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Spousal Carve Out Rules


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Jeanine:

How do you know you must provide for benefits that are mandated by Ohio?

How do you know that you cannot provide benefits that are prohibited?

I wonder if your state has a nonconventional policy provision, which could allow for this.

I am not saying that your commissioner would do this.

The question is "Has this type of negotiation ever been attempted for fully insured plans?"

Is there a state law in Ohio which prohibits this type of dialogue?

Don Levit

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Steve and Jeanine:

One thing I forgot to mention.

Metropolitan v. Massachusetts was a case between an insurer and a state.

It was not between a plan sponsor and a state.

Does anyone know of a federal case in which the 2 parties were a plan sponsor of a fully insured plan and a state?

Don Levit

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Guest b2kates

Don, should not exist, due to the Federal preemption of ERISA, states only regulate plans through the Department of Insurance requirements for insured contracts.

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Brett:

Real funny, you little .........

Okay, now this ERISA preemption stuff is hard to get a handle on.

It's been litigated for over 20 years, so I doubt we can wrap this up today.

But, if we work together, we can make some progress.

Maybe we need a bit of a breather.

Let me know when you feel more comfortable about sticking to the message, not the messenger.

Believe me, the message is a bit more important than the messenger.

Don Levit

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