Pegram v. Herdrich

Last updated
Pegram v. Herdrich
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Argued February 23, 2000
Decided June 12, 2000
Full case nameLori Pegram, et al., Petitioners v. Cynthia Herdrich
Citations 530 U.S. 211 ( more )
120 S. Ct. 2143; 147 L. Ed. 2d 164; 2000 U.S. LEXIS 3964
Holding
Because mixed treatment and eligibility decisions by health maintenance organization physicians are not fiduciary according to the Employee Retirement Income Security Act, Herdrich does not state a claim under the Act.
Court membership
Chief Justice
William Rehnquist
Associate Justices
John P. Stevens  · Sandra Day O'Connor
Antonin Scalia  · Anthony Kennedy
David Souter  · Clarence Thomas
Ruth Bader Ginsburg  · Stephen Breyer
Case opinions
Majority Souter, joined by unanimous
Laws applied
Employee Retirement Income Security Act of 1974, 29 U.S.C.   § 1001 et seq.

Pegram v. Herdrich, 530 U.S. 211 (2000), was a United States Supreme Court case that held that the Employee Retirement Income Security Act of 1974 does not provide a remedy for coverage determinations by health maintenance organizations. The case is important because by excluding suits involving coverage determinations from the Act, it does not pre-empt state law remedies. [1]

Employee Retirement Income Security Act of 1974 U.S. tax and labor law

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal United States tax and labor law that establishes minimum standards for pension plans in private industry. It contains rules on the federal income tax effects of transactions associated with employee benefit plans. ERISA was enacted to protect the interests of employee benefit plan participants and their beneficiaries by:

In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care providers on a prepaid basis. The Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options if the employer offers traditional healthcare options. Unlike traditional indemnity insurance, an HMO covers care rendered by those doctors and other professionals who have agreed by contract to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers. HMOs cover emergency care regardless of the health care provider's contracted status.

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References

  1. Pegram v. Herdrich, 530 U.S. 211 (2000).
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