Health Insurer Data Is Not a 'Plan Asset'

March 29, 2004 ( - Data pertaining to the dollar amounts paid by health insurers does not fall under the "plan assets" umbrella and is not prevented by the Employee Retirement Income Security Act (ERISA) from being distributed by third-party administrators (TPA) per a state law.

>Granting the defendant’s request for summary judgment, U.S. District Judge D. Brock Hornby of the United States District Court for the District of Maine sided with the recommended decision of a magistrate judge.   In the recommendation, the magistrate determined the plaintiffs had not made clear which provision of ERISA was at issue and thus the 1995 Maine law establishing the Maine Health Data Organization (MHDO) was not preempted by ERISA.

Under MHDO, all TPAs licensed to do business in Maine submit the dollar amount, and number, of health claims paid by the TPA by each plan sponsor.   This in an effort by the Maine legislature to maintain a health information database.  

Patient Advocates LLC, the plaintiff in the case, was one such TPA.   The firm informed the state in August 2002 that it would not report financial data, arguing the Maine law was unenforceable because it was preempted by ERISA.   Following the magistrate’s assessment of the case, the TPA filed an objection to the opinion.

>However,  Hornby rejected Patient Advocates’ argument that the data requested by MHDO was valuable intellectual property. “Saying that information has economic value does not make it so. The summary judgment record does not support Patient Advocates’ assertion that the data at issue in this case have financial value,” Hornby said.   Thus, as was held in the magistrate’s opinion, the data could not be considered “plan assets.”

The case is Patient Advocates LLC v. Prysunka , District of Maine, No. 03-118-P-H.