Self-Insured Health Plans

News & Analysis as of

Often Overlooked, but Effective, Provisions to Consider for your Benefit Plans

The Issue: When benefits under welfare plans – such as health plans and disability plans – are denied, litigation frequently results. In the context of “self-funded” plans (in contrast to “fully insured” plans, which are...more

DOL Gives States More Control Over Self-Insured Health Plans

On November 6, 2014, the U.S. Department of Labor, Employee Benefits Security Administration (DOL) published Technical Release 2014-01, which provides technical guidance to States concerning stop-loss insurance. Stop-loss...more

ACA’s Transitional Reinsurance Fee Due for Self-Insured Employers

Self-insured employers need to be mindful of two important Affordable Care Act (ACA) deadlines — the Transitional Reinsurance Fee and the Patient Centered Outcomes Research Institute (PCORI) Trust Fund Fee....more

Self-Insured Group Health Plans: Two Deadlines to Note

As 2014 winds down, plan sponsors are likely thinking ahead to some of the significant changes that will take effect in 2015, most notably, the employer "pay or play" mandate under the ACA. However, there are two deadlines...more

REMINDER: HPID Deadline is November 5th

The U.S. Department of Health and Human Services (HHS) is requiring all self-insured health plans to obtain a Health Plan Identifier number (HPID) as part of its compliance efforts under the Health Insurance Portability and...more

Deadline November 5 For Large Self-Insured Health Plans To Obtain Health Plan Identifier

Regulations issued by the Department of Health and Human Services (“HHS”) pursuant to the Affordable Care Act require certain health plans to obtain a Health Plan Identifier (an “HPID”) by November 5, 2014. The HPID is a...more

Employer Reimbursement of Employee’s Individual Medical Insurance May Subject Employer to Penalty

IRS Notice 2013-54 provides that an employer’s reimbursement of healthcare insurance premiums paid by an employee on an individual health insurance contract of the employee on a pre-tax basis (an “employer payment plan”) may...more

Reinsurance Program Requires Self-Insured Health Plans to File Enrollment Data by November 15 and Pay Fee Later

The Transitional Reinsurance Program - The Health Care Reform Act established a transitional reinsurance program in an attempt to stabilize premium prices for health insurance plans in the individual market. Because...more

ERISA self-insured health plan not required to cover same sex spouses

In Roe v. Empire Blue Cross Blue Shield, No. 12–cv–04788 (NSR), 58 EBC 1077, 2014 WL 1760343 (S.D. N.Y. May 1, 2014), the United States District Court for the Southern District of New York held a self-insured health plan that...more

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

Risk Taking in the Provider World: Is a Knox-Keene Plan a Good Strategic Move For You?

Reimbursement for health care services in California continues its shift toward capitation, resulting in health care providers increasingly forming their own health plans under the Knox Keene Health Care Service Plan Act (the...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

The Affordable Care Act – What You Need to Know Checklist

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

Trustee Alert – Transitional Reinsurance Fee Update

Health care reform imposed on all health plans a Transitional Reinsurance Fee (TRF) for three years— 2014 through 2016. For 2015 and 2016, there is an exemption from the TRF program for self-insured plans that self-administer...more

Health Care Reform – Employer and Plan Reporting Requirements

Health Care Reform requires applicable large employers and plan sponsors of self-insured medical plans to report certain information to the IRS and employees. The first reports will be due in 2016, based on 2015 calendar year...more

More Multiemployer Plan Relief – Final Rule Exempts Self-Insured/Self-Administered Plans from Transitional Reinsurance Fee in 2015...

On March 5, 2014, the Department of Health and Human Services released a Final Rule addressing, among other things, transitional reinsurance fees payable in the 2014 through 2016 benefit years. By way of background,...more

ACA: Employers, Non-Discrimination Rules And The ‘Cadillac Tax’

For most employers, the substantive provisions of the Patient Protection and Affordable Care Act (the PPACA) have been implemented. Almost all plans cover an employee’s child until that child reaches the age of 26, fully...more

Equal Coverage Requirements of Affordable Care Act Delayed

Employers are continuing to feel the impact of and to respond to the federal Affordable Care Act. Just today, it was reported that Target Corporation will be no longer offer health insurance benefits to its part-time...more

Nondiscrimination Testing for Health and Welfare Plans

Some employee benefits enjoy a tax-favored status under the Tax Code, but such favorable tax treatment applies with respect to certain highly compensated individuals only if the plans satisfy applicable nondiscrimination...more

Affordable Care Act’s Special Rules for Grandfathered And Self-Insured Health Plans

The Affordable Care Act’s (“ACA”) mandates regarding health care plans, including the individual mandate, take effect with no change in schedule, despite the recent U.S. Treasury Department’s decision to postpone employer...more

First Payment Of Employer's PCORI Fees For Self-Insured Health Insurance Plans Due July 31

The first payment of the Patient-Centered Outcomes Research Institute (PCORI) fee imposed by the Affordable Care Act is due next week on July 31st. While the U.S. Treasury Department has delayed implementing certain health...more

The Employer’s Playbook for Affordable Care Act Compliance: Self-Insured Plans - Remember - July 31, 2013 Deadline for Paying...

Media coverage of the one year delay in certain Affordable Care Act provisions might mislead some employers into thinking they have no obligations. Many requirements still take effect this year and in 2014. Here is one of the...more

PCOR Trust Fund Fee Due Soon for Many Plans

Calendar-year plans should use updated IRS Form 720 and related instructions to file by July 31 deadline. Under the Affordable Care Act (ACA), for plan years ending on or after October 1, 2012, plan sponsors of...more

Final Affordable Care Act Regulations on the Exemption of Contraceptives Coverage by Religious Employers and Student Health...

The final regulations retain the definition of a religious employer, modify the accommodations provided for eligible organizations that object to contraception coverage on religious grounds, and describe how contraceptives...more

Supreme Court Finds DOMA to Be Unconstitutional -- Impact on Employers Explained

On June 26, 2013, a majority of the Supreme Court held in United States v. Windsor that Section 3 of the Defense of Marriage Act (DOMA), which defined marriage for purposes of federal law as the union of a man and a woman, is...more

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