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Category Archives: Welfare Plans

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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

Failure to Address the 90-Day Waiting Period Rule in a Handbook or CBA Can Cause Problems

Posted in Plan Administration, Welfare Plans

Earlier this year, the agencies implementing the Patient Protection and Affordable Care Act (“the ACA”) published a final rule (“the Regulation”) that prohibits health plans and health insurance issuers from applying any waiting period that exceeds 90 days (i.e., the “waiting period” that must pass before an individual is eligible to receive benefits under a health … Continue Reading

Employers Start Your Reporting (or at Least Start Preparing)

Posted in Plan Administration, Welfare Plans

Effective in 2015, PPACA requires that employers “report” information about the health coverage they offer to employees.  IRC Section 6055 requires employers and insurers to report information about the entity providing coverage, including contact information and a list of individuals with identifying information and the months they were covered.  Under IRC Section 6056, entities must report … Continue Reading

Why It’s Not Too Late for Your Employees to Get on the Exchange—Special Enrollment Periods

Posted in Plan Administration, Welfare Plans

Now that we’ve passed the important deadline of March 31, 2014 for signing up on the Health Care Exchange/Marketplace (“the Exchange”), employers are asking questions about options for employees who did not get into the exchange, like is it too late for them to get coverage.  Most of the time this question comes from employers … Continue Reading

Are You Doing What Your Plan Says You Are Doing? Consistent Plan Administration

Posted in Plan Administration, Retirement Plans, Welfare Plans

Recently a client brought me in to review a defined contribution plan document given to them by a service provider to create their new plan.  In the document, it makes reference to regular investment committee meetings, a benefit committee and an appeals committee.  When I asked my client about who would serve on those committees, … Continue Reading

Be Careful About Appeals: Deny them Completely the First Time

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

Appeals for denial of benefits can create a real quagmire for plan administrators.  The appeal process creates an administrative record, and sometimes the administrative record is not complete.  It is important for plan administrators to consider each appeal completely, and address all issues related to claims processing, even ones not necessarily raised by the participant, … Continue Reading

Be Careful About Paying Claims: Health Plan Denied Reimbursement for Mistakenly Paid Claim

Posted in Court Cases, Plan Administration, Welfare Plans

Previously I had written about instances where a retirement plan was able to recoup overpayments from a pensioner when the payments were made as a result of a mistaken calculation.  As I said then, plan administrators should be wary about relying on ERISA as a guarantee that they could recoup overpayments.  Sure enough, the 7th … Continue Reading

More PPACA Delays, Some Fine Tuning, and even Some Clarification

Posted in Plan Administration, Welfare Plans

Well, Treasury issued the “final” regulations on the employer mandate under PPACA.  The “pay or play” rules got a little delay and some revision that will be debated for weeks to come.  But the nuts and bolts of the “high points” of the regulations are as follows: 1.         Employers that have between 50 and 99 … Continue Reading

Will Your Plan Cover Spouses? Decisions Under PPACA

Posted in Plan Administration, Welfare Plans

I happened upon two interesting articles today about spousal coverage under employer sponsored benefit plans.  The first was an article about UPS eliminating spousal coverage and blaming PPACA.  The second was a study conducted by the Employee Benefits research Institute that concluded that, on average, spouses cost more to insure than employees, but elimination of … Continue Reading

Fiduciaries Can Sometimes Rely on Legal Advice (or Why ERISA Counsel is a Good Thing to Have)

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

One of the hallmarks of the fiduciary obligation is to make decisions on an informed basis and to be reasonably diligent when making decisions related to the plan and its administration.  Fiduciaries can reasonably relay on experts, like plan counsel, when making decisions related to plan administration.  In Clark v. Feder Semo and Bard, P.C., … Continue Reading

White House Delays Non-Discrimination Rules Under PPACA (or At Least Said It Would)

Posted in Plan Administration, Welfare Plans

Employers may recall that one of the key provisions of PPACA was to apply the Section 105 non-discrimination rules to insured health plans.  Starting in 2014, employers could not discriminate in favor of highly-compensated individuals when offering health insurance coverage.  However, the rules relating to non-discrimination have yet to be written and IRS Notice 2011-1 … Continue Reading

Volunteer Firefighters and Emergency Responders To Be Excluded Under the ACA (At Least When Counting to 50)

Posted in Plan Administration, Welfare Plans

On January 10, the Department of Treasury issued a statement regarding the treatment of volunteer firefighters and EMS personnel in regards to ACA compliance.  There has been a growing concern about treatment of “volunteers” in these fields mostly because the ACA employer responsibility rules would appear to require that employers count volunteer hours of nominally … Continue Reading