Safeco Life Insurance Company v. Musser

65 F.3d 647, 19 Employee Benefits Cas. (BNA) 1828, 1995 U.S. App. LEXIS 25812
CourtCourt of Appeals for the Seventh Circuit
DecidedSeptember 12, 1995
Docket94-1657
StatusPublished
Cited by14 cases

This text of 65 F.3d 647 (Safeco Life Insurance Company v. Musser) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Safeco Life Insurance Company v. Musser, 65 F.3d 647, 19 Employee Benefits Cas. (BNA) 1828, 1995 U.S. App. LEXIS 25812 (7th Cir. 1995).

Opinion

65 F.3d 647

64 USLW 2207, 19 Employee Benefits Cas. 1828,
Pens. Plan Guide P 23916J

SAFECO LIFE INSURANCE COMPANY, Plaintiff-Appellant,
v.
Josephine W. MUSSER, in her capacity as Wisconsin
Commissioner of Insurance, and the Wisconsin
Health Insurance Risk Sharing Plan,
Defendants-Appellees.

No. 94-1657.

United States Court of Appeals,
Seventh Circuit.

Argued Sept. 22, 1994.
Decided Sept. 12, 1995.

Jonathan Aked (argued), LaFollette & Sinykin, Madison, WI, for Safeco Life Ins. Co.

Warren D. Weinstein (argued), Laura Sutherland, Asst. Attys. Gen., Office of the Attorney General, WI Dept. of Justice, Madison, WI, for Josephine W. Musser.

Laura Sutherland, Asst. Atty. Gen., Office of the Attorney General, WI Dept. of Justice, Madison, WI, for WI Health Ins. Risk Sharing Plan.

Before FERGUSON,* RIPPLE, and ROVNER, Circuit Judges.

ROVNER, Circuit Judge.

Wisconsin imposes fees on health insurers who do business in the state which it uses to provide health insurance to individuals whose physical and mental conditions prevent them from obtaining coverage in the private market. Safeco Life Insurance Company sells stop-loss insurance coverage to a number of Wisconsin employers who sponsor self-funded employee welfare benefit plans, and it is assessed fees by the state based on the sales of that coverage. Safeco has filed this suit seeking a declaration that Wisconsin's scheme is preempted by the Employee Retirement Income and Security Act, 29 U.S.C. Sec. 1001, et seq. ("ERISA"), insofar as it applies to insurance sales to employers sponsoring ERISA plans. The district court concluded that the scheme is not preempted by ERISA and that, in any event, the Tax Injunction Act, 28 U.S.C. Sec. 1341, deprived it of subject matter jurisdiction to grant the declaratory relief that Safeco requested. Guided by the Supreme Court's recent decision in New York State Conference of Blue Cross & Blue Shield Plans v. Travelers Ins. Co., --- U.S. ----, 115 S.Ct. 1671, 131 L.Ed.2d 695 (1995), we agree with the district court that the Wisconsin scheme is not preempted by ERISA and conclude that the defendants are entitled to judgment on that basis.

I.

Wisconsin enacted the Health Insurance Risk Sharing Plan in order to make health insurance available to individuals whose physical or mental conditions make it infeasible for them to obtain coverage in the private market. Wisconsin residents who are under the age of 65 are eligible to participate in HIRSP if they are HIV positive or if, due to another physical or mental condition, they have been notified that:

1. Their health insurance has been canceled or their application for insurance has been rejected;

2. Their existing coverage has been modified or limited in a way that substantially reduces the coverage of their policy vis a vis the coverage available to a person considered a standard risk;

3. Their premiums for existing coverage have been increased by fifty percent or more above the amount they have paid previously; or

4. The premiums for a policy not yet in effect have been set at a level fifty percent or more higher than a person considered a standard risk would typically pay.

Wis.Stat. Sec. 619.12(1). Individuals certified as eligible are able to obtain major medical expense insurance through the HIRSP in exchange for the payment of premiums set by the state Commissioner of Insurance. Individuals with limited incomes pay reduced premiums (Sec. 619.165(1)); the state also provides financial assistance to assist them in paying their premiums as well as their deductibles.

The number of participants in HIRSP has risen markedly from 309 in 1981 to 12,380 in 1992. Given the health status of the individuals eligible to participate in the Plan, the amount in claims paid and the cost of administering the Plan have consistently outstripped the premiums collected. In 1992, for example, HIRSP collected $17,846,040 in premiums, but paid $37,699,824 in claims and incurred $2,168,546 in administrative expenses. To make up for that shortfall, HIRSP each year assesses a fee upon companies who sell health insurance in Wisconsin. The amount of the fee assessed each insurer is based on the ratio of the company's total health care coverage revenue from Wisconsin residents during the preceding calendar year to the aggregate health care coverage revenue of all participating insurers from Wisconsin residents during that year. HIRSP charges an additional fee to insurers who have denied insurance to HIRSP participants.

Safeco, a Washington corporation, has been licensed to write insurance in Wisconsin since 1959. Among other types of policies, Safeco offers stop-loss insurance to employers who sponsor self-funded "employee welfare benefit plans" and "employee benefit plans" as those terms are defined in ERISA. See 29 U.S.C. Sec. 1002(1), (3). These plans offer a variety of medical, surgical, hospital, and other benefits to employees in the event of sickness, accident, disability, death, or unemployment. Employers pay the expenses of these plans; but when they purchase stop-loss policies, the insurer pays a portion of the plan's expenses above a certain amount, thus limiting the employer's exposure. According to Safeco, ninety-six percent of all employers with less than 1,000 employees that sponsor self-funded ERISA plans purchase some form of stop-loss coverage.

Based upon the stop-loss policies that Safeco sold to Wisconsin employers from 1988 through 1992, HIRSP assessed the insurer $239,577.93 plus interest. (Safeco was assessed an additional $22,889.15 in August 1993.) Safeco refused to pay the fee, contending that ERISA preempts the provisions of HIRSP insofar as they apply to the insurance policies sold to ERISA plans.1 It then filed this suit against the Wisconsin Commissioner of Insurance and HIRSP pursuant to 28 U.S.C. Secs. 1331, 1332 and 29 U.S.C. Sec. 1132(e)(1), seeking a declaratory judgment to that effect.

On cross-motions for summary judgment, the district court concluded that ERISA did not preempt HIRSP insofar as it applied to insurance policies sold to ERISA plans. Addressing the threshold question of whether the HIRSP assessments "relate to" an ERISA plan and are therefore (barring any applicable exemption) preempted (see 29 U.S.C. Sec. 1144(a)), the court observed:

The HIRSP assessment as applied to Safeco taxes only Safeco's total health care revenue. It does not make a reference to an employee benefit plan, nor is it connected to an employee benefit plan. The HIRSP assessment is not based on a figure that is connected with the benefits paid from the plan such as percentage of benefits paid to employees in the plan which would merely be an indirect manner of taxing the plan....

. . . . .

... HIRSP assessments do not affect the substantive provisions of the coverage employees receive under their employee benefit plans. [Safeco] asserts that [it] will pass on the cost of HIRSP assessments to the employers who purchase stop-loss insurance.

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65 F.3d 647, 19 Employee Benefits Cas. (BNA) 1828, 1995 U.S. App. LEXIS 25812, Counsel Stack Legal Research, https://law.counselstack.com/opinion/safeco-life-insurance-company-v-musser-ca7-1995.