Health and Welfare Plans

Two Interesting New Rules Regarding Prescription Drugs — What is Really Going On?

MARY E. POWELL, September, 2019    In the last few months, the Internal Revenue Service (IRS) and the U.S. Department of Health and Human Services (HHS) have issued rules that impact the cost that group health plans (GHPs) can charge participants for certain prescription drugs. This article explains those rules and also takes a critical […]

Final HRA Regulations Issued – Key Highlights

TIFFANY N. SANTOS, July, 2019    On June 13, 2019, the Departments of Labor, Health and Human Services and the Treasury (the “Departments”) released final regulations that will permit employers and other plan sponsors to offer employees two new types of health reimbursement arrangements or “HRAs” (see here for “FAQs”): (1) an Individual Coverage HRA (“ICHRA”)  […]

Improper Delegation of Authority Could Cost a Plan its Deferential Standard of Review

 GISUE MEHDI and MARY E. POWELL, December, 2018   The Employee Retirement Income Security Act (ERISA) gives participants and beneficiaries the right to have plan benefit denials reviewed in federal court. The court reviews a plan claims administrator’s benefit denial decision as “de novo” (looking at the facts anew and reaching its own decision, with no […]

Proposed Regulations for Health Reimbursement Arrangements — Impact of the Trump Administration on the Affordable Care Act

MARY E. POWELL, November, 2018    On October 29, 2018, the U.S. Departments of Labor (DOL), Treasury (“Treasury”) and Health and Human Services (HHS) (together, the “Departments”) issued proposed regulations that would allow a health reimbursement arrangement (HRA) to be used for the purchase of individual health insurance coverage and include an “excepted benefit” HRA that […]

Department of Labor Releases Final Association Health Plan Rule

SARAH KANTER, August, 2018   On June 21, 2018, the Department of Labor (DOL) published its highly anticipated and controversial final rule (the “final rule”) regarding Association Health Plans (AHPs). The final rule significantly expands the kinds of employer groups and associations that are permitted to establish an “employee welfare benefit plan” under the Employee Retirement […]

IRS Issues FAQs Clarifying New Employer Tax Credit for Paid Family and Medical Leave

JENNIFER D. TRUONG, May, 2018   In December 2017, the Tax Cuts and Jobs Act (the “Act”) created a federal tax credit for certain employers offering paid family and medical leave in 2018 and 2019. After much anticipation, the IRS finally posted a set of FAQs on April 9, 2018, clarifying the new tax credit. Background […]

DOL Announces April 1, 2018 Applicability Date for Final Rule Amending Claims Procedure for Disability Benefits

YATINDRA PANDYA, February, 2018   On January 5, 2018, the Department of Labor (DOL) announced April 1, 2018, as the applicability date for the final rule which revises regulations governing disability benefit claims (the “Final Rule”). Published in the Federal Register on December 19, 2016, the Final Rule revised the claims regulations governing disability benefits […]

Be Prepared to Respond to IRS Employer Shared Responsibility Payment Assessments

ELIZABETH LOH, December 27, 2017   Although it is the holiday season and people’s thoughts have turned to vacation with family, eggnog, and gift giving — employers have something slightly less festive to contemplate. The Internal Revenue Service (IRS) has started to send out letters to employers regarding potential Employer Shared Responsibility Payments (ESRP) (one of […]

Disability Claims Regulations Delayed to April 1, 2018

YATINDRA PANDYA and JAHIZ NOEL AGARD, December, 2017   On November 24, 2017, the Department of Labor (DOL) delayed the applicability of the final rule which revises the regulations governing disability benefit claims (the “Final Rule”) to April 1, 2018, from the original January 1, 2018, effective date. Published in the Federal Register on December 19, […]

Due Date for Providing ACA Coverage Forms to Employees/Participants Extended from January 31, 2018 to March 2, 2018

TIFFANY N. SANTOS, December, 2017   Just before the start of the new year, the IRS issued Notice 2018-06, automatically extending to March 2, 2018 the due date for applicable large employers (generally those with 50 or more full-time employees) to furnish the Form 1095-C to full-time employees (pursuant to Section 6056 of the Internal Revenue […]

Compliance Alert: Disaster Relief Guidance for Health Plans

GISUE MEHDI, November 2017   Since August, Hurricane Harvey hit Texas and Louisiana, followed by Irma in Florida and the Caribbean, and Hurricane Maria in Puerto Rico. In addition to the human tragedy, these hurricanes have caused significant disruptions to employer-sponsored health and welfare plans in the impacted regions. Employers will face challenges reaching and […]

The Revolution of Employer-Sponsored Health Insurance

ERIC SCHILLINGER, October 2017   As published by Law360.com on October 19, 2017. On Oct. 12 President Donald Trump issued an executive order regarding the federal laws governing health care and insurance. The executive order itself does not change the existing rules. Rather, it instructs the applicable federal agencies — the U.S. Departments of Treasury, Labor, […]

2018 Annual Open Enrollment Is Here – Are Your Health and Welfare Plans Ready?

TIFFANY N. SANTOS, August 2017   It’s that time of year again for employers and plan sponsors with calendar-year plans — time for annual open enrollment. Here are some items plan sponsors and plan administrators may wish to consider as they prepare amendments and enrollment materials to comply with applicable legal or regulatory requirements for the […]

Does the Trump Administration Control the Fate of the ACA?

MARY POWELL, August 2017   On August 16th, the U.S. Department of Health and Human Services (“HHS”) announced that it would make September cost-sharing reduction payments (“CSR Payments”) to health insurance carriers that offer eligible plans on the public insurance exchanges. CSR Payments are a key component of the Patient Protection and Affordable Care Act (“ACA”), […]

Breaking Down The Graham-Cassidy ACA-Replacement Proposal

ERIC SCHILLINGER, August 2017    Originally published by Law360.com on August 4, 2017.    In the early hours of Friday, July 28, Republican-led efforts to repeal and replace the Patient Protection and Affordable Care Act were rebuffed on the Senate floor. By roughly 1:40 a.m., three Republican Senators — Susan Collins, R-Maine, Lisa Murkowski, R-Alaska, […]

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