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Moukawsher & Walsh, LLC
Pension and Employee Benefit Law

Benefitlawyers.com

 
 

Pomerantz Haudek Block Grossman & Gross LLP ("PHBG&G")

ERISA and Healthcare-Related Class Actions

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FEHB Open Season and FSA Open Season

 

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FEHB HANDBOOK

 

 

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SPD's for NJ State

NJ STATE
HEALTH BENEFITS PROGRAM

SUMMARY PROGRAM DESCRIPTION (SPD)
for employees and retirees

January 2003  (pdf)

 
Kaiser statehealthfacts.org
 
 
 
 
 

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

Rx-1  $$$$$$$$$ERISA"Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
$$$$$$$$$$  Rx-2
US Supreme Court Visits ERISAclaim.com

at 11:57:03 AM on Friday, November 21, 2003

 

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Benefit Claims Procedure Regulation

DOL > EBSA > Frequently Asked Question [PDF]

(Selected Only, Click DOL Links for Updated Official Documents)

Legal Research Resources -Wirtz Law Labor Library

Interactive Tools

2004 Form 5500 Instructions

Schedule A - Insurance Information View  View

 

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)

   

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Health Benefits Advisor

DOL/EBSA Organization Chart/Regional and District EBSA Offices | By Topic | By Audience | By Organization | By Location  

 

DOL 2005 Advisory Opinions

AO/Date/Reference
 
2005-16A, 06/10/2005, ERISA Sec. 503
Recipient
 

Dr. Gary Conant
Conant Chiropractic Clinic

Description of Request
 

Regarding the claims procedure regulation at 29 CFR 2560.503-1(h)(3) which requires the plan's named fiduciary deciding an appeal of a group health claim denied based on a medical judgment to consult with a physician or other health care professional that is licensed, accredited or certified to perform specified health services consistent with State law.

 

Health Care Continuation Coverage; Final Rule [Rules and Regulations] [05/26/2004] | [PDF Version]| [Notices] | [Press Release]

 

Enforcement News from DOL

Employee Benefits Security Administration

 

Fact Sheet - EBSA Achieves Total Monetary Results Exceeding $1.7 Billion

 (DOL, January 2006)

"Through its enforcement of the Employee Retirement Income Security Act (ERISA), the Employee Benefits Security Administration (EBSA) is responsible for ensuring the integrity of the private employee benefit plan system in the United States. EBSA’s oversight authority extends to approximately 730,000 pension plans and another 6 million health and welfare plans. These plans cover approximately 150 million workers and their dependents and include assets of more than $4 trillion.......

 

Record $88.4 Million Restored to Workers through Informal Complaint Resolution

 

When workers experience a problem with an employee benefit plan, EBSA has proven effective in resolving their requests for assistance. In FY 2005, EBSA’s Benefits Advisors handled nearly 160,000 inquiries and recovered $88.4 million in benefits on behalf of workers and their families through informal resolution of individual complaints. Many of these inquiries were received via EBSA’s toll-free number: 1.866.444.EBSA (3272) and Web site: www.askebsa.dol.gov.

 

These inquiries are also a major source of enforcement leads. When EBSA becomes aware of repeated complaints with respect to a particular plan, employer, or service provider, or when there is information indicating a suspected fiduciary breach, the matter is referred for investigation. In FY 2005, 1,067 new investigations were opened as a result of referrals from Benefits Advisors."

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Plan Administrator Indicted for Filing False Annual Reports With DOL

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DOL Sues Former Minneapolis Executives For Health Plan Mismanagement

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DOL Sues to Recover Funds for Tennessee Health Plan

 

U.S. Labor Secretary Elaine L. Chao Announces Stronger Retirement, Health Benefit Security for American Workers - 121% Increase in Monetary Results Shows “Commitment to Protect Hard-Earned Benefits” Release Date: 10/21/2004

"EBSA closed 4,399 civil investigations in FY 2004. Nearly 70% of those investigations resulted in correction of violations under the Employee Retirement Income Security Act (ERISA). Criminal investigations led to the indictment of 121 individuals. In addition, EBSA received a record 474 applications to participate in its compliance assistance program to help employers and plan officials to voluntarily correct specific violations of the law."

EBSA Achieves Record $3.1 Billion in Fiscal Year 2004 Results Press Release

 

DOL Health Benefits Education Campaign [New  Seminars: IL, NY, KY]

DOL Launches National Education Campaign "Getting It Right-Know Your Fiduciary Responsibilities"

 

Labor Department Releases Form 5500 Annual Report and Filing Requirements for 2004

 

Press Release  EBSA News Release: [05/18/2004]

 

Employee Benefits Security Administration Issues Field Assistance Bulletin on Health Savings

 

Field Assistance Bulletin 2004-1 "Whether Health Savings Accounts established in connection with employment-based group health plans constitute "employee welfare benefit plans" for purposes of Title I of ERISA?"

Seminars are scheduled for Florida, Ohio, Massachusetts and Arizona, beginning in June 2004. The program will emphasize the obligation of plan sponsors and other fiduciaries to:

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Understand the terms of their plans;

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Select and monitor service providers carefully;

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Make timely contributions to fund benefits;

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Avoid prohibited transactions; and

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Make timely disclosures to workers and their beneficiaries and reports to the government.

Publications

Meeting Your Fiduciary Responsibilities

Understanding Retirement Plan Fees And Expenses

Selecting An Auditor For Your Employee Benefit Plan

Reporting and Disclosure Guide for Employee Benefit Plans

 


State Insurance Department in All 50 States

Promote & Coordinate with ERISA  "Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance

NAIC ERISA Working Group

 

Health Benefits Laws By State
(Interactive Tools From Insure.com)

Kaiser statehealthfacts.org

Health Insurance Mandates in the States, 2004: a State-by-State Breakdown ... (PDF)
 

Consumer Guides for Health Insurance in Every State and the District of Columbia (Georgetown University)

View a 5-minute clip

Paper Chase "Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance

ERISAclaim.com - U.S. Health-care Crisis
& ERISA Criminal Enforcement

To Avoid "John Q.
ERISA
Enforcement"

 

What You Should Know
about Filing Your Health Benefits Claim
(DOL Claims Card)

 

 Organization Chart/Regional and District EBSA Offices

 

 

 

The Root of U. S. Healthcare Crisis

Jin Zhou, ERISAclaim.com

The Hearing at Senate Committee on Finance on 3-3-04, [View Video "Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
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)

 

 

ERISA Failure Syndrome

U.S. Healthcare Crisis Trilogy

(Copyright © 2004 by Jin Zhou,  ERISAclaim.com)

 

ERISA
Medical Killing
ERISA
Medical Inflation
ERISA
Insurance Robbery
"Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance

Read Making a Killing

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Bar graph showing trends in hospital charges and revenues in California from 1995-2002

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GAO-04-312

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American Job ExportING!

Mass layoffs up in January 2004

Weirton Steel cancels 10,000

GM: $67.5 billion in 2003

One Nation under Debt: U..S. economy threatened by aging of America

 

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

 

Rx-1  $$$$$$$$$ERISA"Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
$$$$$$$$$$  Rx-2

 

"Atlanta, Georgia - The U.S. Department of Labor has obtained a preliminary injunction removing the trustees of the Paramount, California-based International Union of Industrial and Independent Workers Benefit Fund (IUIIW) and permanently barring them from service to the fund."

Labor Department Sues Corporation For Violating Federal Employee Benefit Law (Release Date: 02/02/2004)

"Columbus, Ohio - The U.S. Department of Labor has sued defunct General Clay Products Corporation, of Columbus, Ohio, for abandoning the company’s retirement plan, and also filed suit against its president for failing to forward employee contributions to the health plan. The alleged violations resulted in the loss of health insurance coverage for company workers."

Labor Department Issues Reporting And Disclosure Guide for Employee Benefit Plans (11/20/2003)