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Category Archives: Welfare Plans

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Can I Have A “Skinny” Plan? ACA and the Minimum Value Plan

Posted in Plan Administration, Welfare Plans

No question that employers have been struggling with how to satisfy the ACA requirements of offering coverage while still avoiding what is perceived to be a heavy burned financially of offering full coverage.  Some employers in this situation have considered offering a new type of plan to full-time employees, called a “minimum value” plan.  From … Continue Reading

Thoughts Post-Election: Don’t Count on Changes to the ACA Until They Actually Happen

Posted in Plan Administration, Retirement Plans, Welfare Plans

As soon as the mid-term races were called, I started to get e-mails from people wondering about the potential impact the change to a Republican controlled Congress would have on ACA compliance.  My general response: don’t expect any immediate relief or changes and keep on working toward compliance.  Changes in the law might eventually come, … Continue Reading

It’s Not Easy Having Plans: Revising Benefits Can Give Rise to Other Claims

Posted in Plan Administration, Retirement Plans, Welfare Plans

As employers continue preparing for health plan changes that take place in 2015 under the ACA, I have been following a number of developments that remind me of the importance of thinking globally with respect to revisions to benefits.  What I mean by that is just because you can do something does not necessarily mean … Continue Reading

Locating Missing Particiants, Or at Least Trying To

Posted in Plan Administration, Retirement Plans, Welfare Plans

One of the most frustrating things about benefit plans is that they have participants, participants are people and people sometimes disappear.  It is unfortunately a fact of plan administration and it can be a problem.  Plan sponsors, and administrators sometimes need to locate missing participants or beneficiaries for things like notice, distributions or even corrective … Continue Reading

Who’s in Control? Determining Control Group Status is Important

Posted in Plan Administration, Retirement Plans, Welfare Plans, Withdrawal Liability

The existence of a “control group” is important in a variety of benefit concerns.  From retirement plans to welfare plan, and particularly in withdrawal liability matters, establishing whether companies are under common control is very important.  Under the ACA, it matters for determining whether you are an applicable large employer so as we get closer … Continue Reading

The Latest on Cafeteria Plan Elections: Changes that Allow Changes

Posted in Plan Administration, Welfare Plans

What happens if an employee wants to drop out of the company plan and get into the exchange?  Seems like an option except the cafeteria plan rules prevent someone from making a mid-year change in their cafeteria plan election.  Along comes the IRS with Notice 2014-55.  This notice addresses situations in which individuals can change … Continue Reading

Draft Instructions for PPACA Reporting Requirements: Get Ready for 2015

Posted in Plan Administration, Welfare Plans

They promised they would be coming and now they have.  On August 28, 2014, the IRS issued draft instructions for Forms 1094-C and 1095-C and Forms 1094-B and 1095-B, which I provided in my July 31, 2014 entry.  These forms were provided in draft format and they are used to satisfy PPACA’s “information reporting requirements.” We also got … Continue Reading

COBRA Notice Penalties: Employer Pays Even Though They Also Paid Bills

Posted in Court Cases, Plan Administration, Welfare Plans

The issue of COBRA notices and penalties can create problems when considering who is entitled to the notice and when they have to be issued.  When claims are brought for alleged violations of the provision of COBRA notices, some employers assume that they can just avoid penalties if there are not actual damages, say for … Continue Reading

New Rates for “Affordable Coverage” for 2015: Rev. Proc. 2014-37

Posted in Plan Administration, Welfare Plans

Under the terms of the ACA, large employers are required to provide affordable coverage beginning in 2015 or potentially face penalties.  For 2014, the definition of affordability was set at 9.5% of the employee’s income.  Within the definition of affordability, there is also a provision that provides for adjustment of that figure in the future … Continue Reading

ACA Reporting for Employers: IRS Releases Draft Forms

Posted in Plan Administration, Welfare Plans

Under the ACA, there are two unique reporting requirements.  The first is the “individual mandate reporting” requirement under Section 6055 of the Code.  The second is the “pay or play reporting” requirement under Section 6056.  Many employers have been wondering about how onerous these reporting requirements may be and while not finalized, the IRS did … Continue Reading

Subsidies in the Federal Marketplace: A Definite Maybe

Posted in Court Cases, Plan Administration, Welfare Plans

Amidst all of the other issues surrounding implementation of the ACA, there is an underlying issue about whether or not subsidies (in the form of tax credits) are available for individuals who obtain coverage through the federal exchange marketplace as opposed to the state exchanges.  Many states have determined not to offer exchanges, which means … Continue Reading

Disclosures with Respect to Preventative Care: DOL Notice Requirement post-Hobby Lobby

Posted in Court Cases, Plan Administration, Welfare Plans

It seems like one of the hardest parts of ACA compliance is waiting for guidance on specific issues.  However, after the decision in Hobby Lobby, the DOL promptly issued FAQ Part XX that addresses the notice requirements for employers who cease providing contraceptive services.  The FAQ has a single question and is reprinted below in … Continue Reading

Don’t Get Cute with ACA Compliance: Hobby Lobby, Safe Harbors and ERISA Concerns

Posted in Plan Administration, Welfare Plans

With the Supreme Court’s decision in the Hobby Lobby case, and the granting of the injunction for Wheaton College that came shortly thereafter, there has been considerable hand wringing over the long term implications these decisions might have.  Plan administrators and sponsors dealing with the ACA should not forget about the short term compliance requirements.  … Continue Reading

“Hobby Lobby” Decision Cuts Unique Exemption into Affordable Care Act’s Contraceptive Coverage Requirement

Posted in Court Cases, Plan Administration, Welfare Plans

On June 30, 2014, in a 5-4 decision, the U.S. Supreme Court ruled in Burwell v. Hobby Lobby Stores, Inc. (“Hobby Lobby”) that closely held for-profit companies that formed their companies for a religious purpose can qualify for an exemption from the Patient Protection and Affordable Care Act (“ACA”) requirement to pay for certain contraceptive … Continue Reading

Trials and Tribulations: Agencies Clarify Confusing “Trial Period” Exemption under the Affordable Care Act

Posted in Plan Administration, Welfare Plans

Last week (June 20), the agencies implementing the Affordable Care Act (“the ACA”) released a final rule clarifying the effect of orientation periods (also known as “trial periods”) on the “90-day waiting period rule” under the ACA.  The “90-day waiting period rule” prohibits group health plans and health insurance issuers from imposing a waiting period … Continue Reading

FAQs About the ACA: Out-of-Pockets and Preventative Care

Posted in Plan Administration, Welfare Plans

The Department of Labor FAQ XIX provided model notices for COBRA and, unfortunately, not everyone looked beyond that part to see that some other issues were addressed.  Specifically, Department addressed the new rules applicable to out-of-pocket limits and the preventive services requirement.  So let’s look back at that notice and see what else was provided … Continue Reading

New Post-Windsor Guidance on Same-Sex Marriage

Posted in Court Cases, Plan Administration, Retirement Plans, Welfare Plans

Susan Jordan, one of my partners in Pittsburgh, provides the following guidance with respect to the IRS’ recent guidance on treatment of same-sex marriage: In its decision in United States v. Windsor, handed down on June 26, 2013, the United States Supreme Court declared Section 3 of the Defense of Marriage Act to be unconstitutional. … Continue Reading

New Model COBRA Notices Issued By DOL: Updating “Good Faith Compliance”

Posted in Plan Administration, Welfare Plans

Earlier this week, the Department of Labor issued new proposed regulations that revise the COBRA notice requirements.  Because the regulations are proposed, they are not final per se, but in the release, the DOL published new model COBRA notices.  Until the proposed regulations are finalized and effective, the DOL has stated that it will consider … Continue Reading

Don’t Get Cute When Documents Are Requested: ERISA Penalty Provisions for “Hiding” Plan Documents

Posted in Court Cases, Plan Administration, Retirement Plans, Welfare Plans

ERISA generally requires that plan participants get copies of summary plan descriptions, plan documents and annual reports when requested. ERISA Section 104(b)(4) provides that “the administrator shall, upon written request of any participant or beneficiary, furnish a copy of the latest updated summary, plan description, and the latest annual report, any terminal report, the bargaining … Continue Reading