Understanding Employee Benefits and key developments in the employee benefits field and items of interest to our clients. MORE

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Almost two years ago I blogged about a federal district court decision from Alabama that imposed a penalty of $37,950 ($75 a day) on an employer that failed to provide a COBRA notice for a dental plan to a former employee. With attorneys’ fees and costs, the employer owed a total of $83,063.45. That case…

Parents have searched for effective therapies for children with autism spectrum disorder. One therapy that has shown promise, at least for some children, is applied behavior analysis (“ABA”), which is an intensive behavioral interaction health service. However, ABA is expensive, in some cases requiring many hours of therapy weekly. Insurance carriers and self-funded health plans…

In a recent District Court opinion, a judge dismissed a COBRA claim against an employer based on the oral notice the employer gave a former employee of her right to continue coverage under COBRA. The court said that the statute does not specify the form the notice must take and the employer’s oral notification…

A recent decision of the federal district court for the southern district of Ohio raises interesting questions under Employee Retirement Income Security Act of 1974 (ERISA) that might also affect employer liability under the Affordable Care Act (ACA). The case involved a challenge by a former employee who was originally hired as a part-time pharmacist.…

In an opinion released earlier this month, the United States Court of Appeals for the Seventh Circuit held that a self-insured health plan was not entitled to a refund of the nearly $1.7 million it paid to two Wisconsin hospitals for treatment administered to a participant’s newborn child, despite the plan’s ultimately concluding the newborn…

In Cigna v. Amara, the U.S. Supreme Court held that the plan document is the governing document for an ERISA plan and that in a conflict between the plan document and the summary plan description (SPD), the plan document must be enforced. A participant misled by an SPD may be able to bring various …

Terminating employees who lose coverage under an employer’s group health plan are frequently entitled to continue that coverage under the federal law commonly known as COBRA. Employers are required to provide a former employee with a notice at the time of termination of employment describing the employee’s rights to continue coverage and the cost of …