Employee Retirement Income Security Act Healthcare

Employee Retirement Income Security Act is a United States federal law enacted in 1974 to set minimum standards for pension and health plans in the private sector and to protect participants in those plans.... more +
Employee Retirement Income Security Act is a United States federal law enacted in 1974 to set minimum standards for pension and health plans in the private sector and to protect participants in those plans.  ERISA requires plans to provide information to participants, establishes a grievance process,  and allows participants to sue for benefits or breach of fiduciary duties.  less -
News & Analysis as of

Self-Insured Health Plans May Be Required To Allow Health Care Providers Access To Their Claims And Appeals Process

In a precedent-setting case, a district court in the Northern District of Illinois recently ruled that in-network chiropractors were considered “beneficiaries” under the Employee Retirement Income Security Act of 1974 (ERISA)...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 26: Fitting a Round Peg (the Public Health Service Act 90-day...

The Departments of the Treasury/IRS, Labor and Health and Human Services (the “Departments”) recently issued a final regulation under the 90-day waiting period limitation, which is included among the Affordable Care Act’s...more

The Federal Court for the Southern District of New York Rules that Employers with Self-Insured Health Plans Need Not Offer Medical...

The issue of same-sex spousal rights is now largely resolved for qualified retirement plans. However, substantial questions about same-sex spouse health benefits remain unanswered. In Roe v. Empire Blue Cross Blue Shield,...more

ERISA: “Derivative Standing” Allows Medical Provider To Obtain Reimbursement From ERISA Plan

Medical providers often have a patient/ERISA plan participant assign rights under an ERISA health care plan to allow the medical provider to seek payment for medical services provided....more

Hospital That Failed To Precertify Procedure Gets Paid Anyway

A hospital that provided a medically necessary heart catheterization to a health plan participant is entitled to payment by the insurance company even though the hospital failed to precertify the procedure as required by the...more

Plan Fees: Hi-Lex Puts Welfare Plan Vendors on Notice

- A welfare plan administrative services only (ASO) vendor breached fiduciary duty under ERISA when it failed to properly disclose fees. - Lack of trust did not prohibit contributions from being characterized as plan...more

Plan sponsors need to learn the art of delegation

I prepare my own income taxes because my tax LLM degree and years working on ProSeries gave me the experience to effectively do that. When it comes to treating my allergies, I delegate that role to the person with the medical...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 31: ERISA Section 510 and Limiting Employee Hours

In last week’s post, we examined the appropriateness of capping the annual hours of new “variable hour employees” as a way to limit exposure under the Affordable Care Act’s employer shared responsibility rules. (These rules...more

ERISA = Every Ridiculous Idea Since Adam

It is rumored that President Reagan once referred to the Employee Retirement Income Security Act of 1974 (ERISA) as Every Ridiculous Idea Since Adam. ERISA serves important purposes in our society, but it also presents...more

NY Bill Seeks to Strip Insurers of Discretion When Substance Abuse Services Should Be ERISA Preempted

The New York State Senate is considering passing Bill No. 4326 which seeks to address an epidemic of heroin and prescription drug abuse by requiring insurers to provide in-patient treatment to addicts. Publicity over the...more

Sedgwick’s Top 10 List of Healthcare Issues to Watch in 2014

We are watching decisions and regulatory developments that will impact health insurers and the way they do business. What are you watching for in 2014? Issues surrounding the implementation of the Affordable Care Act (ACA)...more

Sixth Circuit Revisits Controversial ERISA Decision

The Sixth Circuit Court of Appeals voted to rehear an ERISA action that awarded an unprecedented remedy for the alleged denial of long term disability benefits. The order, granting en banc rehearing, vacates a controversial...more

The ERISA Litigation Newsletter - April 2014

This month we discuss the evolving case law on the issue of whether unpaid employer contributions due under a collective bargaining agreement can be viewed as plan assets such that the individuals who decide to withhold such...more

Old Days – Remembering When Small Business Had Pension Plans

We lived in politically charged times. Congress seems unable to reach any consensus on anything including where to have the annual Congressional Christmas Ball! Years of political crossfire over the Affordable Care Act have...more

NJ Federal Court Rules Pension Plan Established By Church-Controlled Hospital Not an ERISA-Exempt Church Plan

On March 31, 2014 the U.S. District Court in New Jersey held that a defined benefit pension plan established by St. Peter’s Healthcare System was not a church plan exempt under ERISA despite the fact that St. Peter’s is...more

Religious Freedom, Contraceptive Services, and The ACA: The Dilemma of the Self-Certification Provision

On February 21, 2014, the Seventh Circuit Court of Appeals, in a 2-to-1 decision, denied a preliminary injunction enjoining the federal government from enforcing the self-certification provisions of the Affordable Care Act...more

Departments of Labor, Treasury, and Health and Human Services Issue Final and Proposed Regulations Implementing the 90-day Limit...

The Affordable Care Act (the “Act”) generally prevents an otherwise eligible employee (or dependent) from having to wait more than 90 days before coverage becomes effective under a group health plan. The regulation of waiting...more

Health Care Reform’s Employer Shared Responsibility Penalties: A Checklist for Employers (Revised February 20, 2014)

Welcome to the SW Benefits Update, formerly the Employee Benefits Update. Historically, employers have had complete discretion in deciding whether to offer group health plan coverage to their employees. If they offered...more

Proposed Regulations Expand the Definition of Excepted Benefits

Recently issued proposed regulations would expand the categories of excepted benefits under the Employee Retirement Income Security Act of 1974 (ERISA), the Internal Revenue Code (the Code) and the Public Health Service Act. ...more

ERISA Fiduciary Duties and the Tension Between the Affordable Care Act and the Religious Freedom Restoration Act

The Patient Protection and Affordable Care Act ("ACA") has significantly changed the healthcare industry in the United States. Among the many changes is the new requirement that healthcare providers must provide all "Food...more

Benefits Litigation Update - January 2014

In this issue: - Will Section 510 of ERISA Restrict Workforce Structuring under the Affordable Care Act? - A New Threat to Sponsors and Fiduciaries: Equitable Remedies After Amara - First ERISA Decision...more

Welcomed Guidance on Wellness Programs

On June 3, 2013, the Departments of Treasury, Labor and Health and Human Services (Agencies) issued final regulations regarding nondiscriminatory wellness programs in group health coverage under the Affordable Care Act and...more

California District Court Denies “Church Plan” ERISA Exemption to Pension Plan of Church-Affiliated Non-Profit Healthcare System,...

The District Court for the Northern District of California recently held in a putative class action that the defined benefit pension plan of a church-affiliated non-profit healthcare system, Dignity Health (“Dignity”), was...more

Departments Release Guidance on Dental and Vision Plans, EAPs, and "Wraparound" Coverage

On December 20, 2013, the Departments of Treasury, Labor, and Health and Human Services (collectively, the Departments) jointly issued proposed rules (Proposed Regulations) that would amend the regulations regarding excepted...more

Health Plan Class Action Lawsuit Filed in Northern California

Approximately 300 employers and other organizations, many of which are in Northern California, were named as co-defendants in an ERISA class action lawsuit filed on November 22, 2013, in the U.S. District Court for the...more

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