Fiduciary duty-HMOs-Disclosure-Physician compensation and financial incentives
Article Abstract:
In this court case, fiduciary obligations under Section 404 of ERISA do not incorporate a broad requirement to reveal the details of its physician compensation and reimbursement schemes to all plan members. Such a requirement might be implied if a participating specifically requests information regarding such arrangements,among other things.
Publication Name: Benefits Quarterly
Subject: Human resources and labor relations
ISSN: 8756-1263
Year: 2001
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HMOs--independent medical review--preemption
Article Abstract:
In the case Rush Prudential HMO Inc. versus Debra Moran, it was determined that a state statute can mandate a health maintenan ce organization to allow for an independent medical review of a denial of a request for a particular treatment as not medically necessary and to supply the treatment if it is determined by the reviewing physician that the covered service is reasonably necessary.
Publication Name: Benefits Quarterly
Subject: Human resources and labor relations
ISSN: 8756-1263
Year: 2003
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HMOs - financial incentives - disclosure
Article Abstract:
The decision given by the Third Circuit Court of Appeals in Horvath v. Keystone Health Plan East, Inc., 2003 U.S. App. LEXIS 12700 (3d Cir. 2003) is discussed. The case clarifies on the extent of applicability of fiduciary duties. Donna Horvath filed the case. The relevant provisions of ERISA are also discussed.
Publication Name: Benefits Quarterly
Subject: Human resources and labor relations
ISSN: 8756-1263
Year: 2005
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- Abstracts: Adopting hybrid pension plans: financial and communication issues. Measuring the value of your 401(k) plan
- Abstracts: Rewarding and retaining the best: compensation strategies for top performers. Rewarding employees with psychic income pays long-term dividends
- Abstracts: Health claim denial-standard of review-arbitrary and capricious-medically necessary. Focus on plan administration: Administration- health benefits- reimbursement