Health and Welfare Plans

ACA Replacement Clears Its First Hurdle: An Analysis of What’s Next (Trucker Huss Webinar on May 24)

ERIC SCHILLINGER, May 2017    On Thursday, May 4, the House of Representatives narrowly passed the American Health Care Act (AHCA), a budget reconciliation bill that would repeal and replace many provisions in the Patient Protection and Affordable Care Act (ACA) that relate to the individual insurance market, Medicaid and employer-sponsored group health plans (GHPs). […]

When Close Is Not Good Enough: A Shift Towards Strict Compliance for ERISA Claim Procedures

JENNIFER TRUONG, March 2017    A string of cases in the Second Circuit Court of Appeals is putting ERISA claims administrators on notice that falling short of strict compliance with the Department of Labor’s (DOL’s) claims and appeal regulations may cost administrators a deferential standard of review. And, this shift towards “strict compliance” is not […]

ACA Update: Major Changes for Employers Still Possible This Year — An In-Depth Look at What’s at Stake

ERIC SCHILLINGER, March 2017    On Friday, March 24th, Speaker Paul Ryan cancelled a House of Representatives vote scheduled for that day on the American Health Care Act (AHCA), a bill that proposed to repeal, replace and revise various tax- and spending-related aspects of the Patient Protection and Affordable Care Act (ACA). As explained in […]

Examining the House ACA-Repeal Bill’s Potential Impact on Employers and Other Sponsors of Group Health Plans

ERIC SCHILLINGER, March 2017    On Monday, March 6, the House Ways and Means Committee and Energy and Commerce Committee each released formal proposals partially repealing and replacing the Patient Protection and Affordable Care Act (the “ACA”). Signed into law in 2010 by then-President Barack Obama, the ACA significantly changed the federal laws governing health […]

The State of Wellness Programs

JENNIFER A. MATTHEWS, February 2017    When the Equal Employment Opportunity Commission (“EEOC”) issued its recent final wellness plan rules under the Americans with Disabilities Act (“ADA”) and the Genetic Information Nondiscrimination Act (“GINA”), it was attempting to clarify previous rules and interpretive guidance. And clarification was needed. Even the best-intentioned employers were sometimes unsure […]

DOL Finalizes Disability Benefit Plan Claims Regulations

TIFFANY N. SANTOS, December 2016   On December 19, 2016, the Department of Labor finalized the regulations governing disability benefit claims (see https://www.gpo.gov/fdsys/pkg/FR-2016-12-19/pdf/2016-30070.pdf). Intended “to promote fairness and accuracy in the claims review process and protect participants and beneficiaries in ERISA-covered disability plans,” the regulations for the most part adopt the rules proposed in November […]

Repeal and Replace — What Health Reform Law Changes Might Be in Store for Employer-Sponsored Group Health Plans Under the Trump Administration

ERIC J. SCHILLINGER, November 2016 President-elect Donald Trump and the Republican Party, which retained its House and Senate majorities during the November 8th election, have made no secret of their desire to “repeal and replace” the Patient Protection and Affordable Care Act (the “ACA”). The ACA, passed in 2010 by a then-Democratic controlled Congress and […]

IRS Delays the Deadline to Furnish the ACA Forms 1095-C and 1095-B to March 2, 2017 and Extends the Good Faith Transition Relief from Reporting Penalties

TIFFANY N. SANTOS and SHANNON OLIVER, November 2016 In a welcome surprise, the Internal Revenue Service (the “IRS”) on November 18, 2016, released Notice 2016-70 which delays the deadline from January 31, 2017 to March 2, 2017 for employers to furnish the Form 1095-C to full-time employees and for providers of health coverage (such as […]

EEOC Issues Final Wellness Rules Under the ADA and GINA

MARY E. POWELL and JENNIFER TRUONG, May 2016 — The Equal Employment Opportunity Commission (“EEOC”) issued final wellness plan rules under Title I of the Americans with Disabilities Act (“ADA”) and Title II of the Genetic Information Nondiscrimination Act (“GINA”) on May 16, 2016. The ADA rule focuses on wellness plan incentives for an employee […]

Understanding How Medicare Coverage Affects HSA Eligibility to Avoid Surprise Tax Penalties

MARY E. POWELL and JENNIFER TRUONG, May 2016 — Health Savings Accounts (“HSA”) are an increasingly popular savings arrangement that allows enrollees to pay for certain out-of-pocket medical expenses on a tax-favored basis. Although there are many rules that govern HSA eligibility and contribution limits, one way an individual loses eligibility to contribute is if […]

Be Prepared for Phase Two of the HIPAA Audit Program

ELIZABETH LOH, April 2016 – Introduction On March 21, 2016, the U.S. Department of Health and Human Services, Office for Civil Rights (“OCR”) launched Phase Two of its Health Insurance Portability and Accountability Act (“HIPAA”) Audit Program. In this phase of the HIPAA Audit Program, the OCR intends to audit a wide variety of covered […]

IRS Issues Guidance Addressing the Impact of the Supreme Court’s Obergefell Decision on Qualified Retirement and Health and Welfare Plans

ROBERT R. GOWER and ERIC J. SCHILLINGER, January 2016 — On December 9, 2015, the Internal Revenue Service (“IRS”) issued Notice 2015-86, providing guidance on the application of the June 26, 2015 United States Supreme Court decision in Obergefell v. Hodges (“Obergefell”) to qualified retirement plans under Internal Revenue Code (“Code”) section 401(a) and health […]

EEOC’s Proposed Rule on GINA and Wellness Programs: Approving Spousal HRA Incentives and Clarifying Other Matters

JAHIZ NOEL AGARD, December 2015 — On October 30, 2015, the U.S. Equal Employment Opportunity Commission (EEOC) released proposed regulations on Title II of the Genetic Information Nondiscrimination Act (GINA) that reverse a prior position prohibiting wellness programs from requiring an employee to provide his genetic information (which includes information about a spouse or other […]

New IRS Proposed Regulations Defining Minimum Value for Employer Shared Responsibility Provisions

JENNIFER TRUONG, September 2015 — On September 1, 2015, the Internal Revenue Service (“IRS”) issued new proposed regulations on the determination of whether an employer-sponsored health plan provides “minimum value,” for purposes of the employer “offer of coverage requirement under Section 4980H of the Internal Revenue Code Under the proposed regulations and consistent with IRS […]

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