Practice Management Alert

ERISA: Employee Retirement Income Security Act -- a federal law governing private-sector self-funded or employer-sponsored insurance plans. ABD: Adverse Benefit Determination -- a denial, reduction or termination of a benefit, or a failure to pay on a benefit. Anytime a plan under ERISA fails to pay 100 percent of the claim, it is defined as an adverse benefit determination. SPD: Summary Plan Description -- a document, which the employer gives to the covered member, that provides a detailed summary of the insurance plan, including how it works, what benefits it provides, and how they may be obtained.