> Health Maintenance Organization (HMO) Managed-care insurers — known generally as HMOs — use a primary care physician as a gatekeeper to screen patients and see that appropriate treatment takes place at the lowest level possible. In order to see a specialist or receive specialized care, patients must see the gatekeeper physician first and be referred on.
> Dependent Property This refers to a kind of business-interruption endorsement on a commercial policy that protects you from financial losses caused by problems somewhere other than your business. “Dependent property” is defined as property not owned, operated or controlled by you but on which you are dependent for normal business operations.
> Basic Hospital Basic-hospital plans cover only in-hospital (inpatient) care, not other services. This benefit also may be limited to an approved or network facility. Hospitalization in a different facility may qualify for less coverage or none at all.
ERISA permits a parent to obtain a court order to provide coverage for children under the noncustodial parent’s health plan (called a qualified medical child support order).
ERISA Disclosure Provisions help to ensure that individuals covered by group health plans receive clear information about their rights, benefits, and obligations under the plan, including information about COBRA continuation coverage, access to urgent or specialized care, and composition of physician and other provider networks.
HIPAA includes protections for newborns and adopted children with preexisting conditions. Specifically, HIPAA does not permit a preexisting condition exclusion to be applied to a newborn or adopted child who enrolls within 30 days of birth or adoption.
ERISA Claims Procedures help ensure timely and fair review of plan denials of claims.
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Did You Know?
LLC envelope offers substantial advantages over other entities
There are at least five common circumstances when a tax regime other than an S corporation may be more appropriate: 1) the business cannot qualify as an S corporation; 2) the one-class-of-stock limitation for S corporations cannot accommodate certain business terms agreed to by the parties; 3) the business involves appreciating assets (i.e., assets that have, or are likely to have, a fair market value in excess of basis), such as real estate; 4) the business has considerable debt and the owners anticipate significant losses;15 and 5) the wage-reduction tax strategy explained previously will not benefit the owners because either the primary income of the business is excluded from self-employment tax16 or, in the case of newly formed companies, one or more employee-owners already receive aggregate wages or self-employment income from an existing business in an amount which approaches the taxable wage base limitation
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