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Objectives. To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services offered by hospitals. Methods. A literature review and information search was conducted to determine which insurers had special policies for CAM and which hospitals were offering CAM. Telephone interviews were conducted with a definitive sample of 18 insurers and a representative subsample of seven hospitals. Results. A majority of the insurers interviewed offered some coverage for the following: nutrition counseling, biofeedback, psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. Twelve insurers said that market demand was their primary motivation for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness based on consumer interest, demonstrable clinical efficacy, and state mandates. Some hospitals are also responding to consumer interest in CAM, although hospitals can only offer CAM therapies for which local, licensed practitioners are available. Among the most common obstacles listed to incorporating CAM into mainstream health care were lack of research on efficacy, economics, ignorance about CAM, provider competition and division, and lack of standards of practice. Conclusions. Consumer demand for CAM is motivating more insurers and hospitals to assess the benefits of incorporating CAM. Outcomes studies for both allopathic and CAM therapies are needed to help create a health care system based upon treatments that work, whether they are mainstream, complementary, or alternative.

Lesson one : The case for why you need insurance -- Lesson two : Getting a handle on cost -- Lesson three : The LPL insurance application -- Lesson four : Interpreting your LPL insurance coverage -- Lesson five : Understanding claims-made coverage -- Lesson six : Avoiding gaps : changing firms and carriers -- Lesson seven : Additional policy provisions -- Lesson eight : Endorsements -- Lesson nine : Understanding coverage limits -- Lesson ten : Understanding your insurance carrier -- Lesson eleven : Assessing insurance carriers -- Lesson twelve : Options to purchase -- Conclusion -- Beyond the lessons -- Addendum A. American Bar Association Standing Committee on Client Protection State implementation of ABA Model court rule on insurance disclosure -- Addendum B. Office sharing : drawing a line in the sand -- Addendum C. Cyber-liability insurance -- Addendum D: Practice management software

Chapter 145 of the 1955 Public Acts' enacted by the Tennessee Legislature, purporting in some degree to permit a third-party action, has evoked considerable interest among members of the Tennessee Bar and liability insurance carriers. The act provides that when a defendant deems some other party primarily liable to the plaintiff, then the defendant may file a cross action against the third party. It will be recalled that when the Federal Rules of Civil Procedure were first promulgated, Rule 14 provided that a defendant, deeming a third party liable to himsel for to the plaintiff, could make such third party a defendant to the cause. The effect of this rule was that the plaintiff could have judgment against either the original defendant or the third-party defendant even though the plaintiff had never himself sued the third-party defendant. Because of the novelty of this procedure and the fact that it was not the intent of the federal rules to change substantive law, Rule 14 was soon amended so as to delete the portion that permitted such a cross action when the defendant deemed the third party liable to the plaintiff, so that such cross actions are now only permitted on an allegation that the third party is liable to the original defendant. It appears, therefore, that the Tennessee statute is unlike the original federal rule in that Chapter 145 does not contemplate plaintiff having judgment against the third-party defendant, and is unlike the present federal rule in that the allegation required is not that the third party is liable to the defendant but rather that he is "primarily liable to the plaintiff."

By capitalizing on the communication and enrollment resources offered by insurance carriers and their sales and enrollment partners, employers can meet high expectations regarding benefit packages without incurring additional expenses and without assuming the burden of administering a marketing program. By choosing a carrier with a flexible menu of enrollment options, an employer can address the concerns of today's workers by providing benefit options that are portable and customizable, with provisions for financial security. This article discusses the wide range of services offered by insurance companies and their partners to help develop and implement successful enrollment—at little to no additional cost to employers.

Over the past years, one of the most contentious topics in policy debates on genetics has been the use of genetic testing in insurance. In the rush to confront concerns about potential abuses of genetic information, most countries throughout Europe and the US have enacted genetics-specific legislation for insurance. Drawing on current debates on the pros and cons of a genetics-specific legislative approach, this article offers empirical insight into how such legislation works out in insurance practice. To this end, ethnographic fieldwork was done in the underwriting departments of Belgian insurance companies. Belgium was one of the first European countries introducing genetics-specific legislation in insurance. Although this approach does not allow us to speak in terms of ' the causal effects of the law', it enables us to point to some developments in insurance practice that are quite different than the law's original intentions. It will not only become clear that the Belgian genetics-specific legislation does not offer adequate solutions to the underlying issues it was intended for. We will also show that, while the legislation's focus has been on the inadmissibility of genetic discrimination, at the same time differences are made in the insurance appraisal within the group of the asymptomatic ill. In other words, by giving exclusive legal protection to the group of genetic risks, other non-genetic risk groups are unintendedly being under-protected. From a policy point of view, studying genetics-specific legislation is especially valuable because it forces us to return to first principles: Which risks deserve our legal protection in insurance? Who do we declare our solidarity with?

Insurance presents a well-recognized preventive value. However, in recent times when it comes to the preventive function of insurance, it is about much more and this can be heard in voices of increasing numbers of experts and insurers. Three fundamental motivators prompted the pursuit of this study: (1) dynamic shifts in the risk landscape, (2) emerging technologies facilitating risk prevention, and (3) a perceived regulatory gap in addressing societal needs and technological potentials. Legal considerations related to the utilization of new technologies in insurance have been extensively discussed, albeit selectively. These discussions have focused on issues such as the policyholder's risk declaration, the potential use of sensitive data for risk assessment, and the automated distribution process (robo-advice). No comprehensive legal analysis of the preventive function of insurance in this context is available. There is a noticeable research and publication gap that should be filled by holistic considerations on risk prevention in insurance, both on the level of private law (insurance contract, duties of the insurance distributors, as well as public law, concerning the supervision over applying the risk prevention measures by the insurance carriers. Finding a new approach that could address the legal challenges is, according to the author, of great importance for the development of insurance as a protection tool for the most imminent social risks. The objectives included in the paper include showing the impact of new technologies on risk prevention, as well as analysis of what the role of the insurer in risk prevention may and should be from the legal perspective, including the potential change of roles in performing the insurance contract. The objectives of the paper involve several aspects, such as whether prevention has the potential to become a distinguished (re-) insurance service, as well as what the boundaries of the insurance contract and insurance business in terms of its compensatory and preventive function are.

Over the past years, one of the most contentious topics in policy debates on genetics has been the use of genetic testing in insurance. In the rush to confront concerns about potential abuses of genetic information, most countries throughout Europe and the US have enacted genetics-specific legislation for insurance. Drawing on current debates on the pros and cons of a genetics-specific legislative approach, this article offers empirical insight into how such legislation works out in insurance practice. To this end, ethnographic fieldwork was done in the underwriting departments of Belgian insurance companies. Belgium was one of the first European countries introducing genetics-specific legislation in insurance. Although this approach does not allow us to speak in terms of ' the causal effects of the law', it enables us to point to some developments in insurance practice that are quite different than the law's original intentions. It will not only become clear that the Belgian genetics-specific legislation does not offer adequate solutions to the underlying issues it was intended for. We will also show that, while the legislation's focus has been on the inadmissibility of genetic discrimination, at the same time differences are made in the insurance appraisal within the group of the asymptomatic ill. In other words, by giving exclusive legal protection to the group of genetic risks, other non-genetic risk groups are unintendedly being under-protected. From a policy point of view, studying genetics-specific legislation is especially valuable because it forces us to return to first principles: Which risks deserve our legal protection in insurance? Who do we declare our solidarity with?

"B-238267"--P.1. ; "GAO/HRD-91-25." ; "November 1990." ; Cover title. ; Includes bibliographical references. ; Mode of access: Internet.

Aviation insurance premiums have become a heavy burden for the airline industry since September 11, 2001. Although the industry must constantly balance its operations between profitability and safety, the reality is that airlines are in the business of making money. Therefore, their ability to reduce cost and manage risk is a key factor for success. Unlike past research, which used subjective judgment methods, this study applied quantitative historical data (1999–2000) and gray relation analysis to identify the primary factors influencing ratemaking for aviation insurance premiums. An empirical study of six airlines in Taiwan was conducted to determine these factors and to analyze the management strategies used to deal with them. Results showed that the loss experience and performance of individual airlines were the key elements associated with aviation insurance premiums paid by each airline. By identifying and understanding the primary factors influencing ratemaking for aviation insurance, airlines will better understand their relative operational strengths and weaknesses, and further help top management identify areas for further improvement. Knowledge of these factors combined with effective risk management strategies, may result in lower premiums and operating costs for airline companies.

A letter report issued by the General Accounting Office with an abstract that begins "This report investigates health care consultants who conduct seminars or workshops that offer advice to health care providers on ways to enhance revenue and avoid audits or investigations. GAO attended several seminars and workshops offered by these consultants. GAO sought to determine whether the consultants were providing advice that could result in improper or excessive claims to Medicare, Medicaid, other federally funded health plans, and private health insurance carriers. GAO found that some advice was inconsistent with guidance provided by the Department of Health and Human Services' Office of Inspector General (OIG). Such advice could result in violations of both civil and criminal statutes."

A letter report issued by the General Accounting Office with an abstract that begins "Five percent of adults suffer from serious mental disorders. Although health insurance carriers in a few states guarantee coverage for mental health treatment, in most states individuals with mental disorders face restrictions in purchasing private health insurance for themselves and their families. Eleven states require carriers to accept all applicants regardless of health status, but coverage options vary. Eight of these 11 states require all carriers to guarantee access to coverage sold in this market. In three states, laws apply only to some carriers, such as Blue Cross and Blue Shield, or certain periods of the year. Carriers in nine of the 11 states are also required to limit the extent to which premium rates vary between healthy and unhealthy individuals. In states without guaranteed coverage in the individual market, the seven carriers GAO reviewed would likely deny coverage more frequently for applicants with mental disorders than for applicants with other chronic health conditions. Specifically, for six mental disorders of generally moderate severity, carriers said that they would likely decline applicants 52 percent of the time. State-sponsored high-risk pools are the primary coverage option available to rejected applicants in most states. In 27 of the 34 states where carriers may deny coverage to applicants with mental disorders or other health conditions, high-risk pools offer coverage to applicants denied individual market coverage. The pools are subsidized--generally through assessments on carriers or state tax revenues--and premium rates are generally capped at 125 to 200 percent of standard rates for healthy individuals. Health benefits available under the pools are generally comparable to those available in the individual market, including similar restrictions on mental health benefits; however, benefits for mental disorders or other health conditions are not permanently excluded as they may be in the individual insurance market."

Testimony issued by the General Accounting Office with an abstract that begins "This testimony discusses the results of GAO's investigation of health care billing consultants whose seminars and workshops advise health care providers on how to boost revenue and avoid audits. Consultants at two workshops that GAO attended provided in-depth discussions of regulations on billing for health care services and compliance with health care laws and regulations. Some of this advice was inconsistent with federal law and guidance provided by the Department of Health and Human Services' Office of Inspector General. Such advice could result in violations of both civil and criminal statutes. Some consultants urged health care providers to not report or refund overpayments from insurance carriers after they were discovered. The consultants also encouraged the performance of unnecessary tests and procedures to generate documentation that would support bills for evaluation and management services at a higher level of complexity than actually confronted during patients' office visits. This testimony summarizes a June report (GAO-01-818)."

Researchers al the Center for the Study of Human Resources conducted exploratory research on return-to-work (RTW) patterns and programs for injured workers covered by workers' compensation in Texas. This study was requested by the Legislature in passing the Texas Workers' Compensation Act of 1989. Several different methodologies were utilized in this research. including: descriptive statistical analysis of agency records for individual workers' compensation claimants provided by the Texas Workers' Compensation Commission and the Texas Department of Insurance, matched to their employment and earnings information from the Texas Employment Commission; mail/telephone surveys of RTW programs/services offered by employers, insurance carriers and private rehabilitation providers; case studies of selected RTW efforts; and focus groups with RTW participants. ; Texas Workers Compensation Research Center ; Ray Marshall Center for the Study of Human Resources