Tag Archives: Medical Plans

EIGHTH CIRCUIT RULES AGAINST THIRD PARTY ADMINISTRATOR IN CROSS-PLAN OFFSETTING IN GROUP HEALTH PLANS

 On January 15, 2019, the federal Eighth Circuit Court of Appeals issued its decision in Peterson v. UnitedHealth Group, Inc., 913 F.3d, 769 (8th Cir. 2019), in which the Court upheld the federal district court’s holding that UnitedHealth Group, Inc. (“United”) was not authorized to reduce (or “offset”) payments to medical providers under ERISA group … Continue Reading

EEOC Pregnancy Discrimination Enforcement Guidance Implicates Contraception Coverage Concerns

On July 14, 2014, the EEOC issued new Enforcement Guidance on Pregnancy Discrimination and Related Issues.  The immediately-effective Guidance sets forth the EEOC’s policies with regard to its enforcement of pregnancy-based employment discrimination prohibitions under Title VII — as clarified by the Pregnancy Discrimination Act of 1978 — and other federal laws. With regard to … Continue Reading

Proposed Regulations on Certificates of Creditable Coverage

Proposed regulations published on March 21, 2013 addressed not only the 90-day waiting period rule discussed below but also the eventual elimination of notices of creditable coverage under HIPAA’s preexisting condition exclusions rules. The 2010 health care reform law prohibits group health plans from imposing preexisting condition exclusions, effective for plan years beginning on or … Continue Reading

Health Care Reform Resource Center

We are pleased to announce the launch of Jackson Lewis’ Health Care Reform Resource Center. Our Resource Center provides one convenient place for you to obtain key health care reform-related law, agency guidance, Jackson Lewis articles and related information. We hope you find this resource helpful.… Continue Reading

New Rules Require Health Plans to Cover Women’s Contraception

Group health plans that are not grandfathered under the 2010 health care reform law (the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010) must provide women’s contraception without cost-sharing beginning with the first plan year that starts on or after August 1, 2012. The three agencies … Continue Reading

IRS Delays Enforcement of Health Care Reform Nondiscrimination Provisions for Insured Group Plans

The Internal Revenue Service has given a last-minute holiday gift to sponsors of insured group health plans.  It announced delayed enforcement for the new nondiscrimination provisions applicable to insured group health plans under the Patient Protection and Affordable Care Act of 2010 (as amended by the Health Care and Education Reconciliation Act of 2010; together … Continue Reading

FAQs on Coverage for Adult Children Under Health Reform

As group health plans brace for open enrollment periods under the new Patient Protection and Affordable Care Act of 2010, one of the key issues they face is the Act’s new coverage requirements for adult children. Previously, a child became ineligible for family coverage under a group health plan for federal tax purposes once the … Continue Reading
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