Showing 47 posts in Insurance.
ERISA Challenge to Michigan’s Health Insurance Claims Tax is Rejected
On August 31, 2012, a federal district court ruled that the Michigan Health Insurance Claims Assessment Act is not preempted by the federal Employee Retirement Income Security Act. The act imposes a 1% tax on paid health insurance claims for services rendered in Michigan to residents of Michigan. The tax is assessed against commercial insurers, HMOs, nonprofit health and dental corporations, Medicaid managed care organizations, specialty prepaid health plans, third-party administrators, and group health plan sponsors. The act, which took effect on January 1, 2012 and expires on December 31, 2013, authorizes the state to collect up to $400 million in revenues each year, which are used to fund the Michigan state share of the Medicaid program. When combined with the federal multiplier, the tax will generate $2.4 billion in funding for Michigan’s Medicaid program. Read More ›
Categories: Employee Benefits, Insurance, Tax
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Upcoming Workshop to Address Most-Favored-Nation- Clauses - Just Announced
On August 17, 2012, the Department of Justice (“DOJ”) and the Federal Trade Commission (“FTC”) announced that they will hold a joint public workshop addressing insurers’ use of most-favored-nation clauses (“MFNs”). The all-day workshop will be held on September 10, 2012 in Washington DC and will be in-person, free and open to the public. At the workshop, the agencies intend “to explore the use of MFN clauses and the implications for antitrust enforcement and policy.” The workshop will also include a series of panel discussions examining the legal treatment of MFNs, the economic theories concerning MFNs, and their impact upon the health care industry. Read More ›
Categories: Hospitals, Insurance, Physicians
Most Favored Nation Order Released by Michigan Insurance Commissioner
In what appears to be a strong response to the most favored nation ("MFN")-related lawsuits filed against Blue Cross Blue Shield of Michigan by the U.S. Department of Justice and Aetna, the Commissioner of the Michigan Office of Financial and Insurance Regulation (“OFIR”) issued an Order dated July 18, 2012. The Order prohibits insurers, HMOs, and Blue Cross Blue Shield of Michigan from either using or enforcing MFN clauses in their provider contracts unless the MFN clause has been filed with and approved by the OFIR Commissioner. This prohibition takes effect February 1, 2013. To read the Order, see the Order posted on the Department of Licensing and Regulatory Affairs webpage.
Categories: Billing/Payment, Hospitals, Insurance
Breaking News: US Supreme Court Upholds Health Care Reform
Today, the United States Supreme Court released its highly anticipated opinion regarding the constitutional challenges to the Patient Protection and Affordable Care Act (the "Act"). The Court ultimately concluded that the Act was constitutional, but it did not grant a complete victory to the government. The Court also held that the federal government may not withhold all Medicaid funds from States that fail to comply with the expansion of Medicaid provisions of the Act. Instead, the federal government may only withhold new Medicaid funds from States that do not comply. Read More ›
Categories: Employment, Health Care Reform, Health Insurance Exchange, Insurance
Michigan State University’s Health Insurance Mandate May Constrain Tuition Increases
Michigan State University (“MSU”) currently requires that uninsured students obtain health insurance as part of its fee structure. This requirement impacts approximately 14 percent of students. While this requirement is aligned with the Patient Protection and Affordable Care Act’s (“PPACA”) individual mandate, the requirement may negatively impact MSU’s ability to raise tuition. Read More ›
Categories: Insurance
Michigan's Integrated Care Proposal for Individuals Eligible for both Medicare and Medicaid
On April 26, 2012, the State of Michigan submitted its Integrated Care Proposal (Pilot Program) to the Centers for Medicare and Medicaid Services (CMS), for review and approval. The Pilot Program is Michigan’s plan to jointly manage the care of approximately 200,000 residents who are eligible for both Medicare and Medicaid. The Pilot Program submitted to CMS is not yet available on the Internet for public review. However, the Department of Community Health has prepared a list of FAQs about the Program on its website. Read More ›
Categories: Insurance, Medicare/Medicaid
Agencies Issue Regulations on Summary of Benefits and Coverage Requirements
The Departments of the Treasury, Labor and Health and Human Services (collectively, the "Departments") recently published the final regulation (the "Regulation") with regard to the Summary of Benefits and Coverage ("SBC") requirements under the Patient Protection and Affordable Care Act ("PPACA"). The Regulation implements certain disclosure requirements in order to help individuals and health plans better understand their medical coverage as well as other coverage options. Many liken the SBC to the summary plan description for retirement plans. Read More ›
Categories: Employee Benefits, Employment, Insurance, Regulatory, Retirement
House of Representatives Votes to Repeal Part of PPACA
On Wednesday, February 2nd, the U.S. House of Representatives approved a measure to repeal the CLASS Act. A similar repeal measure is pending in the U.S. Senate.
The CLASS Act is a heavily criticized portion of the health care reform law. CLASS, or Community Living Assistance Services and Supports, is a national, voluntary insurance program that is intended to offer working individuals some protection against the cost of paying for long-term care. Individuals who pay into the program for at least 5 years and who were employed during at least 3 of those 5 years would, if ever needed, receive a daily cash benefit of at least $50 per day to purchase services and support necessary to remain independent. For example, CLASS would cover home health care, adult day care, home modifications, respite care, transportation services, and the like. Read More ›
Categories: Health Care Reform, Insurance
While Michigan's Congress may be stalling, Employers Should Still Plan for 2014 Health Exchange
Even though the Republican-run Michigan House of Representatives is stalling legislation to create the Michigan Health Exchange, 2014 is quickly approaching. Starting in 2014, insurance will be available on Health Exchanges. If Michigan does create legislation creating its own Exchange, the federal government will implement one for Michigan residents. This will impact Michigan employers and individuals. Read More ›
Categories: Health Care Reform, Health Insurance Exchange, Insurance
Employers Beware: If you extend COBRA benefits, you may be denied stop-loss coverage
A recent case highlights why a plan sponsor must use caution when agreeing to provide COBRA coverage that extends beyond the maximum COBRA coverage period. The court in Bekaert Corporation v. Standard Security Life Insurance Company of New York, 2011 WL 3568028 (N.D. Ohio) recently held that an employer who offered extended COBRA coverage pursuant to a separation agreement with a particular employee was not entitled to stop-loss coverage. In Bekaert,a retiree received extended COBRA continuation health coverage pursuant to a separation agreement with the employer. The retiree's medical claims were paid under the employer's self-funded health plan and then were submitted for reimbursement under the employer's stop-loss policy as excess loss claims. The stop-loss carrier denied the claims, stating the retiree was not a covered person under the stop-loss policy. Read More ›
Categories: Employee Benefits, Employment, Hospitals, Insurance, Physicians
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Best Lawyers® 2021
Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:
- Jennifer B. Van Regenmorter, Holland
To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.