Health Care Benefits Law

Front Cover
Law Journal Press, 2001 - Law
1 Review
Making sense of the nonstop parade of federal and state legislation, regulation and decisional law governing health care benefits is not an easy task. For professionals in the field, however, it is an essential one. Fortunately, there is a comprehensive and practical guide to this complex, evolving area that clarifies the legal framework, including the most recent developments, and keeps you on top of every important issue.

Health Care Benefits Law explains how current laws affect the design and day-to-day administration of health care plans. It also helps you identify--and deal with--hidden areas of liability. You'll find detailed coverage of such topics as: ERISA reporting and disclosure requirements; the Patient Protection and Affordable Care Act (PPACA) and the regulations clarifying its provisions; negotiating ASO (Administrative-Services-Only) contracts; tax treatment of health benefits; auditing utilization review; health and welfare benefit plans and ERISA fiduciary requirements; managed care liability; COBRA (including all the sample notices and forms that an employer needs to comply effectively); Medicare Secondary Payer issues; provision of benefits by professional employer organizations (PEOs); the Americans with Disabilities Act; the Health Maintenance Organization Act; HIPAA; the Family and Medical Leave Act; health care and employee benefit provisions of the 2005 Bankruptcy Act; the Tax Relief and Health Care Act of 2006; and more.

You'll get sample forms, checklists, drafting tips, and the perspective you need to cope with any challenge. Whether you are an attorney, health care plan sponsor, employer or multi-employer trustee, insurance company, HMO, or other health care provider, this guide will save you hours of painstaking work and greatly simplify compliance.
 

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Contents

8 No Preexisting Condition Exclusions for Pregnancy 1610
1-8
9 Special Enrollment Periods Due to Loss
1-9
Other Coverage 1610
1-16
4 Plan Assets Must Be Held for the Exclusive Benefit
1-17
15 Qualification Standards 118
1-18
CHAPTER 2
165
10 Special Enrollment Periods
2-10
Dependents 1610
2-16
19 Penalties 1613
1
03 Group Health Insurer Requirements 1616
4
4 Denial of Coverage May Result in a Suspension of New Business Activity in a Service Area 1617
5
7 Disclosure Requirements 1618
6
10 PreemptionState Flexibility 1619
7
04 Individual Health Insurer Requirements 1620
8
CHAPTER 17
1
5 ERISA Liability for Nonfiduciary
5

CHAPTER 1
1
11 HMO Affiliation Periods 1610
16
CHAPTER 4
4-1
13 New Participant Disclosure Deadlines
13
CHAPTER 5
5-1
CHAPTER 6
6-1
CHAPTER 8
1
1 Liability Arising from Selection or Retention
9-1
CHAPTER 10
9-75
01
9-85
Material Reductions in Group Health Plans 1611
1-16
iii
1-54
CHAPTER 12
1-61
ADAs Impact on Employee Benefit Plans
1-95
CHAPTER 15
1
b Bad Faith Denial 310
3
CHAPTER 16
45
Plans and MEWAs 1612
58
CHAPTER 7
A-7
2 Coverage Requirements 1620
A-16
Appendix BI Model General Notice of COBRA
B-1
Second COBRA Qualifying Event Notices
B-13
Appendix E Frequently Asked Questions about the HIPAA
E-1
Appendix F 2003 Medicare Conference Agreements
F-1
1 Introduction 520
G-1
Appendix H Sample Plan Amendment Addressing HIPAA
G-31
Reserved
K-1
b Indirect Funding 910
K-9
Transition Relief
N-47
Appendix Q Final Regulations for Health Care Coverage
Q-1
CHAPTER 14
Q-14
Appendix R Bankruptcy Abuse Prevention and Consumer
R-1
v Plan Administrators Have
R-7
1 Who Is Entitled to COBRA Continuation
1-1
Copyright

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About the author (2001)

Jeffrey D. Mamorsky is a partner in the New York office of the international law firm of Greenberg Traurig, LLP. He is the editor of the Employee Benefits Handbook, as well as the founder and editor-in-chief of the Journal of Compensation and Benefits. He is the author of Employee Benefits Law: ERISA and Beyond and Health Care Benefits Law, both published by Law Journal Press. Mr. Mamorsky graduated from New York University College of Arts & Sciences and holds a J.D. from New York Law School and an LL.M. in taxation from New York University Law School.

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