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‘Right-Sizing’ Full-Time Employees to Reduce ACA Obligations May Lead to ERISA Class Action Exposure

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.

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IRS Guidance on Employee Benefits Implications of Supreme Court Obergefell Decision on Same-Sex Marriage

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.

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Supreme Court Issues Further Clarification on Equitable Relief Remedies Available Under ERISA

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.

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Flambeau Inc. Wellness Program Testing Falls Within ADA Safe Harbor

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).

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Senate Finance Committee Considering Telehealth Options to Improve Care and Lower Costs

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.

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Cadillac Tax Delayed to January 1, 2020; Extension of ACA Health Plan Information Reporting Due Dates

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.

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How to Determine Full-Time Employment Status of Employees for the ACA Employer Shared Responsibility Mandate

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.

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Final Regulations on Affordable Care Act Market Reforms

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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DOL’s New Disability Claim Rules Add to a Plan Administrator’s Duties under Welfare and Retirement Benefit Plans

Now, faced with an aging baby-boomer generation and increased costs related to disability litigation, the U.S. Department of Labor’s Employee Benefit Security Administration (DOL) has proposed new rules that would revise and strengthen the current rules for claims adjudication of disability claims under welfare and retirement plans.

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Will You Marry Me? The Future of Benefits for Same-Sex Spouses and Partners

The United States Supreme Court’s recent landmark rulings on same-sex marriage have significantly changed employers’ options and obligations with respect to benefit coverage for employees’ same-sex spouses and partners. Until recently, some employers voluntarily extended benefits to same-sex partners in recognition of the fact that same-sex couples had limited ability to marry. However, now that same-sex marriage is legal in all 50 states and recognized under federal law, employers must extend certain spousal benefits to same-sex spouses and can do so without additional administrative complexity. In addition, some employers are phasing out unmarried partner benefits by requiring partners to marry in order to be eligible for spousal benefit coverage.

Click to read the full article from Pension & Benefits Daily.

(c)2015 by The Bureau of National Affairs, Inc., reprinted with permission.




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