Opinion ID: 6334161
Heading Depth: 2
Heading Rank: 1

Heading: Dunnegan & Scileppi’s Health Insurance Plans

Text: Fisher is the spouse of William Dunnegan, a name partner at Dunnegan & Scileppi LLC (“D&S”), a New York based law firm. D&S offers health insurance coverage to its employees (such as Dunnegan) and their beneficiaries (such as Fisher) through a small business group insurance policy. In 2013, D&S had health 6 insurance coverage through a policy issued by Oxford Health. Fred Warner, an independent insurance broker who assisted D&S with selecting a group health insurance policy, advised D&S that the Oxford policy was up for renewal, but the deductible was projected to increase for 2014. Dunnegan worked with Warner to find a new group health insurance plan for the firm. On November 25, 2013, Warner sent Dunnegan an email attaching a summary chart of various group health plans for 2014. As an insurance broker, Warner had access to various plan documents and details through multiple sources. D&S ultimately selected a small business group plan from Aetna known as the Aetna New York “Silver OAMC 2000 80/60 HSA PY” (“2014 Aetna NY Silver Plan”). Under New York law, the Department of Financial Services (“DFS”) regulates small business group health insurance plans in New York and all health insurance providers are required to submit their small business policies for DFS review and approval. DFS approved of the 2014 Aetna NY Silver Plan in October 2013. Once approved, Aetna could not lawfully change the terms of the plan without DFS approval. On December 18, 2013, D&S and each of its six employees sent completed applications for the 2014 Aetna NY Silver Plan to Warner. The application that 7 Dunnegan executed on behalf of D&S contained, among other things, the following provisions: The plan documents, including the policy and certificate, will determine the contractual provisions, including procedures, exclusions, and limitations relating to the plan and will govern in the event they conflict with any benefits comparison, summary or other description of the plan. ... . . . . I understand that this application will form a part of the Group Agreement or Group Policy issued by Aetna, and by my signature below I agree to be bound by the terms and conditions of that Group Agreement or Group Policy. No. 20-3148, App’x at 126.