Meester v. IASD Health Services Corp.
| Citation | 963 F.2d 194 |
| Decision Date | 30 April 1992 |
| Docket Number | No. 91-2960,91-2960 |
| Parties | Gerald L. MEESTER, individually and as parent and next friend of Travis Meester; Connie Meester, individually and as parent and next friend of Travis Meester, Appellants, v. IASD HEALTH SERVICES CORP., doing business as Blue Cross of Iowa, doing business as Blue Shield of Iowa, Appellee. |
| Court | United States Courts of Appeals. United States Court of Appeals (8th Circuit) |
Gregg L. Owens, Dubuque, Iowa, argued (Michael J. Coyle, on the brief), for appellants.
David M. Swinton, Des Moines, Iowa, argued, for appellee.
Before FAGG, Circuit Judge, HENLEY, Senior Circuit Judge, and WOLLMAN, Circuit Judge.
Gerald Meester and Connie Meester appeal from an adverse grant of summary judgment in the action they brought to force an insurance company to pay certain benefits. We affirm.
IASD Health Care Services Corp., d/b/a Blue Cross of Iowa and Blue Shield of Iowa ("Blue Cross"), offered medical insurance to members of the Iowa Medical Society (the "Society"). Members of the Society could obtain coverage for both themselves and their dependents under a variety of plans. Plan A covered a maximum of 365 days of inpatient hospitalization for mental conditions or substance abuse. Plan C provided a maximum of thirty days of such benefits.
Increasing costs and decreasing enrollment caused Blue Cross and the Society to eliminate Plan A, effective December 31, 1989. The agreement between Blue Cross and the Society regarding Plan A ("Agreement") addressed the effect of termination on the payment of benefits. It provided that if an insured was receiving inpatient treatment on the date of termination, payment of benefits would continue for the shortest of three described periods, the longest of which was sixty days from the date of termination.
The Society's insurance broker sent two notices of the termination to all Society members. The first notice was mailed in January 1989. It alerted Society members that Plan A would be "phas[ed] out" and that those covered under this option must convert "to [Plan C] or one of the other options." The notice described Plan A as "expensive," pointed out that only nine percent of the members held this coverage, and described the savings in premiums ($200 per month) for those choosing Plan C. The second notice was sent in November 1989, return receipt requested. It advised participants in Plan A that the option would be "eliminate[d]" beginning in January 1990 and that the coverage of Plan A participants would automatically convert to Plan C unless they selected some other plan. The second notice noted the difference in premiums between Plans A and C. It also described some of Plan C's characteristics, noting that Plan C covered only thirty days of inpatient treatment for "nervous/mental" and "drug/alcohol" conditions. Both notices listed a telephone number that Society members could call if they had questions.
Dr. Gerald Meester is a physician employed by Dubuque Orthopedic Surgeons, P.C. A member of the Society, Dr. Meester subscribed to Plan A and had received from Blue Cross a booklet describing his coverage. He does not dispute having received both notice letters regarding the phase-out of Plan A, but he did not respond to either one. Blue Cross converted his coverage from Plan A to Plan C effective January 1, 1990.
Travis Meester, Dr. and Mrs. Meester's son, was admitted to a hospital in October 1989 for inpatient treatment of mental health and substance abuse problems. Blue Cross paid the cost of Travis Meester's hospitalization for sixty-one days after the Meesters' coverage was converted from Plan A to Plan C.
Dr. and Mrs. Meester sued Blue Cross, claiming that Blue Cross should have paid benefits for more than sixty-one days. The district court granted Blue Cross' motion for summary judgment, and the Meesters appeal.
Meyer v. Barnes, 867 F.2d 464, 466 (8th Cir.) (citations omitted), cert. denied, 493 U.S. 825, 110 S.Ct. 86, 107 L.Ed.2d 51 (1989).
The Meesters assert that genuine issues of material fact exist. First, they note that the Employee Retirement Income Security Act (ERISA) requires that plan participants receive a summary of any material modification in the terms of a plan that may result in the denial or loss of benefits. See 29 U.S.C. § 1022(a), (b). According to the Meesters, the letter notices violate this requirement because they do not describe the substituted coverage or explain the effects of conversion on preexisting hospitalization.
We agree with the district court that the notice letters satisfied the requirements of ERISA. The first letter referred to the "phasing out" of Plan A, and the second letter said that Plan A would be "eliminate[d]." The second letter informed the Meesters that their insurance coverage would automatically convert from Plan A to Plan C unless they chose otherwise. The second letter also notified the Meesters that Plan C would only cover thirty days of inpatient treatment for mental or substance abuse problems. We perceive no genuine issue of material fact regarding the letters' compliance with ERISA.
Second, the Meesters assert that the Agreement...
To continue reading
Request your trial
-
Bidlack v. Wheelabrator Corp.
... ... upon the plant's retired employees lifetime rights to certain health benefits--hence rights that survived the expiration in 1988 of the last ... that the terms of the insurance policies are dispositive); Meester v. IASD Health Services Corp., 963 F.2d 194, 197 (8th Cir.1992) ("welfare ... ...
-
JOHN MORRELL v. UNITED FOOD & COMMERCIAL WKR'S
...may modify or terminate these benefits absent a specific expression of contrary intent by the employer. Meester v. IASD Health Servs. Corp., 963 F.2d 194, 197 (8th Cir.1992), citing, Howe v. Varity Corp., 896 F.2d 1107 (8th Cir.1990); see also, Anderson v. John Morrell & Co., 830 F.2d 872, ......
- Budden v. U.S.
-
Pirkheim v. First Unum Life Ins. Co.
... ... Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d ... as a Tenth Circuit Court of Appeals opinion)); Meester v. IASD Health Services Corp., 963 F.2d 194, 197 (8th ... ...