Kentucky Assn. of Health Plans, Inc. v. Miller, 538 U.S. 329 (2003)

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OCTOBER TERM, 2002

Syllabus

KENTUCKY ASSOCIATION OF HEALTH PLANS, INC., et al. v. MILLER, COMMISSIONER, KENTUCKY DEPARTMENT OF INSURANCE

certiorari to the united states court of appeals for the sixth circuit

No. 00-1471. Argued January 14, 2003—Decided April 2, 2003

Petitioner health maintenance organizations (HMOs) maintain exclusive

"provider networks" with selected doctors, hospitals, and other health-care providers. Kentucky has enacted two "Any Willing Provider" (AWP) statutes, which prohibit "[a] health insurer [from] discriminat[ing] against any provider who is . . . willing to meet the terms and conditions for participation established by the . . . insurer," and require a "health benefit plan that includes chiropractic benefits [to] . . . [p]ermit any licensed chiropractor who agrees to abide by the terms [and] conditions . . . of the . . . plan to serve as a participating primary chiropractic provider." Petitioners filed this suit against respondent, the Commissioner of Kentucky's Department of Insurance, asserting that the AWP laws are pre-empted by the Employee Retirement Income Security Act of 1974 (ERISA), which pre-empts all state laws "insofar as they . . . relate to any employee benefit plan," 29 U. S. C. 1144(a), but saves from pre-emption state "law[s] . . . which regulat[e] insurance . . . ," 1144(b)(2)(A). The District Court concluded that although both AWP statutes "relate to" employee benefit plans under 1144(a), each law "regulates insurance" and is therefore saved from pre-emption by 1144(b)(2)(A). The Sixth Circuit affirmed.

Held: Kentucky's AWP statutes are "law[s] . . . which regulat[e] insurance" under 1144(b)(2)(A). Pp. 334-342.

(a) For these statutes to be "law[s] . . . which regulat[e] insurance," they must be "specifically directed toward" the insurance industry; laws of general application that have some bearing on insurers do not qualify. E. g., Pilot Life Ins. Co. v. Dedeaux, 481 U. S. 41, 50. However, not all state laws "specifically directed toward" the insurance industry will be covered by 1144(b)(2)(A), which saves laws that regulate insurance, not insurers. Insurers must be regulated "with respect to their insurance practices." Rush Prudential HMO, Inc. v. Moran, 536 U. S. 355, 366. P. 334.

329

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