Ganske-Dingell-Norwood-Berry (H.R. 2563) Protects Employers

1.  The Ganske-Dingell-Norwood-Berry bill protects employers first by using a "designated decision maker" who assumes all liability for the employer. The insurance company is automatically the designated decision maker, unless the employer affirmatively acts to change this. The designated decision maker assumes all liability for the employer; the employer cannot be sued. The bill also provides protections to ensure that the designated decision maker is not an empty shell and is not a loophole for HMOs.

2.  The Ganske-Dingell-Norwood-Berry bill also protects employers by using the "direct participation" standard for employers who either actively choose not to use the designated decision maker protection or who run their own insurance plan in-house and do not contract with a third party administrator or insurer. Under this standard, unless the employer directly participated in the decision that caused harm, the employer would be protected. Just paying claims is not enough. The "direct participation" protection also explicitly lists instances that are not direct participation, such as advocating for employees.

3.  The Ganske-Dingell-Norwood-Berry bill only creates liability in Federal court for very limited circumstances – for injuries resulting from improper coverage, eligibility, or express benefit exclusion decisions. It does not open up liability for any plan-related violations.

4.  The Ganske-Dingell-Norwood-Berry bill exempts self-insured, self-administered employer health plans from any liability in Federal court for contract decisions that cause injuries.

5.  The Ganske-Dingell-Norwood-Berry bill protects individual board members, trustees, or volunteers of employer plans from personal liability by virtue of being on a board of trustees of an employer.

6.  The Ganske-Dingell-Norwood-Berry bill ensures that employers who have self-insured, self-administered health plans that do not have an insurer or third party administrator to act as a designated decision maker, can purchase liability insurance for medical claims, just like they can for other types of claims today.

7.  The Ganske-Dingell-Norwood-Berry bill includes specific protections to ensure that insurance agents are not held liable for selling insurance and that limited benefit plans, such as disability insurance or long term care insurance, are not covered as a part of this bill.

8.  The Ganske-Dingell-Norwood-Berry bill ensures that HMOs are prevented from dumping their liability on physicians, other health care professionals, or hospitals and that specific protections to that effect are included.