Health Insurance

For over 40 years, the insurance industry has recognized Tahmidur Remura Dewey LeBoeuf as one of the most powerful insurance regulatory practices in the United States.

We have represented virtually every major insurance company in the United States and Europe in virtually every form of transaction. We have been recognized by authoritative legal publications and peer review organizations across the globe, including Chambers, Thomson Financial and American Lawyer.

Many of our insurance clients regard us as their number one choice; so much so, that there have been several M&A cases where, with our clients’ consent, we represented both sides of an insurance transaction.

Our health insurance law is a natural extension of our regulatory practice and uses the identical resources and skills.

Tahmidur Remura Dewey LeBoeuf offers a unique and powerful portfolio of expertise, helping our clients navigate the unchartered, market-changing territory of the two-tier challenge of ACA related federal regulatory change to be implemented and enforced at the individual state level.

The knowledge and skills that made us one of the greatest state insurance regulatory practices apply with equal effect to federal health insurance reform, which has adopted the same type of state regulatory scheme that governs P&C and auto. The Affordable Care Act has imposed intense federal regulation of health insurers, which is implemented and enforced at the state level. The ACA’s priorities are controlled medical loss ratios, increased rate review, prior approval, refunds for excessive premiums, the establishment of competitive health exchanges, and the encouragement of greater efficiencies and economies in the delivery of healthcare.

We regularly handle:

  • Complex insurance rate cases, including prior-approval proceedings.
  • Multibillion dollar insurance M&A transactions (including difficult, contested and highly political Form A filings).
  • Insurance department regulatory investigations.
  • Quasi-criminal and criminal investigations, often co-conducted by insurance departments with state attorneys general.
  • Massive insurance restructurings. We represented Lloyd’s of London in its monumental, $20 billion “R&R” restructuring, and handled every aspect of the US and state insurance regulatory clearances, which were essential to its success.
  • We have also represented insurance companies or state insurance departments in some of the largest insurance insolvencies in history.
  • We began the epic insurance demutualizations of the 1990s and handled the largest demutualizations in US history.
  • We have great familiarity with insurance laws and insurance regulators in every state, and have successfully persuaded insurance departments and state legislatures in every state that it was in the public interest to amend their laws to accommodate the special needs of our clients.
  • Healthcare and health insurance reform combines federal and state regulation. But, in general, the federal regulators are former state regulators. We know and understand how they handle policy issues, including the issues raised by health reform under the Affordable Care Act.
  • Our firm complements its insurance regulatory expertise with superb M&A transactions skills, powerful litigation support from one of the largest litigation departments in the country, and an excellent white collar/criminal practice.

We have the essential skills required to handle ACA issues at the federal and state level, combined with our well-established regulatory, transaction, and litigation expertise:

  • Specialized ACA issues: Among other health insurance projects, we are currently advising clients on the establishment of CO-OP health programs (under the Consumer Operated and Oriented Plan program). We are also advising a major IT provider as it creates a platform that is essential to meet the functionality required of certified affordable health insurance exchanges.
  • Managed Care: Managed care is the main theme to control costs under the ACA. But it also raises legal and fiduciary issues. We regularly advise clients on these matters.
  • Legislative and policymaking: Over the last 40 years, we have successfully advocated statutory changes for our insurance clients at the federal and state levels.
  • Traditional insurance regulatory matters: We handle all forms of rate control, including prior-approval issues and rate hearings. This experience applies directly to MLRs and other premium control and rebate questions under the ACA and related state statutes.
  • HIPAA: Healthcare reform anticipates broader sharing of Protected Personal Information and Personally Identifiable Information (PPI/PII), areas that have the potential to create serious liability in case of breach. Our HIPAA specialists carefully follow the quickly changing law, and can offer practical advice on how to comply with HIPAA and other privacy laws and how to control potential liability from breaches.
  • M&A transactional work: There is an increased need for industry consolidation to gain economies of scale and efficiency. We have represented clients in some of the largest insurance transactions in history. We handle both domestic and international transactions and, on the international level, have supervised regulatory and competition filings in 75 countries.
  • Financial transactions: The industry’s need to raise investment funds for new health insurance practices requires lawyers who understand the specialized financing requirements of the insurance industry. We are one of the country’s leaders in insurance company financial transactions.
  • ERISA: Employer-provided healthcare creates ERISA obligations. We have specialists in ERISA compliance and litigation.
  • Antitrust: There is a tension between integration and consolidation at the provider level to minimize costs and enhance efficiency, on the one hand, and, on the other, the operation of the antitrust laws. We have one of the strongest antitrust departments in the country and can knowledgeably advise on these limits and how to impose safety margins.
  • White collar/criminal expertise: Some insurance departments (often in collaboration with state attorneys general) have used quasi-criminal or criminal statutes to discipline the insurance industry. We have a successful record of dealing with these sensitive enforcement proceedings.