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Category Archives: Welfare Plans

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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

HIPAA Failure Results In Penalties: Lack of Compliance the Key

Posted in Plan Administration, Welfare Plans

Often, when I am discussing HIPAA privacy compliance, I am asked about possible penalties for privacy breaches.  Plan sponsors sometimes overlook the fact that failing to have a privacy compliance package in place is itself a violation and can lead to some hefty penalties.   Such was the case for Adult & Pediatric Dermatology, P.C., a … Continue Reading

The Plan Says What it Says: Plan Statute of Limitations Applies

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

For the purposes of figuring out when a claim has to be brought, plans can, in some instances, dictate when the “statute of limitations” runs for bringing a lawsuit.  Part of this is for consistent administration and part of it may be to avoid untimely litigation.  This was the issue in the Supreme Court’s recent decision … Continue Reading

PPACA and Deductibles: What the Plans Look Like

Posted in Plan Administration, Welfare Plans

I happened upon an article today where an insurance comparison website by a company called HealthPocket has compiled averages concerning the various metal plans available through the exchanges.  I thought I would share some of the details simply because I think it is important for employers planning their compliance package to be aware of what … Continue Reading

IRS Updates Same-Sex Guidance on Tax Issues: Accounting for Excess Withholding

Posted in Court Cases, Plan Administration, Welfare Plans

In an ongoing effort to address question about how to treat the taxation of employee benefits for same-sex couple post-Windsor, the IRS has updated its FAQs for married same-sex couples with a couple of new questions and answers that further clarify how employers administer their plans.  Both relate to the right to seek a refund … Continue Reading

The 9.5% Conundrum: Discrimination in Employee Contributions

Posted in Plan Administration, Welfare Plans

When considering what constitutes “affordable” coverage under PPACA, some employers have come to me and said “well, I will just charge everybody 9.5% of their pay.”  And on its face, that seems to be what the rule permits.  But as with other components of PPACA, Congress may have overlooked that our old friend ERISA already … Continue Reading

Electronic Disclosures: It is Not as Simple as Sending an E-mail

Posted in Plan Administration, Retirement Plans, Welfare Plans

In light of all the PPACA disclosure requirements, and with the year-distributions required for retirement plans, employers tend to want to distribute benefit plan notices electronically.  Maybe companies want to post them on a company website or e-mail them to employees, but there is no question that mailing paper notices to employees is the least … Continue Reading

Don’t Forget About ERISA: The PPACA Conundrum

Posted in Plan Administration, Welfare Plans

As I am speaking to employers about PPACA compliance and developing their strategies for offering insurance to employees, I am struck by the disconnect between PPACA compliance and ERISA.  Many employers fail to see that by offering health insurance to employees is actually the sponsoring of a welfare benefit plan governed by ERISA.  Then, they … Continue Reading