Physician, physician. . . Litigation Well being Plan Replace

For people who work with employer-funded benefit plans, the last 18 months have been packed with new developments from federal and state legislators as well as initiatives by the executive and official guidelines. Today’s post covers two cases from the judiciary that affect employer-funded health plans.

SCOTUS and the ACA. Yesterday, the US Supreme Court rejected challenges to the Affordable Care Act (ACA) in Texas against California. In particular, the Supreme Court found that plaintiffs have no authority to challenge the individual mandate because they have failed to demonstrate that the individual mandate fine of $ 0.00 caused or would cause harm to plaintiffs.

In the absence of another judicial challenge to the law, which appears unlikely, this decision should ensure the short-term survival of the law, likely for the rest of the Biden government. Since the Court of Auditors was not bipartisan legislation, future legislative challenges are likely. It will be interesting to see how the decision affects future healthcare reform efforts. For example, will the survival of the Court of Auditors reduce the likelihood that Democrats will pursue wider healthcare reform?

Blue Cross Blue Sign Settlement. Blue Cross Blue Shield (BCBS) has agreed to a proposed settlement of a class action lawsuit against BCBS for alleged antitrust violations related to health insurance offered under certain fully insured products and self-financed OSA contracts between 2008 and 2020, by the class (employers sponsoring insured BCBS plans between February 7, 2008 and October 16, 2020 or self-financed BCBS plans between September 1, 2015 and October 16, 2020) should understand the implications of the litigation for the sake of the interests of the Employer / plan on the settlement as well as answering questions from employees and former employees who will be notified of the settlement.

The proposed settlement would result in the payment of approximately $ 2.7 billion to BCBS, with approximately $ 1.9 billion paid out to members of the class, along with other equitable reliefs. It is important that employers and employees who were covered by the underlying plans have separate rights to participate in the settlement. To participate in the settlement proceeds, employers and employees covered by the underlying plans must decide to participate in the class action by November 5, 2021. In general, the amount each Class Member will receive under the Settlement will depend on the amount of the Premiums / Management Fees each Class Member has paid to the remainder of the Participating Class. When submitting claims, employers / plans have the option of including plan-specific information (bonus amounts, allocation between employer and employee) in the application or based on default assumptions in the context of the proposed comparison.

Recommended next steps for employers:

  • Determine whether the employer has the right to participate in the settlement and other reliefs.
  • If allowed, determine the potential value of the settlement (both settlement proceeds and other reliefs).
  • When it pays to collect the billing dollars:
    • assess whether the claim uses default assumptions or plan-specific information;
    • submit the claim; and
    • Determine how the settlement proceeds will be used (that is, whether the proceeds are plan assets and whether plan changes are necessary or advisable).

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