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ERISAClaim.com: Maximal Reimbursement or Crisis Turnaround by Compliance
 ERISAclaim.com v:shapes="_x0000_s1029">
    
USHealthcareCrisis.com
 
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Health Insurance Mandates in the States, 2004: a State-by-State
Breakdown ... (PDF) (Council for Affordable Health Insurance)
U.S. Healthcare
Crisis Turnaround?
U.S. A.
Drs. & Hospitals
Employers
$1.0
Trillion / Year
$$$
ERISA
$$$
50% Savings
The
Only
Company with Compliant
Solutions for
All of You
We Are Seeking New Strategic Partners
Our sister website,
SleepApneaUSA.net,
is finally here, and improving, updating every date.
Welcome
ERISAclaim.com (also now
"USHealthcareCrisis.com") with its
principal and founder, Dr. Jin Zhou, is committed to providing
unique and practical solutions to our nation's
health care crisis, in case the
Congress and the President of the United
States
fail to stop our
health-care
crisis,
probable health care crash and
future federal budget deficits of $44.2 trilion;
We will provide
educational and consulting
solutions to
healthcare providers, clinics
and hospitals for maximum reimbursement or crisis
turnaround only through
compliance of ERISA;
We will provide educational and consulting solutions to
employers/plan sponsors,
insurers and TPA's with
compliance assistance
to minimize administrative costs and risks
through compliance of ERISA;
We will
provide
educational and consulting solutions to the nation to
establish or restore the hope,
faith and
the Law
&
Order for
our health-care system through
education and
compliance of ERISA, the federal law designed to regulate about 80% of the health-care claims and 60% of the U.S.
health-care expenditure,
ERISA is the only "nuclear power" capable of
stopping our escalating health-care costs. Compliance is the
only common
ground for everyone, and it is the only way
that we can bail out of
our worst health-care crisis since World War II.
Our strategy is to solve US
health-care crisis through:
Scientific identification of the
most accurate causation for
skyrocketing medical inflation and fundamental failure of US health care
delivery system - ERISA Failure;
Identification of
common ground for everyone involved,
governing federal law for employer-sponsored
health-care system that has been already on the book
for the past 30 years - ERISA; and
Providing
a solution to
ü Establish Prudent
"Personal Responsibility" without Eliminating Employer-Sponsored
Health-Care System and without "Skipping Necessary Health Care" and
"Personal Bankruptcy";
ü
Keep Employer-Sponsored
Health-Care System with Quality Health Care but without Skyrocketing
Medical Cost Disaster.
Our mission is to prevent another
"Failure of Imagination" in
US healthcare crisis triggered economic
recession or even disaster, and
"John Q. ERISA
Enforcement"!
Unanimous US Supreme Court Ruling
In US Health Care Crisis
by Jin Zhou,
02/11/2005
© 2005,
Jin Zhou,
ERISAclaim.com
Managed-Care Nightmares?
Health-Care Crisis without True Solutions?
What Does
an Unanimous US
Supreme Court Say?
On June 21, 2004,
an unanimous US Supreme Court ruled that claim processing and denials of
benefits under the employer-sponsored health plans,
ERISA-regulated benefit
plans, for
both self-insured and
fully-insured (through purchase of insurance) health plans, are completely governed by federal law ERISA, that
supersedes and invalidates state laws.
How
Can Anyone in USA, from Congress to General Motor to the White House,
from Industry Experts to Patient Advocates, Solve US Health Care Crisis
without Even Thinking of ERISA?
"Failure of Imagination" As a
Nation Is the Real Tragedy
ERISAclaim.com - Supreme Court
Managed Care ERISA Watch
Unanimous US Supreme Court Ruling In US Health Care Crisis
Aetna Health Inc. v. Davila
06/21/04
Opinion of the
Court
"Held:
Respondents’ state causes of action fall
within ERISA§502(a)(1)(B), and are therefore completely
pre-empted by ERISA §502 and removable to federal court.
Pp. 4–20."
"We hold that
respondents’ causes of action, brought to
remedy only the denial of benefits under
ERISA-regulated benefit
plans, fall within the scope of, and are completely pre-empted
by, ERISA §502(a)(1)(B), and thus removable to federal
district court. The judgment of the Court of Appeals is
reversed, and the cases are remanded for further proceedings
consistent with this opinion.7
It is so ordered."
Health-Care 9/11 Report of 2005
Health-care WMD
by Jin Zhou,
02/05/2005
© 2005,
Jin Zhou,
ERISAclaim.com
Unanimous US Supreme Court:
Employer-Sponsored Health-Care Is
Completely Governed by ERISA laws and rules;
Aetna Health Inc. v. Davila, 06/21/04
Congressional Leaders:
One
Administration = One Voice = ERISA Self Enforcement only, or
No Enforcement?
Health-care Terrorists?
"ERISA Advantage" bogus
plans,
"unlimited and frequent premium increases, and the potential for
rampant fraud with little, if any, regulatory recourse" in 30
years of ERISA self enforcement.
Health-care WMD (Weapons of Mass Destruction)
"Medical
Inflation, WMD" for
"ERISA Advantage" from
ERISA Failure -
"Failure of Imagination" Again
for US Healthcare:
USA:
$1.9 Trillion, 15.7% of GDP
GM:
$5.6 Billion, $1,500 Per Car
Economists: Federal deficit a bigger risk than terrorism (USA
Today)"The survey, taken
between Feb. 28 and March 8, found U.S. businesses had three nearly
equal concerns about longer-term risks: health care, the aging
population and the federal deficit."
USA
2005:
Personal Bankruptcy
GM Chapter 11,
National healthcare expenditure $$1,9 trillion
One nation under debt
GAO Report: Tax
Expenditures Represent a Substantial Federal Commitment and Need to
Be Reexamined (PDF) (U.S. Government Accountability Office)
Abstract Highlights-PDF PDF
White
House Rx:
$1,000
HSA personal responsibility + AHP with
More "ERISA Advantage" for
"widespread
plan insolvencies and fraud" and
"A
Prescription For Disaster".
2005 for
Michael Moore?
"John Q. ERISA
Enforcement"???
Congressional conclusion 2008:
"Failure of Imagination" Again,
with No One's Responsibility and Accountability.
Discount for
March 2005: $35
$450 ERISA CD
Book
ERISA
Claim Appeal Books & Systems
Click here or the CD-Picture
to enter our Secured Online Order page
 With New 2005 Update
(including
New ERISA Assignment Form Required for ERISA Appeals,
DOL, FAQ, B2-3)
ERISA Failure Syndrome
U.S.
Healthcare Crisis Trilogy
(Copyright © 2004
by
Jin Zhou,
ERISAclaim.com)
ERISA
Medical Killing
ERISA
Medical Inflation
ERISA
Insurance Robbery
?
?
?
?
GAO-04-312
?
?
American Job ExportING!
Mass layoffs up in January 2004
Weirton Steel cancels 10,000
GM: $67.5 billion in 2003
The Looming National
Benefit Crisis (USATODAY.com)
One Nation under Debt:
U..S. economy threatened by
aging of America
NATIONAL DEBT
COLLISION COURSE
MEDICARE
CALCULATOR
METHODOLOGY
►HIDDEN COSTS
►DEMOGRAPHICS
►RISING
COSTS
►YOUR
SHARE
►EXPLAINOR
Healthcare
Disaster at Fault Verdict Index:
U.S. Government 30%
U.S. Employers &
Insurers 30%
Healthcare Providers 30%
Consumers 10%
(ERISA
Failure + Managed-Care) Destroyed US Healthcare
(ERISA Failure + Managed-Care + HSA) Invite US Federal Budget
Deficit & Social Security Disasters = 100X 9/11 Attacks
GAO: Current and Emerging Fiscal and Retirement Security
Challenges, American Benefits Council/MetLife Conference,
Washington, DC, on January 14, 2005
Rising Health care Costs Have
Many Implications
(Direct)
Rising Healthcare Costs Have Many
Implications
(Indirect)
Rx-1
$$$$$$$$$ERISA $$$$$$$$$$
Rx-2
DOJ: Criminal Resource Manual 2432 Coercive or Fraudulent
Interference with ERISA Rights -- 29 U.S.C. 1141
2432 Coercive or Fraudulent
Interference with ERISA Rights -- 29 U.S.C. 1141
Title 29 U.S.C. § 1141 states:
"It shall be unlawful for any
person through the use of fraud, force, violence, or threat of
the use of force or violence, to restrain, coerce, intimidate,
or attempt to restrain, coerce, or intimidate any participant or
beneficiary for the purpose of interfering with or preventing
the exercise of any right to which he is or may become entitled
under the plan, this title, section 3001, or the Welfare and
Pension Plans Disclosure Act. Any person who willfully violates
this section shall be fined $10,000 or imprisoned for not more
than one year, or both. The amount of fine is governed by 18
U.S.C. § 3571. The U.S. Sentencing Guidelines address 29 U.S.C.
§ 1141 under the guidelines for "Fraud and Deceit" (U.S.S.G. §
2F1.1) or for "Extortion by Force or Threat of Injury or Serious
Damage (U.S.S.G. § 2B3.2)......"
"For example, Section 1141
would reach the use of deception directed
at misleading a welfare plan beneficiary as to the amount of
health benefits owed to the beneficiary under the terms of the
plan or at misleading a pension plan participant as to
the amount of retirement benefits to which he would become
entitled under the plan upon his retirement."
Department of Justice >
USAM >
Title 9 >
Criminal Resource Manual
prev |
next
ERISA in the United States Code
ERISA 510
29 USC 1140
Interference with
protected rights.
ERISA 511
29 USC 1141
Coercive interference.
 ERISAclaim.com v:shapes="_x0000_s1065">
Happy or Sad 30th Birthday To ERISA?
(Copyright
© 2004
by
Jin Zhou, ERISAclaim.com)
Sept. 2, 2004
On Sept. 2, 1974, exactly 30
years ago today, ERISA, The Employee Retirement Income Security Act,
was signed into law by President Gerald R. Ford. The congressional intent in enacting ERISA was to protect employees in pension and
welfare plans, to provide uniform federal protections in response to
the failure of the Studebaker Co. in December 1963, with thousands
of long-service employees cheated out off their promised pensions,
and to preempt any state laws when the employees pension and welfare
benefits were threatened. 30 years later, ERISA Failure in its
compliance and enforcement left thousands of retirees without
medical benefits, and resulted in a skyrocketing national healthcare expenditure explosion with 45 million uninsured and a possible national pension bailout.
ERISA Failure Syndrome
U.S. Healthcare Crisis
Trilogy
Jin Zhou Identifies "ERISA Failure" That Killed
U.S. Healthcare
"Failure of Imagination"
Again?
Statement by
President Gerald R. Ford Upon Signing the Employee Retirement
Income Security Act of 1974
ERISA Celebrates 30th Anniversary As Trouble Brews For the Pension
Insurance Program (Spencer Benefits Reports)
Excerpt: "The seed for ERISA
was planted with the failure of the Studebaker Company in December
1963, leaving thousands of long-service employees without their
promised pensions."
ERISA Shield
Explosion!!!
ERISA Patient's Bill of
Right from Supreme Court
(Copyright © 2004
by
Jin Zhou,
ERISAclaim.com)
04/28/2004
This will change entire health care and
litigation landscape.
Click here for more details
"New
Strike Force"
Medical Fraud Every Day?
Appeal or Re-Bill After
Denial?
You Must APPEAL
No Re-Billing!!!
Claim Appeal
or
Sentencing Appeal?
Your Choice
Maximal Reimbursement
through ERISA Appeal &
Fraud Prevention and
Compliance
The Root
of U. S. Healthcare Crisis
Jin Zhou, ERISAclaim.com
The Hearing at Senate Committee on Finance
on
3-3-04, [View Video
or
Transcript
(PDF)
(KaiserNetwork.org)]
revealed
the
mechanism, nature and
extent of ERISA failure and nonenforcement as the reasons
for
"Growth in
Bogus Health Insurance Plans Targeting Desperate Small Business
Owners", as being concluded as "No the results are not good.
It’s a tragedy."
by
Ann
Combs, assistant secretary of DOL.
The mechanism, nature
and extent of ERISA failure and nonenforcement as presented
at
the Hearing are
universally true and
applicable to all health care claim
denials and delays in
managed care environment from
all
employer sponsored health plans as the root of
U. S. healthcare crisis.
This is a
911 call on
"healthcare 9/11 disaster"!
THE 9/11 COMMISSION REPORT (pdf)
50% Savings in
Healthcare Costs for
Employers, Insurers & TPA's
U. S. Health-care Crisis
Turnaround
Brainstorming
for Executives
ERISA Claims Certification Class
(Denial Management)
Claim Denial &
Appeal Network
Claim Recovery
Appeal
Books
Seminars
Consulting
Reimbursement Crisis?
Contingency Recovery Service for Dead, Difficult and
Hopeless Accounts from Denied Medical/ERISA Claims In past 3 Years,
This Could Be up to 20-40% of Your Revenue.
The Most Powerful &
only Book
in the U.S. Focused on Health Care
ERISA
Claim Denials & Appeals
for Health Care Providers, Physicians, Clinics and Hospitals.
(2003 Update Free Download)
We now offer post-seminar
teleconference for staff training at $190/hour.
The Most Powerful &
only Seminar
in the U.S. Focused on Health Care
ERISA Claim Denials & Appeals
Stop
Managed Care Abusive Claim Delays & Denials!
Getting Paid with New
Federal Claim (ERISA) Rules
Maximal Reimbursement
or
Crisis Turnaround to Get Paid!
Concentrating on ERISA Healthcare Claim
Denials And Appeals When Traditional and Conventional Appeal
Procedures All Failed Because ERISA Preempts Your State Laws.
ERISA OVERHAUL OF U.S. HEALTHCARE
FOR SURVIVAL
"Zhou's Model of Prudent Health Care"
Are All
Consultants Corrupt? (Fast Company)
USA: GM chief talks health care as Republicans convene: Auto
News
"Wagoner reportedly
said much of the discussion in Washington tends to centre
around a complete, free-market system on one extreme, and a
national health care programme [similar to the UK’s National
Health Service] on the other.
"I
suspect we're not going to end up with either one of those
solutions," he told the Associated Press. "So
if we could get people working on stuff in the middle ... I
think there'd be some real improvements made."
Jin Zhou Identifies "ERISA Failure" That Killed
U.S. Healthcare
"Failure of Imagination"
Again?
ASO+HMO+PPO-SPD=$1.8 Trillion/Y US
Healthcare Crisis
ERISA+SPD-HMO-PPO-ASO=50% Savings
The First
Overhaul for U.S. Health care and GM Is to
ERISA-Overhaul
GM Health Care Model
with Followings:
ERISA
Compliant SPD with Complete
Benefits Coverage, Limits & Exclusions;
ERISA
Compliant Claims Procedure as the
Only Rule for Every One;
Elimination of Any
Third-Party
Managed Care Contracts,
UCR &
"Medical Necessity"
GM
Current Model:
$5.1 billion/yr,
$1,400/vehicle)
(GM
says health care obligation hit $67.5 billion in 2003)
Rx-1
$$$$$$$$$ERISA$$$$$$$$$$
Rx-2
Health Spending Projections Through 2013
New Federal Claim
Regulation (Final Rule)
Benefit
Claims Procedure Regulation (FAQ)
Amendments to Summary Plan Description Regulations
(Final Rule)
Patient's Rights Claims Procedure Regulation
(Fact Sheet)
U.S. Health-care Crisis & ERISA Criminal Enforcement
CBO's analysis of the President's budgetary proposals for fiscal year
2005
Fact Sheet:
Affordable Health Care for America's Families (White House)
Zhou's
Medical Inflation
Projection
Through 2008:
$1,000 Deductible
(HDHP /
HSA) +
$1,500 Discount (HHS
/
Indigence)
[Deductible + UCR + PPO Disc.]
=
"Discretionary Spending" + "Price
Gouging"
=
500%
Medical Inflation in 5 years
DOL-Reporting and Disclosure Guide for
Employee Benefit Plans
(pdf)
Compliance Assistance for Group Health Plans (Top
15 Tips)
950,000 MD's Settled With Aetna & Cigna on ERISA
"Aetna
and CIGNA Settlement Secrets"
ERISA Certification Programs for Maximal
Reimbursement
What You
Should Know about Filing Your Health Benefits Claim
HIPAA
Nondiscrimination Requirements Frequently Asked Questions
DOL +
DOJ Enforcement of
ERISA
&
HHS Works with
ERISA (+77 Millions/4 Yrs)
State Insurance Department in All 50 States
Promote
&
Coordinate
with
ERISA
NAIC
ERISA Working Group
To Avoid
"John Q. ERISA Enforcement"
U.S. Healthcare Crisis & ERISA Criminal
Enforcement
U.S. Health-care Crisis
& ERISA Criminal Enforcement
ERISAclaim.com - A $1.0 Trillion Nuclear Solution to U.S. Health-care
Crisis & $44 Trillion Budget Deficits
ERISAclaim.com: 50% Savings - Healthcare Crisis Turnaround for
Employers, Insurers & TPA's
ERISAclaim.com - 950,000 MD's Settled With Aetna & Cigna on ERISA
ERISAclaim.com: ERISA Certification Programs
for Cost-Saving & Reimbursement by Compliance
ERISA
Power
Guides
(Copyright © 2004
by
Jin Zhou,
ERISAclaim.com)
What You Should Know about Filing
Your Health Benefits Claim (Claims Card)
Filing A Claim For Your Health Or Disability Benefits (PDF)
Patient's
Rights Claims Procedure Regulation (Fact
Sheet)
Benefit Claims Procedure Regulation
(FAQ)
(PDF)
New
Federal Claim Regulation (Final Rule)
(PDF)
Amendments to Summary Plan Description
Regulations
(Final Rule) (PDF)
New & Interactive From DOL
DOL/EBSA Organization
Chart/Regional and District EBSA Offices
|
By Topic |
By Audience
| By
Organization |
By Location
Health
Benefits Laws By State
(Interactive Tools From Insure.com)
Health Insurance Mandates in the States, 2004: a
State-by-State Breakdown ... (PDF)
(Council for Affordable Health Insurance)
Kaiser
statehealthfacts.org
Consumer
Guides for Health Insurance in Every State and the District of
Columbia (Georgetown University)
View a 5-minute clip
Paper Chase
ERISAclaim.com - U.S. Health-care
Crisis
& ERISA Criminal Enforcement
To Avoid
"John Q.
ERISA
Enforcement"
Denials +
Recoupment =
Inflation +
Fraud or
Cost-Sharing?
Rx =
Compliant Denials & Appeals!
Forbes.com: "Roughly one in seven Americans has
no health insurance. That hurts HCA Inc. (nyse:
HCA -
news
-
people), the largest U.S. hospital chain, which
last year wrote off $2.21 billion
of revenue because patients couldn't pay their
bills."
The American Hospital Association (AHA): "Hospitals today are faced with the challenge of managing their
limited resources, while continuing to deliver the highest standard of care.
According to health care experts, the cost of clinical
denials to individual healthcare organizations averages
$3.3 million
annually. However, many hospitals do not have the resources or the
expertise needed to avoid unpaid days at the end of admissions and lead the
denial-appeals processes."
Payments Go Under a Microscope (washingtonpost.com)
"MAMSI and CareFirst recoup overpayments to doctors by making
deductions from future reimbursements.
Doctors can appeal insurers' decisions.
But, in the end, they usually pay up, doctors and insurers agree."
U.S.
FILES COMPLAINT AGAINST NATIONAL ACCOUNTING FIRM UNDER FALSE CLAIMS ACT
(DOJ
Press Release) "January 5, 2004
- PHILADELPHIA –
United States Attorney Patrick L. Meehan announced today the filing of the
Government's
complaint against national accounting firm Ernst & Young.
According to the complaint, nine hospitals paid Ernst & Young for billing
advice – advice which later caused the submission of false claims to the
Medicare program."
USATODAY.com - Hospitals Sock Uninsured with Much Bigger Bills
GM to Report $60B in Future Health-Care Obligations
A New Diagnosis & Solution:
EFS-- ERISA FAILURE
SYNDROME--Fatality: 31 YOA
ASO+HMO+PPO-SPD=$1.8 Trillion/Y US
Healthcare Crisis
ERISA+SPD-HMO-PPO-ASO=50% Savings
ERISA Failure,
Noncompliance and
Nonenforcement of
ERISA SPD and
Claims Procedure Rules, Is the
Damaged or Missing Foam on U.S.
Healthcare Wings!
HMO Crisis Is
Really An
ERISA Crisis!
HMO & PPO Managed Care
Contracting to
Disregard & Substitute
ERISA SPD &
Claims Procedure
Is
The Primary & Inevitable Cause of
Medical Inflation
Costly Managed Care &
Medical
Malpractice Lawsuits
American Job Export!
ERISA
Failure Damages Are Greater Than
9/11 and Pearl Harbor Tragedies Combined
U.S. Health-care Crisis & ERISA Criminal Enforcement
(ERISA Failure + Managed-Care)
Destroyed US Healthcare
(ERISA Failure + Managed-Care + HSA) Invite US Federal Budget Deficit &
Social Security Disasters = 100X 9/11 Attacks
Only practical solution is to cut the
skyrocketing healthcare care
costs and
increase the
healthcare coverage and benefits
at the same time without
having to go to Congress to reinvent another new
"Mars Project" or
"Universal
Uninsured Bill
of Right" -
"John Q. ERISA Enforcement".
CBO projects 2.7 trillion in deficits (AP - ktvotv3.com)
Letter to the Honorable Ted Stevens regarding the preliminary results
of CBO's analysis of the President's budgetary proposals for fiscal
year 2005, CBO, February 27, 2004
Report: US FY03 Budget Gap Much Worse Under Accrual Accounting (Quicken - Feb
27, 2004)
"The official U.S. budget deficit, which is calculated using cash
accounting, hit a record $374 billion in fiscal year 2003. That figure
becomes a whopping $665 billion under the accrual method the
government uses to compile its annual financial report."
Greenspan warns against deficits (CNN - Feb
25, 2004)
Text of Alan Greenspan's Statement to Budget Committee on Effect of
Baby Boomer Retirements (U.S. House of Representatives
Budget Committee)
HEALTH CARE SPENDING REACHES $1.6 TRILLION IN 2002 (CMS.HHS.Gov)
Health Spending Projections Through 2013 (Health
Affairs -- Heffler Web Exclusive)
Benefit Spending Drives Compensation Costs (BenefitNews.com)
Employer Costs
for Employee Compensation--December 2003 02/26/2004 (Bureau
of Labor Statistics)
Mass layoffs up in January 2004 (Bureau
of Labor Statistics)
Survey: Americans More Worried About Healthcare Costs Than Terrorist
Attacks (The Henry J. Kaiser Family Foundation)
Excerpt: "We were
surprised to find in our latest tracking poll that more Americans are
worried about health care costs than about losing their job, paying
their rent or mortgage, losing money in the stock market, or being a
victim of a terrorist attack.
Nearly four in 10
Americans (38%) say they are very worried that the amount they pay for
health care services or health insurance will increase, and a similar
share (37%) is very worried that their income might not keep up with
rising prices over the next six months."
Problems and Priorities (pollingreport.com)
82% of Americans rank
healthcare among their top issues, according to
Gallup Poll.
Are All
Consultants Corrupt? (Fast Company)
Excerpt: "That's one possible conclusion in the wake of the
Enron scandal.
According to David Maister, who's been studying professional-services firms
for more than 20 years, it's time to clear the air."
HEALTH COSTS--The
Breaking Point (FORTUNE.com)
"Worker health costs
will rise a staggering 24% this year. Companies can no longer afford to
pick up the bill. The battle is here."
Law Professor Looks at
Criminal Prosecution for HMO Treatment Denial (Prof.
John A. Humbach published by the Health Administration
Responsibility Project (harp.org))
HMOs Earn $10.2 Billion in 2003,
Nearly Doubling Profits, According to Weiss Ratings; Blue Cross Blue
Shield Plans Report 63% Jump in Earnings
(BUSINESS WIRE)--Aug. 30, 2004
Department of Labor
"A group health plan is
an employee welfare benefit plan established or maintained by an
employer or by an employee
organization (such as a union), or
both, that provides medical care for participants or their
dependents directly or through insurance, reimbursement, or
otherwise.
Most private sector health plans are covered by the
Employee Retirement Income Security Act (ERISA). Among other
things, ERISA provides protections for participants and
beneficiaries in employee benefit plans (participant
rights), including providing access to
plan information. Also, those individuals who manage plans
(and other fiduciaries) must meet certain standards of conduct
under the fiduciary responsibilities specified in the law."
Statutes (United
States Code)
ERISA - Title 29, Chapter 18.
Selected links:
Sec.
1002.
Definitions
Sec.
1003.
Coverage
Sec.
1022.
Summary plan description
Sec.
1104.
Fiduciary duties
Sec.
1140.
Interference with protected rights
Sec.
1141.
Coercive interference
part 7
group health plan requirements
Code
of Federal Regulations
Codified in Title 29 of the
Code of Federal Regulations:
Regulations
Selected links:
2520.102-3 Contents of summary plan description.
2560.503-1 Claims procedure.
Department of
Justice
Criminal
Resource Manual
(ERISA)
Criminal Resource Manual 2429 Failure to Perform ERISA Reporting
and Disclosure -- 29 U.S.C. 1131 (ERISA Section 501)
Criminal Resource Manual 2438 Form Indictment -- False
Statements and Concealment of Facts in Employee Benefit Plan
Records or Report
Criminal Resource Manual 2430 Elements of Proof for 29 U.S.C.
1131 and ERISA Obligations
Criminal Resource Manual 2431 Form Indictment -- 29 U.S.C. 1131
Criminal Resource Manual 2432 Coercive or Fraudulent
Interference with ERISA Rights -- 29 U.S.C. 1141
Criminal Resource Manual 2433 Form Indictment -- 29 U.S.C. 1141
Criminal Resource Manual 2435 Investigative Jurisdiction -- 18
U.S.C. 1027
ERISA &
Claim
Aetna Video Shows ERISA Patients Mistreated
"According to the video, when faced with claims for identical
medical problems, Aetna separates the claims where no damages
are available - those subject to the federal Employee Retirement
Income Security Act, or ERISA - from non-ERISA claims, where
consumers can sue.1 2"
Aetna ERISA Settlemnt with
950,000 MD's
Final Rules
Patient's
Rights Claims Procedure Regulation
Fact Sheet - What To Do If Your Health Coverage Can No Longer
Pay Benefits
Questions and
Answers: Recent Changes in Health Care Law (PDF)
Continuation of Health Coverage – COBRA
ERISA Laws/Rules
ERISA in the United States Code: Cross-reference table,
table of contents
ERISA in US CODE
ERISA in the United States Code: Cross-reference table, table
of contents (detailed)
(benefitslink.com)
Department
Of Insurance Web Sites for All 50 States
HHS OCR
Home Page
Office for Civil Rights
- HIPAA
HIPAA Privacy Rules Republished In Single Document (PDF)
View Health Information Privacy Frequently Asked Questions (FAQs)
Privacy Rule Summary [PDF]
[RTF]
Full Text of Final HIPAA Privacy Regulations (PDF format)
(U.S. Department of Health and Human Services)
HHS ISSUES NEW FREQUENTLY-ASKED QUESTIONS ON
AUTHORIZATIONS
UNDER HIPAA PRIVACY RULES, (FAQs) (Updated Sept. 24, 2003)
Is a health care claim appeal considered a HIPAA-adopted
standard transaction?
"No." (11/06/2003)
HIPAA
Privacy
Full Text of Final HIPAA Privacy Regulations (txt)
(U.S. Department of Health and Human Services)
Press Release
Fact Sheet
Office for Civil Rights - HIPAA
OCR Guidance
Explaining Significant Aspects of the Privacy Rule- December 4, 2002
Working Families' Health Insurance Coverage, 1997-2001
(Center for Studying Health System Change)
"Of the 189 million nonelderly people in working families in 2001,
77.5 percent, or 146 million, had employer coverage,.."
Health Spending Rose 10% in 2001, Mostly Because of Hospital
Costs, Study Says (KaiserNetwork.org)
USA Today Opinion Pieces Debate Employers' Role in Healthcare
Cost Increases (KaiserNetwork.org)
USATODAY.com - Workers pay more for same flawed health plans
Opinion: The Coming Crash in Health Care (Fortune.com)
"Thus it may come as a surprise to
learn that the managed-care industry is dying. Oops, did we spill the
beans so soon? Well, so be it. Managed care is on the way out."
HIPPA Final
HHS Adopts Final Security Standards, Transaction Modifications
for Electronic Health Information Under HIPAA
Managed Care and Patients' Rights
(JAMA Editorial)
Enrollee Appeals of Preservice Coverage Denials at 2 Health
Maintenance Organizations (JAMA
Abstract)
National
Compensation Survey: Employee Benefits in Private Industry in the
United States, 2000 (PDF) (U.S. Department of Labor, Bureau
of Labor Statistics)
Government Survey: Employee Benefits in Private Industry, 2003
(U.S. Department of Labor, Bureau of Labor Statistics)
Data
Provide Details on Characteristics of Health Insurance of U.S. Workers
(Agency for Healthcare Research and Quality)
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