As the political battles – and stalemate - over the Affordable Care Act continues, employers may find themselves with the worst of all worlds. The portions of the ACA that create the greatest burdens on employers, such as the mandates, taxes and administrative obligations under the ACA stay, in place. At the same time, uncertainty in the individual markets creates blowback that hurts employers in a number of ways.
Two recent cases illustrate the risks of allowing plan practices to diverge from plan documents. In one case, Acosta v. Macy’s, the Department of Labor has brought a lawsuit against Macy’s department store for (among other things) changing the payment methodology for calculating out-of-network claims without appropriately modifying the Macy’s plan document. In the other case, Erwood v. Life Ins. Company of North America, an administrator’s failure to follow documented plan procedures triggered a $750,000 judgment. Both of these cases highlight how easy it is to overlook the fundamental ERISA responsibility of ensuring that plan administration syncs up with the plan documentation. And, both of these cases highlight the risks posed by such failure.
As legislators continue to repeal and replace the ACA, they look for new ways to separate portions the insurance markets into different segments. Some efforts counter actuarial and insurance principles: segmenting the risk pool increases volatility and that creation of different risk pools based on health status and effect premiums
As the debate in Washington rages on over the efforts to repeal and replace the Affordable Care Act (ACA) there is a fundamental truth that is being ignored: there are no provisions of the current […]
More Americans are working past 65 and continue to have employer-sponsored health insurance. However, the intersection of Medicare and employer coverage has a number of traps for the unwary and some of these traps come […]