Employer Group Health Plans

News & Analysis as of

Cadillac Tax: A Levy in Limbo

The future of the Cadillac tax, a key cost-control mechanism and federal revenue source enacted as part of the Patient Protection and Affordable Care Act (ACA), is unclear. Though initially set to take effect in 2018,...more

New Affordable Care Act FAQs Released on Rescissions of Coverage, Preventive Care Mandate, Out-of-Network Emergency Service...

The U.S. Department of Labor, the Department of Health and Human Services, and the Department of the Treasury (collectively, the “Departments”) have jointly issued a new set of answers to frequently asked questions about the...more

What You Say in Your SPD About Claims Processing Makes a Difference

Employers who self fund their medical plans often have contracts with their third party administrators about claims processing. Some of those contracts provide that the claims processor has discretion to decide claims; others...more

Supreme Court Limits ERISA Reimbursement Rights: Insurers Will Need to be Diligent

On January 20, 2016, the United States Supreme Court held that an ERISA plan could not satisfy its reimbursement rights from a participant’s general assets. ERISA plans’ reimbursement rights are now so limited that...more

SCOTUS ERISA Cases, Part Two: Preemption of State Healthcare Claims Database

This is the second article of a three part series summarizing employee benefit issues that are being argued in front of the U.S. Supreme Court during the current October 2015 term. Part One provided an outline of Montanile v....more

Employee Benefits & Executive Compensation Advisory: The ACA: New Concerns for Employer Plan Sponsors Under the Fair Labor...

The Affordable Care Act (ACA) anti-retaliation provisions have been in effect for several years, but have so far largely gone unnoticed. Now that employees can get financial assistance through the Health Insurance...more

EEOC v. Flambeau, Voluntary Plans, the Insurance Safe Harbor, and the Future of Wellness Programs

The benefits world was set abuzz late last year with Equal Employment Opportunity Commission v. Flambeau, Inc., in which the Federal District Court for the Western District of Wisconsin upheld the validity of Wisconsin-based...more

Supreme Court Reaffirms ERISA’s Preemptive Effect as It Overturns State Health Care Law

In Gobeille v. Liberty Mutual Insurance, the Supreme Court overturned a Vermont law requiring ERISA plans to disclose health payments to the state’s “All Payer Database.” The Court determined that reporting requirements are a...more

Employer-Sponsored Health Plans Should Get Ready for HIPAA Audits

Health Insurance Portability and Accountability Act of 1996, as amended, (HIPAA) audits could be right around the corner for self-funded employee health plans. The Department of Health and Human Services' Office for Civil...more

Supreme Court Limits Plan’s Ability to Recoup Medical Expense Payments

In Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, the US Supreme Court held that when an ERISA plan participant completely dissipates a settlement from a third party on items that are...more

Implementation Date for New Summary of Benefits and Coverage Template

The U.S. Departments of Treasury, Labor, and Health and Human Services (the Departments) recently issued new guidance regarding the intended timeframe for the use of the new summary of benefits and coverage (SBC) template and...more

Gobeille v. Liberty Mutual: The Dog That Didn’t Bark, and the Next Front in the Preemption War

Recently, we reported on Gobeille v. Liberty Mutual, in which the Supreme Court invalidated the Vermont all-payer claims data base law. Applying what appeared to us as a straight-forward application of existing ERISA...more

Supreme Court Protects Health Insurers From Onerous State Claims Reporting

On Tuesday, March 1, 2016, the Supreme Court issued a ruling in Gobeille v. Liberty Mutual, finding that states do not have the authority to require self-insured plans (like Liberty Mutual Insurance Co.) to collect and report...more

Expected Timeline for New SBC Template

The Department of Labor has issued a new FAQ (Part 30) stating that after March 28, 2016 (the end of the comment period for the proposed changes to the Summary of Benefits and Coverage template and related documents), the...more

Providers Beware: In ERISA Land, a Right May Not Have a Remedy

A recent U.S. Supreme Court decision reminds us that straying into the land of the Employee Retirement Income Security Act of 1974 (“ERISA”) can be hazardous for an unwary state or health care provider. When ERISA preempts a...more

Supreme Court: ERISA Pre-empts Law Requiring Reporting to State Healthcare Database

In Gobeille v. Liberty Mut. Ins. Co., the U.S. Supreme Court held that the Employee Retirement Income Security Act of 1974 (ERISA) pre-empts a Vermont law that requires healthcare providers, including health insurers and...more

Supreme Court Rules that ERISA Preempts Vermont Claims Reporting Requirement

The Employee Retirement Income Security Act of 1974 (ERISA) made the regulation of employee benefit plans principally a matter of Federal concern. ERISA broadly and generally preempts—or renders inoperative—state laws that...more

Sixth Circuit Issues Different Opinions on Retiree Medical Coverage After Tackett

For 33 years, unionized employers in the Sixth Circuit had to deal with the holding and, worse still, the application of the decision in UAW v. Yard-Man, Inc., 716 F.2d 1476 (6th Cir. 1983), which created what it called an...more

Employee Benefits & Executive Compensation Advisory: Supreme Court Strikes Down Vermont Health Data Reporting Law as Applied to...

On March 1, 2016, the Supreme Court held that a Vermont law requiring detailed reporting of health data could not be applied to self-funded plans subject to ERISA. In Gobeille v. Liberty Mutual Insurance Company, the Court,...more

Vague COBRA Notices Could Prove Venomous

A recent class action settlement serves to remind employers that the Consolidated Omnibus Budget Reconciliation Act, commonly referred to as COBRA, has real fangs in the hands of the plaintiffs’ bar. A large financial...more

March and April 2016 Filing and Notice Deadlines for Qualified Retirement and Health and Welfare Plans

Employers and plan sponsors must comply with numerous filing and notice deadlines for their retirement and health and welfare plans. Failure to comply with these deadlines can result in costly penalties. To avoid such...more

Supreme Court Decision Weakens the Reach of State Claims Databases to Self-Insured Plans

On March 1, 2016, in a 6-2 decision, the U.S. Supreme Court held, in Gobeille v. Liberty Mutual Insurance Company, that ERISA’s reporting requirements preempted Vermont’s state health care reporting scheme. The case addressed...more

U.S. Supreme Court Reaffirms ERISA’s Preemption Provisions as Applied to State Health Law Reporting Requirements

Recently, the U.S. Supreme Court, in Gobeille v. Liberty Mutual Insurance Co., 2016 U.S. LEXIS 1612, underscored the broad extent to which the preemption language of the Employee Retirement Income Security Act of 1974...more

New ACA Guidance Warrants Another "Checkup" of Employer Health Plans

On December 16, 2015, the IRS issued Notice 2015-87 (the "Notice"), which provides "question-and-answer" guidance regarding how various Affordable Care Act (the "ACA") provisions apply to employer-provided group health plans....more

US Supreme Court Reaffirms ERISA Preemption Doctrine

The Court finds that ERISA preempts the state law “All Payer” data requirement. In a 6–2 decision issued on March 1, the US Supreme Court affirmed a US Court of Appeals for the Second Circuit decision holding that the...more

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