U.S. Supreme Court Upholds State HMO Act Requirement for Independent Medical Review of ERISA Plan Claim Denial

Conway, Susan G.
July 2002
Venulex Legal Summaries;2002 Q3, p1
The article reports on the ruling of the U.S. Supreme Court on the case Rush Prudential HMO Inc. versus Moran which concerns on the state medical review requirement for Employee Retirement Income Security Act (ERISA) plan claim. It held that a health maintenance organization (HMO) that contracts to provide medical services for ERISA benefit plans must conform with the Illinois HMO Act provisions. It added that the medical review requirement is not preempted by ERISA because it does not change any ERISA-governed benefit.


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