ThomsonReuters

MAY 4, 2023

2023) Available at [link] The First Circuit has upheld a trial court’s conclusion that a third-party administrator (TPA) for a self-insured multiemployer health plan was not an ERISA fiduciary based on its administrative activities (see our Checkpoint article ). Thus, the TPA lacked discretionary authority over plan management.

Compliance 64

Compliance 64

ThomsonReuters

MARCH 9, 2023

2023) Available at [link] Two self-insured health plan participants diagnosed with a rare health condition incurred prescription drug expenses of over $50 million, leading the employer plan sponsor to file this lawsuit against the plan’s pharmacy benefits manager (PBM) and stop-loss insurer.

Compliance 52

Compliance 52

ThomsonReuters

MAY 12, 2022

CMS Toolkit on COVID-19 Vaccine: Health Insurance Issuers and Medicare Advantage Plans (Apr. CMS has updated its COVID-19 vaccine toolkit to describe the COVID-19 vaccines and boosters currently authorized or approved by the Food and Drug Administration (FDA). Available at [link].

52

52

ThomsonReuters

MAY 27, 2021

In a dispute about life insurance benefits under an employer-sponsored ERISA plan, the Second Circuit has upheld a trial court’s use of the deferential arbitrary and capricious standard of review, ruling that the plan adequately delegated discretionary authority to the plan’s insurer. Program, 2021 WL 1748474 (2d Cir.

Compliance 52

Compliance 52

ISA

JANUARY 31, 2024

There are numerous reasons to seek a professional appraisal, including planning insurance coverage, charitable donations, probate of an estate, or simply determining the value of your tangible assets. 1/31/2024 12:00:00 AM Hiring an ISA personal property appraiser provides many benefits.

Appraisal 75

Appraisal Fair Market Value Compliance Marketability 75

ThomsonReuters

APRIL 7, 2022

The Ninth Circuit has reversed a federal trial court’s ruling that a large insurer breached its fiduciary duty to health plan participants by using overly restrictive guidelines for administering claims. United Behavioral Health, 2022 WL 850647 (9th Cir. Available at [link].

Compliance 97

Compliance 97

Harvard Corporate Governance

APRIL 17, 2023

Instead, crisis-fighting finds central bankers joining fiscal authorities, deposit insurers, and other regulators while using multi-pronged interventions that target every region of banks’ balance sheets. But while this association is highly salient, it has never represented the full story.

Banking 201

Banking Finance Marketability 201

ThomsonReuters

JUNE 15, 2023

The trial court held that requiring plan coverage of PrEP violates the RFRA and that members of the USPSTF were unconstitutionally appointed and therefore lacked the authority to determine the preventive services that must be covered by private health plans (see our Checkpoint article ). 1 (“Preventive Health Services”).

98

98

Truelytics

MAY 25, 2023

In this episode of the Modern Financial Advisor Podcast, Lucas Siegel , CEO of Harbor Life Settlements shares how financial advisors can help their clients unlock assets that are lying dormant and unproductive in their life insurance policy. Subscribe to the Podcast!

Technology 52

Technology 52

ThomsonReuters

FEBRUARY 10, 2022

The report to Congress emphasizes that health plans and insurers are failing to deliver parity in mental health and substance use disorder benefits and identifies the top noncompliant NQTLs. See also EBIA’s Self-Insured Health Plans manual at Section XIII.E (“Coverage Limitations and Exclusions”).

Compliance 98

Compliance Equity 98

Reynolds Holding

APRIL 10, 2024

The provision would grant the FDIC authority to recoup up to two years of compensation from any senior executive of a failed bank or a parent holding company who was responsible for the bank’s failed condition. banks through special assessments for the Deposit Insurance Fund, which we analyzed here.

Banking 45

Banking Equity Finance 45

ThomsonReuters

NOVEMBER 10, 2022

And more recently, courts have begun to consider the agencies’ authority to determine the preventive services that must be covered by private health plans (see, e.g., our Checkpoint article ). For more information, see EBIA’s Health Care Reform manual at Section XII.C (“Coverage of Preventive Health Services”).

105

105

Appraisers Blog

MARCH 29, 2024

The LAW being cited merely authorizes HUD to seek VOLUNTARY cooperation. Their entire philosophy and that of their employers (E&O insurers) is to ‘settle’ cases. There is only so much money E&O insurers will spend on a case. Not even for the case involved. It does not in any way mandate compliance.

Appraisal 64

Appraisal Compliance 64

ThomsonReuters

JANUARY 7, 2021

ANSWER: “Transparency in coverage” refers to an Affordable Care Act provision that requires health plans and insurers to disclose certain cost-sharing information to participants, beneficiaries, enrollees, and, in some cases, the public. But “grandmothered” health plans are required to comply. as a deductible or an out-of-pocket limit).

98

98

ThomsonReuters

OCTOBER 14, 2021

The court explained that ERISA authorizes only plan participants and beneficiaries to sue for benefits. Providers, lacking direct authority to sue under either of these categories, may obtain derivative standing through an assignment from a participant or beneficiary—but here, that pathway was blocked by an anti-assignment clause.

Compliance 98

Compliance 98

ThomsonReuters

APRIL 20, 2023

In Braidwood , a federal trial court held that the members of USPSTF—but not HRSA or ACIP—lacked the authority to determine the preventive services that must be covered by private health plans (see our Checkpoint article ). See also EBIA’s Self-Insured Health Plans manual at Section XIII.C.1

98

98

ThomsonReuters

NOVEMBER 12, 2020

This case considered whether a benefits committee had properly delegated discretionary authority to a service representative to make an adverse benefit determination for accidental death benefits, so that the court could apply a deferential standard of review.

Compliance 52

Compliance 52

ThomsonReuters

JUNE 30, 2022

The disclosures are intended to allow the public to access health insurance coverage information that can be used to understand health care pricing. See also EBIA’s Self-Insured Health Plans manual at Section XXVIII.H (“Transparency in Coverage Cost-Sharing Disclosures”). Contributing Editors: EBIA Staff.

Marketability 98

Marketability 98

Law 360 M&A

JANUARY 5, 2024

Here, Law360 looks at these and other new claims in the U.K.

40

40

ThomsonReuters

JUNE 30, 2022

The disclosures are intended to allow the public to access health insurance coverage information that can be used to understand health care pricing. See also EBIA’s Self-Insured Health Plans manual at Section XXVIII.H (“Transparency in Coverage Cost-Sharing Disclosures”). Contributing Editors: EBIA Staff.

Marketability 96

Marketability 96

ThomsonReuters

NOVEMBER 3, 2022

An out-of-network health care provider has sued multiple health insurers for failing to reimburse the full cost of COVID-19 testing as posted on the provider’s public website. Given that these cases involve major insurers that also provide administrative services for self-insured plans, their resolution could have far-reaching effects.

Compliance 52

Compliance 52

ThomsonReuters

JUNE 16, 2022

An entity may be a functional fiduciary to the extent it exercises discretionary authority or control over plan management, or any authority or control over management or disposition of plan assets. The court next considered whether the TPA had authority or control over plan assets. Laborers’ Health and Welfare Fund v.

Compliance 52

Compliance 52

Reynolds Holding

JANUARY 5, 2023

The Board of Governors of the Federal Reserve System (Federal Reserve), the Federal Deposit Insurance Corporation (FDIC), and the Office of the Comptroller of the Currency (OCC) (collectively, the agencies) are issuing the following statement on crypto-asset1 risks to banking organizations.

Banking 49

Banking Finance Compliance Marketability 49

ThomsonReuters

JULY 28, 2022

An out-of-network health care provider sued an insurer under the Coronavirus Aid, Relief, and Economic Security (CARES) Act for failing to reimburse the full cost of COVID-19 testing as posted on the provider’s public website. See also EBIA’s Self-Insured Health Plans manual at Section XIII.C.11

Compliance 52

Compliance 52

ThomsonReuters

FEBRUARY 23, 2023

As background, responsible reporting entities (RREs) for group health plans—typically insurers or third-party administrators (TPAs)—are required to report information to CMS about individuals who are both entitled to Medicare and covered under a group health plan.

52

52

ThomsonReuters

FEBRUARY 18, 2021

QUESTION: Our company is planning to change our ERISA-covered health plan from an insured plan to a self-insured plan. Even if you intend to keep the covered benefits the same, certain information in the SPD must change to reflect the plan’s self-insured status.

Compliance 59

Compliance 59

Reynolds Holding

JANUARY 1, 2024

That elaborate template authorizes, conditions, and limits channeling orders in specific ways and applies only to mass-asbestos cases. Much expert analysis suggests that the Court will significantly narrow, or perhaps reject, bankruptcy-court authority to issue channeling orders functioning as nonconsensual third-party releases.

64

64

ThomsonReuters

FEBRUARY 24, 2022

As background, the laws and related agency guidance require group health plans and insurers to cover COVID-19 diagnostic testing without cost-sharing, prior authorization, or other medical management requirements (see our Checkpoint article ). See also EBIA’s Self-Insured Health Plans manual at Section XIII.C.11

98

98

ThomsonReuters

JUNE 23, 2022

In 18 states, a “bifurcated” process applies; parties in those states are instructed to review state law and consult with state authorities to determine which process applies. Plans and insurers in states with a bifurcated process may find this a helpful starting place in determining which process applies to a particular dispute.

98

98

ThomsonReuters

SEPTEMBER 22, 2022

As background, the DOL’s investigative authority under ERISA includes the power to issue subpoenas for documents and records, and courts have generally given the DOL broad authority regarding the variety of materials that it can seek through a subpoena. Contributing Editors: EBIA Staff.

Compliance 52

Compliance 52

Reynolds Holding

MARCH 23, 2023

Surprisingly, some of the citations were not only inaccurate but non-existent, specifying fake titles and arbitrarily crediting them to authors. For instance, if AI creators are strictly liable for all harm, even when taking precautions to prevent it, this gives victims implicit insurance.

Compliance 92

Compliance Marketability Technology 92

ThomsonReuters

JANUARY 21, 2021

QUESTION: If a participant asks our self-insured health plan to send their claim file to a third party, such as their attorney, how do the HIPAA privacy rules apply to these requests? Generally, disclosures for treatment, payment, or specified health care operations do not require an individual authorization. Third-Party Directives.

Compliance 52

Compliance 52

Peak Business Valuation

FEBRUARY 13, 2024

This is important when working with insurance companies, government entities, and equipment transactions. An official equipment valuation is often a requirement for lenders, lawyers, insurance brokers, or the government. Insurance Coverage for Landscaping Equipment Now it’s time to predict the unpredictable.

Appraisal 52

Appraisal Business Valuation Fair Market Value Liquidation Value 52

Appraisers Blog

AUGUST 14, 2023

The same Port Authority working with them also focuses on subsidizing housing for the poor. In reply to Mark skapinetz. aka; predatory lending. They can start offering higher price offers right now, and volunteer for higher taxes, and higher mortgage payments. link] As far as the proper focus for whom to care for, that’s an easy one.

Start-ups 60

Start-ups Equity Appraisal Marketability 60

ThomsonReuters

APRIL 6, 2023

This court previously held that the members of USPSTF—but not HRSA or ACIP—were unconstitutionally appointed and thus lack the authority to determine the preventive services that must be covered by private health plans (see our Checkpoint article ). See also EBIA’s Self-Insured Health Plans manual at Section XIII.C.1

52

52

Peak Business Valuation

MARCH 21, 2024

Insurance Coverage for Electrical Equipment Having accurate insurance coverage is crucial for protecting your electrical equipment. An electrical equipment appraisal ensures that you have adequate insurance coverage. Insurance companies often need an equipment appraisal to establish coverage limits and premiums.

Appraisal 52

Appraisal Business Valuation Fair Market Value Marketability 52

ThomsonReuters

DECEMBER 9, 2021

QUESTION: Since we changed our company’s ERISA-covered major medical plan from fully insured to self-insured this year, do we have more flexibility in administering the plan’s terms? Those claims will have to be paid without the backstop of stop-loss insurance.

Compliance 52

Compliance 52