understanding ERISA vs. HMO,PPO,etc
I am still in the learning stages of what ERISA means and how it all goes and rights and such, so i am curious to know if ERISA applies to companies that are HMO's, PPO's etc such as UNITED...
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To put it simplistically, if the plan is self funded or if the plan is being paid for by the employer, then the plan falls within the jurisdiction of ERISA. The plan could be a PPO or an HMO. It could...
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Steve - does it matter if the employees also contribute toward their insurance benefits? Eileen
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Steve,Is ERISA overruled any state's HMO, PPO, POS, etc.. even if the provider's have a specific agreement with the carriers?Max
View ArticleRe: understanding ERISA vs. HMO,PPO,etc
ERISA, being a federal law, overrides or preempts state laws.If the provider has a contract, then that is a different matter because instead of an ERISA violation, you have a contractual issue, which...
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Steve..thanks for the info.This pretty much indicated that ERISA is really not much help as most of our insurance payors about 90% we're are contracted with. Max
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Max,I think ERISA still applies if the provider and the insurance is contracted however for some reason they have not paid the benefits and say there is a XYZ problem and therefore pymt is not issued...
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It can be both an ERISA issue and a contractual issue.When the provider signs a contract to be paid $X, and the carrier does not pay the provider $X, then it is a contractual issue between the...
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Is there an easy way to determine if the coverage is covered by ERISA, or is that something that has to be asked at time of insurance verification?Thank you,Kathy
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You can ask the person where they are getting their insurance, for example, Add this to your checklist:1) Are you employed? Yes___ No____2. If Yes, is your health insurance a benefit of your...
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