The U.S. Department of Labor recently published proposed revisions to the template and related materials for the summary of benefits and coverage (SBC) and the Uniform Glossary. These documents are required to be provided to plan participants under the Affordable Care Act (ACA).
See our articles Additional Guidance Issued on Summary of Benefits and Coverage Disclosure Requirements and Summary of Benefits and Coverage Disclosure Requirements for more details on the SBC.
The Internal Revenue Service recently updated Publication 969. This publication is used by individuals for preparing tax returns when they participate in HSAs, HRAs, health FSAs, Archer MSAs and Medicare Advantage MSAs.
Compliance with the Affordable Care Act (ACA) has resulted in increased health benefit costs for many employers. A recent court decision demonstrates that while programs to reduce the number of full-time employees may lower health care costs in the short run, they also may lead to ERISA class action litigation. In Marin v. Dave and Buster’s, a federal district judge in the Southern District of New York denied a motion to dismiss a class action lawsuit claiming that the Dave and Buster’s amusement chain violated ERISA by cutting employee hours to avoid providing health care benefits to a class of employees.
The Internal Revenue Service (IRS) recently issued Notice 2015-86, which provides some additional clarification, in the form of questions and answers, on the treatment of same-sex spouses under tax-qualified retirement plans and health and welfare plans, including cafeteria plans, as a result of the June 26, 2015, decision from the Supreme Court of the United States in Obergefell v. Hodges.
The Supreme Court of the United States’ recent ruling in Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan holds that an ERISA plan cannot enforce an equitable lien against a participant’s general assets when the full amount of the settlement is spent on non-traceable items. This decision should encourage plan fiduciaries to take action on reimbursement and subrogation rights more quickly after learning of a third-party recovery, in order to preserve their right to assert an equitable remedy against an identifiable, traceable fund.
On December 30, 2015, a federal judge in the Western District of Wisconsin ruled in favor of Flambeau, Inc. and against the Equal Employment Opportunity Commission (EEOC) in holding that Flambeau’s medical exams as part of its wellness program and self-insured medical plan did not violate the Americans with Disabilities Act (ADA).
On December 18, 2015, the United States Senate Committee on Finance (the Committee) released a Bipartisan Chronic Care Working Group Policy Options Document, which outlines approaches under consideration to improve the care and treatment of Medicare beneficiaries with multiple chronic diseases.
Recent year-end delays to important Affordable Care Act requirements have given employers and other stakeholders much needed reprieve. President Obama signed into law a two-year delay of the Cadillac Tax on December 18, 2015.
This two-year delay is part of Congress’s $1.8 trillion omnibus spending deal, the Consolidated Appropriations Act, 2016. In addition, the IRS recently announced a delay in health information reporting requirements for 2015 Forms 1094 and 1095.
As part of the insurance market reforms enacted under the ACA, large employers are required to maintain a certain level of health insurance for their common law employees (and only their common law employees) or pay a penalty — the so-called pay or play or employer shared responsibility rules. The rules for determining which workers should, or even can, be offered coverage are quite daunting. This article provides a road map for determining which workers must have an offer of health insurance coverage from the employer to avoid triggering penalties under the employer shared responsibility requirements.
The U.S. Departments of Health and Human Services, Labor and the Treasury have issued final regulations on market reform requirements under the Affordable Care Act (ACA) including grandfathered health plans, preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, coverage of dependent children to age 26, internal claims and appeals and external review processes, and patient protections.
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