Health plan cap on AIDS treatment reimbursements upheld

Article Abstract:

The Fifth Circuit has upheld the health plan cap on reimbursements for AIDS treatments. The court ruled that the Employee Retirement Income Security Act does not stop employers from making changes to group health plans to lower the maximum benefits for workers with AIDS. The case involved an employee who submitted insurance claims for AIDS treatments. The employer subsequently changed the group health plan from one that provided a lifetime maximum of $1 million in benefits for AIDS treatments to a self-insured plan that provided a maximum of $5,000.

AIDS patients

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Sole owner of corporation who participates in employee benefit plan not an employee for purposes of ERISA protection

Article Abstract:

A federal district court ruled in Kelly v. Blue Cross & Blue Shield that the owner of a corporation is not an employee under ERISA. This meant that the plaintiff, a corporation owner who had been denied coverage for a bone marrow transplant to treat cancer under the company's health plan, could not file suit for breach of contract under ERISA, since corporate purchase of health benefits qualified as a contract governed by state statutes.

Employee benefits

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Sixth Circuit allows class action against group health plans administered or insured by Nationwide to proceed

Article Abstract:

The US 6th Circuit Court of Appeals in Fallick v. Nationwide Mutual Insurance Co. allowed the certification of a class which alleged that ERISA violations were made by the group health plan insurer, Nationwide. The company allegedly did not provide coverage in accordance with its contract and violated ERISA-based fiduciary duties.

United States, Direct Health and Medical Insurance Carriers, Hospital and medical service plans, Medical Care Insurance, Class actions (Civil procedure), Class action lawsuits, Laws, regulations and rules

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