My colleagues in the Labor and Employment Group have published an Alert on the new wellness guidance from the EEOC. It is linked here.
Understanding Employee Benefits and key developments in the employee benefits field and items of interest to our clients. MORE
Health Plan
What You Say in Your SPD About Claims Processing Makes a Difference
By Stinson LLP on
Employers who self fund their medical plans often have contracts with their third party administrators about claims processing. Some of those contracts provide that the claims processor has discretion to decide claims; others provide that the claims processor is simply acting in a ministerial fashion so that the employer ultimately retains discretion to decide contested …
Bad COBRA Notices Can Cost You
By Stinson LLP on
Sun Trust Bank was sued in a class action challenging its COBRA notice. The plaintiffs who brought the lawsuit claimed that the COBRA notice was materially deficient in that it failed to provide the name and address of the party responsible under the plan for COBRA administration and that it failed to provide an adequate …
Time to Review Plan Subrogation Procedures, Part 2
By Stinson LLP on
I blogged a few days ago about the U.S. Supreme Court decision making it harder for plans to recover from a third-party settlement fund for the amount the plan paid when a participant is injured by that third-party. A recent federal district court decision highlights the need to provide appropriate notice of the plan’s reimbursement/subrogation …
Time to Review Plan Subrogation Procedures
By Stinson LLP on
Most self-funded ERISA medical plans provide that participants who have been injured by other people (think car accidents) must reimburse the plan if the participant recovers from the other person for those injuries. In order to obtain that reimbursement, a plan document must contain appropriate reimbursement/subrogation language and the plan must pay attention to the…
EEOC Loses Another Wellness Case, Part 2 – Beware the ACA Penalties
By Stinson LLP on
In my last blog post, I discussed a recent loss by the EEOC in its efforts to limit the ability of employers to require employees to complete health risk assessments (HRAs) or biometric screenings in order to enroll in the employer’s health plan. I said that I would discuss an Affordable Care Act (ACA)…
EEOC Loses Another Wellness Case, Part 1
By Stinson LLP on
The EEOC has been bringing lawsuits against employers challenging wellness programs. A recent case involved a company that had previously provided a credit to employees enrolled in the health plan who participated in a health risk assessment (HRA) and biometric screenings. The company had eliminated the credit and instead conditioned health plan enrollment on participation…
Claims Administrators can be Liable for Violations of the Mental Health Parity Act
By Stinson LLP on
The Mental Health Parity and Addiction Equity Act (MHPA) requires health plans to treat mental health and physical health benefits in much the same manner and precludes restrictions on mental health benefits that are not also found to apply to physical health benefits. The regulations enforcing those provisions are technical and complicated. A recent Second …
A Summary Plan Description Can be a Plan Document
By Stinson LLP on
In a decision issued a couple of years ago, the United States Supreme Court held that a summary plan description that differed from the plan document could not be enforced as the plan document. The Court said that the summary plan description was supposed to describe the plan and it was the plan that should…
Business As Usual: Supreme Court Upholds ACA Subsidies
By Tom Dowling on
The United States Supreme Court recently held in King v. Burwell that the Affordable Care Act (ACA) permits individuals to receive health insurance premium subsidies through federally-facilitated exchanges (in addition to state-based exchanges). Because this decision is consistent with existing agency interpretation, the decision has little direct effect on employer-sponsored group insurance plans.
In the…