Employee Benefits Employer Group Health Plans

News & Analysis as of

ERISA Preempts State Law Requiring Insurer “Prompt Payment”

Alaska’s prompt pay statute—which requires insurers to pay benefit claims within 30 days of submission—is preempted by federal laws governing employer-provided benefits and benefits for government workers, a federal judge...more

Penalties Increased for Employee Benefit Plan Violations

Recently-enacted legislation has increased many penalty amounts for certain employee benefit plan violations. The new penalties – some of which are more than double previous amounts – were adjusted to catch up with inflation...more

IRS Proposes Adjustments in Individual Mandate Reporting

The IRS has issued proposed regulations on the individual mandate reporting requirements under section 6055 of the Internal Revenue Code. To a significant degree, the new regulations reflect guidance previously published by...more

Proposed Changes to Form 5500 Would Significantly Increase Reporting Obligations for Health and Welfare Plan Sponsors

Summary - On July 11, 2016, the Department of Labor (DOL) and Internal Revenue Service (IRS) announced a proposal to implement significant changes to the forms and regulations that govern annual employee benefit plan...more

ERISA: 2nd Circuit — Mental Health Provider Lacks Standing to Challenge ERISA Benefit Denial

Who can challenge an ERISA benefit denial? Does a physician have standing to challenge the denial of a patient’s coverage? It depends....more

Employee Benefits Developments - July 2016

Section 409A of the Internal Revenue Code (“Section 409A”) generally provides that, if a plan providing for deferred compensation fails to comply with Section 409A, either in form or in operation, then all amounts deferred...more

The EEOC's View of Wellness Programs

The EEOC’s regulations allayed many concerns over the permissible level of incentives/penalties, as well as the challenge of dealing with inconsistent requirements under the various laws. Originally published in The HR...more

Proposed Form 5500 Changes & the new Schedule J: Big Changes for Small Group Health Plans

The US Department of Labor (DOL) has proposed changes to the Form 5500 and schedules that will affect ERISA Title I group health plans of all sizes, but small group health plans should be especially aware of the changes....more

Best in Law: Beware of In-Lieu-Of Payments to Employees

Employers who allow their employees to opt for taxable cash payments in lieu of health benefits must consider the value of the payments when calculating overtime rates, a federal appellate court has ruled. Originally...more

Waves of Guidance and Benefit Plan Developments Worth Watching

Notices on Second Round of Privacy and Security Audits are Out, Expat Plans, OON Surgery Center Billing Issues, and New Nondiscrimination Rules for Federal Contractors, New ERISA Civil Monetary Penalties, COBRA Notices and...more

Time for a Wellness Check on your Wellness Program? New EEOC Regulations Could Diagnose Need for Change

In light of new rules from the Equal Employment Opportunity Commission (EEOC), employers should examine their wellness programs now (and during open enrollment for next year) to determine the potential impact of the final...more

More Clarity on Expatriate Health Plans and the ACA

Expatriate health plans have been surprisingly difficult to reconcile with the Affordable Care Act (ACA). Proposed regulations set to take effect in 2017 provide some useful guidance to U.S. employers that sponsor expatriate...more

DOL Rule Imposes Significant Increases in Penalties for Employee Benefit Plan Violations

On June 30, 2016, the U.S. Department of Labor (“DOL”) issued an interim final rule that significantly increases various penalties under the Employee Retirement Income Security Act of 1974 (“ERISA”). The interim rule is the...more

IRS Issues Proposed Regulations on Health Plan Opt-Out Payments

The Internal Revenue Service (“IRS”) has issued proposed regulations that include additional guidance on the treatment of employer-provided opt-out payments for purposes of affordability under the Affordable Care Act (“ACA”)....more

House Passes Small Business Healthcare Relief Act

Despite repeated guidance from the IRS that employer payment plans violate insurance reforms under the Affordable Care Act (the “ACA”), many small employers continue this arrangement of reimbursing employees for their cost of...more

New Notice Requirements For Employer Wellness Programs

Employers who sponsor employee wellness programs must plan now to comply with a new notice requirement that takes effect soon. Beginning with the first plan year on or after January 1, 2017, employers sponsoring wellness...more

Employee Benefits Developments - June 2016

The Equal Employment Opportunity Commission (EEOC) issued final regulations describing how the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) apply to employer wellness...more

COBRA Notices May Include Additional Information on Exchanges

The Department of Labor (DOL) recently issued an FAQ addressing the inclusion of information about the Health Insurance Exchanges (Marketplace) in COBRA notices. The guidance could be very helpful for employers in directing...more

Transitioning to Coverage: Three Things to Know About the New Transgender Healthcare Regulations

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations implementing the nondiscrimination provisions of the Affordable Care Act. As we discussed in our March 30, 2016 blog, the rule...more

HHS Issues Final Rule on ACA Nondiscrimination in Health Programs and Activities

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations interpreting the nondiscrimination provisions of Section 1557 of the Affordable Care Act (“ACA”). The rule mainly impacts insurers...more

EEOC Issues Sample Wellness Program ADA Notice

As discussed in a prior alert, the Equal Employment Opportunity Commission (EEOC) recently issued final rules providing guidance on the application of the Americans with Disabilities Act (ADA) and the Genetic Information...more

EEOC Issues Final Rules on Wellness Program Incentives Under the ADA, GINA

On May 17, 2016, the Equal Employment Opportunity Commission (the “EEOC”) finalized regulations on wellness program incentives permissible under the Americans with Disabilities Act (the “ADA”), which prohibits discrimination...more

Hospital and Fixed Indemnity and Disease-Specific Policies in the Cross Hairs: Tri-Agency Proposed Rule Portends Some Disruption

On June 10, the Departments of Treasury, Labor, and Health and Human Services (The “Departments”) issued a set of proposed regulations dealing with expatriate health plans, excepted benefits, lifetime and annual limits, and...more

EEOC's Final Wellness Rule: What is Permitted?

Please see Infographic below for more information. ...more

EEOC Issues Final Rules Regarding Employer Sponsored Wellness Program Compliance With ADA And GINA

In May, 2016, the Equal Employment Opportunity Commission ("EEOC") published final rules outlining how employer sponsored wellness programs can comply with the Americans with Disabilities Act ("ADA"), the Genetic Information...more

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