EBIA Weekly Archives - GHPM - Court Cases
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Results (81 articles found)
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- MSP Rules Prohibit Terminating Group Health Plan Coverage Based Solely on ESRD Eligibility, Except as Permitted by COBRA
- From the August 20, 2009 EBIA Weekly
- This case addresses the application of the Medicare Secondary Payer (MSP) rules to Medicare entitlement based on end-stage renal disease (ESRD). A kidney dialysis center (Center), as assignee of a deceased participant’s retiree health care benefits, sued ...
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- Requiring Older, Medicare-Eligible Retirees to Pay Larger Portion of Premium Contribution Under Health Plan Did Not Violate ADEA
- From the April 30, 2009 EBIA Weekly
- After years of providing 100% employer-paid coverage under two retiree health plans, the employer in this case amended the plans so that more recent retirees would have to share in future premium increases under a specified formula. Benefits under ...
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- Health Plan Insurer Could Not Terminate COBRA Coverage When Qualified Beneficiary Became Covered Under Medicaid
- From the February 12, 2009 EBIA Weekly
- A mother sued her health plan insurer after it denied medical benefits for her minor son, who incurred overwhelming medical expenses after a near drowning accident. The son was a COBRA qualified beneficiary who had elected COBRA coverage under the ...
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- Trial Court Dismisses Retirees' Claims That Terminating Their Medical and Prescription Drug Benefits Violated the ADEA
- From the December 11, 2008 EBIA Weekly
- This is the first decision we’ve seen that applies the 2007 final EEOC regulations exempting Medicare coordination for retirees from the ADEA (see our article at http://www.ebia.com/WeeklyArchives/GHPM/Statutes/19256 (Premium Access subscription required)). ...
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- ADA and ERISA Claims Proceed for Employees Terminated After Child Incurred Large Medical Expenses
- From the May 15, 2008 EBIA Weekly
- Employees whose child with brain cancer had coverage under their employer’s group health plan were terminated. They sued under the Americans with Disabilities Act (ADA) provision that prohibits discrimination based on association with a disabled person, claiming that ...
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- WHCRA Doesn't Prohibit Limiting Payments for Breast Reconstruction Surgery to the Usual, Customary, and Reasonable Rate
- From the March 06, 2008 EBIA Weekly
- Following a bilateral mastectomy, the wife of a participant had reconstructive surgery on both breasts. During recovery, she also received private-duty nursing care. Her surgeon, who was an out-of-network provider, charged $40,000 for the reconstructive surgery. ...
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- Retiree Plan Found to Be Primary Payer in Triple Coordination of Benefits Dispute
- From the December 13, 2007 EBIA Weekly
- We recently reported on a coordination of benefits (COB) case involving medical expenses of a disabled individual with triple coverage: (1) as a dependent under his wife’s employer’s plan (wife’s plan); (2) as a ...
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- Paid Leave Was a Reduction of Hours Triggering COBRA Rights
- From the November 29, 2007 EBIA Weekly
- In this case, an employee injured in an auto accident used accrued time off to take paid medical leave under the Family and Medical Leave Act (FMLA). The employer continued his group health plan coverage, as required by the FMLA. ...
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- Medicare Found Not to Be Primary Payer in Triple Plan Coordination of Benefits Dispute
- From the November 15, 2007 EBIA Weekly
- This case involves the medical expenses of a disabled individual covered by three health plans: (1) as a dependent under the plan of his wife’s employer (wife’s plan); (2) as a retiree under his former employer&#...
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- Court Orders QMCSO Coverage for Nonresident Stepchild, Even Though This Exceeded Coverage Ordinarily Provided by Plan
- From the August 30, 2007 EBIA Weekly
- Can a qualified medical child support order (QMCSO) require coverage for the stepchild of a group health plan participant? In what appears to be the first reported decision on ERISA’s QMCSO requirements, the judge in this case holds ...
