Mdphysicians & Associates, Inc. v. State Board of Insurance, a Body Politic of the State of Texas

957 F.2d 178, 15 Employee Benefits Cas. (BNA) 1007, 1992 U.S. App. LEXIS 5608, 1992 WL 48140
CourtCourt of Appeals for the Fifth Circuit
DecidedApril 1, 1992
Docket91-1469
StatusPublished
Cited by116 cases

This text of 957 F.2d 178 (Mdphysicians & Associates, Inc. v. State Board of Insurance, a Body Politic of the State of Texas) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mdphysicians & Associates, Inc. v. State Board of Insurance, a Body Politic of the State of Texas, 957 F.2d 178, 15 Employee Benefits Cas. (BNA) 1007, 1992 U.S. App. LEXIS 5608, 1992 WL 48140 (5th Cir. 1992).

Opinion

GOLDBERG, Circuit Judge:

This case involves the definition of an “employee welfare benefit plan” found in the Employee Retirement Income Security Act of 1974. We confess that the parties seemed “bewitched, bothered and bewildered” 1 in attempting to apply the statute to the facts of this case at oral argument— the outset of our journey through ERISA. The statutory map, along with statements of legislative purpose by Congress, the map-maker, enables us to answer the issue presented: Whether the MDPhysicians & Associates, Inc. Employee Benefit Plan constituted an “employee welfare benefit plan” within the meaning of ERISA. We hold that the plan is not an “employee welfare benefit plan” and affirm the district court’s dismissal for lack of subject matter jurisdiction.

*180 I.

MDPhysicians, Inc. (“MDPhysicians,” also known as MDPhysicians of Amarillo, Inc.) is an independent physician practice association of over 130 doctors who work in the Amarillo, Texas area. MDPhysicians, a Texas corporation, contracts its professional services to health care providers. In 1988, MDPhysicians formed an entity called MDPhysicians & Associates, Inc. (“MDP”) and created the MDPhysicians and Associates, Inc. Employee Benefit Plan (“MDP Plan” or “Plan”). MDP adopted the Plan, served as Plan Administrator, and funded the Plan through a trust established by itself and three physicians. The same three doctors who control MDPhysi-cians, the practice association, also control the MDP entity and the MDP Plan — not only are these three doctors officers of MDP, but they also serve as trustees of the Plan. MDP entered into a service agreement with a third-party administrator to provide administrative claims services. The Plan is self-funded, which simply means that it is not fully insured. Rather, it purchased stop-loss insurance to protect the Plan only from losses exceeding a certain amount per beneficiary.

The MDP Plan operated in the following manner. Through the broadcast and print media, MDP advertised the Plan to employers located in the Texas panhandle. Over 100 disparate employers (“Subscribing Employers”) subscribed to the MDP Plan by executing an Application and Subscription Agreement, paying a one-time fee, and paying a small, monthly, per-employee fee. MDP administered the Plan under the Trust Agreement and Summary Plan Description to provide medical and health benefits to the Subscribing Employers’ employees and the employees’ dependents (collectively, the “Employees”). An Employee who needed medical or health care could choose to obtain treatment from a network medical service provider and pay only 10% of the medical expense or seek treatment from a non-network provider and pay 20% of the charge. Under the Plan, then, the Employees had a financial incentive to pursue treatment from a network medical service provider, which included physicians in the physicians practice association that formed MDP.

MDP sued the Texas State Board of Insurance (“Board”), seeking a declaratory judgment that the Board’s attempts to regulate MDP and the MDP Plan were inconsistent with the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-1461 (“ERISA”), and a permanent injunction restraining the Board from regulating MDP and the MDP Plan. The Secretary of the United States Department of Labor (“DOL”), as amicus curiae, filed a brief in the district court and issued several opinions concerning the MDP Plan’s status under ERISA and its susceptibility to regulation by the Board. DOL Op. No. 90-18a (July 2, 1990); DOL Op. No. 90-10a (May 3, 1990).

The district court concluded that the MDP Plan did not constitute an “employee welfare benefit plan” under ERISA, and, in dicta, noted that even if it did, ERISA did not preempt the application of a Texas law requiring a certificate of authority as a Texas insurance company because the regulation was not inconsistent with Title I of ERISA. After finding that the Plan was not an “employee welfare benefit plan” under ERISA, the court granted the Board’s motion to dismiss for lack of subject matter jurisdiction under Federal Rule of Civil Procedure 12(b)(1). MDPhysicians & Assocs. Inc. v. Wrotenbery, 762 F.Supp. 695 (N.D.Tex.1991).

Appellant MDP argues that the federal district court had jurisdiction over this case because the MDP Plan qualified as an “employee welfare benefit plan” within the meaning of ERISA. If the MDP Plan did not constitute an “employee welfare benefit plan,” however, the district court properly dismissed the case for lack of subject matter jurisdiction. See Hansen v. Continental Ins. Co., 940 F.2d 971, 976 (5th Cir.1991). We conclude that the Plan is not an “employee welfare benefit plan” under ERISA and affirm the district court.

II.

Since a motion to dismiss for lack of subject matter jurisdiction under Federal *181 Rule of Civil Procedure 12(b)(1) concerns the court’s “very power to hear the case ... the trial court is free to weigh the evidence and satisfy itself as to the existence of its power to hear the case.” Williamson v. Tucker, 645 F.2d 404, 413 (5th Cir.) (quoting Mortensen v. First Fed. Sav. and Loan Ass’n, 549 F.2d 884, 891 (3rd Cir.1977)), cert. denied, 454 U.S. 897, 102 S.Ct. 396, 70 L.Ed.2d 212 (1981). The district court dismissed the case for lack of subject matter jurisdiction based on the complaint, supplemented by undisputed facts and the court’s resolution of disputed facts. 2 The court relied in part “on its own determination of disputed factual issues” in resolving the challenge to its jurisdiction; therefore, “we must then review those findings as we would any other district court resolution of factual disputes — we must accept the district court’s findings unless they are ‘clearly erroneous.’ ” Id. (citations omitted).

A. The ERIJ3A Map

Before we embark on our journey, we comment that our task as judicial travellers is confined to following the ERISA map charted by the Congressional cartographers. We travel to determine whether the landmark called “MDP Plan” is located within that jurisdiction marked “employee welfare benefit plan.” Our logical path is dotted with definitional markers, which we discuss in the order in which we encountered them.

The parties do not disagree that the MDP Plan is a “multiple employer welfare arrangement” as defined by ERISA, commonly referred to as a “MEWA.” See DOL Op. No. 90-10A (May 3, 1990). The term “MEWA” includes all arrangements “established or maintained for the purpose of offering or providing” certain benefits “to the employees of two or more employers ... or to their beneficiaries.” 29 U.S.C.

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957 F.2d 178, 15 Employee Benefits Cas. (BNA) 1007, 1992 U.S. App. LEXIS 5608, 1992 WL 48140, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mdphysicians-associates-inc-v-state-board-of-insurance-a-body-politic-ca5-1992.