated 2007-2008 Priority Guidance Plan lists regulations and other guidance still under development. It also adds new items and indicates which items have already been published. Here are some of the significant projects affecting 401(k) plans and health plans that are listed as outstanding in the updated Priority Guidance Plan . . . ." (Employee Benefits Institute of America)http://www.ebia.com/weeklyguest/19370/200805165791fb359aa19bd10905863971c790a9/BNL080424 Guidance Overview Fourth Circuit Rejects Validity of Assignments Taken in Claims Settlement- (Found June 19, 2008 ) Excerpt: "In this recent opinion, the Fourth Circuit considered the issue of derivative standing in the context of an ERISA claim for benefits action. . . . The Fourth Circuit affirmed the district court, holding that the assignments presumably taken by the original PEO defendant (Sikora) in a claims for benefit case through settlement were insufficient to create ERISA standing in a subsequent claim by the PEO against third parties (Fidelity Group) allegedly responsible for the defalcation.http://healthplanlaw.com/?p=610 Opinion The Interaction of LaRue, Bruch, and MetLife v. Glenn- (Found June 19, 2008 ) Excerpt: "The courts are already clogged with a myriad of litigation on countless subjects. It makes no sense to turn every benefit denial or administrative error immediately into a federal lawsuit without, at least, attempting to pursue participant rights through the administrative review process. If that process is not administered in an objective and responsible manner, then it should be reformed and its decisions will not be upheld by courts until it is." (Pension & Benefits...http://bnablog.bna.com/penben/2008/04/the-interaction.html Official Guidance Proposed Dept. of Defense Regs on Relationship between TRICARE and Employer-Sponsored Group Health Plans (PDF)- (Found June 19, 2008 ) 3 pages. Excerpt: "This proposed rule implements Section 1097c of Title 10, United States Code. This law prohibits employers from offering incentives to TRICARE-eligible employees to not enroll, or to terminate enrollment, in an employer-offered Group Health Plan (GHP) that is or would be primary to TRICARE. Cafeteria plans that comport with section 125 of the Internal Revenue Code will be permissible so long as the plan treats all employees the same and does not illegally take TRICARE...http://benefitslink.com/federalregister/dod_propreg_tricare.pdf UNC Health Care Requiring Patients to Pay Costs Up Front- (Found June 19, 2008 ) Excerpt: "UNC Health Care on Saturday began asking patients at its affiliated hospitals and physician clinics to pay up front for their share medical care costs, the Raleigh News & Observer reports. Under the new policy, patients will contribute up front copayments for physician visits, as well as for tests such as MRI scans." (Kaiser Family Foundation)http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=50830 Guidance Overview Carrier's Neglect in Compiling Administrative Record Constitutes an Abuse of Discretion- (Found June 19, 2008 ) Excerpt: "By relying on upon written evidence alone, the carrier in Granite v. Guardian Life abused in discretion in determining that a cancer patient had never been 'actively at work' as required by the life insurance policy. The procedural irregularities in the carrier's adjudication of this claim drew sharp criticism by the district court. The case provides a good backdrop for discussion of the concerns voiced by those critical of the deference afforded plan administrators operating...http://healthplanlaw.com/?p=569 EBSA ERISA Enforcement Efforts - Jan - Feb 2008- (Found June 19, 2008 ) Excerpt: "The U.S. Department of Labor, Employee Benefit Security Administration, reports the following enforcement results for the period January 1, 2008 - February 29, 2008 . . . ." (Health Plan Law blog by Attorney Roy F. Harmon III)http://healthplanlaw.com/?p=574 Aetna Announces Plans to Offer New Online Search Engine to Provide Members with Access to Medical Information- (Found June 19, 2008 ) Excerpt: "Aetna officials . . . announced plans to offer a new online search engine that will allow members to access at no cost medical information, information on local physicians who can address their needs and cost information based on their medical histories and coverage levels, the San Francisco Chronicle reports . . . ." (Kaiser Family Foundation)http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=50921 |