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[Guidance Overview]

Editor's Pick Michigan's New Auto Insurance Law and Group Health Plans

"Under Michigan's new law, residents can opt out of [personal injury protection (PIP)] coverage entirely if they have qualified health coverage that meets specific requirements ... Health insurers and health plans will be required to provide a document that indicates whether a person's coverage is 'qualified health coverage.' ... [S]ponsors of group health plans should consider reviewing their plans' coordination of benefits (COB) provisions and communicating with participants about how their group health coverage coordinates with PIP coverage."

Segal Consulting

Plan May Sue TPA for Fiduciary Breach Stemming from Claim Payment Delay

"The court ruled that the plan could assert fiduciary claims under ERISA because denying that right would be inconsistent with ERISA's primary purpose to protect plan participants and beneficiaries. Moreover, barring the plan from suing under ERISA could leave the plan without a remedy, since the TPA argued that ERISA would preempt any state-law contract claims brought by the plan." [Technibilt Group Ins. Plan and Technibilt Ltd. v. Blue Cross and Blue Shield of North Carolina, No. 19-079 (W.D. N.C. Feb. 3, 2020)]

Thomson Reuters / EBIA

District Court Allows COBRA Election Notice Claims to Proceed

"As a result of the allegedly deficient COBRA election notices, the participant argued that he and his spouse lost their health insurance coverage and sustained 'informational injury.' The participant and his spouse also asserted that they incurred medical bills relating to the spouse's appointments and surgery. The employer moved to dismiss for failure to state a claim.... [T]he district court concluded that the participant sufficiently alleged COBRA notice violations and denied the employer's motion to dismiss." [Riddle v. PEPSICO, Inc., No. 19-3634 (S.D.N.Y. Feb. 24, 2020)]

Thomson Reuters Practical Law

Proposed Regs Address Penalties for MSP Reporting Violations

"While relatively few employers are [responsible reporting entities (RREs)], employers that are group health plan sponsors may be asked to assist their insurers or TPAs in compiling information about participants in their plans. CMS has emphasized the importance of employer cooperation with their plans' RREs. With enforcement activity on the rise, failing to provide necessary information and assistance will put insurers and TPAs at risk of penalties for noncompliance."

Thomson Reuters / EBIA

How States Are Using Independent Dispute Resolution to Resolve Out-of-Network Payments in Surprise Billing

"[Independent dispute resolution (IDR)] has been adopted in nine of the 13 states with comprehensive surprise medical bill protections, either alone or as part of a hybrid approach. In addition, several states without comprehensive protections also use IDR. IDR is also a component in several federal proposals. Some states contract with an existing IDR entity with experience in reviewing benefit appeals. Other states use formal arbitrators trained by organizations like the American Arbitration Association."

The Commonwealth Fund

Addressing Surprise Billing by Setting Payment Standards for Out-of-Network Providers

"Despite bipartisan support for balance billing protections, policymakers have struggled to identify a method for resolving payment disputes that is acceptable to both providers and insurers. [This article discusses] various payment standards adopted by states and key considerations for policymakers."

The Commonwealth Fund

OPM Reports Improvement in Federal Employees Health Benefits Program Performance

"Since 2016, OPM has assessed insurers' FEHBP performance on an annual basis, measuring clinical quality, customer service and resource use, or QCRs. The agency then uses individual insurance companies' QCR scores to determine their service charge and performance bonus. In all, 31 carriers improved over their 2018 scores, while six companies earned the maximum available bonus[.]"

Government Executive

Pennsylvania Moves to Cut Ties with Federal Enrollment Platform

"While Nevada is taking stock of its first [ACA] open enrollment period as a true state-based exchange, Pennsylvania is gearing up to follow in the silver state's footsteps and make its own break with Pennsylvania is one of three states -- alongside New Jersey and New Mexico -- that are planning an imminent transition from the federal health insurance enrollment platform to their own state-based exchange."


Benefits in General

Editor's Pick Litigating the Scope of ERISA's 'Catchall' Civil Enforcement Provision

"Recent ERISA benefits denial cases show that allowing more types of Section 1132(a)(3) claims past the pleading stage has consequences, not all of which may have been intended -- particularly where those claims are closely related to, or in some cases duplicative of, Section 1132(a)(1)(B) claims advanced in the same case."

Manatt, Phelps & Phillips, LLP

Upcoming Events About Health & Welfare Plans

Mar. 4
IRA and HSA Seminar
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District of Columbia
Healthcare Coverage and Costs: Assessing Medicare-Based Approaches
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What To Do When Culture Sucks
Worldwide Employee Benefits Network [WEB] - Greater Cincinnati Chapter
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Mar. 5
Integrated Healthcare Delivery, Data Analytics, and Coordinated Care - Reducing the Cost of Care with Kaiser Permanente
Worldwide Employee Benefits Network [WEB] - Baltimore Chapter
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Most Popular Items in the Previous Issue, Inc.
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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