Category Archives: Welfare Benefit Plans

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Does your group health booklet measure up to ERISA?

If your employer provides group health coverage, you should have received a detailed booklet, usually prepared by an insurance company that describes your coverage. The booklet is a formidable document that describes your group health benefits and the applicable limitations and restrictions on coverage in great detail. The ERISA Requirements But does this booklet measure … Continue Reading

Stolen Laptop Triggers $1.55 Million Fine for HIPAA Violation

Actually, it was “only” a potential violation of privacy and data security rules imposed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for which North Memorial Health Care of Minnesota (“NMHC”) agreed to pay $1.55 million. The violation alleged by the Department of Health and Human Services Office for Civil Rights (“OCR”) … Continue Reading

Happy Affordable Care Act New Year

Ir’s not exactly hats and horns for the 2016 Affordable Care Act (ACA) New Year, but there are a few reasons to celebrate regarding compliance matters. Filing Extensions The 2016 ACA reporting deadlines that apply to all subject employers (those with an average workforce of 50 or more full-time employees plus full-time equivalents, or “FTEs”) … Continue Reading

Enhanced health benefits for executives? That’s another Affordable Care Act issue to consider

A prohibition on discrimination has applied to self-insured plans for years under  Section 105(h) of the Internal Revenue Code. The Affordable Care Act (“ACA”) now extends that ban on discrimination in insured group health plans. What does this mean? Insured health plans  can no longer favor highly compensated employees in terms of eligibility for benefits … Continue Reading

Welfare Benefit Plans: More than just the Affordable Care Act

Many employers sponsoring welfare benefit plans are understandably now totally focused on what they can see in front of them. Namely, the Affordable Care Act. But lurking just below the surface is ERISA and a host of other laws through which employers have to navigate. Let’s start with ERISA. Most welfare benefit plans are subject … Continue Reading

ERISA Employee Benefit Claims: Legislative Goals vs. Litigation Reality

Every Summary Plan Description has to include one, a claims procedure that set forth the requirements for processing benefit claims and appeals. The underlying ERISA statute was written in a paternalistic manner with explicit provisions intended to offer protection to “the interests of participants in employee benefit plans and their beneficiaries…by providing for appropriate remedies, … Continue Reading

The Affordable Care Act: What You Need to Do Now

OK, so you sponsor an insured group health plan and employ at least 50 full-time employees including full-time equivalents, or “FTEs” (that’s ACA jargon for 30 hours of work each week performed by more than one employee so that, for example, two employees working 15 hours per week equals one “FTE”). You have made this … Continue Reading

ERISA Plans Do Have Their Limitations

That’s limitations as in “limitation periods”. A recent court case reminds ERISA plans to have such limitation periods and to communicate it to someone claiming a plan benefit. Let’s start with the basics. What’s a “limitation period”? In layman’s terms, it’s a law set forth in a State statute of limitations that sets time limits … Continue Reading

Who is responsible for service provider mistakes?

It took nine years in the case of Butler v. United Healthcare of Tennessee to determine who was responsible for a denied group health benefit claim. The patient, covered by her husband’s ERISA health benefit plan, sought treatment for inpatient rehabilitation for substance abuse. Treatment for which was denied by United. The patient ultimately received … Continue Reading

Employee Classification as Part-Time or Full-Time: Not the Same Under the Affordable Care Act and ERISA

Some of the most difficult and contentious provisions of the Affordable Care Act (“ACA”) are the employer mandate and upcoming reporting requirements effective in 2015. “Difficult” because the employer mandate requires applicable large employers, generally those with 50 or more “full-time” employees, to offer coverage to full-time employees and dependents (other than spouses). If the employer … Continue Reading

Affordable Care Act “compliance season” begins November 15, 2014

There used to be a brief three month respite between October 15, the final due date for extended Form 5500s, and the following January 1, when the annual administrative cycle began again. Not any more. The Affordable Care Act (“ACA”) provides another set of compliance deadlines starting on November 15, 2014. The new deadlines involve: … Continue Reading

The Deluge of Affordable Care Act Regulations: What Employers Need to Know

There has been a deluge of regulatory activity involving the Affordable Care Act (“Obamacare”), or the ACA. Some developments, such as the general postponement of the employer mandate until 2015 (and the recent postponement until 2016 for employers with 50-99 full time equivalent employees), have received significant press attention. Others involve details of interest primarily … Continue Reading
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