News & Analysis as of

Health Insurance Policy Terms

Maynard Nexsen

Keeping an Eye Out for Litigation Involving Increasingly Popular Gap Coverage

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So-called “gap” insurance policies – policies that provide critical-illness, hospital-indemnity and specified-disease coverage – have been on the rise due to a number of factors, including the frequency of high-deductible...more

Wiley Rein LLP

For the Record: Cyber Coverage “For” a Security Breach is Ambiguous under New Mexico Law

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The New Mexico Court of Appeals has held that cyber policy language affording coverage “for” a security breach was ambiguous and must be construed broadly to provide coverage for a breach of contract claim “because of,”...more

Wiley Rein LLP

Tenth Circuit Deems D&O Policy Ambiguous Based on Interplay of Coverage Grant with Managed Care Exclusion

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The United States Court of Appeals for the Tenth Circuit, applying Kansas law, has held that a D&O insurer was obligated to reimburse defense costs where a policy expressly covered antitrust claims but excluded coverage for...more

Arnall Golden Gregory LLP

Blue Cross Found to Be Behind the Times: Fifth Circuit Finds Blue Cross’ Proton Beam Treatment Guidelines Are Outdated, Superseded...

Background - Revisiting the topic from an article published earlier this year, another plaintiff has successfully challenged a commercial insurer’s internal Proton Beam Radiation Treatment (“PBT”) policy. PBT is a proven...more

Goodwin

R&W Insurance Coverage for Healthcare Services Transactions

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After being squeezed out of the R&W insurance market in 2021, deals in the healthcare services sector have regained interest from insurers and are seeing lower rates and greater competition....more

Latham & Watkins LLP

Healthcare Coverage Developments on the Horizon for Emerging Technologies, Including Digital Technologies

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Technology companies, providers, investors, and other stakeholders should prepare for potential policy changes. In the coming months, a number of significant developments are anticipated to influence the future of the...more

Troutman Pepper Locke

Texas Supreme Court Reverses Stop Loss Insurance Categorization Premium Tax Ruling

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On June 17, 2022, the Texas Supreme Court released an opinion in Hegar v. Health Care Serv. Corp. (No. 21-0080) (Jun 17, 2022) regarding whether the Comptroller properly taxed an insurer based on premiums it received from...more

Stark & Stark

Does Health Insurance Cover Motorcycle Accident Injuries?

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Get the word out: check your Health Insurance policy language to make sure it covers you if you are injured in a motorcycle crash. Every day I meet new clients who have been injured by an irresponsible driver and every day I...more

Michigan Auto Law

Qualified Health Coverage and No-Fault Auto Insurance

Michigan Auto Law on

The big selling point for Michigan’s new auto No-Fault insurance law was that drivers would be able to save money on their car insurance by choosing the level of medical coverage they wanted to have available to them and...more

Carlton Fields

Court Compels Arbitration of Balance Billing Dispute Under a California Health Plan, Severs Certain Unconscionable Provisions, and...

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A patient sued her health plan and the plan’s debt collector under various California and federal laws in connection with alleged attempts by the plan to unlawfully collect the balances of the plaintiff’s medical statements...more

Seyfarth Shaw LLP

Exclusion for Gender Reassignment Surgery May Violate Title VII and the Equal Protection Clause

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Seyfarth Synopsis: On December 23, 2019, District Judge Rosemary Marquez ruled, in connection with a motion to dismiss, that Title VII does protect discrimination based on a person’s transgender status, and that a health...more

Littler

“Medical Necessity” Isn’t Well-Defined Unless It Is Well-Defined

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A U.S. District Court in Connecticut recently issued an order that highlights the importance of understanding exactly what the term “medically necessary” means in an ERISA health plan....more

Seyfarth Shaw LLP

ERISA Preemption — The Courts of Appeal Continue to Rule As They Await Further Supreme Court Attempts To Define, Once and for All,...

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Synopsis: Two Courts of Appeal reach opposite results on ERISA preemption, thus continuing the judicial quest for a definitive meaning of ERISA preemption. Stay tuned for more such decisions, and yet more Supreme Court...more

Faegre Drinker Biddle & Reath LLP

“A Slice” of the 2019 ILTCI Conference

Drinker Biddle is pleased to present you with this recap—or “a slice” of the 2019 ILTCI Conference, Chicago, Illinois. Year after year, the ILTCI Conference is jam-packed with opportunities to reconnect with and learn from...more

Polsinelli

Oregon Regulatory Action a Reminder That Insurers Cannot Outsource Their Regulatory Responsibilities

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The Oregon Department of Consumer and Business Services (“Oregon Department”) recently announced it had entered into an Order to Cease and Desist, Final Order Assessing Civil Penalty and Consent to Entry of Order (“Order”)...more

Carlton Fields

Six Degrees Of Separation: Eleventh Circuit Upholds a Broad ‘Related Claims’ Provision

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“Related Claims” provisions in directors and officers (D&O) and errors and omissions (E&O) policies, while common, can spawn disagreement as to scope and application. ...more

Robinson+Cole ERISA Claim Defense Blog

Fifth Circuit Joins Sister Circuits by Overruling Default Deferential Standard of Review

In Ariana M. v. Humana Health Plan of Tex., 2018 U.S. App. LEXIS 5227, *5, 2018 WL 1096980 (March 1, 2018) (“Ariana M. II”), a majority of judges of the U.S. Court of Appeals for the Fifth Circuit, in an en banc decision,...more

Snell & Wilmer

Air Ambulance Services – What Does Your Plan Cover?

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Due to the increased litigation of air ambulance claims, employers may want to review their plan language to see whether their group health plan covers air ambulance services, and if so, to better understand the terms of the...more

Troutman Pepper Locke

CMS Thwarts Idaho's Attempts to Skirt Affordable Care Act, But Provides a Path Forward

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Last month, we reported that Idaho announced a controversial plan to allow insurers to sell policies that do not comply with certain ACA requirements — a move that some feared would set a precedent for other states. ...more

Hogan Lovells

IVASS and AGCM bring actions against unfair clauses contained in accident and health insurance contracts

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The Italian Insurance Regulator ("IVASS") and the Italian Competition Authority ("AGCM") have taken coordinated actions against certain clauses contained in health and accidents insurance policies that cover permanent...more

Troutman Pepper Locke

States Launch a New Challenge to the ACA: Noncompliant Health Plans

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In the wake of recent failures to repeal the Affordable Care Act, one state has decided to take matters into its own hands. Idaho recently announced a controversial plan to allow insurers to sell policies that do not comply...more

Carlton Fields

Sticking Firmly to Contract Terms, Court Dismisses Premium and COI Overcharge Claims

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In July, in Hancock v. Americo Financial Life & Annuity Co., Americo achieved a total victory on its motion to dismiss a putative class action in the Eastern District of North Carolina that challenged its premium and COI...more

Chambliss, Bahner & Stophel, P.C.

Short-Term Care Insurance: An Alternative to the Long-Term Care Variety

A little-known insurance option can be an answer for some people who might need care but are unable to buy long-term care insurance. Short-term care insurance provides coverage for nursing home or home care for one year or...more

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