Appeals court revives Tiara Yachts’ ERISA case over Blue Cross Blue Shield of Michigan’s claims hand
Rather than using traditional group insurance, Tiara Yachts operated a self-funded plan, hiring BCBSM to administer it. The arrangement, governed by an Administrative Services Contract, gave BCBSM authority to interpret plan terms, determine claim eligibility, and pay providers using plan assets. The ASC also allowed Tiara Yachts to dispute paid claims within 60 days and request audits covering the prior 24 months.
