Employee Benefits Law Report

Archives: Health and Welfare Plans


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Individual coverage HRAs: A potential alternative to traditional group health plan coverage?

In a reversal of previous Obama Administration guidance, the Trump Administration recently finalized regulations that provide for a new type of health reimbursement arrangement—the individual coverage HRA. In a previous blog, we briefly discussed the potential for the individual coverage HRA to provide large employers who are subject to the Affordable Care Act (ACA) employer … Continue Reading

New health reimbursement account rules provide alternative path to Affordable Care Act compliance

Seemingly unfazed by the recent setbacks with the Association Health Plan regulations, the Departments of Treasury, Labor and Health and Human Services have released new health reimbursement (HRA) regulations that could reshape the group health plan landscape by providing employers with potentially cheaper options than traditional group health plan coverage for satisfying Affordable Care Act … Continue Reading

The view from Washington — we have a budget!

In perhaps the last big legislative push of 2015, the Bipartisan Budget Act of 2015 (the “Act”) was passed by the House of Representative on a 266-167 vote on Wednesday, October 28, 2015 — in the waning moments of outgoing Speaker John Boehner’s tenure. In the vote, 79 Republicans joined 187 Democrats to pass the package … Continue Reading

Obama administration budget proposals could affect employee benefit programs

The Obama administration recently released its budget proposals for Fiscal Year 2015 and as in past years those proposals contained a number of provisions that would affect employee benefit plans. A helpful explanation of the administration’s proposals can be found in the Administration’s Fiscal Year 2016 Revenue Proposals (sometimes referred to as the “Green Book”), which … Continue Reading

Protected health information and health care plan design

On our sister blog — Employer Law Report — our partner Brian Hall wrote about the likely availability of an Alzheimer’s blood test, and the impact of new genetic testing in the context of employer sponsored group health care plans and wellness programs. Brian spoke of the “imaginary line” that separates protected health information from human … Continue Reading

Audits of Benefit Plan Financials – What They Are and Are Not

Department of Labor investigations of employee benefit plans can be challenging experiences for employers. The time demand can be a significant drain on the business, and the employer needs to be concerned about potential issues the investigator may raise. We believe the best defense is a good offense: we like our clients to take their responsibilities seriously well before an investigation. But employers are sometimes surprised that an investigator asks questions that were not asked by the auditors who conducted independent financial statement audits over the years. As a JD/CPA (double geek) I can tell you this audit is only one step in the ERISA fiduciary due diligence process. But, I thought it would be helpful to seek the input of a CPA who has been a member of both the Executive Committee of the American Institute of Certified Public Accountants (AICPA), Employee Benefit Plan Audit Quality Center, and the AICPA Employee Benefit Plans Expert Panel – James E. Merklin, partner in charge of Assurance Services at Bober Markey Fedorovich, an independent CPA firm. Jim was gracious enough to share his perspective.… Continue Reading

United States v. Windsor: Where Is My Money! Obtaining Tax Refunds for Same-Sex Spouse Benefits

It is hard to believe that nearly five months have passed since the United States Supreme Court issued its landmark decision in United States v. Windsor. As a reminder, the Supreme Court held that the provisions contained in the Defense of Marriage Act (“DOMA”) that exclude same-sex relationships from the definition of marriage and spouse for federal law purposes (i.e., Section 3 of DOMA) are unconstitutional. The broad impact of this holding is clear: for purposes of federal law (e.g., ERISA, the Internal Revenue Code, etc.), same-sex marriages must be treated the same as opposite-sex marriages. But, while the general effect is clear, the Supreme Court’s decision left many questions unanswered. … Continue Reading

HIPAA Model Notices of Privacy Practices Available: Procrastination Pays Off!

You are probably getting sick of hearing about the September 23, 2013 deadline for compliance with the HIPAA omnibus rule, as we have posted several times about this over the past six months (click here, here, or here for more information). However, given that we have been hounding employers to take action to ensure compliance by this deadline, we thought it only fair that we inform you about a development that makes compliance a bit easier. … Continue Reading

HIPAA Omnibus Rule – September 23, 2013 Deadline Reminder

We hope you had a wonderful summer! Back in May, we alerted our readers to the deadline for complying with the HIPAA Omnibus Rule: September 23, 2013. That may have seemed like a long way off at the time, but here it is September already. Health care plan sponsors who have not yet taken action to ensure compliance with the Rule need to make this a priority. … Continue Reading

The Supreme Court Rejects Same-Sex Prohibitions in DOMA

In a 5-4 opinion written by Justice Kennedy, the United States Supreme today held in United States v. Windsor that the provisions contained in the Defense of Marriage Act (“DOMA”) that exclude same-sex relationships from the definition of marriage and spouse for federal law purposes is unconstitutional as a deprivation of the liberty of persons that is protected by the Fifth Amendment of the Constitution of the United States. In doing so, Justice Kennedy has highlighted once again his role as a critical swing vote on the Court. He also has rendered a decision that seems likely to have far reaching implications for the design and administration of employee benefit plans in this country. … Continue Reading

Summer is Coming, But Don’t Forget About the HIPAA Omnibus Rule

Summer is right around the corner, so you are probably thinking about cookouts, pool parties, and vacations. HIPAA is probably the furthest thing from your mind (if not, you probably wish it was). However, before you book those beach vacations, do not forget to mark September 23, 2013 on your calendars, as this is the general deadline for compliance with the new HIPAA Omnibus Rule.… Continue Reading

HIPAA Omnibus Rule Alters Business Associate Requirements for Covered Entities, Business Associates, and Subcontractors

Most covered entities (e.g., health plans and health care providers) are aware that they are obligated under HIPAA to have business associate agreements (“BAAs”) in place with their business associates who use or disclose protected health information (“PHI”) in carrying out their obligations to the covered entity (e.g., third-party administrators, claim processors, etc.). … Continue Reading

Employer Excise Taxes Under Health Care Reform – Contraceptive Coverage Mandate, New Proposed Regulations and HHS Due Process and Privacy Report Deadline Was 1/1/13

As you may have heard, the U.S Supreme Court denied Hobby Lobby an injunction against the PPACA contraceptive coverage mandate. Employers who maintain health care plans are required to pay excise taxes for failure to comply with a particular aspect of the law, regardless of whether coverage is affordable. … Continue Reading

Health and Welfare Plans Audits on the Rise, Are You Ready?

While audits of qualified retirement plans have become commonplace, audits of health and welfare plans have historically been much less common. Only a select group of “lucky” employers was subjected to health and welfare plan audits, and the scope of those audits was somewhat limited. Unfortunately, it appears that trend is ending. We are seeing a notable increase in the frequency of health and welfare plan audits, and the scope of these audits is becoming much broader.… Continue Reading

U.S. Airways, Inc. v. McCutchen: If you were the victim of a car accident, would you agree to a settlement that required you to pay?

We are anticipating the upcoming oral arguments (November 27) and decision in U.S. Airways, Inc. v. McCutchen, a case at the United States Supreme Court. This case involves a situation where the employer-sponsored plan fronted the payment of health care costs a participant incurred in an automobile accident, on the condition that the participant repay … Continue Reading

Promising Health Care Plan Benefits in Excess of Plan Terms Can be More Costly Than Anticipated

We occasionally hear that an employer wants to promise greater health care coverage than is provided under the plan terms, either in a sympathetic scenario, or to facilitate a separation. Unfortunately, this “generosity” can leave the employer obligated to provide costly benefits, without insurance coverage.  Treating a Qualified Beneficiary on Short-term Disability as Continuing to … Continue Reading

Congress Finally Passes Pension Funding Stabilization Provisions

Now that the excitement (or was that dread?) surrounding the Supreme Court’s ruling upholding the constitutionality of the health care reform legislation has dissipated somewhat, it seems timely to talk a little about pensions. At long last, and after several stalled efforts, meaningful pension funding stabilization legislation was enacted this summer. Congress passed and President … Continue Reading

Fee Disclosures Are Almost Here — What Should Plan Sponsors Do Now?

The quickly approaching deadline for written fee disclosures by covered service providers creates new homework for plan sponsors–in the form of enhanced fiduciary review obligations and a suggested need to review (and/or create) written service agreements. By now folks who work in the tax-qualified retirement industry are well (and perhaps painfully) aware that the United … Continue Reading