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Результаты поиска “Governmental plan exclusion from erisa” за 2017
Advocate Health Care Network v. Stapleton: Oral Argument - March 27, 2017
 
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Facts: The Employee Retirement Income Security Act of 1974 (ERISA) protects employees from unexpected losses in their retirement plans by putting in place required safeguards on plans that qualify for ERISA protections. Church plans are exempted from the Act and its protections to prevent excessive entanglement of the government with religion through regulation. Maria Stapleton and the other plaintiffs in this case are a group of employees who work for Advocate Health Care Network (Advocate), which operates hospitals, inpatient, and outpatient treatment centers through northern Illinois, and are members of Advocate’s retirement plan. Advocate formed in 1995 as the result of a merger between two religiously affiliated hospital systems (though neither system was owned or financially operated by the church with which it was affiliated). Advocate is also affiliated with a church, and though it is not owned or financially operated by the church, it maintains contracts with the church and “affirms [the church’s] ministry.” The plaintiffs in this case sued Advocate and argued that the Advocate retirement plan is subject to ERISA, and therefore Advocate has breached its fiduciary duty by failing to adhere to ERISA’s requirements. The defendants moved for summary judgment because the Advocate plan fell under the ERISA exemption for church plans. The district court denied the motion because it determined that a plan established and maintained by a church-affiliated organization was not a church plan within the meaning of the statutory language. The U.S. Court of Appeals for the Seventh Circuit affirmed, and this case was consolidated with two other ones presenting the same issue before the Supreme Court. Question: Does the exemption to the Employee Retirement Income Security Act of 1974 (ERISA) for church plans apply when the plan is maintained by an otherwise qualifying church-affiliated organization even though a church did not establish the plan? For more information about this case see: https://www.oyez.org/cases/2016/16-74 Section 1: 00:00:05 Section 2: 00:18:32 Section 3: 00:29:27 Section 4: 00:59:41 PuppyJusticeAutomated videos are created by a program written by Adam Schwalm. This program is available on github here: https://github.com/ALSchwalm/PuppyJusticeAutomated The audio and transcript used in this video is provided by the Chicago-Kent College of Law under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License. See this link for details: https://creativecommons.org/licenses/by-nc/4.0/
Просмотров: 130 PuppyJusticeAutomated
Health Insurance
 
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A health insurance policy is: A contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (e.g. an employer or a community organization). The contract can be renewable (e.g. annually, monthly) or lifelong in the case of private insurance, or be mandatory for all citizens in the case of national plans. The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or "Evidence of Coverage" booklet for private insurance, or in a national health policy for public insurance. (US specific) Provided by an employer-sponsored self-funded ERISA plan. The company generally advertises that they have one of the big insurance companies. However, in an ERISA case, that insurance company "doesn't engage in the act of insurance", they just administer it. Therefore, ERISA plans are not subject to state laws. ERISA plans are governed by federal law under the jurisdiction of the US Department of Labor (USDOL). The specific benefits or coverage details are found in the Summary Plan Description (SPD). An appeal must go through the insurance company, then to the Employer's Plan Fiduciary. If still required, the Fiduciary's decision can be brought to the USDOL to review for ERISA compliance, and then file a lawsuit in federal court. The individual insured person's obligations may take several forms:[2] Premium: The amount the policy-holder or their sponsor (e.g. an employer) pays to the health plan to purchase health coverage. Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, policy-holders might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care. Furthermore, most policies do not apply co-pays for doctor's visits or prescriptions against your deductible. Co-payment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor's visit, or to obtain a prescription. A co-payment must be paid each time a particular service is obtained. Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain. Exclusions: Not all services are covered. The insured are generally expected to pay the full cost of non-covered services out of their own pockets. Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maxima. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
Просмотров: 1 Education tools
Legal 09 - Employee Safety, Health, and Benefits
 
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Chapter 9 presentation from the Legal Aspects of Emergency Services textbook (Jones & Bartlett learning, 2016, ISBN 9781284212686), covering employee safety, health, and benefits.
Просмотров: 42 WCTCFIRE
MHSR Day 2:  Effects of the Domenici-Wellstone Parity Law and its Extensions under the ACA
 
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The National Institute of Mental Health hosted the 23rd Conference on Mental Health Services Research (MHSR) with the theme, “Harnessing Science to Strengthen the Public Health Impact.” The MHSR is the nation’s premier mental health services research conference. The August 1-2, 2016 conference brought together leading mental health services researchers, clinicians, mental health advocates, and federal and nonfederal partners. This video from Day 2 of the MHSR Conference captures the Symposium: Emerging Research Evidence on the Effects of the Domenici-Wellstone Parity Law and its Extensions under the ACA. The video features Chair: Colleen L. Barry, Ph.D., Johns Hopkins Bloomberg School of Public Health Discussants: Howard H. Goldman, M.D., Ph.D., University of Maryland School of Medicine Kirsten Beronio, J.D., Office of the Assistant Secretary for Planning and Evaluation, D.H.H.S. An Overview of Research on the Effects of Parity Haiden Huskamp, Ph.D., Harvard Medical School Impact of the Domenici-Wellstone Parity Law on Behavioral Healthcare Benefits Francisca Azocar, Ph.D., OptumHealth Commercial Health Plans’ Responses to Federal Parity Dominic Hodgkin, Ph.D., Brandeis University
Understanding Your Health Insurance
 
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As people arrive on campus and get ready for a new school year, some may experience changes in the way their health insurance works. This workshop is designed to help you understand the types of plans out there and how to make sure you have the one that's right for you.
Просмотров: 38 Common $ense