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Wednesday, March 21, 2012

Health Benefits, US Supreme Court and Workers Compensation

U.S. Supreme Court building.U.S. Supreme Court building.
(Photo credit: Wikipedia)

On Monday, the US Supreme Court will hear oral arguments concerning the validity of the 2010 Patient Protection and Affordable Care Act. Whatever the US Supreme Court decides in the pending matters, the nation's patchwork of workers' compensation systems will ultimately feel the impact. The implementation of the Act will ultimately have far reaching consequences of the overall operation of both the delivery of workers' compensation medical benefits and the ultimate assessment/apportionment of permanent disability.

Workers' Compensation systems have been struggling with the delivery of medical benefits. As more cases are denied initial compensability determinations, and alterate medical care is sought for the prevention, identification and treatment of underlying, co-existing and pre-existing medical conditions will be even more significant issues  in workers' compensation matters.

Thompson-Reuters News & Insight identifies some of the issues the US Supreme Court will consider:


"* Adult children remaining on their parents' insurance coverage through the age of 26.

* An end to lifetime limits on the dollar value of benefits available to people with serious medical conditions that can lead to astronomical treatment costs.

* Preventive healthcare benefits including free coverage for mammograms and birth control.

* For Medicare beneficiaries stuck in the prescription drug benefit coverage gap known as the "doughnut hole," a 50 percent discount on covered brand name drugs and 14 percent savings on generic drugs.

* A requirement that insurance companies justify unreasonably large healthcare premium increases.

* Tax credits for small employers with no more than 25 employees and average annual wages of less than $50,000 that provide health insurance for employees.

* Temporary insurance coverage programs for retirees who are over age 55 but not eligible for Medicare.

* Temporary insurance coverage for individuals with pre-existing medical conditions who have been uninsured for at least six months.

* A requirement that health plans report the proportion of premium dollars spent on clinical services, quality, and other costs, and provide rebates to consumers if the share of the premium spent on clinical services and quality is less than 85 percent in the large group market and 80 percent in the individual and small group markets.

National Federation of Independent Business v. Sebelius, No. 11-393; U.S. Department of Health and Human Services v. Florida, No. 11-398; and Florida v. Department of Health and Human Services, No. 11-400

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