Category: Health and Welfare Plans
December 2018 Client Advisory
This Client Advisory, originally distributed in December 2018, highlights important developments in the law governing employee benefit plans and executive compensation over the past year. It offers insight into what these developments mean for employers and plan sponsors and previews developments we expect to see in 2019. The following...
Near Unanimity Among the Circuits: Anti-Assignment Provisions are Enforceable
U.S. Courts of Appeals in all but four Circuits have now held that anti-assignment provisions in health insurance plans governed by ERISA are enforceable. In American Orthopaedic & Sports Medicine v. Independence Blue Cross Blue Shield , No. 17-1663, 2018 WL 2224394 (3d Cir. May 16, 2018) the Third...
Wellness Programs: Where are we now?
Wellness programs are governed by overlapping and, at times, maddeningly inconsistent regulations and agency guidance. Litigation challenging the wellness program rules issued by the EEOC in 2016 has added another layer of complexity for employers attempting to design and administer wellness programs in compliance with applicable law. Nevertheless, wellness...
IRS Reduces 2018 HSA Family Contribution Limit
UPDATE: On April 26, 2018, the IRS reversed course and restored the limit on deductible contributions to health savings accounts (HSAs) for individuals with family coverage under a high deductible health plan to $6,900, the original amount announced last fall. According to the IRS , individuals who received an...
Noteworthy Federal Cases Relating to Employee Benefit Plans in 2017
Here is a round up of cases decided by the U.S. Supreme Court and the First and Second Circuit Courts of Appeals in 2017 involving ERISA employee benefit plans. While courts decided a number of cases pertinent to benefit plans, we found these to be noteworthy: United States Supreme...
Sound Process and Good Recordkeeping Demonstrate Compliance with COBRA Notice Requirements
Earlier this year the Eleventh Circuit Court of Appeals provided a reminder of how important it is for an employer to establish and follow proper COBRA notice procedures and preserve some type of evidence that the procedures are followed. Employers who do those things will find that their efforts...
EEOC Doubles Down: Final Wellness Program Rules Under ADA and GINA – Part II
Last week the Equal Employment Opportunity Commission (EEOC) issued final rules for wellness programs under both the Americans with Disabilities Act (ADA) (the " Final ADA Rule ") and the Genetic Information and Nondiscrimination Act (GINA) (the " Final GINA Rule "). Part I of this two-part series addressed...
EEOC Doubles Down: Final Wellness Program Rules Under ADA and GINA – Part I
The Equal Employment Opportunity Commission (EEOC) has issued final rules for wellness programs under both the Americans with Disabilities Act (ADA) (the " Final ADA Rule ") and the Genetic Information and Nondiscrimination Act (GINA) (the " Final GINA Rule "). The release is accompanied by Frequently Asked Questions...
Including Limitations Periods in Denial Letters: From “Best Practice” to Necessity
Sponsors of group health plans in the First Circuit must now describe any contractual limitations period, if the plan applies one, in the letter advising a participant of a final adverse benefit determination. In light of the decision of the U.S. Court of Appeals for the First Circuit in...
Avoiding a Patchwork of Pitfalls: Gobeille v. Liberty Mutual Insurance Co.
In the first decision issued since the passing of Justice Scalia, the Supreme Court of the United States held that ERISA preempts a Vermont statute requiring third party administrators of self-insured group health plans to report claims information to state health care databases. Gobeille v. Liberty Mut. Ins. Co...
IRS Issues Guidance on Employer Health Plan Opt-Out Payment Arrangements
Late last month the IRS released, in the form of 26 Q/As in Notice 2015-87 , guidance on the application of various provisions of the Affordable Care Act to employer-sponsored health coverage. The Notice covers a number of important issues, including the effect of health reimbursement account contributions, cafeteria...
Client Advisory - Winter 2016
This Client Advisory highlights certain developments regarding the Affordable Care Act (most significantly, the delay of the ACA reporting requirements and the "Cadillac" tax), discusses the EEOC's proposed rules for wellness programs and the outcome of recent EEOC wellness program litigation, reviews important cases recently decided by and pending...
2015 Mid-Year Client Advisory
At this time of year many employers finalize welfare plan designs for 2016 and gear up for open enrollment. And this summer, many employers are in the process of reviewing updated pre-approved defined contribution plan documents provided by their record keeping firms. With those efforts in mind, this Client...
Where There’s Smoke There’s Questions: Designing Compliant Wellness Programs That Target Tobacco Use
The final regulations concerning wellness programs under the Health Insurance Portability and Accountability Act, as amended (HIPAA) continue to generate a number of questions and concerns for employers whose programs seek to promote employee health by curbing tobacco use. The compliance status of some programs is further complicated by...
EEOC Finally Releases Notice of Proposed Rulemaking for Wellness Programs
The final regulations concerning wellness programs under the Health Insurance Portability and Accountability Act, as amended (HIPAA) continue to generate a number of questions and concerns for employers whose programs seek to promote employee health by curbing tobacco use. The compliance status of some programs is further complicated by...
Notice 2015-17: Small-Scale Excise Tax Relief for Small Employers
On February 18, 2015 the Internal Revenue Service issued Notice 2015-17 , which provides temporary relief from the excise tax under Code section 4980D for employer programs that reimburse employees for the cost of health insurance coverage purchased on the individual market (including coverage obtained through an Exchange). The...
2014 Year-End Employee Benefit Plans Compliance Advisory
The 2014 end-of-year rush seems somewhat less frantic than in years past. Nevertheless, with a month left in the year many employers may find themselves scrambling to meet plan amendment and notice deadlines, and planning for 2015 may still be in process for some. This summary discusses a few...
Complimentary Webinar to Review Recent Legal Issues with Wellness Programs
Join Richard Moon and Chris Lockman on Thursday, November 20, from 9:00 – 10:00 a.m. for a complimentary webinar that will provide a general overview of the final wellness program regulations and recent EEOC litigation attacking certain wellness programs. The DOL, HHS, and the Treasury Department have released detailed...
CMS Delays HPID Application Deadline
On October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a statement delaying enforcement of the health plan identifier (HPID) requirement. Specifically, Controlling Health Plans (CHPs) are no longer required to obtain HPIDs by the originally announced deadline of November 5, 2014, which has been delayed...
Are you Experienced? A Look at the HPID Application Experience
Under final rules issued September 5, 2012 by the Department of Health and Human Services under HIPAA, nearly all employer group health plans are required to obtain a unique health plan identification number (HPID) by November 5, 2014. (We summarize the final rules briefly here .) Health plans with...
Deadline Approaches for Business Associate Agreement Compliance Updates
Employer group health plans and other covered entities that have not already amended business associate agreements (BAAs) to incorporate changes required by the Final Omnibus Rule must do so by September 22, 2014. (You can read our prior blog post on the Final HIPAA Omnibus Rule here...
2014 Mid-Year Compliance Update
While 2014 has been a relatively quiet year in terms of new rules affecting retirement plans, the January 1, 2015 effective date for the Affordable Care Act employer shared responsibility mandate is now in sight. This summary discusses a few key developments regarding employee benefit plans – especially group...
2013 Year End Benefit Plan Compliance Update and Reminders for Employers
As 2013 draws to a close and we look ahead to 2014, there is no shortage of benefit plan administrative challenges with which employers must contend. While the Patient Protection and Affordable Care Act of 2010 ("ACA") remains very much at the forefront of these challenges, retirement plan and...
IRS Modifies Health FSA Rules to Permit Carryover of up to $500
Late last week the IRS released Notice 2013-71 , modifying the health flexible spending account ("health FSA") use-it-or-lose-it rule to allow participants to carry over up to $500 in unused health FSA funds. Although not unexpected (the Service has hinted at such a change a number of times over...
Mid-Year Health Plan Compliance Update
Developments in the employee health plan arena have come fast and furious in the first half of 2013, and there is no lack of compliance activities to occupy the time of human resources and employee benefits professionals. We offer this collection of key developments for employers to consider as...
Enforcement of Employer Mandate Delayed Until 2015
This evening the White House and U.S. Department of Treasury announced that the effective date of the employer shared responsibility component (also known as the employer pay or play mandate) of the Affordable Care Act will be delayed until 2015. Accordingly, businesses will not be penalized in 2014 for...
Seasonal Workers and Your Employee Benefit Plans
Summer is fast approaching and we find ourselves answering a number of questions regarding the coverage of seasonal workers in employee benefit plans. For employers planning to ramp up hiring for the summer season we offer this brief review of the treatment of seasonal employees for purposes of your...
HIPAA Compliance for Group Health Plans – Next Steps for Employers
In three previous posts devoted to the new Final Omnibus Rule under HIPAA we highlighted important changes regarding privacy breach notifications , business associates and business associate arrangements , and increased penalties and enforcement activity . We will complete our series regarding these significant new rules by suggesting steps...
Enhanced Penalties and Stiffer Enforcement for HIPAA Violations
In our two prior posts concerning the Final Omnibus Rule under HIPAA we focused on changes to the breach notification requirements and rule changes affecting business associates . We now turn to the augmented penalty and enforcement provisions incorporated in the Final Rule. Many commentators have perceived stepped up...
Are You Ready for a HIPAA and ACA Audit?
It's no secret that the Office of Civil Rights of the Department of Health and Human Services has been expanding its enforcement activity under the privacy and security standards of HIPAA. And it's not surprising that enforcement activity is in the offing under the Affordable Care Act as well...
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