News & Analysis as of

Employer Group Health Plans Summary Plan Description

Locke Lord LLP

New ERISA Case Results in Another Assignment for Today – Ensure your Group Health Plan’s Claims Administrator is Raising...

Locke Lord LLP on

Anti-assignment clauses in ERISA health plans are useful to plan sponsors in fending off lawsuits by out-of-network providers. Federal courts have consistently upheld anti-assignment provisions contained in the plan document...more

Bass, Berry & Sims PLC

2020 ERISA Welfare Plan Checklist

Bass, Berry & Sims PLC on

We recognize that many of our readers sponsor ERISA welfare benefit plans and are currently undergoing their open enrollment process and issuing related participant communications. To assist with that process, we have...more

Holland & Hart - The Benefits Dial

I Want to Know, Have You Ever Seen…your plan documents?

Owners and employees of smaller organizations often find themselves stretched in many directions. With all of the demands on one’s time associated with operating a business, it is not uncommon to see attention to the...more

Proskauer - Employee Benefits & Executive...

Best Practices in Administering Benefit Claims #10 – The Three C’s

We conclude our blog series on best practices in administering benefit claims with the three C’s: be clear, be consistent, and communicate. The key to effective benefit claim administration ultimately boils down to drafting...more

Proskauer - Employee Benefits & Executive...

Best Practices in Administering Benefit Claims #5 – Establishing (and Following) a Good Claims Process

This week we discuss the importance of establishing good claims procedures and the benefits of following those procedures. A plan’s claims procedures should be spelled out clearly in both the plan document and the summary...more

McDermott Will & Emery

Class Certification Denied in ERISA Health Coverage Lawsuit

McDermott Will & Emery on

A federal district court denied class certification to health plan participants who claimed the plan promised them lifetime benefits. The court found too many individualized questions about what the plan told each...more

Snell & Wilmer

California Cares . . . About Employees Losing Flexible Spending Account (“FSA”) Funds

Snell & Wilmer on

California recently approved Assembly Bill 1554, adding a flexible spending account notice requirement to § 2810.7 of the California Labor Code. The new law, which takes effect January 1, 2020, states...more

Proskauer - Employee Benefits & Executive...

Best Practices in Administering Benefit Claims #4 – Know (and Understand) the Law: Full and Fair Review

This week in our blog series on best practices in administering benefit claims, we discuss the importance of knowing and, importantly, understanding the laws governing benefit claim administration. Section 503 of ERISA...more

Bass, Berry & Sims PLC

2019 ERISA Welfare Plan Checklist

Bass, Berry & Sims PLC on

We recognize that many of our clients sponsor ERISA welfare benefit plans and are currently undergoing their open enrollment process and issuing related participant communications. To assist our clients with that process, we...more

McDermott Will & Emery

ERISA Plan Documents Must State Procedures for Authorizing a Representative under a Plan

McDermott Will & Emery on

In an Information Letter dated February 27, 2019, the Department of Labor (DOL) clarified that an ERISA plan must include any procedures for designating authorized representatives in the plan’s claims procedure and summary...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Eighth Circuit Casts Doubt on Cross-Plan Offsetting for ERISA Health Plans

Employers may soon find themselves reviewing and revising health plan master documents and summary plan descriptions (SPDs) and administrative service agreements with respect to an obscure claims administration practice known...more

Bass, Berry & Sims PLC

2018 ERISA Welfare Plan Checklist

Bass, Berry & Sims PLC on

We recognize that many of our clients sponsor ERISA welfare benefit plans and are currently undergoing their open enrollment process and issuing related participant communications. To assist our clients with that process, we...more

Epstein Becker & Green

Association Health Plans: Federal Rule Broadens Opportunities, but Some States Clamp Down

Epstein Becker & Green on

On June 19, 2018, the Trump administration finalized a rule that will enable small businesses and self-employed individuals to band together to offer access to large group health plans, which are typically less expensive (but...more

Bass, Berry & Sims PLC

Action Needed by Certain ERISA Plans – New Disability Claims Procedures Apply Beginning April 2018

In January 2018, the U.S. Department of Labor (DOL) announced that final regulations affecting how some ERISA plans process claims and appeals will apply beginning April 1, 2018. As explained below, the final regulations...more

Holland & Knight LLP

Summary Plan Descriptions Required for All ERISA Retirement, Health and Welfare Plans

Holland & Knight LLP on

• Administrators of all employee benefit plans subject to the Employee Retirement Income Security Act of 1974 (ERISA) should ensure their plans' compliance with ERISA's Summary Plan Description (SPD) requirement. •...more

Spilman Thomas & Battle, PLLC

Spring Cleaning Comes Early: The Affordable Care Act and the Importance of Updating ERISA Plan Documents

The year 1974 was a watershed for employee benefits. For the first time, the federal government undertook the complicated task of providing a statutory and regulatory framework for employee benefit plans and employee pension...more

Schwabe, Williamson & Wyatt PC

Employment Update: DOL Releases Updated CHIP Notice

ERISA, as amended by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), requires employers to notify their employees of potential opportunities for group health plan premium assistance through...more

Mintz - Employment Viewpoints

The Ninth Circuit Weighs in on ERISA’s Plan Document and Summary Plan Description Requirements: Mull v. Motion Picture Ind. Health...

Mull v. Motion Picture Ind. Health Plan educates employers on the basics of the requirements of the Employee Retirement Income Security Act (ERISA) governing plan documents and summary plan descriptions. The lessons are...more

McDermott Will & Emery

Recent Government-Issued FAQs Cause Plan Sponsors to Clarify Preventive Care and Wellness in Health Plan Communications

McDermott Will & Emery on

On October 23, 2015, the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and Treasury issued frequently asked questions (FAQs) on the implementation of preventive care and wellness provisions of the...more

Poyner Spruill LLP

Checklist for Group Health Plan Participant Disclosure Requirements

Poyner Spruill LLP on

There has been an explosion of participant disclosure requirements for group health plans in recent years. While health care reform created some of these new requirements, many of them became effective years earlier. For busy...more

Proskauer - Employee Benefits & Executive...

Reminder: Non-Grandfathered Plans Must Implement Embedded Out-of-Pocket Maximums

As employers and plans prepare for 2016 open enrollment, they must be sure to address in their benefit design and with their third party vendors the new embedded out-of-pocket maximum limitations on individuals that were...more

McAfee & Taft

New ruling limits out-of-pocket expenses at individual level in 2016

McAfee & Taft on

Most health plan and health insurance policies include strategies that require persons covered under them to share in the costs that are paid. This strategy, often referred to as cost-sharing, serves two purposes. First, it...more

Locke Lord LLP

Starting a New Business: What Employers Need to Know About Health Benefits

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Starting a new business can be very stressful, and with any successful business comes the added stress of hiring and retaining employees. To attract good employees, employers generally need to offer health benefits. ...more

Dorsey & Whitney LLP

The Affordable Care Act – What You Need to Know Checklist

Dorsey & Whitney LLP on

In This Presentation: - Review Employer Information - Fees - Mandates - Additional Points - Communications - Excerpt from Review Employer Information. Employer’s Health Plans - 1. Identify the...more

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